En B-PRESENT_ILLNESS Mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1997, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS intervenida, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS centro, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS glándula I-PRESENT_ILLNESS suprarrenal I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS clínicamente I-PRESENT_ILLNESS no I-PRESENT_ILLNESS funcionante I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS manifestó I-PRESENT_ILLNESS clínicamente I-PRESENT_ILLNESS como I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS poco I-PRESENT_ILLNESS específicas, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS postparto I-PRESENT_ILLNESS inmediato; I-PRESENT_ILLNESS la B-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION abdominales I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION suprarrenal I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cmts., I-EXPLORATION sólida I-EXPLORATION y I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION calcificación I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION siendo I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION la I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION análisis, I-EXPLORATION presentaba I-EXPLORATION ligero I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cortisoluria I-EXPLORATION (284.5 I-EXPLORATION mcgr./24h.) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 17-OH-esteroides I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION (12.7 I-EXPLORATION mcg./24h.), I-EXPLORATION sin I-EXPLORATION síntomas I-EXPLORATION de I-EXPLORATION hipercortisolismo I-EXPLORATION sistémico. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT resección I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración, I-TREATMENT con I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT histológico I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT suprarrenal I-TREATMENT de I-TREATMENT 10 I-TREATMENT x I-TREATMENT 7 I-TREATMENT x I-TREATMENT 5 I-TREATMENT cmts. I-TREATMENT (215 I-TREATMENT grs.) I-TREATMENT bien I-TREATMENT encapsulado, I-TREATMENT aunque I-TREATMENT con I-TREATMENT invasión I-TREATMENT vascular, I-TREATMENT amplias I-TREATMENT zonas I-TREATMENT de I-TREATMENT necrosis I-TREATMENT y I-TREATMENT un I-TREATMENT índice I-TREATMENT mitótico I-TREATMENT de I-TREATMENT 5.8/50; I-TREATMENT el I-TREATMENT estudio I-TREATMENT histoquímico I-TREATMENT fue I-TREATMENT (+) I-TREATMENT para I-TREATMENT Vimentina I-TREATMENT y I-TREATMENT (-) I-TREATMENT para I-TREATMENT Citoqueratina, I-TREATMENT EMA, I-TREATMENT Cromogranina I-TREATMENT y I-TREATMENT Sm- I-TREATMENT 100. I-TREATMENT Se I-TREATMENT etiquetó I-TREATMENT como I-TREATMENT Estadio I-TREATMENT II I-TREATMENT y I-TREATMENT Grado I-TREATMENT II. I-TREATMENT Treinta B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION en I-EVOLUTION los I-EVOLUTION estudios I-EVOLUTION radiológicos I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION una I-EVOLUTION masa I-EVOLUTION en I-EVOLUTION el I-EVOLUTION lecho I-EVOLUTION de I-EVOLUTION resección I-EVOLUTION previo I-EVOLUTION de I-EVOLUTION 7 I-EVOLUTION cmts., I-EVOLUTION en I-EVOLUTION contacto I-EVOLUTION con I-EVOLUTION el I-EVOLUTION hilio I-EVOLUTION renal I-EVOLUTION izquierdo I-EVOLUTION y I-EVOLUTION técnicamente I-EVOLUTION resecable; I-EVOLUTION se B-TREATMENT reintervino I-TREATMENT y I-TREATMENT se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT recidiva I-TREATMENT asociada I-TREATMENT a I-TREATMENT nefrectomía I-TREATMENT izquierda, I-TREATMENT esplenectomía I-TREATMENT y I-TREATMENT pancreatectomía I-TREATMENT distal I-TREATMENT (radical I-TREATMENT completa I-TREATMENT y I-TREATMENT con I-TREATMENT márgenes I-TREATMENT libres). I-TREATMENT Posteriormente, I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT sistémico I-TREATMENT adyuvante I-TREATMENT con I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT completos I-TREATMENT de I-TREATMENT cisplatino I-TREATMENT (CDDP) I-TREATMENT y I-TREATMENT etopósido I-TREATMENT (VP-16) I-TREATMENT en I-TREATMENT régimen I-TREATMENT adyuvante. I-TREATMENT I-TREATMENT Cuatro B-EVOLUTION años I-EVOLUTION y I-EVOLUTION once I-EVOLUTION meses I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION inicial, I-EVOLUTION se I-EVOLUTION detecta I-EVOLUTION en I-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION radiológico I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION varios I-EVOLUTION nódulos I-EVOLUTION hepáticos I-EVOLUTION sugerentes I-EVOLUTION de I-EVOLUTION metástasis. I-EVOLUTION Se B-TREATMENT sometió I-TREATMENT de I-TREATMENT nuevo I-TREATMENT a I-TREATMENT cirugía I-TREATMENT abdominal I-TREATMENT realizándose, I-TREATMENT previo I-TREATMENT control I-TREATMENT con I-TREATMENT ecografía I-TREATMENT hepática I-TREATMENT intraoperatoria, I-TREATMENT una I-TREATMENT bisegmentectomía I-TREATMENT IV-B I-TREATMENT y I-TREATMENT V I-TREATMENT y I-TREATMENT una I-TREATMENT resección I-TREATMENT limitada I-TREATMENT del I-TREATMENT segmento I-TREATMENT VIII; I-TREATMENT el B-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION anatomía-patológica I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION nódulos I-EXPLORATION (de I-EXPLORATION tamaño I-EXPLORATION variable I-EXPLORATION entre I-EXPLORATION 0.5 I-EXPLORATION y I-EXPLORATION 1.5 I-EXPLORATION cmts.) I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION suprarrenal. I-EXPLORATION I-EXPLORATION Diez B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION se I-EVOLUTION detecta I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION recidiva I-EVOLUTION tumoral I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION subdiafragmático I-EVOLUTION izquierdo I-EVOLUTION (de I-EVOLUTION 6 I-EVOLUTION x I-EVOLUTION 4 I-EVOLUTION cmts. I-EVOLUTION según I-EVOLUTION la I-EVOLUTION TAC) I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION raiz I-EVOLUTION del I-EVOLUTION mesenterio, I-EVOLUTION esta I-EVOLUTION última I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION x I-EVOLUTION 3 I-EVOLUTION cmts. I-EVOLUTION y I-EVOLUTION localizada I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION salida I-EVOLUTION de I-EVOLUTION la I-EVOLUTION arteria I-EVOLUTION mesentérica I-EVOLUTION superior I-EVOLUTION (AMS). I-EVOLUTION Dada B-TREATMENT la I-TREATMENT difícil I-TREATMENT resecabilidad I-TREATMENT de I-TREATMENT la I-TREATMENT nueva I-TREATMENT recidiva I-TREATMENT se I-TREATMENT decide I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT con I-TREATMENT intención I-TREATMENT neoadyuvante I-TREATMENT ( I-TREATMENT 5 I-TREATMENT ciclos I-TREATMENT completos I-TREATMENT de I-TREATMENT CDDP I-TREATMENT y I-TREATMENT VP-16), I-TREATMENT decidiéndose I-TREATMENT por I-TREATMENT regresión I-TREATMENT parcial I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT una I-TREATMENT nueva I-TREATMENT exploración I-TREATMENT quirúrgica. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT la I-TREATMENT resección I-TREATMENT de I-TREATMENT las I-TREATMENT dos I-TREATMENT masas I-TREATMENT tumorales, I-TREATMENT la I-TREATMENT primera I-TREATMENT incluyendo I-TREATMENT el I-TREATMENT pilar I-TREATMENT izquierdo I-TREATMENT del I-TREATMENT diafragma I-TREATMENT y I-TREATMENT una I-TREATMENT pastilla I-TREATMENT de I-TREATMENT 5 I-TREATMENT cmts. I-TREATMENT de I-TREATMENT dicho I-TREATMENT músculo, I-TREATMENT y I-TREATMENT la I-TREATMENT segunda I-TREATMENT disecando I-TREATMENT en I-TREATMENT su I-TREATMENT origen I-TREATMENT el I-TREATMENT tronco I-TREATMENT celíaco I-TREATMENT y I-TREATMENT la I-TREATMENT AMS I-TREATMENT y I-TREATMENT resecando I-TREATMENT todo I-TREATMENT el I-TREATMENT tejido I-TREATMENT tumoral I-TREATMENT entre I-TREATMENT ambos I-TREATMENT vasos. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION recidiva, I-EXPLORATION estando I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION no I-EXPLORATION afectos. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION satisfactoria. I-EVOLUTION I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra, I-EVOLUTION tras I-EVOLUTION 7 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION del I-EVOLUTION tumor I-EVOLUTION primario, I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION y I-EVOLUTION con I-EVOLUTION una I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION aceptable, I-EVOLUTION mínimamente I-EVOLUTION limitada I-EVOLUTION por I-EVOLUTION las I-EVOLUTION deposiciones I-EVOLUTION diarreicas I-EVOLUTION secundarias I-EVOLUTION a I-EVOLUTION la I-EVOLUTION denervación I-EVOLUTION simpática I-EVOLUTION celíaca. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS controlado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Consultas I-PRESENT_ILLNESS Externas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hipertrofia I-PRESENT_ILLNESS benigna I-PRESENT_ILLNESS de I-PRESENT_ILLNESS próstata. I-PRESENT_ILLNESS Presenta I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematuria I-PRESENT_ILLNESS monosintomática I-PRESENT_ILLNESS autolimitada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS urinocultivos I-PRESENT_ILLNESS negativos. I-PRESENT_ILLNESS En B-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION ureteropielocaliectasia I-EXPLORATION grado I-EXPLORATION II I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION en I-EXPLORATION U.I.V. I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION anulación I-EXPLORATION funcional I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION motivo B-TREATMENT por I-TREATMENT el I-TREATMENT cuál, I-TREATMENT se I-TREATMENT practica I-TREATMENT nefrostomia I-TREATMENT percutánea I-TREATMENT derecha, I-TREATMENT que I-TREATMENT confirma I-TREATMENT el I-TREATMENT hallazgo I-TREATMENT urográfico. I-TREATMENT Ocho B-EXPLORATION meses I-EXPLORATION antes, I-EXPLORATION est: I-EXPLORATION udio I-EXPLORATION ecográfico I-EXPLORATION y I-EXPLORATION U.I.V. I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY cabe I-PAST_MEDICAL_HISTORY destacar: I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY conocidas. I-PAST_MEDICAL_HISTORY HTA. I-PAST_MEDICAL_HISTORY Diabetes I-PAST_MEDICAL_HISTORY Mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II. I-PAST_MEDICAL_HISTORY Miocardiopatía I-PAST_MEDICAL_HISTORY hipertrófica. I-PAST_MEDICAL_HISTORY Aneurisma I-PAST_MEDICAL_HISTORY carotídeo I-PAST_MEDICAL_HISTORY intracerebral I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY secuelas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION practicada I-EXPLORATION es I-EXPLORATION la I-EXPLORATION siguiente: I-EXPLORATION Abdomen I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible, I-EXPLORATION no I-EXPLORATION doloroso, I-EXPLORATION no I-EXPLORATION megalias, I-EXPLORATION Fosas I-EXPLORATION renales I-EXPLORATION libres I-EXPLORATION indoloras. I-EXPLORATION Genitales I-EXPLORATION externos I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION patológicos. I-EXPLORATION Tacto I-EXPLORATION rectal I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION HBP I-EXPLORATION grado I-EXPLORATION I-II. I-EXPLORATION Se I-EXPLORATION llevan I-EXPLORATION a I-EXPLORATION cabo I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION EXPLORACIONES I-EXPLORATION COMPLEMENTARIAS: I-EXPLORATION I-EXPLORATION ANALISIS: I-EXPLORATION Glucemia I-EXPLORATION 145 I-EXPLORATION mg/dl, I-EXPLORATION Creatinina I-EXPLORATION 1.4 I-EXPLORATION mg/dl. I-EXPLORATION Resto I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION CITOLOGIA I-EXPLORATION URINARIA: I-EXPLORATION Compatible I-EXPLORATION con I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION transicionales I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado. I-EXPLORATION I-EXPLORATION PIELOGRAFIA I-EXPLORATION DESCENDENTE I-EXPLORATION a I-EXPLORATION traves I-EXPLORATION de I-EXPLORATION Nefrostomia: I-EXPLORATION Defecto I-EXPLORATION de I-EXPLORATION replección I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION uréter I-EXPLORATION sacro-ilíaco I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 20 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION longitud, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared. I-EXPLORATION I-EXPLORATION ESTUDIO I-EXPLORATION FUNCIONAL I-EXPLORATION DE I-EXPLORATION RIÑON I-EXPLORATION DERECHO: I-EXPLORATION Aclaramiento I-EXPLORATION de I-EXPLORATION Creatinina I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION ml/minuto. I-EXPLORATION I-EXPLORATION TAC I-EXPLORATION ABDOMINO-PELVICO: I-EXPLORATION Aneurisma I-EXPLORATION de I-EXPLORATION Aorta I-EXPLORATION infrarrenal. I-EXPLORATION Atrofia I-EXPLORATION hidronefrótica I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION visualizarse I-EXPLORATION imágenes I-EXPLORATION endoluminales I-EXPLORATION intraureterales. I-EXPLORATION Dudosas I-EXPLORATION adenopatías I-EXPLORATION paravesicales. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT y I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT tumor I-TREATMENT de I-TREATMENT vías I-TREATMENT de I-TREATMENT uréter I-TREATMENT derecho, I-TREATMENT el I-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenido I-TREATMENT quirúrgicamente I-TREATMENT practicándose I-TREATMENT nefroureterectomía I-TREATMENT radical I-TREATMENT derecha I-TREATMENT con I-TREATMENT evolución I-TREATMENT postoperatoria I-TREATMENT satisfactoria. I-TREATMENT El B-EXPLORATION dictamen I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION nos I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION pielonefritis I-EXPLORATION crónica I-EXPLORATION y I-EXPLORATION cambios I-EXPLORATION de I-EXPLORATION arteriosclerosis, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION lesión I-EXPLORATION inflamatoria I-EXPLORATION ureteral I-EXPLORATION que I-EXPLORATION oblitera I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION en I-EXPLORATION capas I-EXPLORATION musculares, I-EXPLORATION erosión I-EXPLORATION de I-EXPLORATION urotelio I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Actinomices. I-EXPLORATION Tras B-EVOLUTION 9 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION mantiene I-EVOLUTION una I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION aceptable I-EVOLUTION (Creatinina I-EVOLUTION sérica I-EVOLUTION 2.1 I-EVOLUTION mg/dl I-EVOLUTION ) I-EVOLUTION y I-EVOLUTION es I-EVOLUTION controlado I-EVOLUTION por I-EVOLUTION HBP I-EVOLUTION sintomática. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS monorrena I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS incluída I-PRESENT_ILLNESS en I-PRESENT_ILLNESS programa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hemodiálisis I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS al I-PRESENT_ILLNESS trasplante I-PRESENT_ILLNESS por I-PRESENT_ILLNESS IRC I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pielonefritis I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY nefrectomía I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY absceso I-PAST_MEDICAL_HISTORY pararrenal I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY rotura I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY riñón I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY contenía I-PAST_MEDICAL_HISTORY cálculo I-PAST_MEDICAL_HISTORY coraliforme I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ureteroscopia I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cálculo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY uréter I-PAST_MEDICAL_HISTORY pelviano I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY febrero I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1990. I-PAST_MEDICAL_HISTORY Hígado I-PAST_MEDICAL_HISTORY graso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Digestivo, I-PAST_MEDICAL_HISTORY HTA, I-PAST_MEDICAL_HISTORY hipertrigliceridemia, I-PAST_MEDICAL_HISTORY sobrepeso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY gota. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Trasplante I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riñón I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY fosa I-PAST_MEDICAL_HISTORY ilíaca I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY incidencias I-PAST_MEDICAL_HISTORY (también I-PAST_MEDICAL_HISTORY arteria I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY parche I-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anastomosis I-PAST_MEDICAL_HISTORY vasculares I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ilíacas I-PAST_MEDICAL_HISTORY externas, I-PAST_MEDICAL_HISTORY implante I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY uréter I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY vejiga I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY Paquin). I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY rechazo I-PAST_MEDICAL_HISTORY agudo I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY pulses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 6-Metil-Prednisolona I-PAST_MEDICAL_HISTORY (400mg/día, I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY días) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY dada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY niveles I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2'3 I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY progresivamente I-PAST_MEDICAL_HISTORY descenderán I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY mantendrán I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY actualidad I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 0'8-1'1. I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY inmunosupresor I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ciclosporina I-PAST_MEDICAL_HISTORY 8mg/Kg, I-PAST_MEDICAL_HISTORY micofenolato I-PAST_MEDICAL_HISTORY mofetilo I-PAST_MEDICAL_HISTORY 2gr/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY prednisona I-PAST_MEDICAL_HISTORY 1mg/Kg. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY abril I-PAST_MEDICAL_HISTORY de1999, I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY trasplante, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY temblor I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ambas I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY inicialmente I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY atribuído I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY toxicidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ciclosporina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY descenso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pauta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY corticoides. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY embargo, I-PAST_MEDICAL_HISTORY ante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY empeoramiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cuadro, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY asintomática, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Neurología. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS ese I-PRESENT_ILLNESS momento, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS año I-PRESENT_ILLNESS y I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS trasplante I-PRESENT_ILLNESS (marzo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2000) I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS inestabilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS temblores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS parestesias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION moderados I-EXPLORATION signos I-EXPLORATION piramidales I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION EEII, I-EXPLORATION más I-EXPLORATION acusados I-EXPLORATION en I-EXPLORATION eI I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION claro I-EXPLORATION déficit I-EXPLORATION motor; I-EXPLORATION la I-EXPLORATION sensibilidad I-EXPLORATION profunda I-EXPLORATION estaba I-EXPLORATION también I-EXPLORATION levemente I-EXPLORATION alterada. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION ayudaron I-EXPLORATION a I-EXPLORATION esclarecer I-EXPLORATION el I-EXPLORATION diagnóstico: I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION RMN I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION 2 I-EXPLORATION lesiones I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION mielitis I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cervical I-EXPLORATION C2-C4 I-EXPLORATION y I-EXPLORATION dorsal I-EXPLORATION alto I-EXPLORATION D1. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION potenciales I-EXPLORATION evocados I-EXPLORATION demostraron I-EXPLORATION retraso I-EXPLORATION significativo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION latencia I-EXPLORATION del I-EXPLORATION nervio I-EXPLORATION tibial. I-EXPLORATION I-EXPLORATION LCR: I-EXPLORATION leve I-EXPLORATION pleocitosis I-EXPLORATION linfocítica, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION bandas I-EXPLORATION IgG I-EXPLORATION oligoclonales. I-EXPLORATION I-EXPLORATION Pruebas I-EXPLORATION serológicas, I-EXPLORATION ELISA I-EXPLORATION y I-EXPLORATION Western I-EXPLORATION Blot, I-EXPLORATION resultaron I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION HTLV-I I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION y I-EXPLORATION sangre. I-EXPLORATION I-EXPLORATION PCR I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION positiva I-EXPLORATION también I-EXPLORATION para I-EXPLORATION el I-EXPLORATION virus I-EXPLORATION detectándose I-EXPLORATION también I-EXPLORATION en I-EXPLORATION este I-EXPLORATION caso I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION elevada. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratada I-TREATMENT con I-TREATMENT pulses I-TREATMENT de I-TREATMENT 6-Metil-Prednisolona I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT de I-TREATMENT agudización I-TREATMENT del I-TREATMENT proceso I-TREATMENT y I-TREATMENT pauta I-TREATMENT descendente I-TREATMENT progresivamente I-TREATMENT de I-TREATMENT corticoides. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION además I-EVOLUTION de I-EVOLUTION hábito I-EVOLUTION cushingoide, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION audición I-EVOLUTION progresiva, I-EVOLUTION incontinencia I-EVOLUTION de I-EVOLUTION orina I-EVOLUTION de I-EVOLUTION predominio I-EVOLUTION nocturno I-EVOLUTION que I-EVOLUTION ha I-EVOLUTION mejorado I-EVOLUTION con I-EVOLUTION Tolterodina I-EVOLUTION (pendiente I-EVOLUTION de I-EVOLUTION estudio I-EVOLUTION urodinámico I-EVOLUTION en I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION actual) I-EVOLUTION y I-EVOLUTION evoluciona I-EVOLUTION hacia I-EVOLUTION discreta I-EVOLUTION invalidez. I-EVOLUTION I-EVOLUTION Nuestra B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS es I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas I-PAST_MEDICAL_HISTORY conocidas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY dilatada, I-PAST_MEDICAL_HISTORY artrosis, I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY histerectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY anexectomía I-PAST_MEDICAL_HISTORY junto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY quimio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY radioterapia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY tumoración I-PAST_MEDICAL_HISTORY ginecológica I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocho I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS derechos I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS aumentando I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS deambulación. I-PRESENT_ILLNESS A I-PRESENT_ILLNESS su I-PRESENT_ILLNESS vez, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompaña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nauseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS picos I-PRESENT_ILLNESS febriles I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS profusa I-PRESENT_ILLNESS aunque I-PRESENT_ILLNESS en I-PRESENT_ILLNESS le I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encuentra I-PRESENT_ILLNESS afebril I-PRESENT_ILLNESS y I-PRESENT_ILLNESS no I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS miccional. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presenta: I-EXPLORATION soplo I-EXPLORATION protomesosistólico I-EXPLORATION en I-EXPLORATION ápex, I-EXPLORATION abdomen I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION y I-EXPLORATION flanco I-EXPLORATION derechos. I-EXPLORATION También I-EXPLORATION destaca I-EXPLORATION dolor I-EXPLORATION espontáneo I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION muslo I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION aumenta I-EXPLORATION con I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION y I-EXPLORATION con I-EXPLORATION la I-EXPLORATION movilidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION extremidad. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION Urgencias I-EXPLORATION destaca I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda I-EXPLORATION (17.200 I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION 84% I-EXPLORATION de I-EXPLORATION neutrófilos), I-EXPLORATION 567.000 I-EXPLORATION plaquetas, I-EXPLORATION urea I-EXPLORATION 1.35, I-EXPLORATION creatinina I-EXPLORATION 1.80. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION se I-EXPLORATION solicitan I-EXPLORATION Rx. I-EXPLORATION de I-EXPLORATION vías I-EXPLORATION urinarias I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION en I-EXPLORATION las I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION imagen I-EXPLORATION cálcica I-EXPLORATION en I-EXPLORATION silueta I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION ectasia I-EXPLORATION pielocalicial I-EXPLORATION derecha I-EXPLORATION respectivamente. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnostico I-TREATMENT de I-TREATMENT cólico I-TREATMENT nefrítico I-TREATMENT derecho I-TREATMENT complicado I-TREATMENT se I-TREATMENT decide I-TREATMENT ingreso I-TREATMENT para I-TREATMENT derivación I-TREATMENT urinaria I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT intravenoso. I-TREATMENT Se I-TREATMENT coloca I-TREATMENT en I-TREATMENT quirófano I-TREATMENT catéter I-TREATMENT externo I-TREATMENT en I-TREATMENT uréter I-TREATMENT derecho I-TREATMENT con I-TREATMENT salida I-TREATMENT de I-TREATMENT abundante I-TREATMENT orina I-TREATMENT limpia. I-TREATMENT I-TREATMENT A B-EVOLUTION lo I-EVOLUTION largo I-EVOLUTION de I-EVOLUTION los I-EVOLUTION días I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION cólico I-EVOLUTION va I-EVOLUTION cediendo I-EVOLUTION aunque I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION dolor I-EVOLUTION sordo I-EVOLUTION en I-EVOLUTION fosa I-EVOLUTION lumbar I-EVOLUTION y I-EVOLUTION continúa I-EVOLUTION con I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION muslo I-EVOLUTION derecho. I-EVOLUTION Es B-TREATMENT valorada I-TREATMENT por I-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT Traumatología I-TREATMENT pautando I-TREATMENT tratamiento I-TREATMENT antiinflamatorio I-TREATMENT ante I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT rotura I-TREATMENT fibrilar I-TREATMENT del I-TREATMENT cuadriceps. I-TREATMENT I-TREATMENT Debido B-EXPLORATION a I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION del I-EXPLORATION dolor I-EXPLORATION lumbar I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION revisión I-EXPLORATION ecográfica I-EXPLORATION objetivándose I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION músculo I-EXPLORATION psoas I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION x I-EXPLORATION 5.5 I-EXPLORATION cm. I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION un I-EXPLORATION TAC. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION del I-EXPLORATION absceso I-EXPLORATION retroperitoneal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION compartimento I-EXPLORATION del I-EXPLORATION músculo I-EXPLORATION psoas I-EXPLORATION iliaco I-EXPLORATION derecho I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION L2-L3 I-EXPLORATION sin I-EXPLORATION perder I-EXPLORATION la I-EXPLORATION continuidad I-EXPLORATION hasta I-EXPLORATION anillo I-EXPLORATION inguinal I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartar I-EXPLORATION la I-EXPLORATION participación I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION derecho I-EXPLORATION en I-EXPLORATION su I-EXPLORATION tercio I-EXPLORATION medio. I-EXPLORATION I-EXPLORATION Una B-DERIVED_FROM/TO vez I-DERIVED_FROM/TO confirmado I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO nos I-DERIVED_FROM/TO ponemos I-DERIVED_FROM/TO en I-DERIVED_FROM/TO contacto I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Radiología I-DERIVED_FROM/TO Intervensionista I-DERIVED_FROM/TO para I-DERIVED_FROM/TO drenaje I-DERIVED_FROM/TO percutáneo. I-DERIVED_FROM/TO Mediante B-EXPLORATION ecografía I-EXPLORATION se I-EXPLORATION coloca I-EXPLORATION catéter I-EXPLORATION 10 I-EXPLORATION fr. I-EXPLORATION evacuando I-EXPLORATION 200 I-EXPLORATION cc. I-EXPLORATION material I-EXPLORATION purulento, I-EXPLORATION del I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION envía I-EXPLORATION muestra I-EXPLORATION microbiológica I-EXPLORATION (en I-EXPLORATION los I-EXPLORATION días I-EXPLORATION sucesivos I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Bacteriodes I-EXPLORATION fragilis I-EXPLORATION y I-EXPLORATION Streptococcus I-EXPLORATION sanguis). I-EXPLORATION El I-EXPLORATION débito I-EXPLORATION por I-EXPLORATION el I-EXPLORATION drenaje I-EXPLORATION es I-EXPLORATION progresivamente I-EXPLORATION menor I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION nuevo I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION TAC, I-EXPLORATION evidenciándose I-EXPLORATION la I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION volumen I-EXPLORATION del I-EXPLORATION absceso. I-EXPLORATION Se B-EVOLUTION decide I-EVOLUTION retirar I-EVOLUTION el I-EVOLUTION tubo I-EVOLUTION de I-EVOLUTION drenaje I-EVOLUTION al I-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION su I-EVOLUTION colocación I-EVOLUTION pero I-EVOLUTION es I-EVOLUTION necesario I-EVOLUTION recolocación I-EVOLUTION de I-EVOLUTION catéter I-EVOLUTION 14 I-EVOLUTION fr. I-EVOLUTION por I-EVOLUTION empeoramiento I-EVOLUTION clínico. I-EVOLUTION I-EVOLUTION Se B-EXPLORATION desconoce I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION foco I-EXPLORATION primario I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION ingreso, I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION colonoscopia I-EXPLORATION para I-EXPLORATION intentar I-EXPLORATION buscar I-EXPLORATION un I-EXPLORATION origen I-EXPLORATION digestivo I-EXPLORATION del I-EXPLORATION problema. I-EXPLORATION No I-EXPLORATION es I-EXPLORATION posible I-EXPLORATION sobrepasar I-EXPLORATION el I-EXPLORATION ángulo I-EXPLORATION esplénico I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION halla I-EXPLORATION un I-EXPLORATION foco I-EXPLORATION primario. I-EXPLORATION Desde I-EXPLORATION el I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION vista I-EXPLORATION urológico I-EXPLORATION tampoco I-EXPLORATION se I-EXPLORATION justifica I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION del I-EXPLORATION absceso. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION hace I-EXPLORATION cavitograma I-EXPLORATION para I-EXPLORATION estudiar I-EXPLORATION la I-EXPLORATION morfología I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tamaño I-EXPLORATION del I-EXPLORATION absceso I-EXPLORATION y I-EXPLORATION se I-EXPLORATION indica I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION lavados I-EXPLORATION con I-EXPLORATION fibrinolíticos I-EXPLORATION intracavitarios I-EXPLORATION (100.000 I-EXPLORATION unidades I-EXPLORATION de I-EXPLORATION urokinasa I-EXPLORATION en I-EXPLORATION 10 I-EXPLORATION cc I-EXPLORATION de I-EXPLORATION suero I-EXPLORATION fisiológico). I-EXPLORATION I-EXPLORATION Después B-EVOLUTION de I-EVOLUTION un I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION diez I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION confirmada I-EVOLUTION mediante I-EVOLUTION técnicas I-EVOLUTION de I-EVOLUTION imagen. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION en I-EVOLUTION nuestras I-EVOLUTION consultas, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION con I-EVOLUTION resolución I-EVOLUTION total I-EVOLUTION del I-EVOLUTION proceso. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY brucelosis, I-PAST_MEDICAL_HISTORY lumboartrosis, I-PAST_MEDICAL_HISTORY litiasis I-PAST_MEDICAL_HISTORY biliar, I-PAST_MEDICAL_HISTORY apendicectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cesárea. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION casual, I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION confirma I-EXPLORATION este I-EXPLORATION hallazgo I-EXPLORATION evidenciándose I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho; I-EXPLORATION comprobándose I-EXPLORATION realce I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION infusión I-EXPLORATION de I-EXPLORATION contraste, I-EXPLORATION no I-EXPLORATION objetivándose I-EXPLORATION adenopatías I-EXPLORATION hiliares, I-EXPLORATION ni I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION de I-EXPLORATION vecindad. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT masa I-TREATMENT sólida I-TREATMENT compatible I-TREATMENT con I-TREATMENT adenocarcinoma I-TREATMENT renal I-TREATMENT es I-TREATMENT intervenida, I-TREATMENT realizándose I-TREATMENT por I-TREATMENT vía I-TREATMENT lumbar I-TREATMENT oblícua I-TREATMENT nefrectomía I-TREATMENT radical, I-TREATMENT siendo I-TREATMENT el I-TREATMENT curso I-TREATMENT postoperatorio I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION tumoración I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION que I-EXPLORATION no I-EXPLORATION invade I-EXPLORATION cápsula, I-EXPLORATION su I-EXPLORATION aspecto I-EXPLORATION al I-EXPLORATION corte I-EXPLORATION es I-EXPLORATION homogéneo, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blancogrisaceo. I-EXPLORATION La I-EXPLORATION pelvis I-EXPLORATION y I-EXPLORATION cálices I-EXPLORATION no I-EXPLORATION están I-EXPLORATION afectados I-EXPLORATION por I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION y I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION renal I-EXPLORATION esta I-EXPLORATION libre. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION tumoración I-EXPLORATION redondeada I-EXPLORATION de I-EXPLORATION márgenes I-EXPLORATION bien I-EXPLORATION definidos, I-EXPLORATION que I-EXPLORATION crece I-EXPLORATION por I-EXPLORATION expansión I-EXPLORATION sin I-EXPLORATION invadir, I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION mesenquimal, I-EXPLORATION compuesta I-EXPLORATION por I-EXPLORATION células I-EXPLORATION dispuestas I-EXPLORATION en I-EXPLORATION fascículos I-EXPLORATION entrelazados, I-EXPLORATION los I-EXPLORATION núcleos I-EXPLORATION presentan I-EXPLORATION ligera I-EXPLORATION variación I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION forma, I-EXPLORATION la I-EXPLORATION actividad I-EXPLORATION mitótica I-EXPLORATION es I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 50 I-EXPLORATION CGA, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION hemorragias I-EXPLORATION ni I-EXPLORATION necrosis. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION queratinas I-EXPLORATION (AE-1,AE-3), I-EXPLORATION EMA I-EXPLORATION (anfígeno I-EXPLORATION epitelial I-EXPLORATION de I-EXPLORATION membrana) I-EXPLORATION con I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION excluye I-EXPLORATION la I-EXPLORATION naturaleza I-EXPLORATION epitelial I-EXPLORATION del I-EXPLORATION tumor. I-EXPLORATION Negatividad I-EXPLORATION para I-EXPLORATION vimentina, I-EXPLORATION HMB45, I-EXPLORATION S-100. I-EXPLORATION Positividad I-EXPLORATION para I-EXPLORATION marcadores I-EXPLORATION vasculares I-EXPLORATION en I-EXPLORATION la I-EXPLORATION trama I-EXPLORATION vascular I-EXPLORATION y I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION actino. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Neurolues, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY secuelas I-PAST_MEDICAL_HISTORY establecidas I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY trastornos I-PAST_MEDICAL_HISTORY mnésicos I-PAST_MEDICAL_HISTORY visuales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY verbales, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY radiculoneuropatía I-PAST_MEDICAL_HISTORY múltiple. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION radiología I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION presentaba I-EXPLORATION elongación I-EXPLORATION aórtica I-EXPLORATION sin I-EXPLORATION repercusión I-EXPLORATION clínica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION electroencefalograma I-EXPLORATION con I-EXPLORATION trazado I-EXPLORATION normal, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION TC I-EXPLORATION craneal I-EXPLORATION con I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION contraste I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION morfología I-EXPLORATION cerebral I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION Lues I-EXPLORATION en I-EXPLORATION los I-EXPLORATION test I-EXPLORATION RPR I-EXPLORATION y I-EXPLORATION TPHA I-EXPLORATION fueron I-EXPLORATION positivos. I-EXPLORATION El I-EXPLORATION ácido I-EXPLORATION fólico I-EXPLORATION y I-EXPLORATION la I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION rango I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestras I-DERIVED_FROM/TO consultas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Urodinámica I-DERIVED_FROM/TO por I-DERIVED_FROM/TO trastornos I-DERIVED_FROM/TO miccionales I-DERIVED_FROM/TO refiriendo I-DERIVED_FROM/TO incontinencia I-DERIVED_FROM/TO por I-DERIVED_FROM/TO urgencia, I-DERIVED_FROM/TO no I-DERIVED_FROM/TO precisando I-DERIVED_FROM/TO de I-DERIVED_FROM/TO prensa I-DERIVED_FROM/TO abdominal I-DERIVED_FROM/TO para I-DERIVED_FROM/TO el I-DERIVED_FROM/TO vaciado I-DERIVED_FROM/TO vesical. I-DERIVED_FROM/TO Se B-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION urodinámico I-EXPLORATION objetivándose I-EXPLORATION un I-EXPLORATION detrusor I-EXPLORATION hiperrefléxico I-EXPLORATION con I-EXPLORATION presiones I-EXPLORATION altas I-EXPLORATION y I-EXPLORATION contracciones I-EXPLORATION involuntarias I-EXPLORATION no I-EXPLORATION inhibidas I-EXPLORATION que I-EXPLORATION ocasionaban I-EXPLORATION escapes; I-EXPLORATION la I-EXPLORATION curva I-EXPLORATION de I-EXPLORATION Presión/ I-EXPLORATION Flujo I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION alteraciones. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT detrusor I-TREATMENT hiperactivo I-TREATMENT de I-TREATMENT causa I-TREATMENT neurogénica I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anticolinérgicos, I-TREATMENT estando B-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION estable I-EVOLUTION clínicamente I-EVOLUTION con I-EVOLUTION urgencia I-EVOLUTION ocasional I-EVOLUTION sin I-EVOLUTION incontinencia. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS femenina, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS blanca, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS nefrítico I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION ultrasonido I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION doble I-EXPLORATION sistema I-EXPLORATION pieloureteral I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION litiasis I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION cáliz I-EXPLORATION medio, I-EXPLORATION doble I-EXPLORATION sistema I-EXPLORATION pieloureteral I-EXPLORATION izquierdo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION excretora I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION litiasis I-EXPLORATION renal I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION doble I-EXPLORATION sistema I-EXPLORATION pieloureteral I-EXPLORATION derecho I-EXPLORATION e I-EXPLORATION hidronefrosis I-EXPLORATION derecha, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION tres I-EXPLORATION sistemas I-EXPLORATION ureteropielocaliciales. I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION objetivo I-EXPLORATION de I-EXPLORATION poder I-EXPLORATION visualizar I-EXPLORATION la I-EXPLORATION desembocadura I-EXPLORATION de I-EXPLORATION los I-EXPLORATION uréteres I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vejiga I-EXPLORATION realizamos I-EXPLORATION urografía I-EXPLORATION excretora I-EXPLORATION por I-EXPLORATION venoclisis I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION en I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION sistemas I-EXPLORATION ureteropielocaliciales I-EXPLORATION y I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION uréteres I-EXPLORATION desembocando I-EXPLORATION independientes I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vejiga. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION triple I-EXPLORATION sistema I-EXPLORATION ureteropielocalicial I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION entrada I-EXPLORATION independiente I-EXPLORATION de I-EXPLORATION los I-EXPLORATION uréteres I-EXPLORATION en I-EXPLORATION vejiga. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cistoscopia I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION tres I-EXPLORATION meatos I-EXPLORATION ureterales I-EXPLORATION del I-EXPLORATION lado I-EXPLORATION izquierdo, I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION por I-EXPLORATION delante I-EXPLORATION del I-EXPLORATION trígono, I-EXPLORATION cerca I-EXPLORATION del I-EXPLORATION cuello, I-EXPLORATION otro I-EXPLORATION en I-EXPLORATION el I-EXPLORATION trígono I-EXPLORATION y I-EXPLORATION el I-EXPLORATION último I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION mismo, I-EXPLORATION del I-EXPLORATION lado I-EXPLORATION derecho I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION dos I-EXPLORATION meatos I-EXPLORATION ureterales. I-EXPLORATION Todos I-EXPLORATION eyaculando I-EXPLORATION orinas I-EXPLORATION claras I-EXPLORATION y I-EXPLORATION con I-EXPLORATION el I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION 'hoyo I-EXPLORATION de I-EXPLORATION golf'. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS intervenido B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hipospadias I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY correcta I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY micción I-PAST_MEDICAL_HISTORY confortable. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS urólogo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS sordo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ingle I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS testículo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION un I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION muy I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION su I-EXPLORATION totalidad, I-EXPLORATION irregular I-EXPLORATION e I-EXPLORATION indurado I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION testicular I-EXPLORATION con I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION testicular I-EXPLORATION que I-EXPLORATION se I-EXPLORATION describe I-EXPLORATION como I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION quístico I-EXPLORATION con I-EXPLORATION tabiques I-EXPLORATION finos I-EXPLORATION y I-EXPLORATION un I-EXPLORATION granuloma I-EXPLORATION con I-EXPLORATION calcificaciones I-EXPLORATION intratesticular I-EXPLORATION y I-EXPLORATION fuera I-EXPLORATION del I-EXPLORATION testículo I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION otro I-EXPLORATION quiste I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION ecos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION a I-EXPLORATION descartar I-EXPLORATION quiste I-EXPLORATION epidermoide I-EXPLORATION o I-EXPLORATION hidatídico. I-EXPLORATION Los I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION alfa I-EXPLORATION fetoproteína I-EXPLORATION y I-EXPLORATION BHCG I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION TAC I-EXPLORATION solicitado I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION sólida I-EXPLORATION retroperitoneal I-EXPLORATION izquierda I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION renal I-EXPLORATION lateroaórtica I-EXPLORATION y I-EXPLORATION prerrenal I-EXPLORATION de I-EXPLORATION 54x51x90 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION I-EXPLORATION Se B-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT orquiectomía I-TREATMENT inguinal I-TREATMENT izquierda I-TREATMENT con I-TREATMENT resultado I-TREATMENT anatomo-patológico I-TREATMENT de I-TREATMENT teratoma I-TREATMENT maduro I-TREATMENT puro I-TREATMENT poco I-TREATMENT diferenciado I-TREATMENT limitado I-TREATMENT a I-TREATMENT testículo I-TREATMENT sin I-TREATMENT invasión I-TREATMENT vascular I-TREATMENT que I-TREATMENT afectaba I-TREATMENT a I-TREATMENT túnica I-TREATMENT albugínea I-TREATMENT pero I-TREATMENT no I-TREATMENT a I-TREATMENT vaginal, I-TREATMENT sin I-TREATMENT afectación I-TREATMENT de I-TREATMENT rete I-TREATMENT testis I-TREATMENT de I-TREATMENT 5x3x3 I-TREATMENT mm. I-TREATMENT de I-TREATMENT tamaño. I-TREATMENT El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO adyuvante. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Nos B-EXPLORATION encontramos I-EXPLORATION ante I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION testicular I-EXPLORATION no I-EXPLORATION seminomatoso I-EXPLORATION estadio I-EXPLORATION pT2 I-EXPLORATION N3, I-EXPLORATION M0 I-EXPLORATION según I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION TNM I-EXPLORATION y I-EXPLORATION en I-EXPLORATION estadio I-EXPLORATION II I-EXPLORATION c I-EXPLORATION sin I-EXPLORATION factores I-EXPLORATION de I-EXPLORATION mal I-EXPLORATION pronóstico. I-EXPLORATION En B-TREATMENT esta I-TREATMENT situación I-TREATMENT se I-TREATMENT plantean I-TREATMENT dos I-TREATMENT opciones, I-TREATMENT comenzar I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT y I-TREATMENT plantear I-TREATMENT resección I-TREATMENT si I-TREATMENT persistía I-TREATMENT masa I-TREATMENT residual I-TREATMENT o I-TREATMENT realizar I-TREATMENT una I-TREATMENT linfadenectomia I-TREATMENT retroperitoneal. I-TREATMENT I-TREATMENT Dada I-TREATMENT la I-TREATMENT negatividad I-TREATMENT de I-TREATMENT los I-TREATMENT marcadores I-TREATMENT tumorales I-TREATMENT y I-TREATMENT la I-TREATMENT anatomía I-TREATMENT patológica I-TREATMENT de I-TREATMENT la I-TREATMENT pieza I-TREATMENT testicular I-TREATMENT y I-TREATMENT la I-TREATMENT conocida I-TREATMENT quimioresistencia I-TREATMENT del I-TREATMENT teratoma I-TREATMENT maduro I-TREATMENT puro I-TREATMENT se I-TREATMENT decidió I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT linfadenectomía I-TREATMENT retroperitoneal I-TREATMENT por I-TREATMENT las I-TREATMENT posibilidades I-TREATMENT de I-TREATMENT ser I-TREATMENT curativa I-TREATMENT si I-TREATMENT la I-TREATMENT histología I-TREATMENT era I-TREATMENT coincidente I-TREATMENT con I-TREATMENT el I-TREATMENT primario I-TREATMENT sin I-TREATMENT existir I-TREATMENT otros I-TREATMENT componentes I-TREATMENT tumorales I-TREATMENT no I-TREATMENT seminomatosos. I-TREATMENT I-TREATMENT Se I-TREATMENT realizó I-TREATMENT linfadenectomía I-TREATMENT retroperitoneal I-TREATMENT hasta I-TREATMENT vasos I-TREATMENT iliacos I-TREATMENT obteniendo I-TREATMENT la I-TREATMENT pieza I-TREATMENT observada I-TREATMENT en I-TREATMENT Figura I-TREATMENT 2. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomo-patológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION teratoma I-EXPLORATION maduro I-EXPLORATION puro I-EXPLORATION con I-EXPLORATION los I-EXPLORATION componentes I-EXPLORATION de I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION capas I-EXPLORATION embrionarias I-EXPLORATION sin I-EXPLORATION invasión I-EXPLORATION linfovascular. I-EXPLORATION EL B-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION vigilancia I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION mediante I-EVOLUTION marcadores, I-EVOLUTION TAC I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION tórax I-EVOLUTION periódicas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS blanco, B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY llevando I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY prostatismo I-PAST_MEDICAL_HISTORY caracterizado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY polaquiuria I-PAST_MEDICAL_HISTORY nocturna I-PAST_MEDICAL_HISTORY (3-4 I-PAST_MEDICAL_HISTORY veces I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY noche), I-PAST_MEDICAL_HISTORY disuria, I-PAST_MEDICAL_HISTORY chorro I-PAST_MEDICAL_HISTORY débil, I-PAST_MEDICAL_HISTORY micción I-PAST_MEDICAL_HISTORY demorada, I-PAST_MEDICAL_HISTORY micciones I-PAST_MEDICAL_HISTORY imperiosas, I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY mejorando I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY impuesto I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cabecera I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY llegando I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY RAO. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urología I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS sonda I-PRESENT_ILLNESS vesical I-PRESENT_ILLNESS permanente I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS RAO, I-PRESENT_ILLNESS fracasando I-PRESENT_ILLNESS los I-PRESENT_ILLNESS intentos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS retirar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS misma, I-PRESENT_ILLNESS al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION constata I-EXPLORATION mucosas: I-EXPLORATION húmedas I-EXPLORATION y I-EXPLORATION normocoloreadas, I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION no I-EXPLORATION infiltrado, I-EXPLORATION auscultación I-EXPLORATION cardiorespiratoria I-EXPLORATION normal, I-EXPLORATION abdomen I-EXPLORATION negativo, I-EXPLORATION fosas I-EXPLORATION lumbares I-EXPLORATION libres, I-EXPLORATION puntos I-EXPLORATION pielorreno-ureterales I-EXPLORATION no I-EXPLORATION dolorosos, I-EXPLORATION genitales I-EXPLORATION externos I-EXPLORATION y I-EXPLORATION regiones I-EXPLORATION inguinales I-EXPLORATION normales, I-EXPLORATION al I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION una I-EXPLORATION próstata I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION volumen, I-EXPLORATION superficie I-EXPLORATION regular, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION consistencia I-EXPLORATION fibroadenomatosa, I-EXPLORATION grado I-EXPLORATION III, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION hiperplasia I-EXPLORATION benigna I-EXPLORATION de I-EXPLORATION próstata I-EXPLORATION (HBP). I-EXPLORATION Analítica I-EXPLORATION sanguínea I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION hemoglobina, I-EXPLORATION hematocrito, I-EXPLORATION leucocitos I-EXPLORATION totales, I-EXPLORATION urea I-EXPLORATION creatinina, I-EXPLORATION PSA I-EXPLORATION y I-EXPLORATION fosfatasa I-EXPLORATION alcalina, I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Ecográfícamente I-EXPLORATION llamó I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION el I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION prostático I-EXPLORATION con I-EXPLORATION ecogenicidad I-EXPLORATION heterogénea. I-EXPLORATION I-EXPLORATION Dado B-TREATMENT el I-TREATMENT cuadro I-TREATMENT clínico I-TREATMENT y I-TREATMENT los I-TREATMENT antecedentes, I-TREATMENT se I-TREATMENT decide I-TREATMENT tratamiento I-TREATMENT quirúrgico, I-TREATMENT realizándosele I-TREATMENT una I-TREATMENT prostatectomía I-TREATMENT retropúbica. I-TREATMENT En B-EXPLORATION el I-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION describe I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION próstata I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION linfocitario I-EXPLORATION monomorfo, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION corresponde I-EXPLORATION con I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION linfocítico I-EXPLORATION bien I-EXPLORATION diferenciado. I-EXPLORATION Posteriormente B-TREATMENT es I-TREATMENT remitido I-TREATMENT al I-TREATMENT servicio I-TREATMENT de I-TREATMENT Oncología I-TREATMENT donde I-TREATMENT la I-TREATMENT aplican I-TREATMENT tratamiento I-TREATMENT radioterapia. I-TREATMENT Actualmente B-EVOLUTION continúa I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION de I-EVOLUTION Urología. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS para I-PRESENT_ILLNESS solicitar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS realización I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vasectomía. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION los I-EXPLORATION testes I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION y I-EXPLORATION tamaño I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION pene I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION torsión I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 60 I-EXPLORATION grados. I-EXPLORATION Hasta I-EXPLORATION la I-EXPLORATION fecha, I-EXPLORATION dicha I-EXPLORATION alteración I-EXPLORATION no I-EXPLORATION le I-EXPLORATION había I-EXPLORATION producido I-EXPLORATION sintomatología I-EXPLORATION alguna. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS escrotal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS aparecida I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS ido I-PRESENT_ILLNESS creciendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS lentamente I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hernia I-PRESENT_ILLNESS inguinal I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION el I-EXPLORATION testículo I-EXPLORATION derecho I-EXPLORATION parecía I-EXPLORATION situarse I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION raíz I-EXPLORATION escrotal, I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION móvil I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION suave I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 15 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION hemiescroto. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION clínico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION lipoma I-EXPLORATION escrotal. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION de I-EXPLORATION orina, I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION el I-EXPLORATION electrocardiograma I-EXPLORATION fueron I-EXPLORATION todos I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION escrotal I-EXPLORATION y B-TREATMENT se I-TREATMENT decidió I-TREATMENT la I-TREATMENT intervención. I-TREATMENT I-TREATMENT Durante I-TREATMENT la I-TREATMENT operación, I-TREATMENT en I-TREATMENT primer I-TREATMENT lugar, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT reparación I-TREATMENT de I-TREATMENT la I-TREATMENT hernia I-TREATMENT inguinal I-TREATMENT izquierda I-TREATMENT con I-TREATMENT malla I-TREATMENT de I-TREATMENT prolene I-TREATMENT y I-TREATMENT después I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exploración I-TREATMENT del I-TREATMENT hemiescroto I-TREATMENT derecho. I-TREATMENT I-TREATMENT A I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT primera I-TREATMENT incisión I-TREATMENT cutánea I-TREATMENT escrotal I-TREATMENT derecha I-TREATMENT intentamos I-TREATMENT aislar I-TREATMENT una I-TREATMENT voluminosa I-TREATMENT masa I-TREATMENT blanquecina. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT por I-TREATMENT la I-TREATMENT dificultad I-TREATMENT que I-TREATMENT teníamos I-TREATMENT en I-TREATMENT separar I-TREATMENT la I-TREATMENT neoformación I-TREATMENT de I-TREATMENT los I-TREATMENT tejidos I-TREATMENT circundantes I-TREATMENT y I-TREATMENT encontrar I-TREATMENT el I-TREATMENT testículo I-TREATMENT derecho, I-TREATMENT que I-TREATMENT estaba I-TREATMENT envuelto I-TREATMENT por I-TREATMENT la I-TREATMENT masa, I-TREATMENT decidimos I-TREATMENT eligir I-TREATMENT otra I-TREATMENT vía. I-TREATMENT I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT segunda I-TREATMENT incisión I-TREATMENT inguinoescrotál I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT cual, I-TREATMENT mediante I-TREATMENT disección I-TREATMENT roma I-TREATMENT fue I-TREATMENT más I-TREATMENT fácil I-TREATMENT aislar I-TREATMENT la I-TREATMENT neoformación, I-TREATMENT que I-TREATMENT se I-TREATMENT extendía I-TREATMENT superiormente I-TREATMENT hasta I-TREATMENT la I-TREATMENT altura I-TREATMENT del I-TREATMENT anillo I-TREATMENT inguinal I-TREATMENT externo. I-TREATMENT Una I-TREATMENT vez I-TREATMENT que I-TREATMENT fue I-TREATMENT aislado I-TREATMENT el I-TREATMENT cordón I-TREATMENT espermático I-TREATMENT conseguimos I-TREATMENT traer I-TREATMENT fuera I-TREATMENT el I-TREATMENT testículo, I-TREATMENT que I-TREATMENT tenía I-TREATMENT aspecto I-TREATMENT hipotrófico I-TREATMENT pero I-TREATMENT no I-TREATMENT resultaba I-TREATMENT afectado. I-TREATMENT También I-TREATMENT la I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT resultaba I-TREATMENT más I-TREATMENT facil I-TREATMENT y I-TREATMENT segura. I-TREATMENT Los I-TREATMENT márgenes I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT estaban I-TREATMENT bien I-TREATMENT delimitados I-TREATMENT y I-TREATMENT fáciles I-TREATMENT de I-TREATMENT separarse I-TREATMENT a I-TREATMENT excepción I-TREATMENT de I-TREATMENT una I-TREATMENT zona I-TREATMENT del I-TREATMENT fondo I-TREATMENT de I-TREATMENT la I-TREATMENT bolsa I-TREATMENT escrotal, I-TREATMENT donde I-TREATMENT la I-TREATMENT neoformación I-TREATMENT tenía I-TREATMENT más I-TREATMENT adherencia I-TREATMENT con I-TREATMENT el I-TREATMENT dartos. I-TREATMENT I-TREATMENT El B-EXPLORATION aspecto I-EXPLORATION macroscópico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neoformación I-EXPLORATION extirpada I-EXPLORATION era I-EXPLORATION el I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION alongada I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 5cm I-EXPLORATION y I-EXPLORATION peso I-EXPLORATION de I-EXPLORATION 140 I-EXPLORATION gr I-EXPLORATION aparentemente I-EXPLORATION encapsulada I-EXPLORATION con I-EXPLORATION superficie I-EXPLORATION externa I-EXPLORATION lisa I-EXPLORATION y I-EXPLORATION regular. I-EXPLORATION Al I-EXPLORATION corte I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION se I-EXPLORATION presentaba I-EXPLORATION uniforme, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION denso I-EXPLORATION y I-EXPLORATION fibroso, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION degeneración I-EXPLORATION mixoide I-EXPLORATION o I-EXPLORATION necrosis. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION microscópico I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION grupos I-EXPLORATION de I-EXPLORATION células I-EXPLORATION fusiformes, I-EXPLORATION onduladas I-EXPLORATION e I-EXPLORATION hipercrómicas, I-EXPLORATION estrechamente I-EXPLORATION interpuestas I-EXPLORATION en I-EXPLORATION haces I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION de I-EXPLORATION colágeno. I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION inmunohistoquímica I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION positividad I-EXPLORATION citoplásmica I-EXPLORATION para I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION S-100. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION documentaron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION necrosis, I-EXPLORATION mitosis I-EXPLORATION ni I-EXPLORATION atipias I-EXPLORATION nucleares. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION histopatológico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION el I-EXPLORATION de I-EXPLORATION neurofibroma. I-EXPLORATION I-EXPLORATION Un B-EVOLUTION año I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION no I-EVOLUTION se I-EVOLUTION han I-EVOLUTION revelado I-EVOLUTION signos I-EVOLUTION objetivos I-EVOLUTION de I-EVOLUTION recidiva. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS RTU I-PRESENT_ILLNESS de I-PRESENT_ILLNESS próstata. I-PRESENT_ILLNESS Desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS y I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS prostático. I-PRESENT_ILLNESS Estudiado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urología, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS diagnostica I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hipertrofia I-PRESENT_ILLNESS benigna I-PRESENT_ILLNESS de I-PRESENT_ILLNESS próstata. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION preoperatorio I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION alteraciones I-EXPLORATION (electrocardiograma, I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION bioquímica I-EXPLORATION normales). I-EXPLORATION Se B-TREATMENT programa I-TREATMENT para I-TREATMENT RTU. I-TREATMENT No I-TREATMENT se I-TREATMENT realizo I-TREATMENT premedicación. I-TREATMENT La I-TREATMENT anestesia I-TREATMENT intrarraquídea I-TREATMENT se I-TREATMENT realiza I-TREATMENT con I-TREATMENT el I-TREATMENT paciente I-TREATMENT en I-TREATMENT sedestación. I-TREATMENT Antes B-EXPLORATION de I-EXPLORATION la I-EXPLORATION inducción I-EXPLORATION anestésica I-EXPLORATION se I-EXPLORATION monitorizo I-EXPLORATION un I-EXPLORATION electrocardiograma I-EXPLORATION continuo I-EXPLORATION (ECG), I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION (PA) I-EXPLORATION no I-EXPLORATION invasiva I-EXPLORATION y I-EXPLORATION la I-EXPLORATION SpO2. I-EXPLORATION La B-TREATMENT intervención I-TREATMENT tuvo I-TREATMENT duración I-TREATMENT de I-TREATMENT 60 I-TREATMENT minutos I-TREATMENT y I-TREATMENT transcurrio I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT Durante I-TREATMENT la I-TREATMENT misma I-TREATMENT se I-TREATMENT administraron I-TREATMENT 3, I-TREATMENT 5 I-TREATMENT litros I-TREATMENT de I-TREATMENT agua I-TREATMENT estéril I-TREATMENT (hipotónica) I-TREATMENT como I-TREATMENT liquido I-TREATMENT de I-TREATMENT irrigación, I-TREATMENT contabilizandose I-TREATMENT un I-TREATMENT balance I-TREATMENT negativo I-TREATMENT de I-TREATMENT 1500ml. I-TREATMENT En B-EVOLUTION la I-EVOLUTION sala I-EVOLUTION de I-EVOLUTION despertar I-EVOLUTION presento I-EVOLUTION vómitos I-EVOLUTION e I-EVOLUTION hipotensión I-EVOLUTION (100/60mmHg). I-EVOLUTION No B-TREATMENT se I-TREATMENT objetivaron I-TREATMENT alteraciones I-TREATMENT neurológicas, I-TREATMENT ni I-TREATMENT cardiovasculares, I-TREATMENT ni I-TREATMENT edema I-TREATMENT pulmonar. I-TREATMENT ECG I-TREATMENT y I-TREATMENT Rx I-TREATMENT torax I-TREATMENT sin I-TREATMENT alteraciones. I-TREATMENT En I-TREATMENT la I-TREATMENT bioquímica I-TREATMENT sanguínea I-TREATMENT destacaba: I-TREATMENT sodio I-TREATMENT : I-TREATMENT 122 I-TREATMENT mEq/L, I-TREATMENT potasio I-TREATMENT : I-TREATMENT 5, I-TREATMENT 9 I-TREATMENT mmol/L, I-TREATMENT osmolaridad I-TREATMENT : I-TREATMENT 256 I-TREATMENT mOsmol/kg, I-TREATMENT urea I-TREATMENT : I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT g/L, I-TREATMENT creatinina I-TREATMENT (cr.s) I-TREATMENT : I-TREATMENT 38 I-TREATMENT mg/L, I-TREATMENT calcio I-TREATMENT : I-TREATMENT 80 I-TREATMENT mg/L, I-TREATMENT proteínas I-TREATMENT totales I-TREATMENT : I-TREATMENT 51 I-TREATMENT g/L, I-TREATMENT albúmina I-TREATMENT : I-TREATMENT 28 I-TREATMENT g/L, I-TREATMENT CPK I-TREATMENT : I-TREATMENT 225 I-TREATMENT U/L, I-TREATMENT LDH I-TREATMENT : I-TREATMENT 416 I-TREATMENT U/L, I-TREATMENT GOT I-TREATMENT : I-TREATMENT 48 I-TREATMENT U/L, I-TREATMENT GPT I-TREATMENT : I-TREATMENT 97 I-TREATMENT U/L, I-TREATMENT haptoglobina I-TREATMENT : I-TREATMENT 43.8 I-TREATMENT mg/dL I-TREATMENT (rango I-TREATMENT normal I-TREATMENT 50-220 I-TREATMENT mg/dL), I-TREATMENT las I-TREATMENT pruebas I-TREATMENT de I-TREATMENT coagulación I-TREATMENT salieron I-TREATMENT normales, I-TREATMENT Hb I-TREATMENT : I-TREATMENT 10 I-TREATMENT g/dl, I-TREATMENT HCT I-TREATMENT : I-TREATMENT 28.8 I-TREATMENT %, I-TREATMENT leucocitos I-TREATMENT : I-TREATMENT 6400/mm3, I-TREATMENT plaquetas I-TREATMENT : I-TREATMENT 220.000/mm3. I-TREATMENT Gasometría: I-TREATMENT pH I-TREATMENT : I-TREATMENT 7, I-TREATMENT 30; I-TREATMENT PCO2 I-TREATMENT : I-TREATMENT 36 I-TREATMENT mmHg; I-TREATMENT PO2 I-TREATMENT : I-TREATMENT 72 I-TREATMENT mmHg. I-TREATMENT Se B-EVOLUTION procede I-EVOLUTION a I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION Reanimación. I-EVOLUTION I-EVOLUTION Tras B-TREATMENT la I-TREATMENT estabilización I-TREATMENT clínica I-TREATMENT con I-TREATMENT normalización I-TREATMENT de I-TREATMENT la I-TREATMENT tensión I-TREATMENT arterial, I-TREATMENT se I-TREATMENT pudo I-TREATMENT prescindir I-TREATMENT de I-TREATMENT las I-TREATMENT drogas I-TREATMENT vasopresoras, I-TREATMENT se I-TREATMENT administraron I-TREATMENT Furosemida I-TREATMENT IV I-TREATMENT y I-TREATMENT suero I-TREATMENT salino I-TREATMENT hipertónico I-TREATMENT al I-TREATMENT 3% I-TREATMENT para I-TREATMENT minimizar I-TREATMENT la I-TREATMENT sobrecarga I-TREATMENT de I-TREATMENT volumen. I-TREATMENT A I-TREATMENT pesar I-TREATMENT de I-TREATMENT las I-TREATMENT medidas I-TREATMENT aplicadas I-TREATMENT persistia I-TREATMENT con I-TREATMENT insuficiencia I-TREATMENT renal I-TREATMENT aguda I-TREATMENT oligúrica I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días, I-TREATMENT llegando I-TREATMENT a I-TREATMENT cifras I-TREATMENT máximas I-TREATMENT de I-TREATMENT urea I-TREATMENT de I-TREATMENT 2, I-TREATMENT 70 I-TREATMENT g/L I-TREATMENT y I-TREATMENT de I-TREATMENT creatinina I-TREATMENT de I-TREATMENT 72 I-TREATMENT mg/L, I-TREATMENT precisando I-TREATMENT de I-TREATMENT 04 I-TREATMENT sesiones I-TREATMENT de I-TREATMENT hemodiálisis. I-TREATMENT A I-TREATMENT las I-TREATMENT 3 I-TREATMENT semanas, I-TREATMENT reinició I-TREATMENT la I-TREATMENT diuresis I-TREATMENT entrando I-TREATMENT en I-TREATMENT fase I-TREATMENT poliúrica, I-TREATMENT recuperandose I-TREATMENT así I-TREATMENT progresivamente I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT siendo I-TREATMENT la I-TREATMENT Cr.s. I-TREATMENT al I-TREATMENT alta I-TREATMENT de I-TREATMENT 14 I-TREATMENT mg/L. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION normotenso, I-EVOLUTION con I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION Cr.s. I-EVOLUTION 10 I-EVOLUTION mg/L I-EVOLUTION y I-EVOLUTION un I-EVOLUTION Ccr. I-EVOLUTION 76 I-EVOLUTION ml/minuto. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS conocida I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS enero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2003, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS acudir I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS sólida I-PRESENT_ILLNESS dependiente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mesorriñón I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño, I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS adenomegalias I-PRESENT_ILLNESS retrocavas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS nódulo I-PRESENT_ILLNESS hepático I-PRESENT_ILLNESS sospechoso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS metástasis, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS nódulos I-PRESENT_ILLNESS pulmonares I-PRESENT_ILLNESS bilaterales I-PRESENT_ILLNESS en I-PRESENT_ILLNESS campos I-PRESENT_ILLNESS basales. I-PRESENT_ILLNESS Para B-EXPLORATION filiar I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION percutánea I-EXPLORATION renal I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION nefroblastoma. I-EXPLORATION Se B-TREATMENT estadió I-TREATMENT como I-TREATMENT IV I-TREATMENT y I-TREATMENT conforme I-TREATMENT a I-TREATMENT ello I-TREATMENT se I-TREATMENT administraron I-TREATMENT según I-TREATMENT protocolo I-TREATMENT SIOP, I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT poliquimioterapia I-TREATMENT sistémica I-TREATMENT con I-TREATMENT actinomicina I-TREATMENT D, I-TREATMENT vincristina I-TREATMENT y I-TREATMENT doxorrubicina I-TREATMENT separados I-TREATMENT 3 I-TREATMENT semanas. I-TREATMENT Al B-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION este I-EVOLUTION período I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION la I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION masa I-EVOLUTION renal I-EVOLUTION y I-EVOLUTION el I-EVOLUTION evidente I-EVOLUTION cambio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION densidad I-EVOLUTION del I-EVOLUTION nódulo I-EVOLUTION hepático, I-EVOLUTION no I-EVOLUTION habiendo I-EVOLUTION variado I-EVOLUTION ni I-EVOLUTION el I-EVOLUTION tamaño I-EVOLUTION ni I-EVOLUTION la I-EVOLUTION densidad I-EVOLUTION de I-EVOLUTION los I-EVOLUTION ganglios I-EVOLUTION regionales. I-EVOLUTION Se B-TREATMENT sometió I-TREATMENT a I-TREATMENT nefrectomía I-TREATMENT radical I-TREATMENT dcha, I-TREATMENT linfadenectomía I-TREATMENT regional I-TREATMENT y I-TREATMENT exéresis I-TREATMENT de I-TREATMENT nódulo I-TREATMENT hepático. I-TREATMENT En I-TREATMENT riñón I-TREATMENT se I-TREATMENT reconfirmó I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT nefroblastoma I-TREATMENT con I-TREATMENT componente I-TREATMENT mixto, I-TREATMENT un I-TREATMENT tercio I-TREATMENT de I-TREATMENT blastema, I-TREATMENT y I-TREATMENT 2 I-TREATMENT tercios I-TREATMENT epiteliales, I-TREATMENT acompañados I-TREATMENT de I-TREATMENT un I-TREATMENT 60% I-TREATMENT de I-TREATMENT necrosis. I-TREATMENT Tras I-TREATMENT la I-TREATMENT nefrectomía I-TREATMENT continuó I-TREATMENT con I-TREATMENT ciclos I-TREATMENT de I-TREATMENT actinomicina I-TREATMENT D I-TREATMENT y I-TREATMENT vincristina, I-TREATMENT hasta I-TREATMENT que I-TREATMENT en I-TREATMENT estudio I-TREATMENT control I-TREATMENT aparece I-TREATMENT un I-TREATMENT nódulo I-TREATMENT pulmonar I-TREATMENT basal I-TREATMENT izdo, I-TREATMENT estudiado I-TREATMENT mediante I-TREATMENT PET, I-TREATMENT ofreciendo I-TREATMENT resultado I-TREATMENT positivo, I-TREATMENT y I-TREATMENT procediéndose I-TREATMENT a I-TREATMENT resección I-TREATMENT quirúrgica I-TREATMENT poniendo I-TREATMENT de I-TREATMENT manifiesto I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT componente I-TREATMENT nefroblastomatoso I-TREATMENT sin I-TREATMENT poder I-TREATMENT reconocer I-TREATMENT un I-TREATMENT claro I-TREATMENT patrón I-TREATMENT de I-TREATMENT crecimiento. I-TREATMENT Posteriormente I-TREATMENT y I-TREATMENT siguiendo I-TREATMENT las I-TREATMENT indicaciones I-TREATMENT de I-TREATMENT la I-TREATMENT SIOP I-TREATMENT se I-TREATMENT continuó I-TREATMENT con I-TREATMENT la I-TREATMENT poliquimioterapia I-TREATMENT sistémica I-TREATMENT asociando I-TREATMENT carboplatino I-TREATMENT y I-TREATMENT etopósido, I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 26 I-TREATMENT semanas. I-TREATMENT En B-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 46 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION inicial I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY H.T.A. I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS hematuria I-PRESENT_ILLNESS con I-PRESENT_ILLNESS coágulos I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS urológicos I-PRESENT_ILLNESS destacables I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION no I-EXPLORATION detecta I-EXPLORATION anomalías I-EXPLORATION de I-EXPLORATION interés, I-EXPLORATION con I-EXPLORATION riñones I-EXPLORATION y I-EXPLORATION vías I-EXPLORATION excretoras I-EXPLORATION normales, I-EXPLORATION próstata I-EXPLORATION discretamente I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION vejiga I-EXPLORATION sin I-EXPLORATION hallazgos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cistoscopia I-EXPLORATION practicada I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION papilar I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION izquierda I-EXPLORATION retromeatal I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION hasta I-EXPLORATION vertiente I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION vesical. I-EXPLORATION Se B-TREATMENT practica I-TREATMENT resección I-TREATMENT transuretral. I-TREATMENT I-TREATMENT El B-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION de I-EXPLORATION Brunner I-EXPLORATION (papiloma I-EXPLORATION invertido) I-EXPLORATION sobre I-EXPLORATION varios I-EXPLORATION fragmentos I-EXPLORATION resecados I-EXPLORATION que I-EXPLORATION en I-EXPLORATION conjunto I-EXPLORATION miden I-EXPLORATION 10x15x5 I-EXPLORATION mm.. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomático I-EVOLUTION tras I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY histerectomía I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY anexectomía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY miomas I-PAST_MEDICAL_HISTORY uterinos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1997, I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hiato, I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY médico. I-PAST_MEDICAL_HISTORY Presentaba I-PAST_MEDICAL_HISTORY asimismo I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY nódulo I-PAST_MEDICAL_HISTORY tiroideo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diámetro, I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY coloide I-PAST_MEDICAL_HISTORY nodular I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY PAAF I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1995. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2001, I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY nefrectomía I-PAST_MEDICAL_HISTORY radical I-PAST_MEDICAL_HISTORY derecha, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY heterogéneo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diámetro I-PAST_MEDICAL_HISTORY localizado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tercio I-PAST_MEDICAL_HISTORY medio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riñón I-PAST_MEDICAL_HISTORY derecho, I-PAST_MEDICAL_HISTORY correspondiendo I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY anatomopatológico I-PAST_MEDICAL_HISTORY posterior, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alto I-PAST_MEDICAL_HISTORY grado, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY infiltración I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vena I-PAST_MEDICAL_HISTORY renal, I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY pT3bNoMo. I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY coadyuvante I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY interleukina- I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY subcutánea I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY informe I-PAST_MEDICAL_HISTORY anatomopatológico I-PAST_MEDICAL_HISTORY macroscópico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pieza I-PAST_MEDICAL_HISTORY describía I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY nódulo I-PAST_MEDICAL_HISTORY tumoral I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY infiltraba I-PAST_MEDICAL_HISTORY pelvis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vena I-PAST_MEDICAL_HISTORY renal, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY diámetro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY x I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY x I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY cm, I-PAST_MEDICAL_HISTORY combinando I-PAST_MEDICAL_HISTORY áreas I-PAST_MEDICAL_HISTORY grisáceas I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY pardoamarillentas. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY microscópico I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY observó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY tumoración I-PAST_MEDICAL_HISTORY pseudocapsular I-PAST_MEDICAL_HISTORY correspondiente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alto I-PAST_MEDICAL_HISTORY grado, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY alguna I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY anaplásica. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY invadía I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY sistema I-PAST_MEDICAL_HISTORY pielocalicial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY evidencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY invasión I-PAST_MEDICAL_HISTORY vascular I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY vena I-PAST_MEDICAL_HISTORY renal. I-PAST_MEDICAL_HISTORY Los I-PAST_MEDICAL_HISTORY márgenes I-PAST_MEDICAL_HISTORY quirúrgicos I-PAST_MEDICAL_HISTORY estaban I-PAST_MEDICAL_HISTORY libres. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2004 I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY control, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY detectó I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY TAC, I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY marcado I-PAST_MEDICAL_HISTORY crecimiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY lóbulo I-PAST_MEDICAL_HISTORY tiroideo I-PAST_MEDICAL_HISTORY izquierdo, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY nódulo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY heterogéneo, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nódulo I-PAST_MEDICAL_HISTORY coloide I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY conocido. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2005, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY nuevo I-PAST_MEDICAL_HISTORY TAC, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY observó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY lóbulo I-PAST_MEDICAL_HISTORY tiroideo I-PAST_MEDICAL_HISTORY izquierdo, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY crecimiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY nódulo I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 5, I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY desplazando I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY tráquea. I-PAST_MEDICAL_HISTORY La B-EXPLORATION gammagrafía I-EXPLORATION tiroidea I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION 'nódulo I-EXPLORATION frío' I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION izquierdo, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION hormonas I-EXPLORATION tiroideas. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT el I-TREATMENT crecimiento I-TREATMENT progresivo I-TREATMENT del I-TREATMENT nódulo I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT hemitiroidectomía I-TREATMENT izquierda. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION describía I-EXPLORATION un I-EXPLORATION hemitiroides I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION zonas I-EXPLORATION amarillentas I-EXPLORATION en I-EXPLORATION superficie, I-EXPLORATION alternando I-EXPLORATION con I-EXPLORATION otras I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION más I-EXPLORATION carnoso. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION con I-EXPLORATION citoplasma I-EXPLORATION claro, I-EXPLORATION las I-EXPLORATION cuales I-EXPLORATION presentaban I-EXPLORATION una I-EXPLORATION acusada I-EXPLORATION atipia, I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION incluso I-EXPLORATION anaplásicas I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION figuras I-EXPLORATION de I-EXPLORATION mitosis. I-EXPLORATION Presentaban I-EXPLORATION un I-EXPLORATION crecimiento I-EXPLORATION difuso I-EXPLORATION constituyendo I-EXPLORATION nódulos I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION esclerosis I-EXPLORATION y I-EXPLORATION extensas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION rodeada I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION tiroideo I-EXPLORATION respetado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetivaban I-EXPLORATION folículos I-EXPLORATION linfoides. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION técnicas I-EXPLORATION de I-EXPLORATION inmunohistoquímica I-EXPLORATION en I-EXPLORATION las I-EXPLORATION cuales I-EXPLORATION dichas I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION presentaron I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION la I-EXPLORATION tiroglobulina I-EXPLORATION y I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION CK8, I-EXPLORATION CK18, I-EXPLORATION EMA, I-EXPLORATION y I-EXPLORATION Vimentina. I-EXPLORATION I-EXPLORATION Dadas I-EXPLORATION las I-EXPLORATION características I-EXPLORATION histológicas I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION el I-EXPLORATION perfil I-EXPLORATION inmunohistoquímico, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION la I-EXPLORATION historia I-EXPLORATION clínica I-EXPLORATION del I-EXPLORATION paciente, I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION renal I-EXPLORATION de I-EXPLORATION células I-EXPLORATION claras. I-EXPLORATION I-EXPLORATION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Puertas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS escrotal I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemiescroto I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY traumático I-PAST_MEDICAL_HISTORY conocido. I-PAST_MEDICAL_HISTORY No B-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS miccional. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION se I-EXPLORATION detecta I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION enrojecimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION escrotal, I-EXPLORATION más I-EXPLORATION acusado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemiescroto I-EXPLORATION izquierdo I-EXPLORATION ligeramente I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION palpación. I-EXPLORATION Cordón I-EXPLORATION y I-EXPLORATION testículos I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION normales I-EXPLORATION no I-EXPLORATION dolorosos. I-EXPLORATION I-EXPLORATION No I-EXPLORATION aparece I-EXPLORATION hidrocele I-EXPLORATION a I-EXPLORATION la I-EXPLORATION transluminación I-EXPLORATION y I-EXPLORATION la I-EXPLORATION maniobra I-EXPLORATION de I-EXPLORATION Prehn I-EXPLORATION es I-EXPLORATION negativa. I-EXPLORATION Reflejos I-EXPLORATION cremastéricos I-EXPLORATION conservados. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION estudio I-EXPLORATION ultrasonográfico I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION de: I-EXPLORATION testículo I-EXPLORATION y I-EXPLORATION epidídimos I-EXPLORATION bilaterales I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION normales I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION inflamación I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION el I-EXPLORATION flujo I-EXPLORATION al I-EXPLORATION Eco-Doppler. I-EXPLORATION Cubiertas I-EXPLORATION testiculares I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION de I-EXPLORATION hemiescroto I-EXPLORATION izquierdo I-EXPLORATION engrosados I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION flujo I-EXPLORATION Doppler. I-EXPLORATION I-EXPLORATION Se B-TREATMENT le I-TREATMENT diagnosticó I-TREATMENT de I-TREATMENT edema I-TREATMENT de I-TREATMENT escroto I-TREATMENT agudo I-TREATMENT idiopático, I-TREATMENT se I-TREATMENT le I-TREATMENT recetaron I-TREATMENT AINES I-TREATMENT y B-EVOLUTION se I-EVOLUTION le I-EVOLUTION cito I-EVOLUTION para I-EVOLUTION revisión I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION días, I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION observar I-EVOLUTION que I-EVOLUTION el I-EVOLUTION edema, I-EVOLUTION el I-EVOLUTION eritema I-EVOLUTION y I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION habían I-EVOLUTION desaparecido I-EVOLUTION casi I-EVOLUTION por I-EVOLUTION completo. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS Colombiana B-PAST_MEDICAL_HISTORY de B-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS año I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS episódico I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS punzada I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hematuria, I-PRESENT_ILLNESS nauseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS Con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY patológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY quirúrgico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY histerectomía. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION sus I-EXPLORATION signos I-EXPLORATION vitales, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 20kg/Mts2, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION único I-EXPLORATION signo I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION era I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION flanco I-EXPLORATION izquierdo. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT manejo I-TREATMENT médico I-TREATMENT considerando I-TREATMENT pielonefritis, I-TREATMENT sin B-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología, I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION toma I-EXPLORATION Tomografía I-EXPLORATION Axial I-EXPLORATION Computarizada, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION informa I-EXPLORATION masa I-EXPLORATION dependiente I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 10 I-EXPLORATION cms, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION nefrectomía. I-EXPLORATION I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION quirúrgica I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION renal I-EXPLORATION fue I-EXPLORATION fijada I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION extraerse I-EXPLORATION con I-EXPLORATION formaldehído I-EXPLORATION al I-EXPLORATION 10% I-EXPLORATION y I-EXPLORATION embebido I-EXPLORATION en I-EXPLORATION parafina I-EXPLORATION para I-EXPLORATION su I-EXPLORATION preparación I-EXPLORATION y I-EXPLORATION análisis I-EXPLORATION microscópico, I-EXPLORATION la I-EXPLORATION coloración I-EXPLORATION empleada I-EXPLORATION fue I-EXPLORATION Hematoxilina I-EXPLORATION y I-EXPLORATION Eosina. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS referir I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS testicular I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS termometrada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40ºC, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS escalofríos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS miccional I-PRESENT_ILLNESS acompañante I-PRESENT_ILLNESS (disuria, I-PRESENT_ILLNESS polaquiuria, I-PRESENT_ILLNESS tenesmo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS miccional), I-PRESENT_ILLNESS ausencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Durante B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY anamnesis I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY revela I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY profesión, I-PAST_MEDICAL_HISTORY veterinario, I-PAST_MEDICAL_HISTORY profesión I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY ciertas I-PAST_MEDICAL_HISTORY patologías I-PAST_MEDICAL_HISTORY infecciosas I-PAST_MEDICAL_HISTORY (brucelosis, I-PAST_MEDICAL_HISTORY triquinosis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY algunas I-PAST_MEDICAL_HISTORY parasitosis). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION un I-EXPLORATION teste I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION características I-EXPLORATION normales, I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION teste I-EXPLORATION izquierdo, I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION así I-EXPLORATION como I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION al I-EXPLORATION tacto I-EXPLORATION sin I-EXPLORATION fluctuación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION afecta I-EXPLORATION aunque I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION movilización I-EXPLORATION testicular. I-EXPLORATION I-EXPLORATION El I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION resulta I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION abdominal I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION percusión I-EXPLORATION renal I-EXPLORATION también I-EXPLORATION descartó I-EXPLORATION afecciones I-EXPLORATION acompañantes I-EXPLORATION al I-EXPLORATION ser I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Analíticamente I-EXPLORATION destaca I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 22.240 I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (neutrófilos I-EXPLORATION 90%). I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Ecografía I-EXPLORATION testicular I-EXPLORATION realizada I-EXPLORATION previa I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION muestra I-EXPLORATION aumentos I-EXPLORATION homogéneos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ecogenicidad I-EXPLORATION del I-EXPLORATION testículo I-EXPLORATION afecto, I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION epidídimo. I-EXPLORATION Engrosamiento I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION absceso I-EXPLORATION testicular. I-EXPLORATION Imágenes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION orquitis I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION epidídimo. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT orquitis I-TREATMENT infecciosa, I-TREATMENT procediéndose I-TREATMENT a I-TREATMENT su I-TREATMENT ingreso I-TREATMENT con I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT que I-TREATMENT comprendió I-TREATMENT Doxiciclina, I-TREATMENT Imipenem I-TREATMENT y I-TREATMENT Teicoplanina, I-TREATMENT asociando I-TREATMENT Corticoides I-TREATMENT y I-TREATMENT terapia I-TREATMENT analgésica. I-TREATMENT I-TREATMENT Dos B-EXPLORATION días I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION ingresse I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION ecografía, I-EXPLORATION objetivándose I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ecogenicidad I-EXPLORATION homogénea I-EXPLORATION similar I-EXPLORATION al I-EXPLORATION contralateral, I-EXPLORATION afectación I-EXPLORATION epididimaria. I-EXPLORATION Engrosamiento I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION absceso I-EXPLORATION testicular. I-EXPLORATION Se I-EXPLORATION termina I-EXPLORATION de I-EXPLORATION filiar I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION sindrómico: I-EXPLORATION Orquiepididimitis I-EXPLORATION infecciosa. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION averiguar I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION patología I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION hace I-EXPLORATION necesaria I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION que I-EXPLORATION permitan I-EXPLORATION conocer I-EXPLORATION el I-EXPLORATION germen I-EXPLORATION causante. I-EXPLORATION I-EXPLORATION El I-EXPLORATION urocultivo I-EXPLORATION resulta I-EXPLORATION ser I-EXPLORATION negativo, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION aglutinación I-EXPLORATION específica I-EXPLORATION de I-EXPLORATION Brucella. I-EXPLORATION Sin I-EXPLORATION embargo I-EXPLORATION la I-EXPLORATION seroaglutinación I-EXPLORATION de I-EXPLORATION Rosa I-EXPLORATION de I-EXPLORATION Bengala I-EXPLORATION resulta I-EXPLORATION positiva, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION los I-EXPLORATION hemocultivos, I-EXPLORATION que I-EXPLORATION son I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION Brucella I-EXPLORATION spp. I-EXPLORATION (los I-EXPLORATION tres). I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT confirmación I-TREATMENT del I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT orquiepididimitis I-TREATMENT brucelar I-TREATMENT se I-TREATMENT decide I-TREATMENT mantener I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Doxiciclina I-TREATMENT y I-TREATMENT ciprofloxacino. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION favorablemente I-EVOLUTION con I-EVOLUTION remisión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS para I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS litiasis I-PRESENT_ILLNESS piélica I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS nicturia I-PRESENT_ILLNESS 3-4, I-PRESENT_ILLNESS polaquiuria, I-PRESENT_ILLNESS escozor I-PRESENT_ILLNESS miccional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS aislados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematuria. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION el I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION están I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION En I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION aparato I-EXPLORATION urinario, I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION radiopaca I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION anecóica I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION hidronefrosis I-EXPLORATION e I-EXPLORATION importante I-EXPLORATION atrofia I-EXPLORATION cortical. I-EXPLORATION En I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION hidronefrosis I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION imágenes I-EXPLORATION ecogénicas I-EXPLORATION en I-EXPLORATION pelvis, I-EXPLORATION cálices I-EXPLORATION medios I-EXPLORATION e I-EXPLORATION inferiores I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION cálculos. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION urografía I-EXPLORATION intravenosa, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION distinguen I-EXPLORATION un I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION no I-EXPLORATION funcionante I-EXPLORATION y I-EXPLORATION una I-EXPLORATION bifidez I-EXPLORATION pieloureteral, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION coraliforme I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pielón I-EXPLORATION inferior I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION TAC I-EXPLORATION abdomino-pélvico, I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION aparece I-EXPLORATION como I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION cavidad I-EXPLORATION quística, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION cortical I-EXPLORATION funcionante. I-EXPLORATION El I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION presenta I-EXPLORATION hipertrofia I-EXPLORATION compensadora, I-EXPLORATION con I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION quísticas I-EXPLORATION corticales I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION cálculos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION inferior. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION practicar I-EXPLORATION punción I-EXPLORATION percutánea I-EXPLORATION bilateral, I-EXPLORATION observando I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION al I-EXPLORATION uréter I-EXPLORATION y I-EXPLORATION bifidez I-EXPLORATION pieloureteral I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION litiasis I-EXPLORATION coraliforme I-EXPLORATION en I-EXPLORATION pielón I-EXPLORATION inferior. I-EXPLORATION Se B-TREATMENT deja I-TREATMENT colocada I-TREATMENT una I-TREATMENT sonda I-TREATMENT de I-TREATMENT nefrostomía I-TREATMENT en I-TREATMENT el I-TREATMENT lado I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT se I-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT antibiótico, I-TREATMENT al I-TREATMENT extraer I-TREATMENT orina I-TREATMENT purulenta I-TREATMENT en I-TREATMENT la I-TREATMENT descarga I-TREATMENT del I-TREATMENT pielón I-TREATMENT inferior. I-TREATMENT La B-EXPLORATION gammagrafía I-EXPLORATION renal I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION escasa I-EXPLORATION función I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION (11%). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cistoscopia I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION neorformaciones I-EXPLORATION vesicales. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT estudios I-TREATMENT preoperatorios I-TREATMENT dentro I-TREATMENT de I-TREATMENT la I-TREATMENT normalidad I-TREATMENT el I-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenido I-TREATMENT quirúrgicamente I-TREATMENT realizándose I-TREATMENT nefrolitotomía I-TREATMENT percutánea I-TREATMENT izquierda, I-TREATMENT con I-TREATMENT fragmentación I-TREATMENT de I-TREATMENT litiasis I-TREATMENT con I-TREATMENT lithoclast I-TREATMENT y I-TREATMENT extracción I-TREATMENT de I-TREATMENT fragmentos. I-TREATMENT A I-TREATMENT los I-TREATMENT quince I-TREATMENT días I-TREATMENT se I-TREATMENT lleva I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT nueva I-TREATMENT nefrolitotomía I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT eliminar I-TREATMENT todos I-TREATMENT los I-TREATMENT restos I-TREATMENT litiásicos. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION eliminando I-EVOLUTION orina I-EVOLUTION purulenta I-EVOLUTION por I-EVOLUTION sonda I-EVOLUTION de I-EVOLUTION nefrostomía I-EVOLUTION percutánea. I-EVOLUTION La B-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION sustracción I-EXPLORATION digital' I-EXPLORATION (DIVAS) I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION escasa I-EXPLORATION vascularización I-EXPLORATION del I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT es I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT heminefrectomía I-TREATMENT polar I-TREATMENT inferior I-TREATMENT izquierda. I-TREATMENT En I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT se I-TREATMENT produce I-TREATMENT un I-TREATMENT empeoramiento I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT con I-TREATMENT fiebre I-TREATMENT y I-TREATMENT leucocitosis, I-TREATMENT proceso I-TREATMENT compatible I-TREATMENT con I-TREATMENT sepsis I-TREATMENT de I-TREATMENT origen I-TREATMENT urinario I-TREATMENT que I-TREATMENT mejora I-TREATMENT con I-TREATMENT sueroterapia I-TREATMENT y I-TREATMENT antibioterapia I-TREATMENT parenteral. I-TREATMENT I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION extirpada I-EXPLORATION corresponde I-EXPLORATION a I-EXPLORATION un I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 452 I-EXPLORATION gramos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION acompaña I-EXPLORATION de I-EXPLORATION abundante I-EXPLORATION grasa I-EXPLORATION intimamente I-EXPLORATION pegada I-EXPLORATION al I-EXPLORATION parenquima I-EXPLORATION renal. I-EXPLORATION Al I-EXPLORATION corte I-EXPLORATION el I-EXPLORATION parenquima I-EXPLORATION está I-EXPLORATION sustituido I-EXPLORATION por I-EXPLORATION grandes I-EXPLORATION cavidades I-EXPLORATION quísticas I-EXPLORATION ocupadas I-EXPLORATION por I-EXPLORATION un I-EXPLORATION material I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION blando. I-EXPLORATION Histológicamente I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION grandes I-EXPLORATION masas I-EXPLORATION sólidas, I-EXPLORATION nidos I-EXPLORATION y I-EXPLORATION regueros I-EXPLORATION infiltrantes I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION hábito I-EXPLORATION escamoso I-EXPLORATION que I-EXPLORATION presentan I-EXPLORATION grandes I-EXPLORATION núcleos I-EXPLORATION vesiculosos I-EXPLORATION e I-EXPLORATION irregulares I-EXPLORATION con I-EXPLORATION nucleolo I-EXPLORATION prominente, I-EXPLORATION citoplasma I-EXPLORATION amplio, I-EXPLORATION bien I-EXPLORATION definido, I-EXPLORATION eosinófilo I-EXPLORATION claro, I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION queratinización I-EXPLORATION individual I-EXPLORATION y I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION perlas I-EXPLORATION corneas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION urografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION función I-EXPLORATION normal I-EXPLORATION del I-EXPLORATION hemirriñón I-EXPLORATION superior I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION uropatía I-EXPLORATION obstructiva. I-EXPLORATION I-EXPLORATION Un B-EVOLUTION año I-EVOLUTION y I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION ingresa I-EVOLUTION desde I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION hematuria I-EVOLUTION macroscópica. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION replección I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION derecha, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION corroborado I-EXPLORATION mediante I-EXPLORATION cistoscopia. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT resección I-TREATMENT transuretral I-TREATMENT de I-TREATMENT tumoración I-TREATMENT sólida I-TREATMENT en I-TREATMENT cara I-TREATMENT lateral I-TREATMENT derecha I-TREATMENT de I-TREATMENT vejiga, I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT anatomo-patológico I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT vesical I-TREATMENT con I-TREATMENT áreas I-TREATMENT de I-TREATMENT diferenciación I-TREATMENT escamosa I-TREATMENT que I-TREATMENT infiltra I-TREATMENT la I-TREATMENT muscular, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT es I-TREATMENT sometido I-TREATMENT a I-TREATMENT cistoprostatectomía I-TREATMENT radical I-TREATMENT con I-TREATMENT derivación I-TREATMENT urinaria I-TREATMENT de I-TREATMENT uréter I-TREATMENT izquierdo I-TREATMENT a I-TREATMENT sigma I-TREATMENT (Mainz I-TREATMENT II). I-TREATMENT En I-TREATMENT el I-TREATMENT mismo I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT practica I-TREATMENT una I-TREATMENT nefroureterectomía I-TREATMENT derecha, I-TREATMENT donde I-TREATMENT se I-TREATMENT observa I-TREATMENT un I-TREATMENT riñón I-TREATMENT hidronefrótico, I-TREATMENT con I-TREATMENT un I-TREATMENT síndrome I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT pieloureteral I-TREATMENT por I-TREATMENT un I-TREATMENT vaso I-TREATMENT polar. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION escamosas, I-EXPLORATION estadio I-EXPLORATION pT3a, I-EXPLORATION pNx, I-EXPLORATION pMx. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fallece I-EVOLUTION cuatro I-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde, I-EVOLUTION con I-EVOLUTION metástasis I-EVOLUTION pulmonares I-EVOLUTION y I-EVOLUTION hepáticas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS litiasis I-PRESENT_ILLNESS piélica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS riñón I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS Se B-TREATMENT le I-TREATMENT propone I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT NLPC. I-TREATMENT Bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT y I-TREATMENT en I-TREATMENT posición I-TREATMENT de I-TREATMENT decúbito I-TREATMENT prono I-TREATMENT se I-TREATMENT accede I-TREATMENT al I-TREATMENT riñón I-TREATMENT por I-TREATMENT grupo I-TREATMENT calicial I-TREATMENT inferior, I-TREATMENT bajo I-TREATMENT control I-TREATMENT de I-TREATMENT escopia. I-TREATMENT Se I-TREATMENT dilata I-TREATMENT el I-TREATMENT trayecto I-TREATMENT de I-TREATMENT acceso I-TREATMENT percutáneo I-TREATMENT con I-TREATMENT dilatadores I-TREATMENT metálicos I-TREATMENT coaxiales I-TREATMENT de I-TREATMENT Alken. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT fragmentación I-TREATMENT de I-TREATMENT la I-TREATMENT litiasis I-TREATMENT con I-TREATMENT el I-TREATMENT litotriptor I-TREATMENT intracorpóreo I-TREATMENT StoneBreakerTM I-TREATMENT (LMA I-TREATMENT Urology, I-TREATMENT Gland, I-TREATMENT Switzerland). I-TREATMENT El I-TREATMENT tiempo I-TREATMENT de I-TREATMENT fragmentación I-TREATMENT de I-TREATMENT la I-TREATMENT litiasis I-TREATMENT fue I-TREATMENT de I-TREATMENT 30 I-TREATMENT minutos I-TREATMENT utilizando I-TREATMENT tres I-TREATMENT cartuchos I-TREATMENT de I-TREATMENT dióxido I-TREATMENT de I-TREATMENT carbono I-TREATMENT comprimido. I-TREATMENT No B-EVOLUTION existieron I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION procedimiento I-EVOLUTION con B-TREATMENT un I-TREATMENT catéter I-TREATMENT doble I-TREATMENT J I-TREATMENT por I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT restos I-TREATMENT litiásicos I-TREATMENT menores I-TREATMENT de I-TREATMENT 3 I-TREATMENT mm. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY al B-PRESENT_ILLNESS que I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS solicitada I-PRESENT_ILLNESS para I-PRESENT_ILLNESS el I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS prostático, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS RH I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS sólida I-PRESENT_ILLNESS que I-PRESENT_ILLNESS asienta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS istmo I-PRESENT_ILLNESS renal. I-PRESENT_ILLNESS El B-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION cm. I-EXPLORATION en I-EXPLORATION el I-EXPLORATION istmo I-EXPLORATION renal I-EXPLORATION sin I-EXPLORATION evidenciar I-EXPLORATION adenopatías, I-EXPLORATION metástasis I-EXPLORATION locoregionales I-EXPLORATION ni I-EXPLORATION lesiones I-EXPLORATION a I-EXPLORATION distancia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION vascular I-EXPLORATION preoperatorio I-EXPLORATION mediante I-EXPLORATION arteriografía, I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION arterias I-EXPLORATION renales I-EXPLORATION con I-EXPLORATION nacimiento I-EXPLORATION ortotópico. I-EXPLORATION Las I-EXPLORATION imágenes I-EXPLORATION selectivas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION renal I-EXPLORATION derecha, I-EXPLORATION evidenciaron I-EXPLORATION vasos I-EXPLORATION neoformados I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION medial I-EXPLORATION en I-EXPLORATION su I-EXPLORATION bifurcación I-EXPLORATION con I-EXPLORATION normalidad I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION venoso I-EXPLORATION intra I-EXPLORATION y I-EXPLORATION extrarrenal. I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT presunción I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT renal, I-TREATMENT se I-TREATMENT practicó I-TREATMENT istmectomía I-TREATMENT y I-TREATMENT nefrectomía I-TREATMENT izquierda I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT media. I-TREATMENT Durante I-TREATMENT el I-TREATMENT acto I-TREATMENT operatorio I-TREATMENT se I-TREATMENT apreció I-TREATMENT que I-TREATMENT la I-TREATMENT pelvis I-TREATMENT renal I-TREATMENT y I-TREATMENT el I-TREATMENT uréter I-TREATMENT izquierdos I-TREATMENT se I-TREATMENT hallaban I-TREATMENT infiltrados I-TREATMENT por I-TREATMENT el I-TREATMENT tumor. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION renal I-EXPLORATION neoformada I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm. I-EXPLORATION afectando I-EXPLORATION cápsula, I-EXPLORATION grasa I-EXPLORATION perirrenal, I-EXPLORATION así I-EXPLORATION como, I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION urinaria I-EXPLORATION izquierda. I-EXPLORATION La I-EXPLORATION histología I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION de I-EXPLORATION célula I-EXPLORATION no I-EXPLORATION pequeña. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmuno-histoquímico I-EXPLORATION resultó I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION CD-56 I-EXPLORATION y I-EXPLORATION sinaptofisina. I-EXPLORATION I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 4 I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención, I-EXPLORATION el I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION sólido I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm. I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION así I-EXPLORATION como, I-EXPLORATION adenopatías I-EXPLORATION para-aórticas I-EXPLORATION izquierdas I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION nódulos I-EXPLORATION retrocrurales I-EXPLORATION subcentimétricos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION PET-TC I-EXPLORATION mostró I-EXPLORATION que I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION descritas I-EXPLORATION eran I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION metástasis. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT radioterapia I-TREATMENT externa I-TREATMENT (RT) I-TREATMENT y I-TREATMENT quimioterapia I-TREATMENT (QT) I-TREATMENT (carboplatino I-TREATMENT y I-TREATMENT VP-16) I-TREATMENT con I-TREATMENT buena I-TREATMENT tolerancia I-TREATMENT y I-TREATMENT respuesta I-TREATMENT parcial. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION efectos I-EVOLUTION secundarios I-EVOLUTION tardíos I-EVOLUTION de I-EVOLUTION RT I-EVOLUTION ni I-EVOLUTION QT. I-EVOLUTION Dos I-EVOLUTION años I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION el I-EVOLUTION TAC I-EVOLUTION abdominal I-EVOLUTION muestra I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION pequeños I-EVOLUTION ganglios I-EVOLUTION retroperitoneales, I-EVOLUTION sin I-EVOLUTION otros I-EVOLUTION hallazgos I-EVOLUTION destacables. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS al I-PRESENT_ILLNESS que I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS había I-PRESENT_ILLNESS realizado I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hemorragia I-PRESENT_ILLNESS bilateral. I-PRESENT_ILLNESS Resto B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS un I-PRESENT_ILLNESS bulto I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pene, I-PRESENT_ILLNESS doloroso I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS erección. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION cordón I-EXPLORATION longitudinal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION del I-EXPLORATION pene I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION tres I-EXPLORATION centímetros, I-EXPLORATION móvil I-EXPLORATION y I-EXPLORATION doloroso. I-EXPLORATION Afebril. I-EXPLORATION No I-EXPLORATION adenopatías I-EXPLORATION inguinales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION eco-doppler I-EXPLORATION peneano I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION clara I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION dorsal I-EXPLORATION superficial I-EXPLORATION del I-EXPLORATION pene I-EXPLORATION y I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION colapsaba I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION del I-EXPLORATION transductor. I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Juicio I-EXPLORATION Diagnóstico: I-EXPLORATION Enfermedad I-EXPLORATION de I-EXPLORATION Mondor. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT y I-TREATMENT antiinflamatorios. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS el I-PRESENT_ILLNESS día I-PRESENT_ILLNESS 18/9/07 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS sufre I-PRESENT_ILLNESS una I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS calle, I-PRESENT_ILLNESS golpeándose I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS lumbar. I-PRESENT_ILLNESS Acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS MAP I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS aumenta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS flexo-extensión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS piernas; I-PRESENT_ILLNESS se B-TREATMENT pauta I-TREATMENT tratamiento I-TREATMENT analgésico I-TREATMENT y I-TREATMENT observación I-TREATMENT domiciliaria. I-TREATMENT Dos B-EVOLUTION horas I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION avisan I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION domicilio I-EVOLUTION por I-EVOLUTION hematuria I-EVOLUTION franca I-EVOLUTION e I-EVOLUTION intenso I-EVOLUTION dolor I-EVOLUTION abdominal; I-EVOLUTION presenta B-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal, I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 110/70 I-EXPLORATION y I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas; I-EXPLORATION se B-DERIVED_FROM/TO decide I-DERIVED_FROM/TO traslado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Universitario I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Salamanca I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION su I-EXPLORATION llegada I-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencias I-EXPLORATION (en I-EXPLORATION torno I-EXPLORATION las I-EXPLORATION 23 I-EXPLORATION horas) I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION marcada I-EXPLORATION defensa I-EXPLORATION abdominal, I-EXPLORATION con I-EXPLORATION tensiones I-EXPLORATION de I-EXPLORATION 135/85, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 94 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION y I-EXPLORATION pulsos I-EXPLORATION conservados; I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION ECG I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION detecta I-EXPLORATION fibrilación I-EXPLORATION auricular I-EXPLORATION no I-EXPLORATION conocida I-EXPLORATION previamente. I-EXPLORATION Presenta I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION 12.8 I-EXPLORATION g/dl I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION y I-EXPLORATION 69 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION como I-EXPLORATION datos I-EXPLORATION más I-EXPLORATION destacables. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION urgente I-EXPLORATION con I-EXPLORATION contraste, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION informa I-EXPLORATION como I-EXPLORATION riñón I-EXPLORATION en I-EXPLORATION herradura I-EXPLORATION con I-EXPLORATION rotura I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION central I-EXPLORATION y I-EXPLORATION medial I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION gran I-EXPLORATION hematoma I-EXPLORATION retroperitoneal, I-EXPLORATION con I-EXPLORATION extravasación I-EXPLORATION activa I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION próxima I-EXPLORATION a I-EXPLORATION la I-EXPLORATION fractura I-EXPLORATION renal; I-EXPLORATION no I-EXPLORATION existe I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION estructuras. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION y I-EXPLORATION la I-EXPLORATION situación I-EXPLORATION clínica I-EXPLORATION del I-EXPLORATION enfermo I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION laparotomía I-EXPLORATION media I-EXPLORATION exploradora, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION gran I-EXPLORATION hemorretroperitoneo I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION la I-EXPLORATION raíz I-EXPLORATION de I-EXPLORATION mesenterio, I-EXPLORATION consecuencia I-EXPLORATION de I-EXPLORATION rotura I-EXPLORATION múltiple I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hemi-riñón I-EXPLORATION izquierdo, I-EXPLORATION llegando I-EXPLORATION a I-EXPLORATION comprometer I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION intrarrenal I-EXPLORATION (grado I-EXPLORATION IV I-EXPLORATION según I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION orgánica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION American I-EXPLORATION Association I-EXPLORATION for I-EXPLORATION the I-EXPLORATION Surgery I-EXPLORATION of I-EXPLORATION Trauma) I-EXPLORATION (5); I-EXPLORATION se B-TREATMENT realiza I-TREATMENT evacuación I-TREATMENT del I-TREATMENT hematoma I-TREATMENT retroperitoneal I-TREATMENT junto I-TREATMENT con I-TREATMENT nefrectomía I-TREATMENT del I-TREATMENT hemi-riñón I-TREATMENT izquierdo. I-TREATMENT Durante I-TREATMENT la I-TREATMENT intervención I-TREATMENT el I-TREATMENT paciente I-TREATMENT permanece I-TREATMENT estable, I-TREATMENT precisando I-TREATMENT la I-TREATMENT transfusión I-TREATMENT de I-TREATMENT 2 I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION estable I-EVOLUTION hemodinámicamente, I-EVOLUTION con I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION hemoglobina I-EVOLUTION en I-EVOLUTION torno I-EVOLUTION a I-EVOLUTION 10 I-EVOLUTION g/dl, I-EVOLUTION ligera I-EVOLUTION febrícula, I-EVOLUTION continúa I-EVOLUTION con I-EVOLUTION cierta I-EVOLUTION distensión I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION escaso I-EVOLUTION peristaltismo. I-EVOLUTION En B-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION realizado I-EXPLORATION el I-EXPLORATION día I-EXPLORATION 23/9/07 I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION optando I-EXPLORATION por I-EXPLORATION la I-EXPLORATION vigilancia I-EXPLORATION activa. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS trasplantado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 1986 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS glomerulonefritis I-PRESENT_ILLNESS mesangiocapilar I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS II, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS disfunción I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS del I-PRESENT_ILLNESS injerto I-PRESENT_ILLNESS por I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mismo, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS obliga I-PRESENT_ILLNESS a I-PRESENT_ILLNESS reanudar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hemodiálisis I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 1996. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS realizado I-PRESENT_ILLNESS un I-PRESENT_ILLNESS descenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS inmunosupresión I-PRESENT_ILLNESS con I-PRESENT_ILLNESS CsA I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS adición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Azathioprina, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS resultados. I-PRESENT_ILLNESS Presenta I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS iniciar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hemodiálisis I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS el I-PRESENT_ILLNESS injerto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS inestabilidad I-PRESENT_ILLNESS hemodinámica I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS refractaria I-PRESENT_ILLNESS al I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS médico. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION urgente I-EXPLORATION se I-EXPLORATION detecta I-EXPLORATION hematoma I-EXPLORATION subcapsular I-EXPLORATION e I-EXPLORATION intraparenquimatoso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION injerto, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION mediante I-EXPLORATION TC, I-EXPLORATION realizándose B-TREATMENT trasplantectomía I-TREATMENT pocas I-TREATMENT horas I-TREATMENT después. I-TREATMENT Durante B-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION lesión I-EXPLORATION sólida I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION injerto, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION con I-EXPLORATION evidentes I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION ruptura I-EXPLORATION espontánea I-EXPLORATION y I-EXPLORATION sangrado. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION advierten I-EXPLORATION otras I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION sólidas I-EXPLORATION y I-EXPLORATION quísticas I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION del I-EXPLORATION injerto. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION anatomopatológico I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION CCR I-EXPLORATION multicéntrico, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION de I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION quística I-EXPLORATION renal I-EXPLORATION adquirida I-EXPLORATION del I-EXPLORATION injerto. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION reanudó I-EVOLUTION la I-EVOLUTION hemodiálisis I-EVOLUTION y I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION y I-EVOLUTION asintomático I-EVOLUTION tras I-EVOLUTION 12 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY litiásica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY centro I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ambos I-PAST_MEDICAL_HISTORY riñones. I-PAST_MEDICAL_HISTORY Según I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY informaba I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado, I-PAST_MEDICAL_HISTORY pielolitotomía I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY practica I-PAST_MEDICAL_HISTORY pielolitotomía I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY atendida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY (año I-PAST_MEDICAL_HISTORY 2005) I-PAST_MEDICAL_HISTORY nueva I-PAST_MEDICAL_HISTORY nefrolitotomía I-PAST_MEDICAL_HISTORY sobre I-PAST_MEDICAL_HISTORY riñón I-PAST_MEDICAL_HISTORY izquierdo, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY litiasis I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY compleja. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS urinaria I-PRESENT_ILLNESS complicada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pionefrosis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS septicemia, I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS coloca I-PRESENT_ILLNESS cateter I-PRESENT_ILLNESS doble I-PRESENT_ILLNESS J I-PRESENT_ILLNESS que I-PRESENT_ILLNESS queda I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS posicionado, I-PRESENT_ILLNESS subpiélico, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS resuelve I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS séptico, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS preciso I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS nefrostomia I-PRESENT_ILLNESS percutánea I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS para I-PRESENT_ILLNESS drenaje I-PRESENT_ILLNESS renal, I-PRESENT_ILLNESS situación, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS es I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION intravenosa I-EXPLORATION que I-EXPLORATION aporta I-EXPLORATION la I-EXPLORATION enferma, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION litiasis I-EXPLORATION radiodensa I-EXPLORATION infecciosa, I-EXPLORATION pielolocalicial I-EXPLORATION múltiple I-EXPLORATION compleja, I-EXPLORATION sobre I-EXPLORATION riñón I-EXPLORATION con I-EXPLORATION hidronefrosis I-EXPLORATION grado I-EXPLORATION III-IV I-EXPLORATION por I-EXPLORATION importante I-EXPLORATION esclerosis I-EXPLORATION piélica I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION cirugías I-EXPLORATION previas I-EXPLORATION sobre I-EXPLORATION dicha I-EXPLORATION unidad I-EXPLORATION renal. I-EXPLORATION Presenta I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION relativamente I-EXPLORATION conservada. I-EXPLORATION Observamos I-EXPLORATION asimismo, I-EXPLORATION cambios I-EXPLORATION postquirúrgicos I-EXPLORATION con I-EXPLORATION moderada I-EXPLORATION atrofia I-EXPLORATION parenquimatosa I-EXPLORATION de I-EXPLORATION unidad I-EXPLORATION renal I-EXPLORATION derecha. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION reflejaba I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION urea I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT los I-TREATMENT hallazgos I-TREATMENT urográficos, I-TREATMENT dada I-TREATMENT la I-TREATMENT situación I-TREATMENT del I-TREATMENT riñón I-TREATMENT contralateral I-TREATMENT y I-TREATMENT la I-TREATMENT edad I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT se I-TREATMENT decide I-TREATMENT lumbotomía I-TREATMENT exploradora I-TREATMENT para I-TREATMENT intentar I-TREATMENT cirugía I-TREATMENT conservadora, I-TREATMENT consistente I-TREATMENT en I-TREATMENT nefrectomía I-TREATMENT polar I-TREATMENT inferior I-TREATMENT con I-TREATMENT nefrolitotomía I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT urinaria I-TREATMENT superior I-TREATMENT mediante I-TREATMENT uréterocalicostomía. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION requiere I-EVOLUTION la I-EVOLUTION trasfusión I-EVOLUTION de I-EVOLUTION dos I-EVOLUTION concentrados I-EVOLUTION de I-EVOLUTION hematíes I-EVOLUTION por I-EVOLUTION anemia I-EVOLUTION persistente. I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION mayores I-EVOLUTION complicaciones I-EVOLUTION dándose I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION séptimo I-EVOLUTION día. I-EVOLUTION La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION cambios I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION pielonefritis I-EXPLORATION crónica I-EXPLORATION postlitiásica I-EXPLORATION y I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION del I-EXPLORATION cálculo I-EXPLORATION reveló I-EXPLORATION su I-EXPLORATION composición I-EXPLORATION de I-EXPLORATION fosfato I-EXPLORATION amónico I-EXPLORATION magnésico. I-EXPLORATION I-EXPLORATION Dos B-EVOLUTION años I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION únicamente I-EVOLUTION molestias I-EVOLUTION leves I-EVOLUTION en I-EVOLUTION flanco I-EVOLUTION izquierdo. I-EVOLUTION I-EVOLUTION La B-EXPLORATION urografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION refleja I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION litiasis I-EXPLORATION con I-EXPLORATION cierto I-EXPLORATION retraso I-EXPLORATION nefrográfico I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION vía I-EXPLORATION excretora I-EXPLORATION derecha I-EXPLORATION sin I-EXPLORATION cambios I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION previos. I-EXPLORATION El I-EXPLORATION renograma I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION del I-EXPLORATION 30%, I-EXPLORATION con I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION compensador, I-EXPLORATION 70%. I-EXPLORATION Continúa B-EVOLUTION con I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad, I-EVOLUTION y I-EVOLUTION solo I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION ITU I-EVOLUTION que I-EVOLUTION ha I-EVOLUTION cedido I-EVOLUTION con I-EVOLUTION ciprofloxacino. I-EVOLUTION Presencia B-EXPLORATION de I-EXPLORATION pequeños I-EXPLORATION restos I-EXPLORATION litiásicos I-EXPLORATION bilaterales I-EXPLORATION subclínicos I-EXPLORATION según I-EXPLORATION técnicas I-EXPLORATION de I-EXPLORATION imagen. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Hospital, I-PRESENT_ILLNESS porque I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS la I-PRESENT_ILLNESS introducción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS objeto I-PRESENT_ILLNESS metálico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS área I-PRESENT_ILLNESS genital I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS contexto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prácticas I-PRESENT_ILLNESS erótico-sexuales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Clínicamente B-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION asintomática, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION genital I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION material I-EXPLORATION alguno I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vagina. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION un I-EXPLORATION objeto I-EXPLORATION metálico I-EXPLORATION que I-EXPLORATION sobresalía I-EXPLORATION del I-EXPLORATION contorno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vejiga I-EXPLORATION urinaria. I-EXPLORATION Se I-EXPLORATION practica I-EXPLORATION finalmente I-EXPLORATION ecografia, I-EXPLORATION seguida I-EXPLORATION de I-EXPLORATION TAC I-EXPLORATION abdominal, I-EXPLORATION en I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION un I-EXPLORATION objeto I-EXPLORATION metálico I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION alojado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION pelviano I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Se B-TREATMENT procede I-TREATMENT a I-TREATMENT intervenir I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT y I-TREATMENT se I-TREATMENT realiza I-TREATMENT cistoscopia I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT objetivándose I-TREATMENT cilindro I-TREATMENT metálico I-TREATMENT que I-TREATMENT sobresale I-TREATMENT del I-TREATMENT interior I-TREATMENT del I-TREATMENT orificio I-TREATMENT ureteral I-TREATMENT derecho. I-TREATMENT I-TREATMENT Ante I-TREATMENT la I-TREATMENT imposibilidad I-TREATMENT de I-TREATMENT extraer I-TREATMENT dicho I-TREATMENT objeto I-TREATMENT por I-TREATMENT vía I-TREATMENT endoscópica, I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT infraumbilical, I-TREATMENT con I-TREATMENT apertura I-TREATMENT de I-TREATMENT vejiga I-TREATMENT y I-TREATMENT extracción I-TREATMENT de I-TREATMENT cilindro I-TREATMENT metálico I-TREATMENT de I-TREATMENT 8 I-TREATMENT cm. I-TREATMENT de I-TREATMENT longitud, I-TREATMENT que I-TREATMENT correspondía I-TREATMENT a I-TREATMENT perfilador I-TREATMENT de I-TREATMENT ojos. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS femenina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY anexo I-PAST_MEDICAL_HISTORY histerectomía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY miomatosis I-PAST_MEDICAL_HISTORY uterina, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY gastritis I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY severo I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Debuta B-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS macrohematuria I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS efectúa I-PRESENT_ILLNESS diagnostico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS exofítica I-PRESENT_ILLNESS vesical. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS su I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS sometida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS resección I-PRESENT_ILLNESS endoscópica I-PRESENT_ILLNESS (RTUV). I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS corto I-PRESENT_ILLNESS plazo I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS tumoral I-PRESENT_ILLNESS requiriendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS RTUV. I-PRESENT_ILLNESS Tras I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS resección I-PRESENT_ILLNESS el I-PRESENT_ILLNESS material I-PRESENT_ILLNESS remitido I-PRESENT_ILLNESS se I-PRESENT_ILLNESS informa I-PRESENT_ILLNESS como I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS trabecular I-PRESENT_ILLNESS anaplásico. I-PRESENT_ILLNESS Concurre B-DERIVED_FROM/TO para I-DERIVED_FROM/TO una I-DERIVED_FROM/TO segunda I-DERIVED_FROM/TO opinión I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO ser I-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO oncólogo I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO urólogo I-DERIVED_FROM/TO tratante. I-DERIVED_FROM/TO En B-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION sólida I-EXPLORATION con I-EXPLORATION vascularización I-EXPLORATION central I-EXPLORATION y I-EXPLORATION periférica I-EXPLORATION de I-EXPLORATION 35 I-EXPLORATION x I-EXPLORATION 28 I-EXPLORATION x I-EXPLORATION 33 I-EXPLORATION mm I-EXPLORATION con I-EXPLORATION otra I-EXPLORATION imagen I-EXPLORATION polipoidea I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION postero I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION x I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 9 I-EXPLORATION mm. I-EXPLORATION En I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION severa I-EXPLORATION atrofia I-EXPLORATION renal I-EXPLORATION derecha. I-EXPLORATION Ausencia I-EXPLORATION de I-EXPLORATION adenomegalias. I-EXPLORATION Vejiga I-EXPLORATION con I-EXPLORATION pólipo I-EXPLORATION de I-EXPLORATION 38 I-EXPLORATION x I-EXPLORATION 35 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION sólido I-EXPLORATION y I-EXPLORATION con I-EXPLORATION superficie I-EXPLORATION irregular. I-EXPLORATION Otra I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION posterolateral I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION mm. I-EXPLORATION El I-EXPLORATION centellograma I-EXPLORATION óseo I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT indica I-TREATMENT cistectomía I-TREATMENT radical I-TREATMENT con I-TREATMENT linfadenectomía I-TREATMENT pelviana I-TREATMENT bilateral I-TREATMENT laparoscópica I-TREATMENT y I-TREATMENT ureterostomía I-TREATMENT cutánea I-TREATMENT izquierda. I-TREATMENT La I-TREATMENT técnica I-TREATMENT empleada I-TREATMENT fue I-TREATMENT la I-TREATMENT desarrollada I-TREATMENT por I-TREATMENT Castillo I-TREATMENT et I-TREATMENT al. I-TREATMENT (4). I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS prepucial I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS peneano I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS niega I-PRESENT_ILLNESS relaciones I-PRESENT_ILLNESS sexuales I-PRESENT_ILLNESS de I-PRESENT_ILLNESS riesgo, I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS miccional, I-PRESENT_ILLNESS o I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pene I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cordón I-PRESENT_ILLNESS indurado I-PRESENT_ILLNESS y I-PRESENT_ILLNESS palpable I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dicha I-PRESENT_ILLNESS región, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acentúa I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS erección. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cigarrillos/ I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY ninguna I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY base I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY habitual; I-PAST_MEDICAL_HISTORY en B-FAMILY_HISTORY su I-FAMILY_HISTORY historia I-FAMILY_HISTORY familiar I-FAMILY_HISTORY tampoco I-FAMILY_HISTORY se I-FAMILY_HISTORY encontraron I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY I-FAMILY_HISTORY Durante B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION inflamación I-EXPLORATION prepucial I-EXPLORATION intensa I-EXPLORATION con I-EXPLORATION erosiones I-EXPLORATION blanquecinas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION candidiasis. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION peneano I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION un I-EXPLORATION cordón I-EXPLORATION duro I-EXPLORATION y I-EXPLORATION doloroso I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION base I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION surco I-EXPLORATION balanoprepucial, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION inflamación I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION adyacente. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Mondor I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION doppler I-EXPLORATION peneana I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT instaurado I-TREATMENT fue I-TREATMENT Fluconazol I-TREATMENT tópico I-TREATMENT 1 I-TREATMENT aplicación I-TREATMENT /12h, I-TREATMENT Amoxicilina- I-TREATMENT Clavulanico I-TREATMENT 875 I-TREATMENT mg/8h I-TREATMENT e I-TREATMENT Ibuprofeno I-TREATMENT 600 I-TREATMENT mg/8h I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días, I-TREATMENT asociado I-TREATMENT a I-TREATMENT reposo I-TREATMENT de I-TREATMENT la I-TREATMENT actividad I-TREATMENT sexual I-TREATMENT hasta I-TREATMENT la I-TREATMENT resolución I-TREATMENT del I-TREATMENT cuadro. I-TREATMENT I-TREATMENT Durante B-EVOLUTION la I-EVOLUTION primera I-EVOLUTION semana, I-EVOLUTION se I-EVOLUTION objetiva I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION progresiva I-EVOLUTION del I-EVOLUTION cordón I-EVOLUTION dorsal I-EVOLUTION en I-EVOLUTION sentido I-EVOLUTION distal I-EVOLUTION y I-EVOLUTION del I-EVOLUTION dolor. I-EVOLUTION Las I-EVOLUTION lesiones I-EVOLUTION relacionadas I-EVOLUTION con I-EVOLUTION la I-EVOLUTION candidiasis I-EVOLUTION han I-EVOLUTION desaparecido. I-EVOLUTION En B-EXPLORATION este I-EXPLORATION momento I-EXPLORATION se I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION una I-EXPLORATION fimosis I-EXPLORATION puntiforme I-EXPLORATION que I-EXPLORATION impide I-EXPLORATION la I-EXPLORATION retracción I-EXPLORATION prepucial, I-EXPLORATION y I-EXPLORATION por I-EXPLORATION la I-EXPLORATION que I-EXPLORATION precisará I-EXPLORATION ser I-EXPLORATION circuncidado. I-EXPLORATION A I-EXPLORATION las I-EXPLORATION 6 I-EXPLORATION semanas I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION ecografía I-EXPLORATION doppler I-EXPLORATION peneana I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION la I-EXPLORATION repermeabilización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION dorsal I-EXPLORATION superficial I-EXPLORATION del I-EXPLORATION pene I-EXPLORATION en I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION trombo I-EXPLORATION venoso, I-EXPLORATION dando I-EXPLORATION por I-EXPLORATION resuelto I-EXPLORATION el I-EXPLORATION cuadro. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS revisaron I-PRESENT_ILLNESS las I-PRESENT_ILLNESS historias I-PRESENT_ILLNESS clínicas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS todos I-PRESENT_ILLNESS los I-PRESENT_ILLNESS pacientes I-PRESENT_ILLNESS intervenidos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS les I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS RTU I-PRESENT_ILLNESS vesical I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 1990-2009 I-PRESENT_ILLNESS descartando I-PRESENT_ILLNESS aquellos I-PRESENT_ILLNESS tumores I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cumplían I-PRESENT_ILLNESS los I-PRESENT_ILLNESS criterios I-PRESENT_ILLNESS histológicos, I-PRESENT_ILLNESS excluyendo I-PRESENT_ILLNESS los I-PRESENT_ILLNESS adenocarcinomas I-PRESENT_ILLNESS metastáticos I-PRESENT_ILLNESS o I-PRESENT_ILLNESS por I-PRESENT_ILLNESS infiltración I-PRESENT_ILLNESS local I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vejiga. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Encontramos B-EXPLORATION nueve I-EXPLORATION casos I-EXPLORATION con I-EXPLORATION carcinoma I-EXPLORATION vesical I-EXPLORATION de I-EXPLORATION células I-EXPLORATION en I-EXPLORATION anillo I-EXPLORATION de I-EXPLORATION sello I-EXPLORATION diagnosticados I-EXPLORATION y I-EXPLORATION tratados I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION servicio I-EXPLORATION entre I-EXPLORATION Enero I-EXPLORATION de I-EXPLORATION 1992 I-EXPLORATION y I-EXPLORATION Enero I-EXPLORATION de I-EXPLORATION 2009; I-EXPLORATION ocho I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION eran I-EXPLORATION varones I-EXPLORATION y I-EXPLORATION sólo I-EXPLORATION había I-EXPLORATION una I-EXPLORATION mujer, I-EXPLORATION con I-EXPLORATION de I-EXPLORATION edades I-EXPLORATION comprendidas I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION 39 I-EXPLORATION y I-EXPLORATION los I-EXPLORATION 82 I-EXPLORATION años, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 69 I-EXPLORATION años. I-EXPLORATION I-EXPLORATION El I-EXPLORATION debut I-EXPLORATION clínico I-EXPLORATION fue I-EXPLORATION la I-EXPLORATION hematuria I-EXPLORATION en I-EXPLORATION seis I-EXPLORATION de I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION y I-EXPLORATION clínica I-EXPLORATION irritativa I-EXPLORATION con I-EXPLORATION polaquiuria I-EXPLORATION y I-EXPLORATION disuria I-EXPLORATION importante I-EXPLORATION en I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION ellos. I-EXPLORATION Uno I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION pacientes I-EXPLORATION presentaba I-EXPLORATION importante I-EXPLORATION síndrome I-EXPLORATION general I-EXPLORATION con I-EXPLORATION caquexia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION diagnóstico. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION citológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION orina I-EXPLORATION mostró I-EXPLORATION células I-EXPLORATION malignas I-EXPLORATION en I-EXPLORATION tres I-EXPLORATION pacientes, I-EXPLORATION atipias I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION y I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION restantes. I-EXPLORATION I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION mostró I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION vesical I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION casos, I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION del I-EXPLORATION pericistio I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION múltiples I-EXPLORATION retroperitoneales I-EXPLORATION en I-EXPLORATION cuatro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION y I-EXPLORATION uropatía I-EXPLORATION obstructiva I-EXPLORATION uni I-EXPLORATION o I-EXPLORATION bilateral I-EXPLORATION en I-EXPLORATION cuatro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION casos. I-EXPLORATION I-EXPLORATION Dos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION presentaron I-EXPLORATION alteración I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION gastroduodenal I-EXPLORATION siendo I-EXPLORATION completado I-EXPLORATION con I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION y I-EXPLORATION baja I-EXPLORATION con I-EXPLORATION el I-EXPLORATION hallazgo I-EXPLORATION de I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION antral I-EXPLORATION con I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION metaplasia I-EXPLORATION intestinal I-EXPLORATION en I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION sujetos I-EXPLORATION y I-EXPLORATION pólipo I-EXPLORATION adenomatoso I-EXPLORATION de I-EXPLORATION sigma I-EXPLORATION en I-EXPLORATION otro. I-EXPLORATION I-EXPLORATION En I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION estudios I-EXPLORATION histológicos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION masas I-EXPLORATION resecadas I-EXPLORATION con I-EXPLORATION inclusión I-EXPLORATION en I-EXPLORATION parafina, I-EXPLORATION colorante I-EXPLORATION Hematoxilina/Eosina I-EXPLORATION y I-EXPLORATION tinción I-EXPLORATION PAS. I-EXPLORATION En I-EXPLORATION algunos I-EXPLORATION casos I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION estudios I-EXPLORATION inmunohistoquimicos I-EXPLORATION (PSA, I-EXPLORATION E-caderina, I-EXPLORATION citoqueratina I-EXPLORATION 20, I-EXPLORATION S100) I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION origen I-EXPLORATION extravesical I-EXPLORATION (1). I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION encontramos I-EXPLORATION cuatro I-EXPLORATION casos I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION vesical I-EXPLORATION de I-EXPLORATION células I-EXPLORATION en I-EXPLORATION anillo I-EXPLORATION de I-EXPLORATION sello I-EXPLORATION primario I-EXPLORATION puros I-EXPLORATION y I-EXPLORATION cinco I-EXPLORATION mixtos I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION células I-EXPLORATION en I-EXPLORATION anillo I-EXPLORATION de I-EXPLORATION sello I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION de I-EXPLORATION carcinomas I-EXPLORATION de I-EXPLORATION células I-EXPLORATION transicionales. I-EXPLORATION I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION tumores I-EXPLORATION mostró I-EXPLORATION células I-EXPLORATION de I-EXPLORATION citoplasma I-EXPLORATION amplio I-EXPLORATION eosinófilo I-EXPLORATION con I-EXPLORATION vacuola I-EXPLORATION central I-EXPLORATION PAS I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION desplazamiento I-EXPLORATION del I-EXPLORATION núcleo I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION periferia I-EXPLORATION (morfología I-EXPLORATION típica I-EXPLORATION en I-EXPLORATION anillo I-EXPLORATION de I-EXPLORATION sello). I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT definitivo I-TREATMENT consistió I-TREATMENT en I-TREATMENT cistectomía I-TREATMENT radical I-TREATMENT con I-TREATMENT derivación I-TREATMENT tipo I-TREATMENT Bricker I-TREATMENT en I-TREATMENT tres I-TREATMENT de I-TREATMENT los I-TREATMENT pacientes, I-TREATMENT cistectomía I-TREATMENT con I-TREATMENT derivación I-TREATMENT Mainz I-TREATMENT II I-TREATMENT en I-TREATMENT otro I-TREATMENT de I-TREATMENT ellos I-TREATMENT y I-TREATMENT paliativo I-TREATMENT en I-TREATMENT los I-TREATMENT cuatro I-TREATMENT restantes I-TREATMENT con I-TREATMENT RTU I-TREATMENT en I-TREATMENT tres I-TREATMENT casos I-TREATMENT y I-TREATMENT NPC I-TREATMENT paliativas I-TREATMENT en I-TREATMENT otro. I-TREATMENT I-TREATMENT Recibieron I-TREATMENT quimioterapia I-TREATMENT adyuvante I-TREATMENT tres I-TREATMENT pacientes I-TREATMENT consistentes I-TREATMENT en I-TREATMENT MVAC. I-TREATMENT I-TREATMENT La B-EVOLUTION supervivencia I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 570, I-EVOLUTION 480, I-EVOLUTION 250 I-EVOLUTION y I-EVOLUTION 8 I-EVOLUTION días I-EVOLUTION para I-EVOLUTION los I-EVOLUTION tumores I-EVOLUTION puros I-EVOLUTION y I-EVOLUTION de I-EVOLUTION 512, I-EVOLUTION 410, I-EVOLUTION 280, I-EVOLUTION 270 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION mayor I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION años I-EVOLUTION en I-EVOLUTION un I-EVOLUTION caso, I-EVOLUTION para I-EVOLUTION los I-EVOLUTION tumores I-EVOLUTION mixtos. I-EVOLUTION Todos I-EVOLUTION los I-EVOLUTION pacientes, I-EVOLUTION excepto I-EVOLUTION dos I-EVOLUTION habían I-EVOLUTION fallecido I-EVOLUTION en I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION realizarse I-EVOLUTION este I-EVOLUTION estudio. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION literatura I-EVOLUTION revisada I-EVOLUTION la I-EVOLUTION supervivencia I-EVOLUTION global I-EVOLUTION no I-EVOLUTION supera I-EVOLUTION el I-EVOLUTION 11% I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION (2,3). I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS cervical. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION bocio I-EXPLORATION difuso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION y I-EXPLORATION sus I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION revelaron I-EXPLORATION hormonas I-EXPLORATION tiroideas I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION anti-tiroglobulina I-EXPLORATION (AAT) I-EXPLORATION positivos. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION tiroidea I-EXPLORATION reveló I-EXPLORATION tres I-EXPLORATION nódulos I-EXPLORATION tiroideos, I-EXPLORATION el I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION mm I-EXPLORATION con I-EXPLORATION microcalcificaciones I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION punción-biopsia I-EXPLORATION bajo I-EXPLORATION ecografía, I-EXPLORATION demostrándose I-EXPLORATION cáncer I-EXPLORATION papilar I-EXPLORATION del I-EXPLORATION tiroides. I-EXPLORATION Se B-TREATMENT sometió I-TREATMENT a I-TREATMENT tiroidectomía I-TREATMENT total, I-TREATMENT resultando I-TREATMENT un I-TREATMENT foco I-TREATMENT de I-TREATMENT cáncer I-TREATMENT papilar I-TREATMENT de I-TREATMENT 6x5x5 I-TREATMENT mm I-TREATMENT y I-TREATMENT metástasis I-TREATMENT paratraqueales I-TREATMENT bilaterales. I-TREATMENT Recibió I-TREATMENT 200 I-TREATMENT mCi I-TREATMENT de I-TREATMENT radioyodo I-TREATMENT con I-TREATMENT rastreo I-TREATMENT sistémico I-TREATMENT post-dosis I-TREATMENT terapéutica I-TREATMENT negativo. I-TREATMENT Se I-TREATMENT mantuvo I-TREATMENT con I-TREATMENT dosis I-TREATMENT supresiva I-TREATMENT de I-TREATMENT levotiroxina I-TREATMENT (Eutirox®). I-TREATMENT I-TREATMENT Al B-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION rastreo I-EVOLUTION sistémico I-EVOLUTION con I-EVOLUTION dosis I-EVOLUTION trazadora I-EVOLUTION de I-EVOLUTION 10 I-EVOLUTION mCi, I-EVOLUTION resultando I-EVOLUTION negativo, I-EVOLUTION la I-EVOLUTION tiroglobulina I-EVOLUTION no I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION utilidad I-EVOLUTION dado I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION anticuerpos I-EVOLUTION AAT: I-EVOLUTION 164 I-EVOLUTION ng/mL. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION por I-EVOLUTION ecografía I-EVOLUTION cervical, I-EVOLUTION se I-EVOLUTION detectó I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION un I-EVOLUTION nódulo I-EVOLUTION de I-EVOLUTION 9, I-EVOLUTION 6 I-EVOLUTION mm, I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION no I-EVOLUTION fue I-EVOLUTION técnicamente I-EVOLUTION posible I-EVOLUTION de I-EVOLUTION puncionar, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION asoció I-EVOLUTION a I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION títulos I-EVOLUTION de I-EVOLUTION AAT I-EVOLUTION 174 I-EVOLUTION ng/mL. I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT dar I-TREATMENT una I-TREATMENT nueva I-TREATMENT dosis I-TREATMENT terapéutica I-TREATMENT de I-TREATMENT 200 I-TREATMENT mCi I-TREATMENT con I-TREATMENT rastreo I-TREATMENT que I-TREATMENT mostró I-TREATMENT captación I-TREATMENT a I-TREATMENT nivel I-TREATMENT cervical. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION al I-EXPLORATION año I-EXPLORATION post I-EXPLORATION segunda I-EXPLORATION dosis I-EXPLORATION de I-EXPLORATION radioyodo, I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION supraesternal I-EXPLORATION central I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION ganglios I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION cada I-EXPLORATION uno, I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION cervical I-EXPLORATION izquierda, I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION neoplasia, I-EXPLORATION contralaterales I-EXPLORATION a I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION primaria, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION un I-EXPLORATION ascenso I-EXPLORATION de I-EXPLORATION los I-EXPLORATION AAT I-EXPLORATION a I-EXPLORATION 217 I-EXPLORATION ng/mL. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT realizar I-TREATMENT una I-TREATMENT exploración I-TREATMENT quirúrgica, I-TREATMENT con I-TREATMENT una I-TREATMENT disección I-TREATMENT selectiva I-TREATMENT de I-TREATMENT cuello I-TREATMENT bilateral I-TREATMENT de I-TREATMENT los I-TREATMENT niveles I-TREATMENT II, I-TREATMENT III, I-TREATMENT IV I-TREATMENT y I-TREATMENT Vb I-TREATMENT y I-TREATMENT una I-TREATMENT disección I-TREATMENT del I-TREATMENT nivel I-TREATMENT VI I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT pretraqueal. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION compromiso I-EXPLORATION neoplásico I-EXPLORATION ganglionar I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION IV I-EXPLORATION y I-EXPLORATION Vb I-EXPLORATION derechos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION IIb, I-EXPLORATION III, I-EXPLORATION IV, I-EXPLORATION Vb I-EXPLORATION y I-EXPLORATION VI I-EXPLORATION izquierdo. I-EXPLORATION Recibió B-TREATMENT 300 I-TREATMENT mCi I-TREATMENT de I-TREATMENT radioyodo I-TREATMENT con I-TREATMENT rastreo I-TREATMENT post-dosis I-TREATMENT negativo I-TREATMENT y I-TREATMENT los I-TREATMENT AAT I-TREATMENT se I-TREATMENT hicieron I-TREATMENT negativos I-TREATMENT con I-TREATMENT una I-TREATMENT tiroglobulina I-TREATMENT (TG) I-TREATMENT menor I-TREATMENT de I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT ng/mL, I-TREATMENT con I-TREATMENT 85% I-TREATMENT de I-TREATMENT recuperación. I-TREATMENT I-TREATMENT A B-FAMILY_HISTORY solicitud I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY familia, I-FAMILY_HISTORY se I-FAMILY_HISTORY realizó I-FAMILY_HISTORY estudio I-FAMILY_HISTORY tiroideo I-FAMILY_HISTORY a I-FAMILY_HISTORY padres I-FAMILY_HISTORY y I-FAMILY_HISTORY dos I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY quienes I-FAMILY_HISTORY no I-FAMILY_HISTORY presentaban I-FAMILY_HISTORY evidencia I-FAMILY_HISTORY de I-FAMILY_HISTORY enfermedad. I-FAMILY_HISTORY La I-FAMILY_HISTORY madre I-FAMILY_HISTORY presentó I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY ecografía I-FAMILY_HISTORY tiroidea I-FAMILY_HISTORY un I-FAMILY_HISTORY nódulo I-FAMILY_HISTORY de I-FAMILY_HISTORY 7 I-FAMILY_HISTORY mm, I-FAMILY_HISTORY el I-FAMILY_HISTORY cual I-FAMILY_HISTORY resultó I-FAMILY_HISTORY ser I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY papilar, I-FAMILY_HISTORY sin I-FAMILY_HISTORY compromiso I-FAMILY_HISTORY capsular I-FAMILY_HISTORY ni I-FAMILY_HISTORY ganglionar. I-FAMILY_HISTORY El I-FAMILY_HISTORY hermano I-FAMILY_HISTORY presentó I-FAMILY_HISTORY 2 I-FAMILY_HISTORY nódulos I-FAMILY_HISTORY de I-FAMILY_HISTORY 8 I-FAMILY_HISTORY y I-FAMILY_HISTORY 5 I-FAMILY_HISTORY mm I-FAMILY_HISTORY cuyo I-FAMILY_HISTORY estudio I-FAMILY_HISTORY con I-FAMILY_HISTORY biopsia I-FAMILY_HISTORY fue I-FAMILY_HISTORY negativo I-FAMILY_HISTORY para I-FAMILY_HISTORY células I-FAMILY_HISTORY neoplásicas I-FAMILY_HISTORY y I-FAMILY_HISTORY la I-FAMILY_HISTORY hermana I-FAMILY_HISTORY presentó I-FAMILY_HISTORY signos I-FAMILY_HISTORY ecográficos I-FAMILY_HISTORY de I-FAMILY_HISTORY tiroiditis I-FAMILY_HISTORY crónica I-FAMILY_HISTORY con I-FAMILY_HISTORY AAT I-FAMILY_HISTORY positivos. I-FAMILY_HISTORY I-FAMILY_HISTORY Paciente B-PRESENT_ILLNESS diestro, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS iniciar I-PRESENT_ILLNESS disartria I-PRESENT_ILLNESS severa, I-PRESENT_ILLNESS desviación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mirada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS hemiplejia I-PRESENT_ILLNESS facio-braquio-crural, I-PRESENT_ILLNESS hemianestesia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hemianopsia I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS El B-EXPLORATION resto I-EXPLORATION de I-EXPLORATION su I-EXPLORATION examen I-EXPLORATION no I-EXPLORATION evidenciaba I-EXPLORATION otras I-EXPLORATION alteraciones. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION precoces I-EXPLORATION de I-EXPLORATION un I-EXPLORATION IMACM I-EXPLORATION derecho. I-EXPLORATION Se B-TREATMENT discutió I-TREATMENT con I-TREATMENT la I-TREATMENT familia I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT una I-TREATMENT progresión I-TREATMENT a I-TREATMENT un I-TREATMENT IMACM I-TREATMENT y I-TREATMENT la I-TREATMENT eventual I-TREATMENT necesidad I-TREATMENT de I-TREATMENT una I-TREATMENT HD. I-TREATMENT La I-TREATMENT familia I-TREATMENT comprendió I-TREATMENT y I-TREATMENT aceptó I-TREATMENT la I-TREATMENT intervención. I-TREATMENT I-TREATMENT Su B-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION A I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION h, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION en I-EXPLORATION sopor I-EXPLORATION superficial I-EXPLORATION sin I-EXPLORATION midriasis I-EXPLORATION ni I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION Babinski I-EXPLORATION a I-EXPLORATION derecha. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TC. I-EXPLORATION Debido B-TREATMENT a I-TREATMENT la I-TREATMENT progresión I-TREATMENT del I-TREATMENT cuadro I-TREATMENT clínico I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT TC, I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT la I-TREATMENT HD, I-TREATMENT la I-TREATMENT cual I-TREATMENT se I-TREATMENT efectuó I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION recuperó I-EVOLUTION conciencia I-EVOLUTION antes I-EVOLUTION de I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION extubado I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h. I-EVOLUTION No I-EVOLUTION presentó I-EVOLUTION complicaciones. I-EVOLUTION Recuperó I-EVOLUTION la I-EVOLUTION movilidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION izquierda, I-EVOLUTION logró I-EVOLUTION deglución I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 22 I-EVOLUTION días. I-EVOLUTION Desde B-TREATMENT el I-TREATMENT séptimo I-TREATMENT día I-TREATMENT se I-TREATMENT inició I-TREATMENT aspirina I-TREATMENT (325 I-TREATMENT mg/día). I-TREATMENT Se I-TREATMENT mantuvo I-TREATMENT en I-TREATMENT neurorrehabilitación I-TREATMENT en I-TREATMENT su I-TREATMENT domicilio, I-TREATMENT logrando B-EVOLUTION marcha I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Al B-TREATMENT cuarto I-TREATMENT mes I-TREATMENT se I-TREATMENT instaló I-TREATMENT la I-TREATMENT plaqueta I-TREATMENT ósea, I-TREATMENT siendo B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION quinto I-EVOLUTION día. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION crisis I-EVOLUTION convulsiva, I-EVOLUTION se B-TREATMENT inició I-TREATMENT fenitoína I-TREATMENT (300 I-TREATMENT mg/día). I-TREATMENT A B-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION realiza I-EVOLUTION una I-EVOLUTION vida I-EVOLUTION independiente I-EVOLUTION pero I-EVOLUTION limitada I-EVOLUTION a I-EVOLUTION su I-EVOLUTION casa: I-EVOLUTION camina I-EVOLUTION ayudado I-EVOLUTION de I-EVOLUTION un I-EVOLUTION bastón, I-EVOLUTION come I-EVOLUTION solo, I-EVOLUTION se I-EVOLUTION viste I-EVOLUTION y I-EVOLUTION va I-EVOLUTION al I-EVOLUTION baño I-EVOLUTION ayudado I-EVOLUTION por I-EVOLUTION su I-EVOLUTION señora I-EVOLUTION (escala I-EVOLUTION modificada I-EVOLUTION de I-EVOLUTION Rankin= I-EVOLUTION 3). I-EVOLUTION I-EVOLUTION Al I-EVOLUTION preguntarle I-EVOLUTION a I-EVOLUTION ambos I-EVOLUTION pacientes I-EVOLUTION y I-EVOLUTION sus I-EVOLUTION familias, I-EVOLUTION individualmente, I-EVOLUTION si I-EVOLUTION volverían I-EVOLUTION a I-EVOLUTION realizar I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION después I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION sufrido I-EVOLUTION la I-EVOLUTION experiencia, I-EVOLUTION respondieron I-EVOLUTION afirmativamente. I-EVOLUTION I-EVOLUTION Hombre, B-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY cardiovasculares. I-PAST_MEDICAL_HISTORY Mientras B-PRESENT_ILLNESS jugaba I-PRESENT_ILLNESS fútbol, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS palpitaciones I-PRESENT_ILLNESS rápidas, I-PRESENT_ILLNESS regulares, I-PRESENT_ILLNESS asociadas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS retroesternal I-PRESENT_ILLNESS opresivo, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedieron I-PRESENT_ILLNESS espontáneamente I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS min. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS ciudad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS hospitalizado I-PRESENT_ILLNESS para I-PRESENT_ILLNESS monitorización. I-PRESENT_ILLNESS Su B-EXPLORATION ECG I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION mostró I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION preexcitación I-EXPLORATION ventricular, I-EXPLORATION con I-EXPLORATION intervalo I-EXPLORATION PR I-EXPLORATION corto, I-EXPLORATION onda I-EXPLORATION delta I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION derivaciones I-EXPLORATION precordiales I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION inferior, I-EXPLORATION con I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION repolarización I-EXPLORATION ventricular, I-EXPLORATION caracterizadas I-EXPLORATION por I-EXPLORATION supradesnivel I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION V2 I-EXPLORATION y I-EXPLORATION V3. I-EXPLORATION Se I-EXPLORATION controlaron I-EXPLORATION enzimas I-EXPLORATION cardíacas I-EXPLORATION seriadas. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION éstas, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION coronariografía I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Fue B-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO para I-DERIVED_FROM/TO EEF I-DERIVED_FROM/TO que I-DERIVED_FROM/TO mostró I-DERIVED_FROM/TO HPE I-DERIVED_FROM/TO lateral I-DERIVED_FROM/TO izquierdo, I-DERIVED_FROM/TO el I-DERIVED_FROM/TO cual I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO exitosamente I-DERIVED_FROM/TO fulgurado. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Mujer, B-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tetralogía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Fallot, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY correctora I-PAST_MEDICAL_HISTORY definitiva I-PAST_MEDICAL_HISTORY consistente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cierre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY comunicación I-PAST_MEDICAL_HISTORY interventricular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ampliación I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY TSVD I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY anillo I-PAST_MEDICAL_HISTORY valvular I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY parche I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pericardio, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY TVS I-PAST_MEDICAL_HISTORY recurrentes, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY pesar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY amiodarona, I-PAST_MEDICAL_HISTORY requiriendo I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY hospitalizaciones I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antiarrítmicos I-PAST_MEDICAL_HISTORY intravenosos I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY cardioversión I-PAST_MEDICAL_HISTORY eléctrica. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY ecocardiográfico I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY moderado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY función I-PAST_MEDICAL_HISTORY sistólica I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ventrículo I-PAST_MEDICAL_HISTORY derecho, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY libre I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dilatación I-PAST_MEDICAL_HISTORY progresiva I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY TSVD, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY llegó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY constituir I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY verdadero I-PAST_MEDICAL_HISTORY aneurisma, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY sometida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nueva I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY implantó I-PAST_MEDICAL_HISTORY homoinjerto I-PAST_MEDICAL_HISTORY valvulado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY arteria I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY resecó I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY aneurisma I-PAST_MEDICAL_HISTORY ventricular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY esta I-PAST_MEDICAL_HISTORY última I-PAST_MEDICAL_HISTORY intervención I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY mantuvo I-PAST_MEDICAL_HISTORY asintomática, I-PAST_MEDICAL_HISTORY libre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY arritmias, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY capacidad I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY I. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY mantuvo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY amiodarona I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY suspendió I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 23 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY embarazo. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS palpitaciones I-PRESENT_ILLNESS rápidas, I-PRESENT_ILLNESS sostenidas. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS documentó I-PRESENT_ILLNESS taquicardia I-PRESENT_ILLNESS ventricular I-PRESENT_ILLNESS con I-PRESENT_ILLNESS frecuencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 150 I-PRESENT_ILLNESS latidos I-PRESENT_ILLNESS por I-PRESENT_ILLNESS minuto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS imagen I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bloqueo I-PRESENT_ILLNESS completo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS I-PRESENT_ILLNESS rama I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS y I-PRESENT_ILLNESS eje I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS hemodinámico. I-PRESENT_ILLNESS Se B-TREATMENT hospitalizó I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona I-TREATMENT intravenosa, I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT lo I-TREATMENT cual I-TREATMENT permaneció I-TREATMENT con I-TREATMENT taquicardia, I-TREATMENT por I-TREATMENT lo I-TREATMENT cual I-TREATMENT 24 I-TREATMENT h I-TREATMENT después I-TREATMENT de I-TREATMENT su I-TREATMENT ingreso I-TREATMENT se I-TREATMENT realizó I-TREATMENT cardioversión I-TREATMENT eléctrica. I-TREATMENT Su B-EXPLORATION electrocardiograma I-EXPLORATION en I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION mostró I-EXPLORATION conducción I-EXPLORATION aurículo-ventricular I-EXPLORATION con I-EXPLORATION PR I-EXPLORATION de I-EXPLORATION 200 I-EXPLORATION ms I-EXPLORATION y I-EXPLORATION complejos I-EXPLORATION QRS I-EXPLORATION ancho I-EXPLORATION con I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION completo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION 240 I-EXPLORATION ms I-EXPLORATION de I-EXPLORATION duración. I-EXPLORATION Estando B-TREATMENT hospitalizada I-TREATMENT presentó I-TREATMENT recurrencia I-TREATMENT de I-TREATMENT TVS, I-TREATMENT apareciendo I-TREATMENT una I-TREATMENT segunda I-TREATMENT morfología, I-TREATMENT por I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT decidió I-TREATMENT intentar I-TREATMENT tratamiento I-TREATMENT mediante I-TREATMENT fulguración I-TREATMENT con I-TREATMENT radiofrecuencia. I-TREATMENT Bajo B-EXPLORATION sedación I-EXPLORATION con I-EXPLORATION midazolam I-EXPLORATION y I-EXPLORATION fentanyl, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION electrofisiológico. I-EXPLORATION Por I-EXPLORATION vía I-EXPLORATION venosa I-EXPLORATION femoral I-EXPLORATION derecha I-EXPLORATION se I-EXPLORATION avanzaron I-EXPLORATION tres I-EXPLORATION catéteres I-EXPLORATION cuadripolares I-EXPLORATION (Daig®, I-EXPLORATION St. I-EXPLORATION Jude I-EXPLORATION Medical I-EXPLORATION Inc) I-EXPLORATION que I-EXPLORATION se I-EXPLORATION ubicaron I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION alta I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION His I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ápex I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION derecho, I-EXPLORATION para I-EXPLORATION registrar I-EXPLORATION potenciales I-EXPLORATION endocavitarios I-EXPLORATION y I-EXPLORATION realizar I-EXPLORATION estimulación. I-EXPLORATION Con I-EXPLORATION estimulación I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION ápex I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION ciclo I-EXPLORATION basal I-EXPLORATION de I-EXPLORATION 550 I-EXPLORATION ms I-EXPLORATION e I-EXPLORATION introduciendo I-EXPLORATION dos I-EXPLORATION extraestímulos I-EXPLORATION se I-EXPLORATION indujo I-EXPLORATION fácilmente I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION morfologías I-EXPLORATION de I-EXPLORATION taquicardia. I-EXPLORATION Mediante I-EXPLORATION mapeo I-EXPLORATION durante I-EXPLORATION estimulación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION TSVD, I-EXPLORATION con I-EXPLORATION catéter I-EXPLORATION de I-EXPLORATION fulguración I-EXPLORATION EPT I-EXPLORATION curva I-EXPLORATION estándar I-EXPLORATION y I-EXPLORATION punta I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION mm I-EXPLORATION (Boston I-EXPLORATION Scientific® I-EXPLORATION Corporation) I-EXPLORATION se I-EXPLORATION reprodujo I-EXPLORATION la I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION taquicardias, I-EXPLORATION con I-EXPLORATION concordancia I-EXPLORATION en I-EXPLORATION las I-EXPLORATION 12 I-EXPLORATION derivaciones I-EXPLORATION del I-EXPLORATION electrocardiograma. I-EXPLORATION Además B-TREATMENT se I-TREATMENT aplicó I-TREATMENT radiofrecuencia I-TREATMENT en I-TREATMENT la I-TREATMENT región I-TREATMENT del I-TREATMENT infundíbulo, I-TREATMENT identificando I-TREATMENT zonas I-TREATMENT de I-TREATMENT electrogramas I-TREATMENT fragmentados I-TREATMENT y I-TREATMENT potenciales I-TREATMENT mediodiastólicos I-TREATMENT durante I-TREATMENT taquicardia. I-TREATMENT Se I-TREATMENT completó I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 46 I-TREATMENT pulsos I-TREATMENT de I-TREATMENT radiofrecuencia. I-TREATMENT Post-radiofrecuencia I-TREATMENT se I-TREATMENT repitió I-TREATMENT la I-TREATMENT estimulación I-TREATMENT ventricular, I-TREATMENT introduciendo I-TREATMENT hasta I-TREATMENT tres I-TREATMENT extraestímulos, I-TREATMENT sin I-TREATMENT lograr I-TREATMENT reinducir I-TREATMENT TVS I-TREATMENT aun I-TREATMENT bajo I-TREATMENT efecto I-TREATMENT de I-TREATMENT infusión I-TREATMENT de I-TREATMENT isoproterenol I-TREATMENT endovenoso. I-TREATMENT I-TREATMENT La I-TREATMENT paciente I-TREATMENT fue I-TREATMENT dada I-TREATMENT de I-TREATMENT alta I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT h I-TREATMENT con I-TREATMENT amiodarona I-TREATMENT 100 I-TREATMENT mg/día. I-TREATMENT Después B-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION suspendió I-EVOLUTION el I-EVOLUTION antiarrítmico I-EVOLUTION por I-EVOLUTION nuevo I-EVOLUTION embarazo. I-EVOLUTION A I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION su I-EVOLUTION monitorización I-EVOLUTION con I-EVOLUTION electrocardiograma I-EVOLUTION de I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION muestra I-EVOLUTION sólo I-EVOLUTION extrasistolia I-EVOLUTION ventricular I-EVOLUTION aislada I-EVOLUTION ocasional I-EVOLUTION de I-EVOLUTION morfología I-EVOLUTION diferente I-EVOLUTION a I-EVOLUTION la I-EVOLUTION de I-EVOLUTION las I-EVOLUTION taquicardias I-EVOLUTION ventriculares I-EVOLUTION tratadas. I-EVOLUTION I-EVOLUTION Historia B-PRESENT_ILLNESS actual: I-PRESENT_ILLNESS mujer, I-PRESENT_ILLNESS 84 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mantenía I-PRESENT_ILLNESS en I-PRESENT_ILLNESS buenas I-PRESENT_ILLNESS condiciones I-PRESENT_ILLNESS generales, I-PRESENT_ILLNESS autovalente I-PRESENT_ILLNESS para I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS actividades I-PRESENT_ILLNESS habituales. I-PRESENT_ILLNESS Ingresó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 31/12/04 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS través I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS decaimiento I-PRESENT_ILLNESS y I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general I-PRESENT_ILLNESS inespecífico. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS día I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS semilíquidas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS leve. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS observada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hijo I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS la I-PRESENT_ILLNESS encontró I-PRESENT_ILLNESS comprometida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS falta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS reactividad I-PRESENT_ILLNESS a I-PRESENT_ILLNESS órdenes I-PRESENT_ILLNESS verbales, I-PRESENT_ILLNESS mirada I-PRESENT_ILLNESS fija, I-PRESENT_ILLNESS midriasis I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipoventilación I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evoluciona I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS apnea, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS sometida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS reanimación I-PRESENT_ILLNESS básica, I-PRESENT_ILLNESS recuperando I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ventilación I-PRESENT_ILLNESS espontánea. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY mórbidos: I-PAST_MEDICAL_HISTORY angina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pecho I-PAST_MEDICAL_HISTORY estable I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY cerebrovascular I-PAST_MEDICAL_HISTORY cerebeloso I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY secuelas, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY Linfoma I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY recidiva I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA) I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY difícil I-PAST_MEDICAL_HISTORY manejo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY mitral I-PAST_MEDICAL_HISTORY severa, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY disnea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY medianos I-PAST_MEDICAL_HISTORY esfuerzos. I-PAST_MEDICAL_HISTORY Terapia I-PAST_MEDICAL_HISTORY habitual: I-PAST_MEDICAL_HISTORY carvedilol I-PAST_MEDICAL_HISTORY 6, I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY losartan I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY espironolactona I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY hidroclorotiazida I-PAST_MEDICAL_HISTORY 12, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY amlodipino I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg/día. I-PAST_MEDICAL_HISTORY Mantenía I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY laboratorio I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY periódica. I-PAST_MEDICAL_HISTORY De I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY exámenes I-PAST_MEDICAL_HISTORY previos, I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY basal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY mg/dl, I-PAST_MEDICAL_HISTORY clearence I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY 35-40 I-PAST_MEDICAL_HISTORY ml/min I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY electrocardiograma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ritmo I-PAST_MEDICAL_HISTORY sinusal. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Examen B-EXPLORATION físico: I-EXPLORATION soporosa, I-EXPLORATION sin I-EXPLORATION déficit I-EXPLORATION neurológico I-EXPLORATION focal, I-EXPLORATION presión I-EXPLORATION arterial: I-EXPLORATION 146/76 I-EXPLORATION mmHg, I-EXPLORATION pulso I-EXPLORATION 30 I-EXPLORATION a I-EXPLORATION 40 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION Sa02 I-EXPLORATION >95%. I-EXPLORATION Pulso I-EXPLORATION venoso I-EXPLORATION yugular I-EXPLORATION normal. I-EXPLORATION Examen I-EXPLORATION cardíaco: I-EXPLORATION ruidos I-EXPLORATION regulares, I-EXPLORATION soplo I-EXPLORATION holosistólico I-EXPLORATION intensidad I-EXPLORATION III/VI I-EXPLORATION en I-EXPLORATION foco I-EXPLORATION mitral. I-EXPLORATION Sin I-EXPLORATION signos I-EXPLORATION congestivos I-EXPLORATION pulmonares, I-EXPLORATION sin I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION extremidades. I-EXPLORATION Abdomen I-EXPLORATION depresible I-EXPLORATION e I-EXPLORATION indoloro. I-EXPLORATION I-EXPLORATION Laboratorio I-EXPLORATION al I-EXPLORATION ingreso: I-EXPLORATION electrocardiograma: I-EXPLORATION ritmo I-EXPLORATION idioventricular I-EXPLORATION 50/min, I-EXPLORATION trastorno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION conducción I-EXPLORATION intraventricular I-EXPLORATION mal I-EXPLORATION definido I-EXPLORATION con I-EXPLORATION QRS I-EXPLORATION 0, I-EXPLORATION 12 I-EXPLORATION s I-EXPLORATION y I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION aumentadas I-EXPLORATION de I-EXPLORATION voltaje. I-EXPLORATION Electrólitos I-EXPLORATION plasmáticos: I-EXPLORATION K: I-EXPLORATION 8, I-EXPLORATION 4 I-EXPLORATION mEq/l, I-EXPLORATION Cl: I-EXPLORATION 109 I-EXPLORATION mEq/l, I-EXPLORATION Na: I-EXPLORATION 132 I-EXPLORATION mEq/, I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 24, I-EXPLORATION PCO2: I-EXPLORATION 27, I-EXPLORATION HCO3 I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION mEq/, I-EXPLORATION anion I-EXPLORATION gap I-EXPLORATION 10. I-EXPLORATION BE: I-EXPLORATION -14, I-EXPLORATION 4. I-EXPLORATION Nitrógeno I-EXPLORATION ureico I-EXPLORATION 61 I-EXPLORATION mg/dl, I-EXPLORATION creatinina I-EXPLORATION 2, I-EXPLORATION 63 I-EXPLORATION mg/dl, I-EXPLORATION hematocrito I-EXPLORATION 33%, I-EXPLORATION hemoglobina I-EXPLORATION 0, I-EXPLORATION 7 I-EXPLORATION mg/dl, I-EXPLORATION glóbulos I-EXPLORATION blancos I-EXPLORATION 8.660, I-EXPLORATION glicemia I-EXPLORATION 137 I-EXPLORATION mg/dl, I-EXPLORATION troponinas I-EXPLORATION T I-EXPLORATION <0, I-EXPLORATION 01, I-EXPLORATION orina I-EXPLORATION completa I-EXPLORATION normal. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION sin I-EXPLORATION congestión I-EXPLORATION pulmonar. I-EXPLORATION Ecocardiograma: I-EXPLORATION mixomatosis I-EXPLORATION mitral I-EXPLORATION y I-EXPLORATION tricuspídea, I-EXPLORATION con I-EXPLORATION prolapso I-EXPLORATION mitral I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION y I-EXPLORATION tricuspídea I-EXPLORATION severas, I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION izquierda I-EXPLORATION concéntrica I-EXPLORATION leve I-EXPLORATION con I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION normal, I-EXPLORATION dilatación I-EXPLORATION biauricular I-EXPLORATION moderada. I-EXPLORATION I-EXPLORATION Evolución: B-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION diarrea I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION hospitalización. I-EVOLUTION No B-TREATMENT hubo I-TREATMENT respuesta I-TREATMENT a I-TREATMENT las I-TREATMENT medidas I-TREATMENT médicas I-TREATMENT habituales I-TREATMENT para I-TREATMENT controlar I-TREATMENT la I-TREATMENT hiperkalemia, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT efectuó I-TREATMENT hemodiálisis I-TREATMENT de I-TREATMENT emergencia I-TREATMENT después I-TREATMENT de I-TREATMENT su I-TREATMENT ingreso. I-TREATMENT Durante I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT recuperó I-TREATMENT ritmo I-TREATMENT sinusal I-TREATMENT 102 I-TREATMENT por I-TREATMENT min, I-TREATMENT inicialmente I-TREATMENT hipertensa I-TREATMENT sistólica I-TREATMENT hasta I-TREATMENT 208/63 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT luego I-TREATMENT con I-TREATMENT uso I-TREATMENT de I-TREATMENT propanolol I-TREATMENT mantuvo I-TREATMENT presiones I-TREATMENT normales, I-TREATMENT en B-EXPLORATION estas I-EXPLORATION circunstancias I-EXPLORATION presentó I-EXPLORATION angina I-EXPLORATION de I-EXPLORATION pecho I-EXPLORATION con I-EXPLORATION infradesnivel I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ECG I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION daño I-EXPLORATION miocárdico: I-EXPLORATION CPK I-EXPLORATION fracción I-EXPLORATION MB I-EXPLORATION hasta I-EXPLORATION 8, I-EXPLORATION 3 I-EXPLORATION mg/dl, I-EXPLORATION TT I-EXPLORATION hasta I-EXPLORATION 0, I-EXPLORATION 072 I-EXPLORATION y I-EXPLORATION mioglobina I-EXPLORATION hasta I-EXPLORATION 384 I-EXPLORATION mg/dl, I-EXPLORATION el I-EXPLORATION K I-EXPLORATION había I-EXPLORATION descendido I-EXPLORATION a I-EXPLORATION 4, I-EXPLORATION 7 I-EXPLORATION mEq/L. I-EXPLORATION Fracción I-EXPLORATION excretada I-EXPLORATION de I-EXPLORATION Na I-EXPLORATION 13%, I-EXPLORATION fracción I-EXPLORATION excretada I-EXPLORATION de I-EXPLORATION nitrógeno I-EXPLORATION ureico: I-EXPLORATION 16%. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION normalizó I-EVOLUTION antes I-EVOLUTION de I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION su I-EVOLUTION potasio I-EVOLUTION y B-EXPLORATION diuresis, I-EXPLORATION mantuvo I-EXPLORATION cifras I-EXPLORATION tensionales I-EXPLORATION normales, I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 3 I-EXPLORATION m/dl, I-EXPLORATION nitrógeno I-EXPLORATION ureico I-EXPLORATION 24 I-EXPLORATION mg/dl I-EXPLORATION y B-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY ni B-PRESENT_ILLNESS de I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS local, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mejilla I-PRESENT_ILLNESS y I-PRESENT_ILLNESS malar I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS previo I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta, I-PRESENT_ILLNESS tratada I-PRESENT_ILLNESS inicialmente I-PRESENT_ILLNESS como I-PRESENT_ILLNESS absceso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS dental. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION fijo I-EXPLORATION y I-EXPLORATION levemente I-EXPLORATION doloroso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION ocupación I-EXPLORATION del I-EXPLORATION vestíbulo I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION extensión I-EXPLORATION al I-EXPLORATION paladar I-EXPLORATION duro I-EXPLORATION y I-EXPLORATION blando I-EXPLORATION derechos. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION sólido-quística I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION netos, I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION musculares I-EXPLORATION faciales I-EXPLORATION profundos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION malar I-EXPLORATION y I-EXPLORATION que I-EXPLORATION rellenaba I-EXPLORATION seno I-EXPLORATION maxilar. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION proceso I-EXPLORATION expansivo, I-EXPLORATION sólido I-EXPLORATION quístico, I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION la I-EXPLORATION quinta I-EXPLORATION pieza I-EXPLORATION dental I-EXPLORATION superior I-EXPLORATION derecha, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho, I-EXPLORATION expandía I-EXPLORATION y I-EXPLORATION adelgazaba I-EXPLORATION sus I-EXPLORATION paredes, I-EXPLORATION especialmente I-EXPLORATION hacia I-EXPLORATION fosa I-EXPLORATION maxilar I-EXPLORATION y I-EXPLORATION pterigomaxilar, I-EXPLORATION destruyendo I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION ventral I-EXPLORATION de I-EXPLORATION cornetes I-EXPLORATION nasales I-EXPLORATION y I-EXPLORATION ascendiendo I-EXPLORATION el I-EXPLORATION piso I-EXPLORATION orbitario I-EXPLORATION con I-EXPLORATION abombamiento I-EXPLORATION del I-EXPLORATION paladar I-EXPLORATION óseo I-EXPLORATION hacia I-EXPLORATION cavidad I-EXPLORATION oral. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION incisional, I-EXPLORATION cuyo I-EXPLORATION diagnóstico I-EXPLORATION fue: I-EXPLORATION quiste I-EXPLORATION óseo I-EXPLORATION aneurismático. I-EXPLORATION A B-TREATMENT los I-TREATMENT 2 I-TREATMENT meses I-TREATMENT fue I-TREATMENT reintervenida I-TREATMENT extirpándose I-TREATMENT la I-TREATMENT masa I-TREATMENT tumoral I-TREATMENT que I-TREATMENT ocupaba I-TREATMENT todo I-TREATMENT el I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT derecho, I-TREATMENT con I-TREATMENT destrucción I-TREATMENT de I-TREATMENT su I-TREATMENT pared I-TREATMENT anterior I-TREATMENT y I-TREATMENT medial, I-TREATMENT paladar I-TREATMENT óseo I-TREATMENT y I-TREATMENT reborde I-TREATMENT alveolar I-TREATMENT superior. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT extracción I-TREATMENT amplia I-TREATMENT mediante I-TREATMENT maxilectomía I-TREATMENT de I-TREATMENT infraestructura, I-TREATMENT que I-TREATMENT consiste I-TREATMENT en I-TREATMENT la I-TREATMENT extirpación I-TREATMENT de I-TREATMENT las I-TREATMENT estructuras I-TREATMENT antes I-TREATMENT mencionadas, I-TREATMENT conservando I-TREATMENT el I-TREATMENT piso I-TREATMENT de I-TREATMENT la I-TREATMENT órbita. I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION quirúrgica, I-EXPLORATION macroscópicamente, I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION expansiva, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION compuesta I-EXPLORATION por I-EXPLORATION múltiples I-EXPLORATION cavidades, I-EXPLORATION separadas I-EXPLORATION por I-EXPLORATION tabiques I-EXPLORATION pardo I-EXPLORATION rojizos, I-EXPLORATION rellenos I-EXPLORATION por I-EXPLORATION material I-EXPLORATION hemático. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION microscópico I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION numerosos I-EXPLORATION tabiques I-EXPLORATION que I-EXPLORATION separaban I-EXPLORATION cavidades, I-EXPLORATION sin I-EXPLORATION revestimiento I-EXPLORATION endotelial, I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION irregular I-EXPLORATION y I-EXPLORATION contenido I-EXPLORATION hemático. I-EXPLORATION Los I-EXPLORATION tabiques I-EXPLORATION tenían I-EXPLORATION estroma I-EXPLORATION fibroso, I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION multinucleadas, I-EXPLORATION fibroblastos, I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION antigua I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION con I-EXPLORATION tejido I-EXPLORATION osteoide, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION anaplasia. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION actividad I-EXPLORATION mitótica. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION coexistencia I-EXPLORATION con I-EXPLORATION otras I-EXPLORATION lesiones. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION en I-EVOLUTION controles I-EVOLUTION permanentes, I-EVOLUTION evolucionando I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS soldado. B-PAST_MEDICAL_HISTORY Al B-PRESENT_ILLNESS reiniciar I-PRESENT_ILLNESS su I-PRESENT_ILLNESS entrenamiento I-PRESENT_ILLNESS físico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS intención I-PRESENT_ILLNESS de I-PRESENT_ILLNESS participar I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS triatlón, I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS una I-PRESENT_ILLNESS actividad I-PRESENT_ILLNESS física I-PRESENT_ILLNESS intensa, I-PRESENT_ILLNESS recorrió I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS kilómetros I-PRESENT_ILLNESS en I-PRESENT_ILLNESS bicicleta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS ascendió I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cima I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cerro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1.828 I-PRESENT_ILLNESS metros, I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS calor I-PRESENT_ILLNESS ambiental I-PRESENT_ILLNESS e I-PRESENT_ILLNESS ingiriendo I-PRESENT_ILLNESS un I-PRESENT_ILLNESS escaso I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS de I-PRESENT_ILLNESS líquidos. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS bajar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS montaña I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS mareos, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS diarrea, I-PRESENT_ILLNESS I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS muscular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS calambres I-PRESENT_ILLNESS musculares I-PRESENT_ILLNESS intensos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS extremidades. I-PRESENT_ILLNESS En B-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT urgencia I-TREATMENT se I-TREATMENT lo I-TREATMENT hidrató, I-TREATMENT enviándolo I-TREATMENT posteriormente I-TREATMENT a I-TREATMENT su I-TREATMENT domicilio. I-TREATMENT Al B-EVOLUTION día I-EVOLUTION subsiguiente I-EVOLUTION acudió I-EVOLUTION al I-EVOLUTION hospital I-EVOLUTION por I-EVOLUTION debilidad I-EVOLUTION muscular, I-EVOLUTION mialgias I-EVOLUTION difusas, I-EVOLUTION calambres I-EVOLUTION y I-EVOLUTION malestar I-EVOLUTION general. I-EVOLUTION Había I-EVOLUTION orinado I-EVOLUTION escasamente I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION día I-EVOLUTION anterior. I-EVOLUTION Existía B-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION fuerzas I-EXPLORATION en I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION muscular. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION mostraron I-EXPLORATION azotemia I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION enzimas I-EXPLORATION musculares. I-EXPLORATION La I-EXPLORATION orina I-EXPLORATION era I-EXPLORATION rosada I-EXPLORATION y I-EXPLORATION el I-EXPLORATION sedimento I-EXPLORATION mostró I-EXPLORATION 1 I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION eritrocitos I-EXPLORATION por I-EXPLORATION campo. I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION una I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION aguda I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION una I-EXPLORATION RML I-EXPLORATION de I-EXPLORATION esfuerzo I-EXPLORATION y B-EVOLUTION se I-EVOLUTION trasladó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos. I-EVOLUTION Allí B-TREATMENT recibió I-TREATMENT solución I-TREATMENT salina I-TREATMENT isotónica, I-TREATMENT bicarbonato I-TREATMENT y I-TREATMENT furosemide, I-TREATMENT recuperando B-EVOLUTION rápidamente I-EVOLUTION la I-EVOLUTION diuresis. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION 9 I-EVOLUTION días I-EVOLUTION siguientes I-EVOLUTION se I-EVOLUTION obtuvo I-EVOLUTION una I-EVOLUTION recuperación I-EVOLUTION paulatina I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal, I-EVOLUTION sin I-EVOLUTION emplearse I-EVOLUTION diálisis, I-EVOLUTION persistiendo I-EVOLUTION las I-EVOLUTION mialgias, I-EVOLUTION los I-EVOLUTION calambres I-EVOLUTION y I-EVOLUTION la I-EVOLUTION elevación I-EVOLUTION de I-EVOLUTION las I-EVOLUTION enzimas I-EVOLUTION musculares. I-EVOLUTION Fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION décimoprimer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION con I-EVOLUTION azotemia I-EVOLUTION leve I-EVOLUTION (creatinina I-EVOLUTION 1, I-EVOLUTION 43 I-EVOLUTION mg/dl, I-EVOLUTION uremia I-EVOLUTION 51 I-EVOLUTION mg/dl) I-EVOLUTION y I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION una I-EVOLUTION creatinquinasa I-EVOLUTION (CK) I-EVOLUTION -total I-EVOLUTION elevada. I-EVOLUTION Un I-EVOLUTION mes I-EVOLUTION después, I-EVOLUTION estando I-EVOLUTION con I-EVOLUTION actividad I-EVOLUTION física I-EVOLUTION liviana, I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION y I-EVOLUTION la I-EVOLUTION concentración I-EVOLUTION de I-EVOLUTION las I-EVOLUTION enzimas I-EVOLUTION musculares I-EVOLUTION fue I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS obeso, I-PRESENT_ILLNESS marino I-PRESENT_ILLNESS mercante, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS estilo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS sedentario. I-PRESENT_ILLNESS Estando I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vacaciones, I-PRESENT_ILLNESS observó I-PRESENT_ILLNESS que I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS se I-PRESENT_ILLNESS ahogaba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mar. I-PRESENT_ILLNESS Intentó I-PRESENT_ILLNESS rescatarla I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mucho I-PRESENT_ILLNESS esfuerzo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS desesperación, I-PRESENT_ILLNESS aspirando I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tragando I-PRESENT_ILLNESS mucha I-PRESENT_ILLNESS agua, I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS casi I-PRESENT_ILLNESS ahogarse. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS siguientes I-PRESENT_ILLNESS tuvo I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS incapacidad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS alimentarse, I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS intensas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS del I-PRESENT_ILLNESS débito I-PRESENT_ILLNESS urinario. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia. I-PRESENT_ILLNESS Estaba B-EXPLORATION hipertenso I-EXPLORATION (170/110 I-EXPLORATION mmHg) I-EXPLORATION y I-EXPLORATION tenía I-EXPLORATION aliento I-EXPLORATION urémico. I-EXPLORATION Era I-EXPLORATION llamativa I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION petequias I-EXPLORATION conjuntivales I-EXPLORATION (signo I-EXPLORATION de I-EXPLORATION asfixia) I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal. I-EXPLORATION La I-EXPLORATION ecotomografía I-EXPLORATION mostró I-EXPLORATION riñones I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacó I-EXPLORATION azotemia I-EXPLORATION marcada I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION enzimas I-EXPLORATION musculares. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION el I-EXPLORATION sedimento I-EXPLORATION mostró I-EXPLORATION sólo I-EXPLORATION 2 I-EXPLORATION a I-EXPLORATION 3 I-EXPLORATION eritrocitos I-EXPLORATION por I-EXPLORATION campo. I-EXPLORATION Se B-TREATMENT manejó I-TREATMENT con I-TREATMENT aporte I-TREATMENT de I-TREATMENT volumen I-TREATMENT y I-TREATMENT bicarbonato I-TREATMENT parenteral. I-TREATMENT Al I-TREATMENT día I-TREATMENT siguiente I-TREATMENT los I-TREATMENT síntomas I-TREATMENT urémicos I-TREATMENT se I-TREATMENT intensificaron I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT hemodializó I-TREATMENT por I-TREATMENT dos I-TREATMENT días I-TREATMENT consecutivos. I-TREATMENT Al B-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION inició I-EVOLUTION una I-EVOLUTION poliuria I-EVOLUTION con I-EVOLUTION recuperación I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION su I-EVOLUTION función I-EVOLUTION renal, I-EVOLUTION hasta I-EVOLUTION alcanzar I-EVOLUTION una I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 1, I-EVOLUTION 1 I-EVOLUTION mg/dl I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION episodio I-EVOLUTION inicial I-EVOLUTION referido. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertenso, B-PAST_MEDICAL_HISTORY tabáquico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dislipidémico. I-PAST_MEDICAL_HISTORY Comenzó B-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS retroesternal I-PRESENT_ILLNESS bajo, I-PRESENT_ILLNESS opresivo, I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS hipocondrios I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS espalda, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS decidió I-PRESENT_ILLNESS consultar I-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS después I-PRESENT_ILLNESS del I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION estaba I-EXPLORATION vígil, I-EXPLORATION orientado, I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 140/90, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 80 I-EXPLORATION lat/min, I-EXPLORATION con I-EXPLORATION pulsos I-EXPLORATION distales I-EXPLORATION simétricos I-EXPLORATION y I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION relevantes. I-EXPLORATION I-EXPLORATION Un I-EXPLORATION electrocardiograma I-EXPLORATION practicado I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION sólo I-EXPLORATION demostró I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION izquierda. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION hallazgos I-EXPLORATION relevantes. I-EXPLORATION I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION del I-EXPLORATION fuerte I-EXPLORATION dolor I-EXPLORATION torácico I-EXPLORATION y I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION disección I-EXPLORATION aórtica, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION (Angio-Tac), I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION flap I-EXPLORATION de I-EXPLORATION disección I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION agudo, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION descendente I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hilios I-EXPLORATION renales, I-EXPLORATION con I-EXPLORATION permeabilidad I-EXPLORATION del I-EXPLORATION falso I-EXPLORATION lumen I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hemotórax I-EXPLORATION menor I-EXPLORATION y I-EXPLORATION hemopericardio. I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION entonces I-EXPLORATION disección I-EXPLORATION aórtica I-EXPLORATION aguda I-EXPLORATION tipo I-EXPLORATION B, I-EXPLORATION complicada I-EXPLORATION por I-EXPLORATION rotura. I-EXPLORATION I-EXPLORATION Debido B-TREATMENT a I-TREATMENT la I-TREATMENT complicación I-TREATMENT de I-TREATMENT la I-TREATMENT disección, I-TREATMENT anatomía I-TREATMENT favorable I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT y I-TREATMENT de I-TREATMENT los I-TREATMENT accesos I-TREATMENT vasculares, I-TREATMENT se I-TREATMENT decidió I-TREATMENT colocación I-TREATMENT de I-TREATMENT prótesis I-TREATMENT endovascular. I-TREATMENT I-TREATMENT Se I-TREATMENT realizó I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT con I-TREATMENT acceso I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT arterias I-TREATMENT femorales I-TREATMENT e I-TREATMENT hipotensión I-TREATMENT controlada, I-TREATMENT instalándose I-TREATMENT prótesis I-TREATMENT endovascular I-TREATMENT (Talent®) I-TREATMENT de I-TREATMENT 34 I-TREATMENT mm I-TREATMENT de I-TREATMENT diámetro I-TREATMENT y I-TREATMENT 130 I-TREATMENT mm I-TREATMENT de I-TREATMENT longitud I-TREATMENT en I-TREATMENT la I-TREATMENT aorta I-TREATMENT torácica I-TREATMENT con I-TREATMENT resultado I-TREATMENT técnico I-TREATMENT adecuado, I-TREATMENT cobertura I-TREATMENT de I-TREATMENT sitio I-TREATMENT de I-TREATMENT fractura I-TREATMENT proximal I-TREATMENT y I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT I-TREATMENT En B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION control I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION adecuada I-EXPLORATION posición I-EXPLORATION de I-EXPLORATION endoprótesis I-EXPLORATION con I-EXPLORATION exclusión I-EXPLORATION del I-EXPLORATION falso I-EXPLORATION lumen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION torácica, I-EXPLORATION sólo I-EXPLORATION con I-EXPLORATION permeabilidad I-EXPLORATION de I-EXPLORATION éste I-EXPLORATION distal I-EXPLORATION a I-EXPLORATION origen I-EXPLORATION de I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION inferior, I-EXPLORATION el I-EXPLORATION que I-EXPLORATION no I-EXPLORATION había I-EXPLORATION aumentado I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION ingreso. I-EXPLORATION Los I-EXPLORATION accesos I-EXPLORATION vasculares I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION complicaciones. I-EXPLORATION Se B-EVOLUTION decidió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION cinco I-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION procedimiento, I-EVOLUTION con I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones. I-EVOLUTION I-EVOLUTION En I-EVOLUTION control I-EVOLUTION un I-EVOLUTION año I-EVOLUTION después I-EVOLUTION del I-EVOLUTION procedimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION con I-EVOLUTION Angio-Tac I-EVOLUTION que I-EVOLUTION no I-EVOLUTION demostró I-EVOLUTION complicaciones I-EVOLUTION en I-EVOLUTION la I-EVOLUTION endoprótesis, I-EVOLUTION con I-EVOLUTION exclusión I-EVOLUTION total I-EVOLUTION del I-EVOLUTION falso I-EVOLUTION lumen I-EVOLUTION torácico I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION variaciones I-EVOLUTION con I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION examen I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY segundo I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enseñanza I-PAST_MEDICAL_HISTORY media I-PAST_MEDICAL_HISTORY completa, I-PAST_MEDICAL_HISTORY casada, I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hija I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Asistió B-PRESENT_ILLNESS al I-PRESENT_ILLNESS consultorio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS atención I-PRESENT_ILLNESS primaria I-PRESENT_ILLNESS por I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS angustiosos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS depresivos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocho I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS e I-PRESENT_ILLNESS iniciados I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS al I-PRESENT_ILLNESS nacimiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hija I-PRESENT_ILLNESS mayor. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS exacerbado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS año, I-PRESENT_ILLNESS después I-PRESENT_ILLNESS del I-PRESENT_ILLNESS nacimiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS hijo. I-PRESENT_ILLNESS Junto I-PRESENT_ILLNESS a I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS anterior, I-PRESENT_ILLNESS golpeaba I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hija, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS marido I-PRESENT_ILLNESS le I-PRESENT_ILLNESS sugirió I-PRESENT_ILLNESS consultar. I-PRESENT_ILLNESS Fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Psiquiatría I-DERIVED_FROM/TO por I-DERIVED_FROM/TO la I-DERIVED_FROM/TO pesquisa I-DERIVED_FROM/TO que I-DERIVED_FROM/TO hizo I-DERIVED_FROM/TO el I-DERIVED_FROM/TO médico I-DERIVED_FROM/TO general I-DERIVED_FROM/TO del I-DERIVED_FROM/TO antecedente I-DERIVED_FROM/TO de I-DERIVED_FROM/TO abuso I-DERIVED_FROM/TO sexual I-DERIVED_FROM/TO infantil, I-DERIVED_FROM/TO que I-DERIVED_FROM/TO hasta I-DERIVED_FROM/TO esa I-DERIVED_FROM/TO fecha I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO había I-DERIVED_FROM/TO silenciado. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Antecedentes. B-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY golpeada I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY padre I-PAST_MEDICAL_HISTORY alcohólico, I-PAST_MEDICAL_HISTORY quién I-PAST_MEDICAL_HISTORY abusó I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ella I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY caricias I-PAST_MEDICAL_HISTORY sexuales I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY penetración, I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 15, I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY abandonó I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY colegio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY trasladó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY ciudad I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY trabajar I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY asesora I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY hogar. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY primera I-PAST_MEDICAL_HISTORY casa I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY trabajó I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY violada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY patrona. I-PAST_MEDICAL_HISTORY Esta I-PAST_MEDICAL_HISTORY experiencia I-PAST_MEDICAL_HISTORY traumática I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY silenció I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY susto, I-PAST_MEDICAL_HISTORY vergüenza I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY culpa. I-PAST_MEDICAL_HISTORY Posteriormente I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY angustia, I-PAST_MEDICAL_HISTORY pesadillas I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY imágenes I-PAST_MEDICAL_HISTORY intrusivas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY violación I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY cedieron I-PAST_MEDICAL_HISTORY espontáneamente I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY mes, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY abandono I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY lugar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trabajo. I-PAST_MEDICAL_HISTORY Estos I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY reactivaron I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY después, I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY divisó I-PAST_MEDICAL_HISTORY casualmente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY calle I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY victimario I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY nuevamente I-PAST_MEDICAL_HISTORY cedieron I-PAST_MEDICAL_HISTORY espontáneamente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY regreso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY lugar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY casó I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY sexual. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY angustia I-PAST_MEDICAL_HISTORY relacionada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY idea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tener I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hija, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY podría I-PAST_MEDICAL_HISTORY suceder I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ella, I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY decir I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY violada. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY angustia I-PAST_MEDICAL_HISTORY aumentó I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY nació I-PAST_MEDICAL_HISTORY ésta, I-PAST_MEDICAL_HISTORY agregándose I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY puerperio I-PAST_MEDICAL_HISTORY anhedonia, I-PAST_MEDICAL_HISTORY intolerancia, I-PAST_MEDICAL_HISTORY irritabilidad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY labilidad I-PAST_MEDICAL_HISTORY emocional, I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consultó. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY reiniciar I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY sexual, I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY parto, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY oportunidad I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY marido I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY bajo I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY efecto I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY alcohol, I-PAST_MEDICAL_HISTORY reaparecieron I-PAST_MEDICAL_HISTORY imágenes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY percepciones I-PAST_MEDICAL_HISTORY olfativas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY padre I-PAST_MEDICAL_HISTORY abusaba I-PAST_MEDICAL_HISTORY sexualmente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ella. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY volvió I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY «sentir I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY olor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY padre» I-PAST_MEDICAL_HISTORY cerca I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ella. I-PAST_MEDICAL_HISTORY Antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY recuerdos I-PAST_MEDICAL_HISTORY borrosos I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY abuso I-PAST_MEDICAL_HISTORY sufrido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY niñez. I-PAST_MEDICAL_HISTORY Después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY incidente, I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY imágenes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY abuso I-PAST_MEDICAL_HISTORY infantil I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY presentaron I-PAST_MEDICAL_HISTORY egodistónicamente I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY vez I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY sexuales. I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY aparecieron I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipervigilancia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY conductas I-PAST_MEDICAL_HISTORY evitativas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY sexual, I-PAST_MEDICAL_HISTORY originándose I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY frigidez I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY serios I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pareja. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY violación I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY disfunción I-PAST_MEDICAL_HISTORY sexual I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY habían I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY develadas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente. I-PAST_MEDICAL_HISTORY Un I-PAST_MEDICAL_HISTORY ejemplo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY constata I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ficha I-PAST_MEDICAL_HISTORY clínica, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ginecología I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY matrimonio I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY fibroadenoma I-PAST_MEDICAL_HISTORY mamario, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY atendió I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY esa I-PAST_MEDICAL_HISTORY oportunidad I-PAST_MEDICAL_HISTORY consignó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes: I-PAST_MEDICAL_HISTORY nulípara I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY sexuales, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY referencia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY traumáticos I-PAST_MEDICAL_HISTORY sexuales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Evolución B-EVOLUTION y I-EVOLUTION tratamiento. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION experimentó I-EVOLUTION un I-EVOLUTION gran I-EVOLUTION alivio I-EVOLUTION cuando I-EVOLUTION el I-EVOLUTION médico I-EVOLUTION general I-EVOLUTION le I-EVOLUTION preguntó I-EVOLUTION por I-EVOLUTION el I-EVOLUTION antecedente I-EVOLUTION de I-EVOLUTION abuso I-EVOLUTION sexual. I-EVOLUTION Uno I-EVOLUTION de I-EVOLUTION los I-EVOLUTION aspectos I-EVOLUTION que I-EVOLUTION más I-EVOLUTION la I-EVOLUTION habían I-EVOLUTION angustiado I-EVOLUTION durante I-EVOLUTION su I-EVOLUTION vida I-EVOLUTION era I-EVOLUTION el I-EVOLUTION miedo I-EVOLUTION de I-EVOLUTION que I-EVOLUTION otras I-EVOLUTION personas, I-EVOLUTION incluyendo I-EVOLUTION su I-EVOLUTION marido, I-EVOLUTION supiesen I-EVOLUTION de I-EVOLUTION su I-EVOLUTION historia I-EVOLUTION traumática I-EVOLUTION sexual, I-EVOLUTION pues I-EVOLUTION se I-EVOLUTION imaginaba I-EVOLUTION que I-EVOLUTION sería I-EVOLUTION rechazada I-EVOLUTION y I-EVOLUTION enjuiciada, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION para I-EVOLUTION su I-EVOLUTION alivio I-EVOLUTION no I-EVOLUTION ocurrió. I-EVOLUTION I-EVOLUTION Con I-EVOLUTION el I-EVOLUTION equipo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION especialidad I-EVOLUTION habló I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION otros I-EVOLUTION antecedentes I-EVOLUTION traumáticos. I-EVOLUTION Posteriormente I-EVOLUTION a I-EVOLUTION la I-EVOLUTION tercera I-EVOLUTION intervención, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refirió I-EVOLUTION sus I-EVOLUTION traumas I-EVOLUTION a I-EVOLUTION su I-EVOLUTION marido, I-EVOLUTION quien I-EVOLUTION no I-EVOLUTION sólo I-EVOLUTION la I-EVOLUTION comprendió I-EVOLUTION sino I-EVOLUTION que I-EVOLUTION también I-EVOLUTION le I-EVOLUTION brindó I-EVOLUTION apoyo. I-EVOLUTION Después I-EVOLUTION de I-EVOLUTION este I-EVOLUTION acontecimiento I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION mejoró I-EVOLUTION sustancialmente, I-EVOLUTION remitieron I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION depresivos, I-EVOLUTION la I-EVOLUTION disfunción I-EVOLUTION sexual I-EVOLUTION y I-EVOLUTION el I-EVOLUTION maltrato I-EVOLUTION a I-EVOLUTION su I-EVOLUTION hija. I-EVOLUTION I-EVOLUTION Asistió I-EVOLUTION en I-EVOLUTION total I-EVOLUTION a I-EVOLUTION cinco I-EVOLUTION controles I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Psiquiatría I-EVOLUTION en I-EVOLUTION los I-EVOLUTION que I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION su I-EVOLUTION mejoría. I-EVOLUTION Durante B-TREATMENT ese I-TREATMENT tiempo I-TREATMENT se I-TREATMENT la I-TREATMENT trató I-TREATMENT con I-TREATMENT fluoxetina I-TREATMENT 20 I-TREATMENT mg/día I-TREATMENT y I-TREATMENT meleril I-TREATMENT 25 I-TREATMENT mg/día. I-TREATMENT A B-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION el I-EVOLUTION equipo I-EVOLUTION de I-EVOLUTION salud I-EVOLUTION mental I-EVOLUTION se I-EVOLUTION enteró I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION asintomática, I-EVOLUTION trabajando I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION conflictos I-EVOLUTION de I-EVOLUTION pareja. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY intenso, I-PAST_MEDICAL_HISTORY bronquítico I-PAST_MEDICAL_HISTORY crónico, I-PAST_MEDICAL_HISTORY portador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY prostático I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución. I-PAST_MEDICAL_HISTORY Enfermedad B-PRESENT_ILLNESS actual: I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 4/6/04 I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS precordial I-PRESENT_ILLNESS opresivo. I-PRESENT_ILLNESS Se B-TREATMENT diagnosticó I-TREATMENT infarto I-TREATMENT agudo I-TREATMENT de I-TREATMENT miocardio I-TREATMENT y I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT fibrinolítico I-TREATMENT sistémico I-TREATMENT con I-TREATMENT estreptoquinasa. I-TREATMENT Reapareció B-EXPLORATION angor, I-EXPLORATION realizándose I-EXPLORATION cineangiocoronariografía I-EXPLORATION (CACG) I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION arterias I-EXPLORATION coronarias I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION significativas. I-EXPLORATION En B-EVOLUTION forma I-EVOLUTION inmediata I-EVOLUTION al I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION procedimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION frialdad I-EVOLUTION intensa I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION ambos I-EVOLUTION miembros I-EVOLUTION inferiores I-EVOLUTION de I-EVOLUTION predominio I-EVOLUTION distal, I-EVOLUTION con I-EVOLUTION cianosis I-EVOLUTION de I-EVOLUTION dedos I-EVOLUTION de I-EVOLUTION los I-EVOLUTION pies. I-EVOLUTION Concomitantemente I-EVOLUTION apareció I-EVOLUTION epigastralgia, I-EVOLUTION náuseas I-EVOLUTION y I-EVOLUTION vómitos. I-EVOLUTION I-EVOLUTION Al B-EXPLORATION examen I-EXPLORATION destacaba I-EXPLORATION cianosis I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION pies, I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION seca I-EXPLORATION en I-EXPLORATION 3º, I-EXPLORATION 4º I-EXPLORATION y I-EXPLORATION 5º I-EXPLORATION dedos I-EXPLORATION derechos I-EXPLORATION y I-EXPLORATION 3º I-EXPLORATION y I-EXPLORATION 5º I-EXPLORATION dedos I-EXPLORATION izquierdos. I-EXPLORATION I-EXPLORATION Examen I-EXPLORATION cardiovascular: I-EXPLORATION ritmo I-EXPLORATION irregular I-EXPLORATION 110 I-EXPLORATION lpm, I-EXPLORATION pulsos I-EXPLORATION distales I-EXPLORATION conservados, I-EXPLORATION simétricos I-EXPLORATION en I-EXPLORATION 4 I-EXPLORATION miembros. I-EXPLORATION I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio. I-EXPLORATION Azoemia: I-EXPLORATION 140 I-EXPLORATION mg/dL. I-EXPLORATION Creatininemia: I-EXPLORATION 5, I-EXPLORATION 8 I-EXPLORATION mg/dL I-EXPLORATION (función I-EXPLORATION renal I-EXPLORATION 3 I-EXPLORATION meses I-EXPLORATION previos I-EXPLORATION normal). I-EXPLORATION Depuración I-EXPLORATION de I-EXPLORATION creatinina: I-EXPLORATION 11 I-EXPLORATION ml/min. I-EXPLORATION Hemograma, I-EXPLORATION ionograma I-EXPLORATION sanguíneo I-EXPLORATION y I-EXPLORATION glicemia: I-EXPLORATION normales. I-EXPLORATION Examen I-EXPLORATION de I-EXPLORATION orina: I-EXPLORATION densidad I-EXPLORATION 1015; I-EXPLORATION proteínas I-EXPLORATION 2, I-EXPLORATION 09 I-EXPLORATION g/L; I-EXPLORATION hematíes+++; I-EXPLORATION leucocitos++. I-EXPLORATION Antígeno I-EXPLORATION prostático I-EXPLORATION específico: I-EXPLORATION 2, I-EXPLORATION 4 I-EXPLORATION ng/mL. I-EXPLORATION Ecografía I-EXPLORATION aparato I-EXPLORATION urinario: I-EXPLORATION tamaño I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION espesor I-EXPLORATION parenquimatoso I-EXPLORATION conservados, I-EXPLORATION leve I-EXPLORATION dilatación I-EXPLORATION pielocalicial I-EXPLORATION izquierda, I-EXPLORATION hipertrofia I-EXPLORATION prostática I-EXPLORATION grado I-EXPLORATION III. I-EXPLORATION ECG: I-EXPLORATION fibrilación I-EXPLORATION auricular I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION promedio I-EXPLORATION de I-EXPLORATION 90 I-EXPLORATION lpm. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION normal. I-EXPLORATION Ecocardiograma: I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION izquierda, I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION aurícula I-EXPLORATION izquierda, I-EXPLORATION fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION ventricular I-EXPLORATION izquierda: I-EXPLORATION 57%. I-EXPLORATION Doppler I-EXPLORATION arterial I-EXPLORATION miembros I-EXPLORATION inferiores: I-EXPLORATION lesiones I-EXPLORATION hemodinámicamente I-EXPLORATION significativas I-EXPLORATION en I-EXPLORATION sector I-EXPLORATION ilíaco I-EXPLORATION y I-EXPLORATION femoral I-EXPLORATION común, I-EXPLORATION bilaterales; I-EXPLORATION arterias I-EXPLORATION distales I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION significativas. I-EXPLORATION Colonoscopia: I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION lesiones I-EXPLORATION ulceradas I-EXPLORATION superficiales I-EXPLORATION cubiertas I-EXPLORATION por I-EXPLORATION fibrina, I-EXPLORATION desde I-EXPLORATION recto I-EXPLORATION bajo I-EXPLORATION hasta I-EXPLORATION sigmoides I-EXPLORATION proximal, I-EXPLORATION donde I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION eran I-EXPLORATION más I-EXPLORATION extensas I-EXPLORATION e I-EXPLORATION impidieron I-EXPLORATION proseguir I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION (aspecto I-EXPLORATION de I-EXPLORATION colitis I-EXPLORATION isquémica). I-EXPLORATION Biopsia I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION sigmoides: I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION de I-EXPLORATION especificidad. I-EXPLORATION Gastroscopia: I-EXPLORATION lesiones I-EXPLORATION ulceradas I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION duodeno. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo: I-EXPLORATION embolias I-EXPLORATION colesterínicas I-EXPLORATION en I-EXPLORATION retina I-EXPLORATION izquierda. I-EXPLORATION Biopsia I-EXPLORATION de I-EXPLORATION piel: I-EXPLORATION cristales I-EXPLORATION de I-EXPLORATION colesterol I-EXPLORATION ocluyendo I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION mediano I-EXPLORATION calibre; I-EXPLORATION trombosis I-EXPLORATION vascular I-EXPLORATION en I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION calibre. I-EXPLORATION I-EXPLORATION Evolución B-EVOLUTION y I-EVOLUTION tratamiento. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION evolución, I-EVOLUTION destacó I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION masiva I-EVOLUTION (reiterado I-EVOLUTION en I-EVOLUTION dos I-EVOLUTION oportunidades) I-EVOLUTION que B-TREATMENT requirió I-TREATMENT uso I-TREATMENT de I-TREATMENT tranfusiones; I-TREATMENT posteriormente, B-EVOLUTION diarrea I-EVOLUTION mantenida. I-EVOLUTION Esto I-EVOLUTION impidió I-EVOLUTION su I-EVOLUTION traslado I-EVOLUTION para I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION angiorresonancia I-EVOLUTION magnética I-EVOLUTION para I-EVOLUTION evaluación I-EVOLUTION de I-EVOLUTION aorta I-EVOLUTION torácica I-EVOLUTION y I-EVOLUTION abdominal. I-EVOLUTION A I-EVOLUTION nivel I-EVOLUTION ocular, I-EVOLUTION presentó I-EVOLUTION gran I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION agudeza I-EVOLUTION visual. I-EVOLUTION Hubo I-EVOLUTION franco I-EVOLUTION empeoramiento I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION miembros I-EVOLUTION inferiores, I-EVOLUTION llegando B-TREATMENT a I-TREATMENT requerir I-TREATMENT opiáceos, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT simpaticectomía I-TREATMENT lumbar I-TREATMENT unilateral, I-TREATMENT con I-TREATMENT criterio I-TREATMENT analgésico, I-TREATMENT con I-TREATMENT resultado I-TREATMENT favorable. I-TREATMENT I-TREATMENT Bajo B-EVOLUTION tratamiento I-EVOLUTION médico, I-EVOLUTION se I-EVOLUTION logró I-EVOLUTION estabilización I-EVOLUTION de I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION creatinina, I-EVOLUTION destacando I-EVOLUTION el I-EVOLUTION difícil I-EVOLUTION manejo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION HTA, I-EVOLUTION que I-EVOLUTION requirió I-EVOLUTION de I-EVOLUTION múltiples I-EVOLUTION fármacos. I-EVOLUTION I-EVOLUTION Como B-TREATMENT tratamiento I-TREATMENT tentativo I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT de I-TREATMENT base, I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT anticoagulante I-TREATMENT (enoxaparina I-TREATMENT 1 I-TREATMENT mg/kg I-TREATMENT peso I-TREATMENT corporal I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h) I-TREATMENT y I-TREATMENT corticoides I-TREATMENT (prednisona I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT mg/kg I-TREATMENT peso I-TREATMENT corporal), I-TREATMENT debiendo I-TREATMENT ser I-TREATMENT suspendida I-TREATMENT por I-TREATMENT la I-TREATMENT hemorragia I-TREATMENT digestiva I-TREATMENT relatada. I-TREATMENT I-TREATMENT Evolución B-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION control: I-EVOLUTION hubo I-EVOLUTION caída I-EVOLUTION espontánea I-EVOLUTION de I-EVOLUTION falanges I-EVOLUTION distales I-EVOLUTION del I-EVOLUTION tercer I-EVOLUTION dedo I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION pies I-EVOLUTION y I-EVOLUTION quinto I-EVOLUTION dedo I-EVOLUTION de I-EVOLUTION pie I-EVOLUTION izquierdo, I-EVOLUTION estabilización I-EVOLUTION de I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION renal. I-EVOLUTION Azoemia: I-EVOLUTION 80 I-EVOLUTION mg/dL. I-EVOLUTION Creatininemia: I-EVOLUTION 2, I-EVOLUTION 5 I-EVOLUTION mg/dL. I-EVOLUTION Continúa I-EVOLUTION actualmente I-EVOLUTION bajo I-EVOLUTION tratamiento I-EVOLUTION médico I-EVOLUTION y I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION repetido I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION deterioro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION agudeza I-EVOLUTION visual I-EVOLUTION ni I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION digestivo. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipotiroidea. B-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS 2000 I-PRESENT_ILLNESS debutó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS falla I-PRESENT_ILLNESS renal, I-PRESENT_ILLNESS ingresando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hemodiálisis I-PRESENT_ILLNESS crónica. I-PRESENT_ILLNESS En B-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION siguientes I-EVOLUTION tuvo I-EVOLUTION múltiples I-EVOLUTION oclusiones I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION accesos I-EVOLUTION vasculares, I-EVOLUTION practicándose B-TREATMENT fístulas I-TREATMENT arteriovenosas I-TREATMENT radiocefálicas I-TREATMENT y I-TREATMENT braquiales I-TREATMENT bilaterales, I-TREATMENT instalación I-TREATMENT de I-TREATMENT prótesis I-TREATMENT axilohumerales I-TREATMENT bilaterales I-TREATMENT de I-TREATMENT politetrafluoretileno I-TREATMENT (PTFE) I-TREATMENT y I-TREATMENT numerosos I-TREATMENT catéteres I-TREATMENT transitorios I-TREATMENT y I-TREATMENT tunelizados I-TREATMENT en I-TREATMENT posiciones I-TREATMENT yugular, I-TREATMENT subclavia I-TREATMENT y I-TREATMENT femoral. I-TREATMENT En B-EXPLORATION 2003 I-EXPLORATION se I-EXPLORATION determinó I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina, I-EXPLORATION TTPK, I-EXPLORATION anticoagulante I-EXPLORATION lúpico, I-EXPLORATION VDRL, I-EXPLORATION antitrombina I-EXPLORATION III I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION anticardiolipina I-EXPLORATION IgG I-EXPLORATION e I-EXPLORATION IgM, I-EXPLORATION los I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION o I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION 2004 I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION una I-EXPLORATION diabetes I-EXPLORATION mellitus I-EXPLORATION 2. I-EXPLORATION I-EXPLORATION En B-TREATMENT marzo I-TREATMENT de I-TREATMENT 2005 I-TREATMENT recibió I-TREATMENT un I-TREATMENT riñón I-TREATMENT de I-TREATMENT donante I-TREATMENT cadáver, I-TREATMENT con I-TREATMENT el I-TREATMENT que I-TREATMENT compartía I-TREATMENT 2 I-TREATMENT antígenos I-TREATMENT DR I-TREATMENT y I-TREATMENT presentaba I-TREATMENT incompatibilidades I-TREATMENT en I-TREATMENT los I-TREATMENT 2 I-TREATMENT antígenos I-TREATMENT A I-TREATMENT y I-TREATMENT B. I-TREATMENT Su B-EXPLORATION reactividad I-EXPLORATION histórica I-EXPLORATION y I-EXPLORATION previa I-EXPLORATION al I-EXPLORATION trasplante I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION linfocitos I-EXPLORATION de I-EXPLORATION panel I-EXPLORATION era I-EXPLORATION 0%. I-EXPLORATION Hubo B-TREATMENT un I-TREATMENT sangrado I-TREATMENT intraoperatorio I-TREATMENT abundante, I-TREATMENT usaba I-TREATMENT clopidogrel I-TREATMENT para I-TREATMENT evitar I-TREATMENT la I-TREATMENT oclusión I-TREATMENT de I-TREATMENT los I-TREATMENT catéteres. I-TREATMENT Recibió I-TREATMENT glóbulos I-TREATMENT rojos, I-TREATMENT plaquetas, I-TREATMENT plasma I-TREATMENT fresco I-TREATMENT congelado I-TREATMENT e I-TREATMENT inmunosupresión I-TREATMENT con I-TREATMENT ciclosporina I-TREATMENT (CsA), I-TREATMENT micofenolato I-TREATMENT (MMF) I-TREATMENT y I-TREATMENT esteroides. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION una I-EVOLUTION necrosis I-EVOLUTION tubular I-EVOLUTION aguda, I-EVOLUTION hemodializándose I-EVOLUTION en I-EVOLUTION 6 I-EVOLUTION ocasiones I-EVOLUTION durante I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION 14 I-EVOLUTION días. I-EVOLUTION Recibió B-TREATMENT insulina, I-TREATMENT y I-TREATMENT por I-TREATMENT no I-TREATMENT tener I-TREATMENT anticuerpos I-TREATMENT de I-TREATMENT tipo I-TREATMENT IgG I-TREATMENT anti I-TREATMENT CMV I-TREATMENT utilizó I-TREATMENT ganciclovir I-TREATMENT endovenoso I-TREATMENT y I-TREATMENT luego I-TREATMENT valganciclovir I-TREATMENT (VGC) I-TREATMENT oral. I-TREATMENT Como I-TREATMENT complicaciones I-TREATMENT tuvo I-TREATMENT una I-TREATMENT infección I-TREATMENT urinaria I-TREATMENT y I-TREATMENT un I-TREATMENT urinoma, I-TREATMENT que I-TREATMENT requirió I-TREATMENT de I-TREATMENT drenaje I-TREATMENT quirúrgico. I-TREATMENT Egresó B-EVOLUTION a I-EVOLUTION los I-EVOLUTION 34 I-EVOLUTION días, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 1, I-EVOLUTION 6 I-EVOLUTION mg/dl. I-EVOLUTION Una I-EVOLUTION semana I-EVOLUTION después, I-EVOLUTION notó I-EVOLUTION edema I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION superior I-EVOLUTION derecha, I-EVOLUTION tos I-EVOLUTION y I-EVOLUTION disnea I-EVOLUTION de I-EVOLUTION esfuerzos. I-EVOLUTION Una B-EXPLORATION ecotomografía I-EXPLORATION doppler I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION axilar I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cintigrama I-EXPLORATION pulmonar I-EXPLORATION mostró I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION embolia I-EXPLORATION pulmonar. I-EXPLORATION Inició B-TREATMENT terapia I-TREATMENT con I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT y I-TREATMENT luego I-TREATMENT acenocumarol. I-TREATMENT Egresó B-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION con I-EVOLUTION una I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 1, I-EVOLUTION 6 I-EVOLUTION mg/dl I-EVOLUTION y I-EVOLUTION un I-EVOLUTION clearence I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 35 I-EVOLUTION ml/min. I-EVOLUTION I-EVOLUTION A I-EVOLUTION los I-EVOLUTION cuatro I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION trasplante I-EVOLUTION renal I-EVOLUTION (TxR) I-EVOLUTION y I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION reducir I-EVOLUTION la I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION MMF I-EVOLUTION desde I-EVOLUTION 1.500 I-EVOLUTION a I-EVOLUTION 500 I-EVOLUTION mg/día I-EVOLUTION por I-EVOLUTION leucopenia, I-EVOLUTION utilizando I-EVOLUTION prednisona I-EVOLUTION 10 I-EVOLUTION mg I-EVOLUTION y I-EVOLUTION CsA I-EVOLUTION 80 I-EVOLUTION mg I-EVOLUTION (obteniendo I-EVOLUTION una I-EVOLUTION concentración I-EVOLUTION sanguínea I-EVOLUTION de I-EVOLUTION 504 I-EVOLUTION ng/ml I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 2 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION ingerida) I-EVOLUTION la I-EVOLUTION creatinina I-EVOLUTION se I-EVOLUTION elevó I-EVOLUTION a I-EVOLUTION 4, I-EVOLUTION 9 I-EVOLUTION mg/dl, I-EVOLUTION el I-EVOLUTION clearence I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION cayó I-EVOLUTION a I-EVOLUTION 8, I-EVOLUTION 7 I-EVOLUTION ml/min I-EVOLUTION y I-EVOLUTION apareció I-EVOLUTION proteinuria I-EVOLUTION de I-EVOLUTION 14, I-EVOLUTION 9 I-EVOLUTION g/día. I-EVOLUTION Se I-EVOLUTION diagnosticó I-EVOLUTION un I-EVOLUTION rechazo I-EVOLUTION agudo. I-EVOLUTION No B-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION por I-EXPLORATION estar I-EXPLORATION bajo I-EXPLORATION terapia I-EXPLORATION anticoagulante. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT metilprednisolona I-TREATMENT por I-TREATMENT 3 I-TREATMENT días, I-TREATMENT descendiendo I-TREATMENT la I-TREATMENT creatinina I-TREATMENT a I-TREATMENT 1, I-TREATMENT 7 I-TREATMENT mg/dl I-TREATMENT y I-TREATMENT la I-TREATMENT proteinuria I-TREATMENT a I-TREATMENT 780 I-TREATMENT mg/día, I-TREATMENT elevándose I-TREATMENT el I-TREATMENT clearence I-TREATMENT de I-TREATMENT creatinina I-TREATMENT a I-TREATMENT 40 I-TREATMENT ml/min. I-TREATMENT La B-EXPLORATION antigenemia I-EXPLORATION para I-EXPLORATION CMV I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION Egresó B-EVOLUTION con I-EVOLUTION el I-EVOLUTION mismo I-EVOLUTION esquema I-EVOLUTION inmunosupresor. I-EVOLUTION I-EVOLUTION Once I-EVOLUTION semanas I-EVOLUTION después, I-EVOLUTION recibiendo I-EVOLUTION MMF I-EVOLUTION 1.000 I-EVOLUTION mg, I-EVOLUTION CsA I-EVOLUTION 70 I-EVOLUTION mg I-EVOLUTION (obteniendo I-EVOLUTION un I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION 457 I-EVOLUTION ng/ml I-EVOLUTION a I-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION hora I-EVOLUTION de I-EVOLUTION ingerida) I-EVOLUTION y I-EVOLUTION prednisona I-EVOLUTION 10 I-EVOLUTION mg, I-EVOLUTION hizo I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION rechazo I-EVOLUTION agudo, I-EVOLUTION tratándose I-EVOLUTION con I-EVOLUTION pulsos I-EVOLUTION de I-EVOLUTION metilprednisolona, I-EVOLUTION descendiendo I-EVOLUTION la I-EVOLUTION creatinina I-EVOLUTION desde I-EVOLUTION 2, I-EVOLUTION 9 I-EVOLUTION a I-EVOLUTION 1, I-EVOLUTION 6 I-EVOLUTION mg/dl. I-EVOLUTION Posterior B-TREATMENT a I-TREATMENT ello I-TREATMENT se I-TREATMENT cambió I-TREATMENT la I-TREATMENT CsA I-TREATMENT por I-TREATMENT tacrolimus I-TREATMENT (TCR) I-TREATMENT 4 I-TREATMENT mg I-TREATMENT c/12 I-TREATMENT h I-TREATMENT (obteniendo I-TREATMENT un I-TREATMENT nivel I-TREATMENT de I-TREATMENT 8 I-TREATMENT ng/ml) I-TREATMENT y I-TREATMENT se I-TREATMENT reinició I-TREATMENT el I-TREATMENT VGC I-TREATMENT por I-TREATMENT aparición I-TREATMENT de I-TREATMENT febrículas I-TREATMENT asociadas I-TREATMENT a I-TREATMENT una I-TREATMENT antigenemia I-TREATMENT (+). I-TREATMENT A I-TREATMENT los I-TREATMENT 7 I-TREATMENT meses I-TREATMENT del I-TREATMENT TxR I-TREATMENT y I-TREATMENT a I-TREATMENT los I-TREATMENT 6 I-TREATMENT meses I-TREATMENT de I-TREATMENT iniciada I-TREATMENT la I-TREATMENT terapia I-TREATMENT anticoagulante, I-TREATMENT ésta I-TREATMENT se I-TREATMENT suspendió, I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT a I-TREATMENT lo I-TREATMENT programado I-TREATMENT a I-TREATMENT su I-TREATMENT inicio. I-TREATMENT Egresó B-EVOLUTION con I-EVOLUTION una I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 1, I-EVOLUTION 6 I-EVOLUTION mg/dl. I-EVOLUTION Dos I-EVOLUTION días I-EVOLUTION más I-EVOLUTION tarde, I-EVOLUTION 12 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION del I-EVOLUTION anticoagulante, I-EVOLUTION cayó I-EVOLUTION bruscamente I-EVOLUTION en I-EVOLUTION anuria. I-EVOLUTION Una B-EXPLORATION ecotomografía I-EXPLORATION doppler I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION flujo I-EXPLORATION arterial I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cintigrama I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION perfusión I-EXPLORATION renal. I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION una I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION renal. I-EXPLORATION Se B-TREATMENT instalaron I-TREATMENT nuevos I-TREATMENT catéteres I-TREATMENT tunelizados I-TREATMENT por I-TREATMENT vía I-TREATMENT femoral I-TREATMENT derecha I-TREATMENT e I-TREATMENT inició I-TREATMENT hemodiálisis. I-TREATMENT Tres B-EXPLORATION días I-EXPLORATION después I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION renal I-EXPLORATION y B-TREATMENT posteriormente I-TREATMENT se I-TREATMENT efectuó I-TREATMENT una I-TREATMENT nefrectomía. I-TREATMENT Se B-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION renal I-EXPLORATION con I-EXPLORATION infarto I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION injerto, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION intersticial I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION rechazo I-EXPLORATION leve. I-EXPLORATION Frente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION trombofilia I-EXPLORATION como I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION trombosis I-EXPLORATION arterial, I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION confirmar I-EXPLORATION dicha I-EXPLORATION hipótesis. I-EXPLORATION Los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION antitrombina I-EXPLORATION III, I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION activada, I-EXPLORATION factor I-EXPLORATION V I-EXPLORATION Leiden, I-EXPLORATION mutación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION G20210A I-EXPLORATION de I-EXPLORATION la I-EXPLORATION protrombina, I-EXPLORATION proteína I-EXPLORATION S, I-EXPLORATION anticoagulante I-EXPLORATION lúpico, I-EXPLORATION anticuerpos I-EXPLORATION anticardiolipinas I-EXPLORATION IgG I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION o I-EXPLORATION negativos. I-EXPLORATION La I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION PrC I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION sólo I-EXPLORATION 39, I-EXPLORATION 1% I-EXPLORATION (VN: I-EXPLORATION 72-106%) I-EXPLORATION y I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION homocisteína I-EXPLORATION total I-EXPLORATION estuvieron I-EXPLORATION levemente I-EXPLORATION elevados I-EXPLORATION 16, I-EXPLORATION 6 I-EXPLORATION umol/L I-EXPLORATION (VN: I-EXPLORATION 4, I-EXPLORATION 5-11). I-EXPLORATION I-EXPLORATION Días B-EVOLUTION después I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION trombosis I-EVOLUTION de I-EVOLUTION la I-EVOLUTION vena I-EVOLUTION femoral I-EVOLUTION común I-EVOLUTION y I-EVOLUTION profunda I-EVOLUTION derechas. I-EVOLUTION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT con I-TREATMENT acenocumarol I-TREATMENT permanente. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Puerto I-PAST_MEDICAL_HISTORY Aisén, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY realizada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY causa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY difuso I-PAST_MEDICAL_HISTORY hipertiroideo. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY consecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cirugía, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY desarrolló I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hipoparatiroidismo I-PAST_MEDICAL_HISTORY definitivo. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY indicó I-PAST_MEDICAL_HISTORY suplemento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vitamina I-PAST_MEDICAL_HISTORY D, I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY cumplió I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY irregular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY laboratorio. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Quince I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY tarde, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1999, I-PAST_MEDICAL_HISTORY consultó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY hospital I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY calambres, I-PAST_MEDICAL_HISTORY parestesias I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY espasmos I-PAST_MEDICAL_HISTORY faciales, I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY signos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Chvostek I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Trousseau I-PAST_MEDICAL_HISTORY manifiestos. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY reinició I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vitamina I-PAST_MEDICAL_HISTORY D I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY solicitó I-PAST_MEDICAL_HISTORY exámenes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcemia, I-PAST_MEDICAL_HISTORY T4 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY TSH. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY regresó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY control. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Reapareció I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY noviembre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2003, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY Presentaba I-PAST_MEDICAL_HISTORY marcado I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY general, I-PAST_MEDICAL_HISTORY astenia, I-PAST_MEDICAL_HISTORY debilidad I-PAST_MEDICAL_HISTORY muscular, I-PAST_MEDICAL_HISTORY calambres, I-PAST_MEDICAL_HISTORY parestesias I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cefalea. I-PAST_MEDICAL_HISTORY Sus I-PAST_MEDICAL_HISTORY menstruaciones I-PAST_MEDICAL_HISTORY eran I-PAST_MEDICAL_HISTORY abundantes. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY examen I-PAST_MEDICAL_HISTORY físico I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY facies I-PAST_MEDICAL_HISTORY hipotiroidea, I-PAST_MEDICAL_HISTORY cicatriz I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY tiroidectomía, I-PAST_MEDICAL_HISTORY pulso I-PAST_MEDICAL_HISTORY regular I-PAST_MEDICAL_HISTORY 70x', I-PAST_MEDICAL_HISTORY presión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY 110/70 I-PAST_MEDICAL_HISTORY mmHg, I-PAST_MEDICAL_HISTORY palidez I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY signos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Chvostek I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Trousseau; I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY examen I-PAST_MEDICAL_HISTORY cardiopulmonar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY eran I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Sus I-PAST_MEDICAL_HISTORY exámenes I-PAST_MEDICAL_HISTORY revelaron: I-PAST_MEDICAL_HISTORY calcemia I-PAST_MEDICAL_HISTORY 7, I-PAST_MEDICAL_HISTORY 98 I-PAST_MEDICAL_HISTORY mg/dL I-PAST_MEDICAL_HISTORY (probable I-PAST_MEDICAL_HISTORY error I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY laboratorio, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY discordancia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY calcemias I-PAST_MEDICAL_HISTORY posteriores), I-PAST_MEDICAL_HISTORY fosfemia I-PAST_MEDICAL_HISTORY 6, I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY mg/dL, I-PAST_MEDICAL_HISTORY BUN I-PAST_MEDICAL_HISTORY 14 I-PAST_MEDICAL_HISTORY mg/dL, I-PAST_MEDICAL_HISTORY proteína I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY 6, I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY g/dL, I-PAST_MEDICAL_HISTORY albuminemia I-PAST_MEDICAL_HISTORY 3, I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY g/dL, I-PAST_MEDICAL_HISTORY hematocrito I-PAST_MEDICAL_HISTORY 27%, I-PAST_MEDICAL_HISTORY hemoglobina I-PAST_MEDICAL_HISTORY 6, I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY g/dL, I-PAST_MEDICAL_HISTORY microcitosis I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipocromía, I-PAST_MEDICAL_HISTORY TSH I-PAST_MEDICAL_HISTORY 9, I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY µU/ml I-PAST_MEDICAL_HISTORY (vn: I-PAST_MEDICAL_HISTORY 0, I-PAST_MEDICAL_HISTORY 4-4, I-PAST_MEDICAL_HISTORY 8). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Con I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipoparatiroidismo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY postiroidectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY ferropriva, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY indicó I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Elcal I-PAST_MEDICAL_HISTORY D I-PAST_MEDICAL_HISTORY Forte® I-PAST_MEDICAL_HISTORY (carbonato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY 1.125 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY vitamina I-PAST_MEDICAL_HISTORY D I-PAST_MEDICAL_HISTORY 175 I-PAST_MEDICAL_HISTORY UI) I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY Elcal® I-PAST_MEDICAL_HISTORY (carbonato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY 800 I-PAST_MEDICAL_HISTORY mg) I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY levotiroxina I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY µg I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sulfato I-PAST_MEDICAL_HISTORY ferroso I-PAST_MEDICAL_HISTORY 400 I-PAST_MEDICAL_HISTORY mg/día. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Dos B-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS después, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS a I-PRESENT_ILLNESS mínimos I-PRESENT_ILLNESS esfuerzos, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rápida I-PRESENT_ILLNESS progresión. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION afebril, I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION 70x' I-EXPLORATION regular, I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION 100/70 I-EXPLORATION mmHg, I-EXPLORATION ortopnea, I-EXPLORATION edema I-EXPLORATION generalizado, I-EXPLORATION ingurgitación I-EXPLORATION yugular, I-EXPLORATION estertores I-EXPLORATION pulmonares, I-EXPLORATION ruidos I-EXPLORATION cardíacos I-EXPLORATION apagados, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION auscultaron I-EXPLORATION soplos, I-EXPLORATION hepatomegalia I-EXPLORATION sensible I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION bajo I-EXPLORATION el I-EXPLORATION reborde I-EXPLORATION costal. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION profunda. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION indicó I-EXPLORATION hospitalización. I-EXPLORATION En I-EXPLORATION sus I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacaba: I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION cardiomegalia I-EXPLORATION y I-EXPLORATION congestión I-EXPLORATION pulmonar. I-EXPLORATION ECG: I-EXPLORATION ritmo I-EXPLORATION sinusal, I-EXPLORATION 83x', I-EXPLORATION bajo I-EXPLORATION voltaje I-EXPLORATION generalizado, I-EXPLORATION intervalo I-EXPLORATION QT I-EXPLORATION prolongado I-EXPLORATION y I-EXPLORATION alteraciones I-EXPLORATION inespecíficas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION repolarización I-EXPLORATION ventricular. I-EXPLORATION Ecocardiograma: I-EXPLORATION marcada I-EXPLORATION dilatación, I-EXPLORATION disfunción I-EXPLORATION sistólica I-EXPLORATION y I-EXPLORATION disfunción I-EXPLORATION diastólica I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION restrictivo I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo, I-EXPLORATION severa I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION y I-EXPLORATION tricuspídea, I-EXPLORATION hipertensión I-EXPLORATION pulmonar I-EXPLORATION sistólica I-EXPLORATION moderada, I-EXPLORATION derrame I-EXPLORATION pericárdico I-EXPLORATION moderado I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION aurícula I-EXPLORATION izquierda. I-EXPLORATION Ecotomografía I-EXPLORATION abdominal: I-EXPLORATION hepatomegalia I-EXPLORATION congestiva. I-EXPLORATION Endoscopia I-EXPLORATION digestiva I-EXPLORATION alta: I-EXPLORATION gastritis I-EXPLORATION hiperémica. I-EXPLORATION Calcemia I-EXPLORATION 2, I-EXPLORATION 9 I-EXPLORATION mg/dL, I-EXPLORATION parathormona I-EXPLORATION 5, I-EXPLORATION 9 I-EXPLORATION ng/l I-EXPLORATION (vn: I-EXPLORATION 10-73), I-EXPLORATION magnesio I-EXPLORATION 1, I-EXPLORATION 08 I-EXPLORATION mEq/l I-EXPLORATION (vn: I-EXPLORATION 1, I-EXPLORATION 4-2, I-EXPLORATION 1), I-EXPLORATION albúmina I-EXPLORATION 3, I-EXPLORATION 3 I-EXPLORATION g/dL, I-EXPLORATION sodio I-EXPLORATION 140 I-EXPLORATION mEq/l, I-EXPLORATION potasio I-EXPLORATION 2, I-EXPLORATION 3 I-EXPLORATION mEq/l, I-EXPLORATION hematocrito I-EXPLORATION 26%, I-EXPLORATION hemoglobina I-EXPLORATION 7, I-EXPLORATION 4 I-EXPLORATION g/dL, I-EXPLORATION proteinuria I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION h: I-EXPLORATION negativa, I-EXPLORATION bilirrubinemia I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 3 I-EXPLORATION mg/dL, I-EXPLORATION transaminasas I-EXPLORATION glutámico I-EXPLORATION oxalacéticas I-EXPLORATION 63 I-EXPLORATION U/l I-EXPLORATION (vn: I-EXPLORATION <35), I-EXPLORATION creatinfosfokinasa I-EXPLORATION total I-EXPLORATION 1.260 I-EXPLORATION U/l I-EXPLORATION (vn: I-EXPLORATION <70) I-EXPLORATION (fracción I-EXPLORATION miocárdica I-EXPLORATION 3%), I-EXPLORATION TSH I-EXPLORATION 18, I-EXPLORATION 1 I-EXPLORATION µU/ml. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION cardíaca I-EXPLORATION congestiva I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION hipocalcemia I-EXPLORATION severa, I-EXPLORATION descompensada I-EXPLORATION por I-EXPLORATION sustitución I-EXPLORATION con I-EXPLORATION hormona I-EXPLORATION tiroidea I-EXPLORATION y I-EXPLORATION agravada I-EXPLORATION por I-EXPLORATION anemia I-EXPLORATION ferropriva. I-EXPLORATION I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT gluconato I-TREATMENT de I-TREATMENT calcio I-TREATMENT 1 I-TREATMENT g I-TREATMENT iv I-TREATMENT c/12 I-TREATMENT h, I-TREATMENT carbonato I-TREATMENT de I-TREATMENT calcio I-TREATMENT 2 I-TREATMENT g I-TREATMENT vo, I-TREATMENT vitamina I-TREATMENT D I-TREATMENT 175 I-TREATMENT µ/día, I-TREATMENT vitamina I-TREATMENT D I-TREATMENT 300.000 I-TREATMENT UI I-TREATMENT por I-TREATMENT una I-TREATMENT vez, I-TREATMENT l-tiroxina I-TREATMENT 100 I-TREATMENT µg, I-TREATMENT sulfato I-TREATMENT ferroso I-TREATMENT 400 I-TREATMENT mg, I-TREATMENT furosemida I-TREATMENT 40 I-TREATMENT mg, I-TREATMENT cloruro I-TREATMENT de I-TREATMENT potasio I-TREATMENT 1, I-TREATMENT 8 I-TREATMENT g, I-TREATMENT captopril I-TREATMENT 12, I-TREATMENT 5 I-TREATMENT mg I-TREATMENT y I-TREATMENT digoxina I-TREATMENT 0, I-TREATMENT 125 I-TREATMENT mg/día. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION con I-EVOLUTION diuresis I-EVOLUTION intensa I-EVOLUTION y I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION las I-EVOLUTION manifestaciones I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION cardíaca, I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION edema I-EVOLUTION y I-EVOLUTION la I-EVOLUTION hepatomegalia. I-EVOLUTION Diez B-EXPLORATION días I-EXPLORATION después I-EXPLORATION tenía I-EXPLORATION calcemia I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mg/dL, I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 37% I-EXPLORATION y I-EXPLORATION en I-EXPLORATION ecocardiograma I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION reducción I-EXPLORATION del I-EXPLORATION grado I-EXPLORATION del I-EXPLORATION reflujo I-EXPLORATION mitral I-EXPLORATION y I-EXPLORATION tricuspídeo, I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION sistólica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION a I-EXPLORATION 33 I-EXPLORATION mmHg I-EXPLORATION (vn: I-EXPLORATION 15-30) I-EXPLORATION y I-EXPLORATION del I-EXPLORATION derrame I-EXPLORATION pericárdico. I-EXPLORATION En B-EVOLUTION controles I-EVOLUTION posteriores, I-EVOLUTION hasta I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION cumplía I-EVOLUTION rigurosamente I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION sólo I-EVOLUTION presentaba I-EVOLUTION disnea I-EVOLUTION a I-EVOLUTION esfuerzos I-EVOLUTION medianos I-EVOLUTION a I-EVOLUTION mayores, I-EVOLUTION su B-EXPLORATION calcemia I-EXPLORATION se I-EXPLORATION mantenía I-EXPLORATION entre I-EXPLORATION 8 I-EXPLORATION y I-EXPLORATION 8, I-EXPLORATION 5 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION en I-EXPLORATION seguimiento I-EXPLORATION ecocardiográfico, I-EXPLORATION se I-EXPLORATION observó, I-EXPLORATION además, I-EXPLORATION una I-EXPLORATION recuperación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION marcada I-EXPLORATION disfunción I-EXPLORATION diastólica I-EXPLORATION inicial I-EXPLORATION -evaluada I-EXPLORATION por I-EXPLORATION el I-EXPLORATION índice I-EXPLORATION E/A: I-EXPLORATION relación I-EXPLORATION entre I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION llene I-EXPLORATION ventricular I-EXPLORATION rápido I-EXPLORATION (E) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION llene I-EXPLORATION relacionada I-EXPLORATION a I-EXPLORATION la I-EXPLORATION contracción I-EXPLORATION auricular I-EXPLORATION (A) I-EXPLORATION -, I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION desaparición I-EXPLORATION del I-EXPLORATION derrame I-EXPLORATION pericárdico, I-EXPLORATION persistiendo I-EXPLORATION la I-EXPLORATION dilatación I-EXPLORATION y I-EXPLORATION disfunción I-EXPLORATION sistólica I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo, I-EXPLORATION en I-EXPLORATION grado I-EXPLORATION similar I-EXPLORATION a I-EXPLORATION la I-EXPLORATION observada I-EXPLORATION en I-EXPLORATION exámenes I-EXPLORATION iniciales. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY CPT. I-PAST_MEDICAL_HISTORY La B-EXPLORATION biopsia I-EXPLORATION quirúrgica I-EXPLORATION informó I-EXPLORATION un I-EXPLORATION CPT I-EXPLORATION bifocal, I-EXPLORATION variedad I-EXPLORATION usual, I-EXPLORATION con I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION permea-ción I-EXPLORATION vascular, I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION cápsula I-EXPLORATION ni I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION borde I-EXPLORATION quirúrgico. I-EXPLORATION Recibió B-TREATMENT 150 I-TREATMENT mCi I-TREATMENT I131 I-TREATMENT y B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION sistémica I-EXPLORATION posdosis I-EXPLORATION mostró I-EXPLORATION remanente I-EXPLORATION tiroideo I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION ganglionar I-EXPLORATION derecho. I-EXPLORATION Inició B-TREATMENT terapia I-TREATMENT supresiva I-TREATMENT con I-TREATMENT levotiroxina I-TREATMENT y B-EVOLUTION en I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION presentó I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION Tg I-EVOLUTION indetectables I-EVOLUTION (<0, I-EVOLUTION 2 I-EVOLUTION ng/ml) I-EVOLUTION en I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION AcTg I-EVOLUTION y B-EXPLORATION las I-EXPLORATION ecografías I-EXPLORATION cervicales I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION recidiva I-EXPLORATION tumoral. I-EXPLORATION En I-EXPLORATION control I-EXPLORATION de I-EXPLORATION los I-EXPLORATION 18 I-EXPLORATION meses I-EXPLORATION poscirugía I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION mostró I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION región I-EXPLORATION cervical I-EXPLORATION derecha, I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION linfonodo. I-EXPLORATION En I-EXPLORATION forma I-EXPLORATION simultánea, I-EXPLORATION la I-EXPLORATION Tg-s I-EXPLORATION estimulada I-EXPLORATION (TSH I-EXPLORATION =105 I-EXPLORATION uUI/mL) I-EXPLORATION fue I-EXPLORATION <0, I-EXPLORATION 2 I-EXPLORATION ng/ml, I-EXPLORATION en I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION AcTg. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION sistémica I-EXPLORATION mostró I-EXPLORATION captación I-EXPLORATION aumentada I-EXPLORATION en I-EXPLORATION compartimento I-EXPLORATION central I-EXPLORATION a I-EXPLORATION ambos I-EXPLORATION lados I-EXPLORATION de I-EXPLORATION línea I-EXPLORATION media, I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION derecha. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION CPT. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT disección I-TREATMENT cervical, I-TREATMENT cuya B-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION CPT I-EXPLORATION en I-EXPLORATION ganglio I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION VI, I-EXPLORATION intrano-dal, I-EXPLORATION sin I-EXPLORATION extensión I-EXPLORATION al I-EXPLORATION tejido I-EXPLORATION adiposo. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION para I-EXPLORATION Tg I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION difusa I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION coloide I-EXPLORATION como I-EXPLORATION en I-EXPLORATION citoplasma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION tumorales. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS Dental I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Referencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Salud I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Peñalolén, I-PRESENT_ILLNESS Cordillera I-PRESENT_ILLNESS Oriente, I-PRESENT_ILLNESS Santiago, I-PRESENT_ILLNESS Chile. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS señaló I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS había I-PRESENT_ILLNESS crecido I-PRESENT_ILLNESS lentamente I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS año I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ella I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS detectó. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION clínica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION el I-EXPLORATION labio I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION nodular, I-EXPLORATION irregular, I-EXPLORATION globuloso I-EXPLORATION (como I-EXPLORATION racimo), I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION indoloro, I-EXPLORATION y I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION más I-EXPLORATION o I-EXPLORATION menos I-EXPLORATION difusos I-EXPLORATION y I-EXPLORATION recubierto I-EXPLORATION por I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION anamnesis I-EXPLORATION no I-EXPLORATION se I-EXPLORATION pesquisaron I-EXPLORATION otros I-EXPLORATION procesos I-EXPLORATION ni I-EXPLORATION antecedentes I-EXPLORATION mórbidos I-EXPLORATION relevantes. I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT hipótesis I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT adenoma I-TREATMENT pleomorfo, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT realizar I-TREATMENT la I-TREATMENT biopsia I-TREATMENT excisional I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT local. I-TREATMENT Se I-TREATMENT logró I-TREATMENT extraer I-TREATMENT toda I-TREATMENT la I-TREATMENT tumoración I-TREATMENT además I-TREATMENT de I-TREATMENT tejido I-TREATMENT adyacente, I-TREATMENT ya I-TREATMENT que I-TREATMENT si I-TREATMENT bien I-TREATMENT se I-TREATMENT observaba I-TREATMENT algo I-TREATMENT de I-TREATMENT fibrosis I-TREATMENT periférica, I-TREATMENT ésta I-TREATMENT se I-TREATMENT entremezclaba I-TREATMENT con I-TREATMENT el I-TREATMENT tejido I-TREATMENT conjuntivo I-TREATMENT y I-TREATMENT capa I-TREATMENT muscular I-TREATMENT de I-TREATMENT los I-TREATMENT labios. I-TREATMENT La B-EXPLORATION muestra I-EXPLORATION fue I-EXPLORATION enviada I-EXPLORATION a I-EXPLORATION análisis I-EXPLORATION histopatológico. I-EXPLORATION I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION histopatológico I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION capsulada, I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION vasos I-EXPLORATION sanguíneos I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION engrosadas, I-EXPLORATION entremezclados I-EXPLORATION con I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION linfocitario I-EXPLORATION que I-EXPLORATION se I-EXPLORATION disponía I-EXPLORATION a I-EXPLORATION manera I-EXPLORATION de I-EXPLORATION I-EXPLORATION folículos I-EXPLORATION con I-EXPLORATION centros I-EXPLORATION germinativos, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION presencia I-EXPLORATION destacada I-EXPLORATION de I-EXPLORATION eosinófilos. I-EXPLORATION El I-EXPLORATION tejido I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION tabicaciones I-EXPLORATION por I-EXPLORATION haces I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION colágenas. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION histopatológico I-EXPLORATION correspondió I-EXPLORATION a I-EXPLORATION hiperplasia I-EXPLORATION angiolinfoidea I-EXPLORATION con I-EXPLORATION eosinofilia. I-EXPLORATION Los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION los I-EXPLORATION distintos I-EXPLORATION parámetros I-EXPLORATION del I-EXPLORATION hemograma I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION controlada I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION se I-EVOLUTION procedió I-EVOLUTION al I-EVOLUTION retiro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sutura. I-EVOLUTION Luego I-EVOLUTION se I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION controlar I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION realizada I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION sin I-EVOLUTION observarse I-EVOLUTION recidiva. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY relevancia, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS en I-PRESENT_ILLNESS junio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2005, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS epigástrico, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carácter I-PRESENT_ILLNESS sordo, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS moderada I-PRESENT_ILLNESS intensidad, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedió I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antiespasmó-dicos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS bloqueadores I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS bomba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS protones, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS dada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS reconsultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día I-PRESENT_ILLNESS siguiente I-PRESENT_ILLNESS por I-PRESENT_ILLNESS persistencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS epigastralgia, I-PRESENT_ILLNESS realizándose B-EXPLORATION una I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION retroperitoneal. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC), I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION quística I-EXPLORATION multitabicada I-EXPLORATION de I-EXPLORATION 44 I-EXPLORATION x I-EXPLORATION 26 I-EXPLORATION mm, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION que I-EXPLORATION contactaba I-EXPLORATION caudalmente I-EXPLORATION con I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION del I-EXPLORATION páncreas. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometida I-TREATMENT a I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT exploradora I-TREATMENT subcostal I-TREATMENT bilateral, I-TREATMENT encontrándose I-TREATMENT la I-TREATMENT lesión, I-TREATMENT descrita I-TREATMENT en I-TREATMENT la I-TREATMENT TAC, I-TREATMENT íntimamente I-TREATMENT adherida I-TREATMENT al I-TREATMENT páncreas, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT debió I-TREATMENT realizar I-TREATMENT una I-TREATMENT pancreatectomía I-TREATMENT distal I-TREATMENT junto I-TREATMENT a I-TREATMENT la I-TREATMENT resección I-TREATMENT del I-TREATMENT quiste, I-TREATMENT enviándose I-TREATMENT la I-TREATMENT pieza I-TREATMENT a I-TREATMENT anatomía I-TREATMENT patológica. I-TREATMENT I-TREATMENT Hallazgos I-TREATMENT patológicos I-TREATMENT I-TREATMENT El I-TREATMENT páncreas I-TREATMENT mostraba I-TREATMENT acinos I-TREATMENT e I-TREATMENT islotes I-TREATMENT pancreáticos I-TREATMENT de I-TREATMENT arquitectura I-TREATMENT normal. I-TREATMENT Se I-TREATMENT identificaban I-TREATMENT además I-TREATMENT dos I-TREATMENT ganglios I-TREATMENT linfáticos I-TREATMENT peripancreáticos I-TREATMENT sin I-TREATMENT alteraciones. I-TREATMENT I-TREATMENT El I-TREATMENT diagnóstico I-TREATMENT histológico I-TREATMENT fue I-TREATMENT compatible I-TREATMENT con I-TREATMENT un I-TREATMENT quiste I-TREATMENT broncogénico I-TREATMENT retroperitoneal. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION en I-EVOLUTION el I-EVOLUTION posopera-torio, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION posoperatorio. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcoholismo I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Emergencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Complejo I-PRESENT_ILLNESS Asistencial I-PRESENT_ILLNESS Barros I-PRESENT_ILLNESS Luco I-PRESENT_ILLNESS (CABL) I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cadera I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS intensidad. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS se I-PRESENT_ILLNESS asoció I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuadrante I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS ipsilateral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lipotimia. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY enfermedades I-PAST_MEDICAL_HISTORY asociadas. I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 80/54 I-EXPLORATION mmHg, I-EXPLORATION pulso I-EXPLORATION 78 I-EXPLORATION x', I-EXPLORATION coloración I-EXPLORATION lívida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION infraumbilical I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores. I-EXPLORATION Se I-EXPLORATION aportaron I-EXPLORATION entonces I-EXPLORATION 1.000 I-EXPLORATION ce I-EXPLORATION de I-EXPLORATION solución I-EXPLORATION cristaloide I-EXPLORATION intravenosa I-EXPLORATION que I-EXPLORATION permitieron I-EXPLORATION normalizar I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION arterial. I-EXPLORATION El I-EXPLORATION abdomen I-EXPLORATION aparecía I-EXPLORATION distendido, I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION intenso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION hipocondrio, I-EXPLORATION flanco I-EXPLORATION y I-EXPLORATION fosa I-EXPLORATION ilíaca I-EXPLORATION derecha. I-EXPLORATION Presentaba, I-EXPLORATION además, I-EXPLORATION dolor I-EXPLORATION de I-EXPLORATION rebote I-EXPLORATION difuso, I-EXPLORATION resistencia I-EXPLORATION muscular I-EXPLORATION difusa I-EXPLORATION y I-EXPLORATION puño I-EXPLORATION percusión I-EXPLORATION derecha I-EXPLORATION positiva. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION obtuvo: I-EXPLORATION glicemla I-EXPLORATION de I-EXPLORATION 250 I-EXPLORATION mg/dl, I-EXPLORATION nitrógeno I-EXPLORATION ureico I-EXPLORATION de I-EXPLORATION 17 I-EXPLORATION mg/dl, I-EXPLORATION creatininemia I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 17 I-EXPLORATION mg/dl, I-EXPLORATION amilasa I-EXPLORATION 86 I-EXPLORATION U/1, I-EXPLORATION lipasa I-EXPLORATION 40 I-EXPLORATION U/1, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 2 I-EXPLORATION mg/1, I-EXPLORATION protrombine-mia I-EXPLORATION 83, I-EXPLORATION 5%; I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION tromboplastina I-EXPLORATION parcial I-EXPLORATION activado: I-EXPLORATION 28, I-EXPLORATION 1 I-EXPLORATION s, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 18.200/fxl, I-EXPLORATION hemoglobinemia I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 7 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 39%. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION con I-EXPLORATION contraste, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION espontáneamente I-EXPLORATION hiperdensa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hipocondrio I-EXPLORATION y I-EXPLORATION flanco I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION por I-EXPLORATION 12 I-EXPLORATION por I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION derecho I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION periferia, I-EXPLORATION manteniendo I-EXPLORATION un I-EXPLORATION plano I-EXPLORATION de I-EXPLORATION clivaje I-EXPLORATION con I-EXPLORATION él. I-EXPLORATION Se I-EXPLORATION sugería I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION hematoma I-EXPLORATION mesentérico, I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartar I-EXPLORATION también I-EXPLORATION neoplasia I-EXPLORATION subyacente. I-EXPLORATION Al B-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION hemodinámicamente I-EVOLUTION estable, I-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION con I-EVOLUTION menos I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION espontáneo, I-EVOLUTION sin I-EVOLUTION embargo, I-EVOLUTION el I-EVOLUTION hematocrito I-EVOLUTION de I-EVOLUTION control I-EVOLUTION descendió I-EVOLUTION a I-EVOLUTION 21%, I-EVOLUTION decidiéndose B-TREATMENT entonces I-TREATMENT transfundir I-TREATMENT 2 I-TREATMENT U I-TREATMENT de I-TREATMENT glóbulos I-TREATMENT rojos I-TREATMENT e I-TREATMENT intervenir I-TREATMENT quirúrgicamente I-TREATMENT al I-TREATMENT paciente. I-TREATMENT I-TREATMENT Se I-TREATMENT efectuó I-TREATMENT laparotomía I-TREATMENT exploradora, I-TREATMENT encontrándose I-TREATMENT un I-TREATMENT gran I-TREATMENT hematoma I-TREATMENT encapsulado I-TREATMENT retrope-ritoneal I-TREATMENT derecho, I-TREATMENT que I-TREATMENT se I-TREATMENT extendía I-TREATMENT desde I-TREATMENT el I-TREATMENT mesocolon I-TREATMENT transverso I-TREATMENT hasta I-TREATMENT la I-TREATMENT pelvis, I-TREATMENT sin I-TREATMENT observar I-TREATMENT lesión I-TREATMENT con I-TREATMENT sangrado I-TREATMENT activo. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT vaciamiento, I-TREATMENT aseo, I-TREATMENT instalación I-TREATMENT de I-TREATMENT drenajes I-TREATMENT en I-TREATMENT el I-TREATMENT retroperito-neo I-TREATMENT y I-TREATMENT toma I-TREATMENT de I-TREATMENT muestras I-TREATMENT para I-TREATMENT biopsia, I-TREATMENT la I-TREATMENT que, I-TREATMENT posteriormente, I-TREATMENT se I-TREATMENT informó I-TREATMENT como I-TREATMENT hematoma I-TREATMENT de I-TREATMENT mesenterio I-TREATMENT sin I-TREATMENT evidencias I-TREATMENT de I-TREATMENT neoplasia. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION satisfactoriamente I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION del I-EVOLUTION posoperatorio, I-EVOLUTION cuando I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION salida I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION fecal I-EVOLUTION por I-EVOLUTION los I-EVOLUTION drenajes, I-EVOLUTION realizándose I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION fístula I-EVOLUTION estercorácea. I-EVOLUTION Se B-TREATMENT decidió, I-TREATMENT entonces, I-TREATMENT conectar I-TREATMENT los I-TREATMENT tubulares I-TREATMENT a I-TREATMENT aspiración I-TREATMENT e I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT metronidazol I-TREATMENT más I-TREATMENT ciprofloxacina, I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT consiguió I-TREATMENT buen I-TREATMENT control I-TREATMENT de I-TREATMENT la I-TREATMENT fístula, I-TREATMENT la I-TREATMENT cual I-TREATMENT evolucionó I-TREATMENT al I-TREATMENT cierre I-TREATMENT definitivo I-TREATMENT al I-TREATMENT vigésimo I-TREATMENT día I-TREATMENT desde I-TREATMENT la I-TREATMENT operación, I-TREATMENT dándose I-TREATMENT de I-TREATMENT alta I-TREATMENT en I-TREATMENT óptimas I-TREATMENT condiciones I-TREATMENT generales I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT herida. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION en I-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION en I-EVOLUTION policlínico I-EVOLUTION de I-EVOLUTION cirugía, I-EVOLUTION permaneciendo I-EVOLUTION asintomático I-EVOLUTION a I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION su I-EVOLUTION egreso. I-EVOLUTION I-EVOLUTION Familia B-PRESENT_ILLNESS afectada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS madre. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Estudio I-PRESENT_ILLNESS molecular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hormonal. I-PRESENT_ILLNESS El B-FAMILY_HISTORY estudio I-FAMILY_HISTORY hormonal I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY tía I-FAMILY_HISTORY y I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY del I-FAMILY_HISTORY probando I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II. I-FAMILY_HISTORY 2 I-FAMILY_HISTORY y I-FAMILY_HISTORY II. I-FAMILY_HISTORY 3) I-FAMILY_HISTORY incluyó I-FAMILY_HISTORY una I-FAMILY_HISTORY prueba I-FAMILY_HISTORY de I-FAMILY_HISTORY ACTH, I-FAMILY_HISTORY cuyos I-FAMILY_HISTORY valores I-FAMILY_HISTORY de I-FAMILY_HISTORY 170H I-FAMILY_HISTORY Progesterona I-FAMILY_HISTORY basal I-FAMILY_HISTORY y I-FAMILY_HISTORY estimulado I-FAMILY_HISTORY fueron I-FAMILY_HISTORY normales, I-FAMILY_HISTORY no I-FAMILY_HISTORY permitiendo I-FAMILY_HISTORY aclarar I-FAMILY_HISTORY si I-FAMILY_HISTORY estos I-FAMILY_HISTORY sujetos I-FAMILY_HISTORY eran I-FAMILY_HISTORY heterocigotos I-FAMILY_HISTORY de I-FAMILY_HISTORY una I-FAMILY_HISTORY mutación I-FAMILY_HISTORY del I-FAMILY_HISTORY CYP21A2. I-FAMILY_HISTORY I-FAMILY_HISTORY El B-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION en I-EXPLORATION ADN I-EXPLORATION genómi-co I-EXPLORATION extraído I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION las I-EXPLORATION siete I-EXPLORATION mutaciones I-EXPLORATION más I-EXPLORATION frecuentes I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION CYP21A2 I-EXPLORATION fueron I-EXPLORATION estudiadas I-EXPLORATION con I-EXPLORATION PCR I-EXPLORATION alelo I-EXPLORATION específica I-EXPLORATION (Fardella, I-EXPLORATION 1998). I-EXPLORATION Este B-FAMILY_HISTORY estudio I-FAMILY_HISTORY demostró I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY paterna I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II.2, I-FAMILY_HISTORY II.4, I-FAMILY_HISTORY II.6) I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY Q318X I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY exón I-FAMILY_HISTORY 8, I-FAMILY_HISTORY que I-FAMILY_HISTORY consiste I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY cambio I-FAMILY_HISTORY de I-FAMILY_HISTORY una I-FAMILY_HISTORY glutamina I-FAMILY_HISTORY por I-FAMILY_HISTORY un I-FAMILY_HISTORY codón I-FAMILY_HISTORY de I-FAMILY_HISTORY stop. I-FAMILY_HISTORY Este I-FAMILY_HISTORY resultado I-FAMILY_HISTORY no I-FAMILY_HISTORY permitió I-FAMILY_HISTORY clasificar I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY materna I-FAMILY_HISTORY y I-FAMILY_HISTORY por I-FAMILY_HISTORY ende I-FAMILY_HISTORY decidir I-FAMILY_HISTORY sobre I-FAMILY_HISTORY la I-FAMILY_HISTORY necesidad I-FAMILY_HISTORY del I-FAMILY_HISTORY tratamiento I-FAMILY_HISTORY prenatal I-FAMILY_HISTORY en I-FAMILY_HISTORY estas I-FAMILY_HISTORY parejas. I-FAMILY_HISTORY I-FAMILY_HISTORY Posteriormente, B-EXPLORATION el I-EXPLORATION gen I-EXPLORATION CYP21A2fue I-EXPLORATION secuenciado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Sao I-EXPLORATION Paulo I-EXPLORATION según I-EXPLORATION las I-EXPLORATION técnicas I-EXPLORATION clásicas I-EXPLORATION (Wedell, I-EXPLORATION 1993). I-EXPLORATION Usando B-FAMILY_HISTORY esta I-FAMILY_HISTORY metodología, I-FAMILY_HISTORY se I-FAMILY_HISTORY encontró I-FAMILY_HISTORY en I-FAMILY_HISTORY uno I-FAMILY_HISTORY de I-FAMILY_HISTORY los I-FAMILY_HISTORY alelos I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY paterna I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II.2, I-FAMILY_HISTORY II.4, I-FAMILY_HISTORY II.6) I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY Q318X I-FAMILY_HISTORY junto I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY R483W, I-FAMILY_HISTORY la I-FAMILY_HISTORY que I-FAMILY_HISTORY consiste I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY sustitución I-FAMILY_HISTORY de I-FAMILY_HISTORY una I-FAMILY_HISTORY arginina I-FAMILY_HISTORY por I-FAMILY_HISTORY triptofano I-FAMILY_HISTORY (CGG>TGG). I-FAMILY_HISTORY En I-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY materna I-FAMILY_HISTORY (sujetos I-FAMILY_HISTORY II. I-FAMILY_HISTORY 1, I-FAMILY_HISTORY II.3, I-FAMILY_HISTORY II.5) I-FAMILY_HISTORY se I-FAMILY_HISTORY encontró I-FAMILY_HISTORY un I-FAMILY_HISTORY alelo I-FAMILY_HISTORY con I-FAMILY_HISTORY la I-FAMILY_HISTORY mutación I-FAMILY_HISTORY R483->frameshift, I-FAMILY_HISTORY también I-FAMILY_HISTORY conocida I-FAMILY_HISTORY como I-FAMILY_HISTORY R483delGGinsC, I-FAMILY_HISTORY la I-FAMILY_HISTORY cuál I-FAMILY_HISTORY consiste I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY cambio I-FAMILY_HISTORY de I-FAMILY_HISTORY los I-FAMILY_HISTORY nucleótidos I-FAMILY_HISTORY GG I-FAMILY_HISTORY por I-FAMILY_HISTORY C, I-FAMILY_HISTORY alterando I-FAMILY_HISTORY la I-FAMILY_HISTORY lectura I-FAMILY_HISTORY del I-FAMILY_HISTORY codón. I-FAMILY_HISTORY De I-FAMILY_HISTORY este I-FAMILY_HISTORY modo I-FAMILY_HISTORY se I-FAMILY_HISTORY certificó I-FAMILY_HISTORY que I-FAMILY_HISTORY los I-FAMILY_HISTORY seis I-FAMILY_HISTORY cónyuges I-FAMILY_HISTORY poseen I-FAMILY_HISTORY mutaciones I-FAMILY_HISTORY para I-FAMILY_HISTORY HSC I-FAMILY_HISTORY perdedora I-FAMILY_HISTORY de I-FAMILY_HISTORY sal, I-FAMILY_HISTORY y I-FAMILY_HISTORY por I-FAMILY_HISTORY lo I-FAMILY_HISTORY tanto, I-FAMILY_HISTORY se I-FAMILY_HISTORY encuentran I-FAMILY_HISTORY en I-FAMILY_HISTORY riesgo I-FAMILY_HISTORY de I-FAMILY_HISTORY tener I-FAMILY_HISTORY hijas I-FAMILY_HISTORY con I-FAMILY_HISTORY ambigüedad I-FAMILY_HISTORY genital. I-FAMILY_HISTORY I-FAMILY_HISTORY Consejo B-TREATMENT genético I-TREATMENT y I-TREATMENT manejo I-TREATMENT de I-TREATMENT los I-TREATMENT embarazos. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT dar I-TREATMENT consejo I-TREATMENT genético I-TREATMENT a I-TREATMENT los I-TREATMENT tres I-TREATMENT matrimonios I-TREATMENT afectados. I-TREATMENT La B-EVOLUTION tía I-EVOLUTION paterna I-EVOLUTION (sujeto I-EVOLUTION II.2), I-EVOLUTION mujer I-EVOLUTION sana I-EVOLUTION de I-EVOLUTION 34 I-EVOLUTION años, I-EVOLUTION suspende I-EVOLUTION el I-EVOLUTION método I-EVOLUTION anticonceptivo I-EVOLUTION por I-EVOLUTION deseos I-EVOLUTION de I-EVOLUTION fertilidad I-EVOLUTION y I-EVOLUTION logra I-EVOLUTION concepción I-EVOLUTION espontánea I-EVOLUTION en I-EVOLUTION marzo I-EVOLUTION 2005. I-EVOLUTION Se B-TREATMENT explican I-TREATMENT los I-TREATMENT beneficios I-TREATMENT y I-TREATMENT riesgos I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT prenatal I-TREATMENT con I-TREATMENT corti-coides, I-TREATMENT los I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT entiende I-TREATMENT y I-TREATMENT acepta, I-TREATMENT firmando I-TREATMENT un I-TREATMENT consentimiento I-TREATMENT en I-TREATMENT que I-TREATMENT opta I-TREATMENT por I-TREATMENT realizar I-TREATMENT esta I-TREATMENT terapia. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT comenzó I-TREATMENT a I-TREATMENT las I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT edad I-TREATMENT gestacional I-TREATMENT (EG) I-TREATMENT con I-TREATMENT dexametasona I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 20 I-TREATMENT µg/kg/día. I-TREATMENT I-TREATMENT A B-EXPLORATION las I-EXPLORATION 13 I-EXPLORATION semanas I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sexo I-EXPLORATION fetal I-EXPLORATION masculino I-EXPLORATION por I-EXPLORATION ultrasonografía I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución I-EXPLORATION (Voluson I-EXPLORATION 730, I-EXPLORATION General I-EXPLORATION Electric, I-EXPLORATION Austria, I-EXPLORATION transductor I-EXPLORATION transabdominal I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5-5 I-EXPLORATION MHz), I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION es I-EXPLORATION capaz I-EXPLORATION de I-EXPLORATION predecir I-EXPLORATION conectamente I-EXPLORATION el I-EXPLORATION sexo I-EXPLORATION fetal I-EXPLORATION con I-EXPLORATION 99% I-EXPLORATION de I-EXPLORATION certeza I-EXPLORATION después I-EXPLORATION de I-EXPLORATION 12+6 I-EXPLORATION semanas I-EXPLORATION EG I-EXPLORATION (Efrat, I-EXPLORATION 2006); I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION no I-EXPLORATION aceptó I-EXPLORATION técnicas I-EXPLORATION invasivas I-EXPLORATION de I-EXPLORATION diagnóstico I-EXPLORATION prenatal. I-EXPLORATION Se B-TREATMENT disminuyó I-TREATMENT progresivamente I-TREATMENT las I-TREATMENT dosis I-TREATMENT de I-TREATMENT esteroides, I-TREATMENT suspendiéndolo I-TREATMENT en I-TREATMENT forma I-TREATMENT completa I-TREATMENT a I-TREATMENT las I-TREATMENT 22 I-TREATMENT semanas. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION período I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION edema I-EVOLUTION e I-EVOLUTION hipertensión I-EVOLUTION arterial I-EVOLUTION que B-TREATMENT requirió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ametildo-pa. I-TREATMENT Los B-EVOLUTION síntomas I-EVOLUTION revirtieron I-EVOLUTION parcialmente I-EVOLUTION con I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION de I-EVOLUTION terapia I-EVOLUTION corticoidal, I-EVOLUTION y I-EVOLUTION totalmente I-EVOLUTION posparto. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 39 I-EVOLUTION semanas I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION cesárea I-EVOLUTION y I-EVOLUTION se I-EVOLUTION obtuvo I-EVOLUTION recién I-EVOLUTION nacido I-EVOLUTION de I-EVOLUTION sexo I-EVOLUTION masculino, I-EVOLUTION con I-EVOLUTION peso I-EVOLUTION adecuado I-EVOLUTION y I-EVOLUTION examen I-EVOLUTION físico I-EVOLUTION normal. I-EVOLUTION Los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION 170HP I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION se I-EVOLUTION muestran I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Figura I-EVOLUTION IB. I-EVOLUTION I-EVOLUTION La I-EVOLUTION tía I-EVOLUTION materna I-EVOLUTION (sujeto I-EVOLUTION II.5) I-EVOLUTION de I-EVOLUTION 37 I-EVOLUTION años I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION embarazo I-EVOLUTION inicial I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION EG. I-EVOLUTION Se B-TREATMENT ofrece I-TREATMENT nuevamente I-TREATMENT tratamiento I-TREATMENT prenatal I-TREATMENT de I-TREATMENT HSC, I-TREATMENT y I-TREATMENT también I-TREATMENT se I-TREATMENT solicitó I-TREATMENT firma I-TREATMENT de I-TREATMENT consentimiento I-TREATMENT informado. I-TREATMENT La I-TREATMENT familia I-TREATMENT optó I-TREATMENT nuevamente I-TREATMENT por I-TREATMENT seguir I-TREATMENT este I-TREATMENT tratamiento. I-TREATMENT A I-TREATMENT las I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT EG I-TREATMENT se I-TREATMENT inició I-TREATMENT dexametasona I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 20 I-TREATMENT Lig/kg/día. I-TREATMENT La B-EXPLORATION madre I-EXPLORATION no I-EXPLORATION aceptó I-EXPLORATION las I-EXPLORATION técnicas I-EXPLORATION invasivas I-EXPLORATION de I-EXPLORATION diagnóstico I-EXPLORATION prenatal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sexo I-EXPLORATION fetal I-EXPLORATION mediante I-EXPLORATION ecografía I-EXPLORATION precoz. I-EXPLORATION En B-TREATMENT caso I-TREATMENT de I-TREATMENT que I-TREATMENT se I-TREATMENT tratara I-TREATMENT de I-TREATMENT un I-TREATMENT feto I-TREATMENT femenino I-TREATMENT continuarían I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT hasta I-TREATMENT el I-TREATMENT término I-TREATMENT del I-TREATMENT embarazo. I-TREATMENT A I-TREATMENT las I-TREATMENT 12 I-TREATMENT semanas I-TREATMENT se I-TREATMENT diagnosticó I-TREATMENT sexo I-TREATMENT fetal I-TREATMENT masculino I-TREATMENT y I-TREATMENT se I-TREATMENT programó I-TREATMENT suspensión I-TREATMENT de I-TREATMENT esteroides. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION efectos I-EVOLUTION adversos I-EVOLUTION a I-EVOLUTION la I-EVOLUTION dexametasona. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 40 I-EVOLUTION semanas I-EVOLUTION nació I-EVOLUTION niño I-EVOLUTION sano, I-EVOLUTION no I-EVOLUTION afectado. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad. I-PRESENT_ILLNESS Después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS varicela, I-PRESENT_ILLNESS inició I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS deglutir I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS evidencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipo I-PRESENT_ILLNESS o I-PRESENT_ILLNESS hipertiroidismo. I-PRESENT_ILLNESS Su I-PRESENT_ILLNESS velocidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS pondoestatural I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS año I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS normal I-PRESENT_ILLNESS (5 I-PRESENT_ILLNESS cm/año) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS su I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS ósea I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY previos. I-PAST_MEDICAL_HISTORY Recién I-PAST_MEDICAL_HISTORY nacido I-PAST_MEDICAL_HISTORY pretérmino I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 33 I-PAST_MEDICAL_HISTORY semanas; I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY periodo I-PAST_MEDICAL_HISTORY neonatal I-PAST_MEDICAL_HISTORY cursó I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY distress I-PAST_MEDICAL_HISTORY respiratorio; I-PAST_MEDICAL_HISTORY requirió I-PAST_MEDICAL_HISTORY ventilación I-PAST_MEDICAL_HISTORY mecánica I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY días. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY relevantes. I-PAST_MEDICAL_HISTORY Actualmente I-PAST_MEDICAL_HISTORY cursa I-PAST_MEDICAL_HISTORY sexto I-PAST_MEDICAL_HISTORY básico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buen I-PAST_MEDICAL_HISTORY rendimiento I-PAST_MEDICAL_HISTORY escolar. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Historia B-FAMILY_HISTORY familiar I-FAMILY_HISTORY Hijo I-FAMILY_HISTORY de I-FAMILY_HISTORY padres I-FAMILY_HISTORY sanos, I-FAMILY_HISTORY con I-FAMILY_HISTORY antecedente I-FAMILY_HISTORY de I-FAMILY_HISTORY tiroiditis I-FAMILY_HISTORY de I-FAMILY_HISTORY Hashimoto I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY abuelo I-FAMILY_HISTORY y I-FAMILY_HISTORY tía I-FAMILY_HISTORY materna. I-FAMILY_HISTORY Su I-FAMILY_HISTORY talla I-FAMILY_HISTORY familiar I-FAMILY_HISTORY es I-FAMILY_HISTORY de I-FAMILY_HISTORY l69±5 I-FAMILY_HISTORY cm I-FAMILY_HISTORY (percentil I-FAMILY_HISTORY 13, I-FAMILY_HISTORY 7). I-FAMILY_HISTORY I-FAMILY_HISTORY Examen B-EXPLORATION físico. I-EXPLORATION Talla: I-EXPLORATION 146, I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION (percentil I-EXPLORATION 54), I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION Masa I-EXPLORATION Corporal: I-EXPLORATION 18, I-EXPLORATION 2 I-EXPLORATION kg/m2 I-EXPLORATION (percentil I-EXPLORATION 62, I-EXPLORATION 5); I-EXPLORATION sin I-EXPLORATION desarrollo I-EXPLORATION puberal I-EXPLORATION (vello I-EXPLORATION púbico I-EXPLORATION Tanner I-EXPLORATION I, I-EXPLORATION testículos I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION ce, I-EXPLORATION simétricos). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION faringe, I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION rojiza I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2x2 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua, I-EXPLORATION con I-EXPLORATION vasos I-EXPLORATION venosos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION superficie, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION o I-EXPLORATION ulceración. I-EXPLORATION Sin I-EXPLORATION estridor I-EXPLORATION u I-EXPLORATION odinofagia. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION cuello I-EXPLORATION no I-EXPLORATION se I-EXPLORATION palpó I-EXPLORATION tiroides I-EXPLORATION en I-EXPLORATION la I-EXPLORATION posición I-EXPLORATION pre I-EXPLORATION traqueal. I-EXPLORATION I-EXPLORATION Laboratorio. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION tiroidea I-EXPLORATION revelaron I-EXPLORATION TSH I-EXPLORATION elevada I-EXPLORATION 10, I-EXPLORATION 79 I-EXPLORATION UI/mL I-EXPLORATION (rango I-EXPLORATION normal I-EXPLORATION =0, I-EXPLORATION 7-5, I-EXPLORATION 7 I-EXPLORATION UI/mL), I-EXPLORATION con I-EXPLORATION tiroxina I-EXPLORATION normal, I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION su I-EXPLORATION cuartil I-EXPLORATION más I-EXPLORATION bajo, I-EXPLORATION 6, I-EXPLORATION 0 I-EXPLORATION Lig/dl I-EXPLORATION (rango I-EXPLORATION normal I-EXPLORATION TT I-EXPLORATION =5, I-EXPLORATION 5-11, I-EXPLORATION 7 I-EXPLORATION Hg/dl) I-EXPLORATION y I-EXPLORATION triyodotironina I-EXPLORATION baja I-EXPLORATION 57, I-EXPLORATION 8 I-EXPLORATION ng/dL I-EXPLORATION (rango I-EXPLORATION normal I-EXPLORATION =84, I-EXPLORATION 4-214, I-EXPLORATION 3 I-EXPLORATION ng/dL) I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antiperoxidasa I-EXPLORATION y I-EXPLORATION antiroglobulina I-EXPLORATION ausentes. I-EXPLORATION I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION imágenes. I-EXPLORATION La I-EXPLORATION nasofibrolaringoscopia I-EXPLORATION óptica I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION rojiza, I-EXPLORATION tensa, I-EXPLORATION redondeada, I-EXPLORATION con I-EXPLORATION vasos I-EXPLORATION sanguíneos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION cuello I-EXPLORATION confirmó I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION bien I-EXPLORATION circunscrita I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua, I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 0 I-EXPLORATION x I-EXPLORATION 1, I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 1, I-EXPLORATION 8 I-EXPLORATION cm, I-EXPLORATION hiperdensa I-EXPLORATION en I-EXPLORATION los I-EXPLORATION cortes I-EXPLORATION sin I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION endovenoso, I-EXPLORATION sin I-EXPLORATION nodulos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION cinügrafía I-EXPLORATION con I-EXPLORATION Tc-99 I-EXPLORATION mostró I-EXPLORATION captación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION tiroides I-EXPLORATION en I-EXPLORATION su I-EXPLORATION localización I-EXPLORATION normal, I-EXPLORATION concordante I-EXPLORATION con I-EXPLORATION una I-EXPLORATION ectopia I-EXPLORATION lingual I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION tiroides. I-EXPLORATION I-EXPLORATION Seguimiento. B-TREATMENT Después I-TREATMENT que I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT fue I-TREATMENT realizado, I-TREATMENT el I-TREATMENT paciente I-TREATMENT inició I-TREATMENT L-Tiroxina I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 75 I-TREATMENT \ig/día. I-TREATMENT Al B-EVOLUTION mes I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION la I-EVOLUTION TSH I-EVOLUTION estaba I-EVOLUTION suprimida I-EVOLUTION (0, I-EVOLUTION 11 I-EVOLUTION UI/mL) I-EVOLUTION con I-EVOLUTION tiroxina I-EVOLUTION libre I-EVOLUTION normal I-EVOLUTION alta I-EVOLUTION 1, I-EVOLUTION 93 I-EVOLUTION ng/dL I-EVOLUTION (0,8-2,0). I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION gradual I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tiroides I-EXPLORATION lingual I-EXPLORATION y I-EXPLORATION desaparición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION disfagia. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY DM I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY actual I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY esquema I-PAST_MEDICAL_HISTORY insulínico I-PAST_MEDICAL_HISTORY intensivo I-PAST_MEDICAL_HISTORY (una I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY nocturna I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY insulina I-PAST_MEDICAL_HISTORY glargina I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insulina I-PAST_MEDICAL_HISTORY lispro I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY comidas). I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY gran I-PAST_MEDICAL_HISTORY tabaquismo, I-PAST_MEDICAL_HISTORY dislipidemia I-PAST_MEDICAL_HISTORY mixta I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY irregular I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ciprofibrato I-PAST_MEDICAL_HISTORY 100 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY microalbuminuria I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg/12 I-PAST_MEDICAL_HISTORY h, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg/día. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS por I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuantificada, I-PRESENT_ILLNESS calofríos, I-PRESENT_ILLNESS odinofagia, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS alimentarios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Se B-EXPLORATION constató I-EXPLORATION deshidratación I-EXPLORATION moderada, I-EXPLORATION temperatura I-EXPLORATION axilar I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 8°C I-EXPLORATION y I-EXPLORATION glicemia I-EXPLORATION capilar I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 400 I-EXPLORATION mg/dl. I-EXPLORATION Fue B-TREATMENT internado, I-TREATMENT recibiendo I-TREATMENT solución I-TREATMENT fisiológica I-TREATMENT e I-TREATMENT insulina I-TREATMENT cristalina I-TREATMENT en I-TREATMENT esquema I-TREATMENT de I-TREATMENT minidosis. I-TREATMENT Entre B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION obtenidos I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION destacaban I-EXPLORATION glicemia I-EXPLORATION 549 I-EXPLORATION mg/dl, I-EXPLORATION creatinina I-EXPLORATION 1, I-EXPLORATION 67 I-EXPLORATION mg/dl, I-EXPLORATION pH I-EXPLORATION 6, I-EXPLORATION 91, I-EXPLORATION BE I-EXPLORATION -27, I-EXPLORATION HC03 I-EXPLORATION 4, I-EXPLORATION 6 I-EXPLORATION (en I-EXPLORATION sangre I-EXPLORATION arterial), I-EXPLORATION cetonemia I-EXPLORATION +++, I-EXPLORATION natremia I-EXPLORATION 141, I-EXPLORATION 7 I-EXPLORATION mEq/L, I-EXPLORATION kalemia I-EXPLORATION 5, I-EXPLORATION 92 I-EXPLORATION mEq/L, I-EXPLORATION cloremia I-EXPLORATION 98 I-EXPLORATION mEq/L, I-EXPLORATION amilasemia I-EXPLORATION 48 I-EXPLORATION U/L, I-EXPLORATION hematocrito I-EXPLORATION 40, I-EXPLORATION 5%, I-EXPLORATION leucocitos I-EXPLORATION 9-100 I-EXPLORATION mm3, I-EXPLORATION VHS I-EXPLORATION 38 I-EXPLORATION mm/h I-EXPLORATION y I-EXPLORATION urocultivo I-EXPLORATION negativo. I-EXPLORATION Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION cetoacidosis I-EVOLUTION diabética, I-EVOLUTION se B-TREATMENT le I-TREATMENT indicó I-TREATMENT mantener I-TREATMENT el I-TREATMENT esquema I-TREATMENT insulínico I-TREATMENT intensificado I-TREATMENT y I-TREATMENT asistir I-TREATMENT a I-TREATMENT control I-TREATMENT ambulatorio. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION trasladó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION ciudad I-EVOLUTION de I-EVOLUTION Temuco, I-EVOLUTION consultando I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION por I-EVOLUTION sensación I-EVOLUTION febril I-EVOLUTION no I-EVOLUTION cuantificada, I-EVOLUTION sudoración I-EVOLUTION nocturna, I-EVOLUTION odinofagia I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION al I-EVOLUTION movilizar I-EVOLUTION el I-EVOLUTION cuello. I-EVOLUTION Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION cuello, I-EXPLORATION sensible, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios I-EXPLORATION ni I-EXPLORATION crepitación, I-EXPLORATION fetor I-EXPLORATION pútrido I-EXPLORATION y I-EXPLORATION faringe I-EXPLORATION congestiva I-EXPLORATION con I-EXPLORATION escaso I-EXPLORATION exudado I-EXPLORATION purulento. I-EXPLORATION Se B-EVOLUTION indicó I-EVOLUTION hospitalización I-EVOLUTION con I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION DM I-EVOLUTION descompensada, I-EVOLUTION faringo-amigdalitis I-EVOLUTION pultácea I-EVOLUTION y I-EVOLUTION masa I-EVOLUTION cervical I-EVOLUTION en I-EVOLUTION estudio. I-EVOLUTION Entre B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION destacaban I-EXPLORATION glicemia I-EXPLORATION 270 I-EXPLORATION mg/dl, I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION mg/ I-EXPLORATION di, I-EXPLORATION hematocrito I-EXPLORATION 35, I-EXPLORATION 7%, I-EXPLORATION leucocitos I-EXPLORATION 18.800 I-EXPLORATION por I-EXPLORATION mm3, I-EXPLORATION VHS I-EXPLORATION 91 I-EXPLORATION mm/hora, I-EXPLORATION PCR I-EXPLORATION 309 I-EXPLORATION mg/L. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT hidratación I-TREATMENT con I-TREATMENT solución I-TREATMENT fisiológica I-TREATMENT e I-TREATMENT infusión I-TREATMENT endovenosa I-TREATMENT continua I-TREATMENT de I-TREATMENT insulina, I-TREATMENT fue B-EXPLORATION evaluado I-EXPLORATION por I-EXPLORATION otorrinolaringólogo I-EXPLORATION con I-EXPLORATION nasofaringoscopia, I-EXPLORATION pesquisándose I-EXPLORATION flegmón I-EXPLORATION faríngeo. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT terapia I-TREATMENT con I-TREATMENT penicilina I-TREATMENT sódica I-TREATMENT EV I-TREATMENT 20 I-TREATMENT millones I-TREATMENT U/día, I-TREATMENT cloxacilina I-TREATMENT 12 I-TREATMENT g I-TREATMENT EV/ I-TREATMENT día I-TREATMENT y I-TREATMENT ceftriaxona I-TREATMENT 2 I-TREATMENT g I-TREATMENT EV/día. I-TREATMENT El B-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION cervical I-EXPLORATION fue I-EXPLORATION estudiado I-EXPLORATION con I-EXPLORATION ecotomografía I-EXPLORATION cervical, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION en I-EXPLORATION el I-EXPLORATION compartimiento I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION multicorte I-EXPLORATION de I-EXPLORATION cuello I-EXPLORATION en I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION retrofa-ríngeo I-EXPLORATION y I-EXPLORATION de I-EXPLORATION los I-EXPLORATION compartimientos I-EXPLORATION posteriores I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION flegmonoso. I-EXPLORATION I-EXPLORATION Evaluado B-TREATMENT en I-TREATMENT conjunto I-TREATMENT con I-TREATMENT otorrinolaringólogo I-TREATMENT y I-TREATMENT cirujano I-TREATMENT de I-TREATMENT cabeza I-TREATMENT y I-TREATMENT cuello, I-TREATMENT se I-TREATMENT decidió I-TREATMENT practicar I-TREATMENT drenaje I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT la I-TREATMENT colección. I-TREATMENT Al I-TREATMENT segundo I-TREATMENT día I-TREATMENT de I-TREATMENT hospitalización I-TREATMENT se I-TREATMENT realizaron I-TREATMENT 2 I-TREATMENT incisiones I-TREATMENT en I-TREATMENT la I-TREATMENT región I-TREATMENT posterior I-TREATMENT del I-TREATMENT cuello, I-TREATMENT drenando I-TREATMENT líquido I-TREATMENT purulento. I-TREATMENT No B-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION o I-EXPLORATION gas. I-EXPLORATION Se I-EXPLORATION obtuvo I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION secreción, I-EXPLORATION aislándose I-EXPLORATION Streptococcus I-EXPLORATION grupo I-EXPLORATION B, I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Luego B-TREATMENT de I-TREATMENT una I-TREATMENT semana I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT EV, I-TREATMENT los I-TREATMENT drenajes I-TREATMENT Penrose I-TREATMENT dejaron I-TREATMENT de I-TREATMENT entregar I-TREATMENT secreción I-TREATMENT y I-TREATMENT fueron I-TREATMENT retirados. I-TREATMENT La B-EVOLUTION exploración I-EVOLUTION de I-EVOLUTION las I-EVOLUTION incisiones I-EVOLUTION fue I-EVOLUTION satisfactoria. I-EVOLUTION Se B-TREATMENT dio I-TREATMENT de I-TREATMENT alta I-TREATMENT con I-TREATMENT antibiótico I-TREATMENT oral I-TREATMENT hasta I-TREATMENT completar I-TREATMENT otra I-TREATMENT semana I-TREATMENT (Ampicilina/Sulbactam). I-TREATMENT I-TREATMENT Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY (20 I-PAST_MEDICAL_HISTORY cig/día) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY urolitiasis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 27 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS súbito, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS irradiación, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómito I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS ocasión I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cede I-PRESENT_ILLNESS espontáneamente. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS se I-PRESENT_ILLNESS repitió I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS después, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS similares I-PRESENT_ILLNESS características I-PRESENT_ILLNESS al I-PRESENT_ILLNESS anterior. I-PRESENT_ILLNESS I-PRESENT_ILLNESS No B-EXPLORATION presentó I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 140/82 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION ilíaca I-EXPLORATION derecha I-EXPLORATION (FID). I-EXPLORATION I-EXPLORATION Dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION orina I-EXPLORATION completa I-EXPLORATION sin I-EXPLORATION hematuria, I-EXPLORATION hemogra-ma I-EXPLORATION con I-EXPLORATION leucocitosis I-EXPLORATION (17.200 I-EXPLORATION x I-EXPLORATION mm3), I-EXPLORATION creatininemia I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION de I-EXPLORATION 1.457 I-EXPLORATION UI/1. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION pieloTC I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION ser I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION urolitiasis, I-EXPLORATION prosiguiéndose I-EXPLORATION con I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION extensa I-EXPLORATION área I-EXPLORATION hipodensa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION cuneiforme I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION derecho, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION infarto I-EXPLORATION parcial I-EXPLORATION renal I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Se B-EVOLUTION hospitalizó I-EVOLUTION al I-EVOLUTION paciente. I-EVOLUTION Se B-EXPLORATION tomaron I-EXPLORATION exámenes I-EXPLORATION para I-EXPLORATION trombofilia, I-EXPLORATION cuyos I-EXPLORATION resultados I-EXPLORATION fueron I-EXPLORATION normales, I-EXPLORATION previo I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION anticoagulación I-EXPLORATION (Fragmin I-EXPLORATION y I-EXPLORATION Neosintrón I-EXPLORATION ). I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecocardiografía I-EXPLORATION transesofágica I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION un I-EXPLORATION angioTC I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION arteria I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION dominante I-EXPLORATION (AD) I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION polar I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION calibre I-EXPLORATION con I-EXPLORATION trayecto I-EXPLORATION normal, I-EXPLORATION e I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION arterial I-EXPLORATION con I-EXPLORATION infarto I-EXPLORATION renal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION prosiguió I-EXPLORATION con I-EXPLORATION estudio I-EXPLORATION angiográfico, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION aortografía I-EXPLORATION normal, I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION perfusión I-EXPLORATION del I-EXPLORATION polo I-EXPLORATION superior, I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION riñon I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION perfusión I-EXPLORATION del I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION dado I-EXPLORATION por I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION polar I-EXPLORATION secundaria. I-EXPLORATION La I-EXPLORATION arteria I-EXPLORATION renal I-EXPLORATION dominante I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION irregular, I-EXPLORATION dilatada I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION su I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION que I-EXPLORATION además I-EXPLORATION presentó I-EXPLORATION un I-EXPLORATION flap I-EXPLORATION de I-EXPLORATION disección I-EXPLORATION que I-EXPLORATION comprometió I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION de I-EXPLORATION las I-EXPLORATION ramas I-EXPLORATION interlobares, I-EXPLORATION limitando I-EXPLORATION así I-EXPLORATION el I-EXPLORATION flujo I-EXPLORATION distal. I-EXPLORATION El I-EXPLORATION flap I-EXPLORATION de I-EXPLORATION disección I-EXPLORATION fue I-EXPLORATION descrito I-EXPLORATION como I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION complejidad I-EXPLORATION sin I-EXPLORATION posibilidades I-EXPLORATION de I-EXPLORATION maniobras I-EXPLORATION endovasculares. I-EXPLORATION I-EXPLORATION Dos B-EVOLUTION días I-EVOLUTION después I-EVOLUTION presentó I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION flanco I-EVOLUTION derecho. I-EVOLUTION Nuevo B-EXPLORATION angioTC I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION clara I-EXPLORATION progresión I-EXPLORATION del I-EXPLORATION infarto I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION los I-EXPLORATION 2/3 I-EXPLORATION superiores I-EXPLORATION del I-EXPLORATION riñon I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION presiones I-EVOLUTION arteriales I-EVOLUTION en I-EVOLUTION el I-EVOLUTION rango I-EVOLUTION de I-EVOLUTION 160/100 I-EVOLUTION mmHg I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION deterioro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION (creatininemia I-EVOLUTION 1, I-EVOLUTION 2 I-EVOLUTION mg/dl). I-EVOLUTION Fue B-TREATMENT dado I-TREATMENT de I-TREATMENT alta I-TREATMENT con I-TREATMENT terapia I-TREATMENT antihipertensiva I-TREATMENT (Blox I-TREATMENT 4 I-TREATMENT mg/día) I-TREATMENT en I-TREATMENT buenas I-TREATMENT condiciones I-TREATMENT generales I-TREATMENT para I-TREATMENT su I-TREATMENT manejo I-TREATMENT ambulatorio. I-TREATMENT En B-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION y I-EVOLUTION diecisiete I-EVOLUTION días I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION se I-EVOLUTION encontró I-EVOLUTION al I-EVOLUTION paciente I-EVOLUTION asintomático, I-EVOLUTION normotenso I-EVOLUTION y I-EVOLUTION con I-EVOLUTION el I-EVOLUTION resto I-EVOLUTION del I-EVOLUTION examen I-EVOLUTION físico I-EVOLUTION sin I-EVOLUTION hallazgos I-EVOLUTION patológicos. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 76 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS quien B-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY urgencia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1974 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY lesión I-PAST_MEDICAL_HISTORY ulcerada I-PAST_MEDICAL_HISTORY gástrica I-PAST_MEDICAL_HISTORY sangrante. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY practicó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY gastrectomía I-PAST_MEDICAL_HISTORY subtotal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY reconstrucción I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY Billroth I-PAST_MEDICAL_HISTORY II. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY postoperatoria I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY normal. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pieza I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gastrectomía I-PAST_MEDICAL_HISTORY subtotal I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontró I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY ulcerado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cara I-PAST_MEDICAL_HISTORY anterior, I-PAST_MEDICAL_HISTORY distante I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY mm I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY sección I-PAST_MEDICAL_HISTORY gástrica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY píloro. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY medía I-PAST_MEDICAL_HISTORY 3, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY eje I-PAST_MEDICAL_HISTORY longitudinal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY transversal, I-PAST_MEDICAL_HISTORY comprometiendo I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY curvatura I-PAST_MEDICAL_HISTORY menor I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY extendiéndose I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cara I-PAST_MEDICAL_HISTORY posterior. I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY corte, I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY constituido I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY tejido I-PAST_MEDICAL_HISTORY rosado I-PAST_MEDICAL_HISTORY pálido I-PAST_MEDICAL_HISTORY lobulado, I-PAST_MEDICAL_HISTORY liso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY brillante, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY reemplazaba I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY túnicas I-PAST_MEDICAL_HISTORY submucosa, I-PAST_MEDICAL_HISTORY muscular I-PAST_MEDICAL_HISTORY propia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY subserosa, I-PAST_MEDICAL_HISTORY abombando I-PAST_MEDICAL_HISTORY levemente I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY serosa. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY examen I-PAST_MEDICAL_HISTORY histopatológico I-PAST_MEDICAL_HISTORY demostró I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY linfoma I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY Hodgkin I-PAST_MEDICAL_HISTORY mixto I-PAST_MEDICAL_HISTORY linfo-histiocítico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY clasificación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Rappaport I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1966, I-PAST_MEDICAL_HISTORY vigente I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY formularon I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY clasificaciones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Kiel I-PAST_MEDICAL_HISTORY (1974) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Lukes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Collins I-PAST_MEDICAL_HISTORY (1974). I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontró I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY ganglios I-PAST_MEDICAL_HISTORY linfáticos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY linfoma. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY enfermo I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY radioterapia I-PAST_MEDICAL_HISTORY adyuvante I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY seguido I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY endoscopias I-PAST_MEDICAL_HISTORY anuales I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY 23 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY observaron I-PAST_MEDICAL_HISTORY nuevas I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY gástricas I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY demostró I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Helicobacter I-PAST_MEDICAL_HISTORY pylori. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY período, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY desarrolló I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY tumores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Warthin I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ambas I-PAST_MEDICAL_HISTORY glándulas I-PAST_MEDICAL_HISTORY parótidas, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY resecó I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY piel I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY epidermoide I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY extremidad I-PAST_MEDICAL_HISTORY inferior I-PAST_MEDICAL_HISTORY derecha. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS septiembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2006, I-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS operación I-PRESENT_ILLNESS gástrica, I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS anemia. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION palidez, I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION abdominales. I-EXPLORATION El I-EXPLORATION hematocrito I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 34, I-EXPLORATION 5% I-EXPLORATION y I-EXPLORATION una I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION proliferativa I-EXPLORATION y I-EXPLORATION ulcerada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION muñón I-EXPLORATION gástrico I-EXPLORATION que I-EXPLORATION obstruía I-EXPLORATION parcialmente I-EXPLORATION la I-EXPLORATION anastomosis I-EXPLORATION gastroyeyunal. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION mostró I-EXPLORATION que I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION gástrica I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION infiltrada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION tubular I-EXPLORATION moderadamente I-EXPLORATION diferenciado. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Helicobacter I-EXPLORATION pylori. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT operado I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT gastrectomía I-TREATMENT total I-TREATMENT con I-TREATMENT disección I-TREATMENT ganglionar. I-TREATMENT La B-EVOLUTION recuperación I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION normal. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION ulcerada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION muñón I-EXPLORATION gástrico I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anastomosis I-EXPLORATION gastroyeyunal. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION tubular I-EXPLORATION moderadamente I-EXPLORATION diferenciado I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION subserosa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION gástrica, I-EXPLORATION metástasis I-EXPLORATION en I-EXPLORATION 10 I-EXPLORATION linfonodos I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION resecados I-EXPLORATION y I-EXPLORATION permeaciones I-EXPLORATION vasculares I-EXPLORATION linfáticas I-EXPLORATION (T2bN2M0, I-EXPLORATION Etapa I-EXPLORATION IIIB). I-EXPLORATION I-EXPLORATION En B-PRESENT_ILLNESS septiembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2006 I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS Dento-Máxilo-Facial I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Universidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Chile, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS estudiante, B-PAST_MEDICAL_HISTORY derivada B-DERIVED_FROM/TO por I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Hematología I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO blanquecinas I-DERIVED_FROM/TO en I-DERIVED_FROM/TO mucosa I-DERIVED_FROM/TO bucal. I-DERIVED_FROM/TO I-DERIVED_FROM/TO La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY aplásica I-PAST_MEDICAL_HISTORY severa I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2005, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY atribuyó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY derivado I-PAST_MEDICAL_HISTORY fenotiacínico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY sometida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY médula I-PAST_MEDICAL_HISTORY ósea I-PAST_MEDICAL_HISTORY (TMO) I-PAST_MEDICAL_HISTORY alogénico. I-PAST_MEDICAL_HISTORY Presentó B-PRESENT_ILLNESS las I-PRESENT_ILLNESS primeras I-PRESENT_ILLNESS manifestaciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS EICH I-PRESENT_ILLNESS agudo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS predominante I-PRESENT_ILLNESS cutáneo I-PRESENT_ILLNESS el I-PRESENT_ILLNESS día I-PRESENT_ILLNESS +42, I-PRESENT_ILLNESS manifestado B-EXPLORATION como I-EXPLORATION lesión I-EXPLORATION máculo-pápulo I-EXPLORATION eritematosa I-EXPLORATION de I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION extremidades I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION EICH I-EXPLORATION agudo, I-EXPLORATION momento B-TREATMENT en I-TREATMENT que I-TREATMENT se I-TREATMENT administró I-TREATMENT asociación I-TREATMENT de I-TREATMENT corticoides I-TREATMENT (prednisona I-TREATMENT 20 I-TREATMENT mg/dia) I-TREATMENT con I-TREATMENT ciclosporina, I-TREATMENT reemplazándose I-TREATMENT luego I-TREATMENT la I-TREATMENT ciclosporina I-TREATMENT por I-TREATMENT tacrolimus, I-TREATMENT 3 I-TREATMENT mg/dia I-TREATMENT vía I-TREATMENT oral, I-TREATMENT debido I-TREATMENT a I-TREATMENT toxicidad I-TREATMENT neurológica I-TREATMENT de I-TREATMENT la I-TREATMENT primera. I-TREATMENT Las B-EVOLUTION lesiones I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mucosa I-EVOLUTION oral I-EVOLUTION aparecieron I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION más I-EVOLUTION tardía I-EVOLUTION y I-EVOLUTION su I-EVOLUTION primera I-EVOLUTION descripción I-EVOLUTION aparece I-EVOLUTION en I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION día I-EVOLUTION +310. I-EVOLUTION I-EVOLUTION En B-EXPLORATION el I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION clínico, I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION bucales I-EXPLORATION comprometían I-EXPLORATION casi I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION manifestaban I-EXPLORATION mayormente I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION labios, I-EXPLORATION cara I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION mejilla I-EXPLORATION y I-EXPLORATION cara I-EXPLORATION ventral I-EXPLORATION de I-EXPLORATION lengua. I-EXPLORATION Las I-EXPLORATION lesiones I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blanquecino, I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION reticular I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION desprendían I-EXPLORATION al I-EXPLORATION raspado. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refería I-EXPLORATION síntomas I-EXPLORATION asociados. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION hipótesis I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION oral I-EXPLORATION por I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION injerto I-EXPLORATION contra I-EXPLORATION huésped I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION realizar I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION cara I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION labio I-EXPLORATION inferior, I-EXPLORATION lugar I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION eran I-EXPLORATION manifiestas. I-EXPLORATION I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION histopatológico I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION EIVH. I-EXPLORATION Se I-EXPLORATION describió I-EXPLORATION un I-EXPLORATION epitelio I-EXPLORATION de I-EXPLORATION revestimiento I-EXPLORATION plano I-EXPLORATION pluriestratificado I-EXPLORATION hiperparaqueratinizado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION hiperplasia I-EXPLORATION agujiforme. I-EXPLORATION Un I-EXPLORATION estrato I-EXPLORATION basal I-EXPLORATION con I-EXPLORATION desorganización I-EXPLORATION celular I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION corion I-EXPLORATION inmediatamente I-EXPLORATION subyacente I-EXPLORATION infiltración I-EXPLORATION linfocitaria I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION neoformación I-EXPLORATION y I-EXPLORATION proliferación I-EXPLORATION fibroblástica. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION describió I-EXPLORATION leve I-EXPLORATION infiltrado I-EXPLORATION linfocitario I-EXPLORATION periductal I-EXPLORATION en I-EXPLORATION glándula I-EXPLORATION salival I-EXPLORATION menor I-EXPLORATION vecina. I-EXPLORATION I-EXPLORATION Se B-TREATMENT indicaron I-TREATMENT medidas I-TREATMENT locales I-TREATMENT para I-TREATMENT disminuir I-TREATMENT el I-TREATMENT riesgo I-TREATMENT de I-TREATMENT infecciones I-TREATMENT y I-TREATMENT mantener I-TREATMENT adecuada I-TREATMENT humectación I-TREATMENT del I-TREATMENT medio I-TREATMENT bucal; I-TREATMENT clorhexidina I-TREATMENT al I-TREATMENT 0, I-TREATMENT 12% I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT sustituto I-TREATMENT de I-TREATMENT saliva I-TREATMENT de I-TREATMENT uso I-TREATMENT diario, I-TREATMENT además I-TREATMENT de I-TREATMENT instrucción I-TREATMENT de I-TREATMENT higiene I-TREATMENT oral. I-TREATMENT I-TREATMENT Seis B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION controlada I-EVOLUTION manifestando I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION algunas I-EVOLUTION zonas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mucosa I-EVOLUTION bucal, I-EVOLUTION evidenciándose I-EVOLUTION lesiones I-EVOLUTION erosivas I-EVOLUTION en I-EVOLUTION el I-EVOLUTION examen I-EVOLUTION clínico. I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT incorporar I-TREATMENT en I-TREATMENT el I-TREATMENT esquema I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT local, I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT betametasona I-TREATMENT al I-TREATMENT 0, I-TREATMENT 1% I-TREATMENT en I-TREATMENT plastibase, I-TREATMENT reforzando I-TREATMENT las I-TREATMENT medidas I-TREATMENT de I-TREATMENT higiene I-TREATMENT bucal. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION permanecieron I-EVOLUTION y I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION aumentó, I-EVOLUTION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT cambió I-TREATMENT por I-TREATMENT tacrolimus I-TREATMENT 0, I-TREATMENT 1% I-TREATMENT en I-TREATMENT aplicación I-TREATMENT tópica I-TREATMENT 3 I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT agregándose I-TREATMENT además I-TREATMENT miconazol I-TREATMENT 2% I-TREATMENT (Daktarin I-TREATMENT Gel) I-TREATMENT de I-TREATMENT aplicación I-TREATMENT tópica, I-TREATMENT 3 I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT Además I-TREATMENT se I-TREATMENT sustituyó I-TREATMENT la I-TREATMENT clorhexidina I-TREATMENT al I-TREATMENT 0, I-TREATMENT 12% I-TREATMENT por I-TREATMENT una I-TREATMENT concentración I-TREATMENT más I-TREATMENT baja, I-TREATMENT 0, I-TREATMENT 05%, I-TREATMENT dado I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT le I-TREATMENT costaba I-TREATMENT tolerar I-TREATMENT la I-TREATMENT primera I-TREATMENT por I-TREATMENT provocarle I-TREATMENT ardor I-TREATMENT al I-TREATMENT momento I-TREATMENT de I-TREATMENT usarla. I-TREATMENT Después B-EVOLUTION de I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION remitieron I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentaba I-EVOLUTION dolor I-EVOLUTION ni I-EVOLUTION dificultades I-EVOLUTION para I-EVOLUTION alimentarse. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquista I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY paquetes/año, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY LNH I-PAST_MEDICAL_HISTORY sistémico I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY características I-PAST_MEDICAL_HISTORY clínicas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY SAA, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY variante I-PAST_MEDICAL_HISTORY disección I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aorta I-PAST_MEDICAL_HISTORY descendente. I-PAST_MEDICAL_HISTORY Se B-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS emergencias I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS del I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea. I-PRESENT_ILLNESS La B-EXPLORATION TAC I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION blando, I-EXPLORATION periaórtico, I-EXPLORATION tóraco-abdominal I-EXPLORATION y I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION adenopatías. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN). I-EXPLORATION Se I-EXPLORATION internó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Unidad I-EXPLORATION de I-EXPLORATION Cuidados I-EXPLORATION Intensivos, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION transesofágico I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION disección I-EXPLORATION aórtica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION toracocentesis, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aspiraron I-EXPLORATION cerca I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION litros I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION hemorrágico, I-EXPLORATION cuya I-EXPLORATION citología I-EXPLORATION reveló I-EXPLORATION células I-EXPLORATION malignas I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION LNH. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION mostró I-EXPLORATION linfoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION pequeñas, I-EXPLORATION fenotipo I-EXPLORATION B. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION laparotomía I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION periaórtica I-EXPLORATION mostró I-EXPLORATION LNH I-EXPLORATION folicular I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION con I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION arribó I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION LP. I-EXPLORATION I-EXPLORATION La B-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT CHOP-R I-TREATMENT fue I-TREATMENT efectiva, I-TREATMENT con I-TREATMENT resolución I-TREATMENT inicial I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT objetivado I-TREATMENT por I-TREATMENT TAC, I-TREATMENT pero B-EVOLUTION desarrolló I-EVOLUTION luego I-EVOLUTION quilotórax, I-EVOLUTION malnutrición I-EVOLUTION y I-EVOLUTION falleció. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY o B-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia. I-FAMILY_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS septiembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS afebril, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tránsito I-PRESENT_ILLNESS intestinal. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION concluyente I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION e I-EXPLORATION imágenes. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION análisis I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 2 I-EXPLORATION mg/dL, I-EXPLORATION leucocitos I-EXPLORATION 8.080/mm3 I-EXPLORATION con I-EXPLORATION 67, I-EXPLORATION 8% I-EXPLORATION de I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION amilasemia I-EXPLORATION normal. I-EXPLORATION Una I-EXPLORATION ecotomografía I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION sólido-quística I-EXPLORATION compleja I-EXPLORATION de I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION izquierdo I-EXPLORATION del I-EXPLORATION hígado. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION probable I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION y I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION focal I-EXPLORATION hepática I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION absceso. I-EXPLORATION Se B-TREATMENT efectuó I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT biopsia I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT hepática. I-TREATMENT No I-TREATMENT se I-TREATMENT identifican I-TREATMENT otras I-TREATMENT lesiones I-TREATMENT abdominales I-TREATMENT durante I-TREATMENT la I-TREATMENT exploración I-TREATMENT quirúrgica. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION metástasis I-EXPLORATION hepática I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION neuroendocrino I-EXPLORATION con I-EXPLORATION inmunohistoquímica I-EXPLORATION concordante. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION PET/CT I-EXPLORATION con I-EXPLORATION 18FDG I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION entero I-EXPLORATION el I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION sólo I-EXPLORATION captación I-EXPLORATION fisiológica I-EXPLORATION en I-EXPLORATION diversos I-EXPLORATION órganos I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION significativo I-EXPLORATION del I-EXPLORATION metabolismo I-EXPLORATION glucídico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION izquierdo I-EXPLORATION del I-EXPLORATION hígado I-EXPLORATION en I-EXPLORATION comparación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION hepático. I-EXPLORATION Una I-EXPLORATION colonoscopia I-EXPLORATION en I-EXPLORATION búsqueda I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION origen I-EXPLORATION fue I-EXPLORATION catalogada I-EXPLORATION como I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Tres I-EXPLORATION meses I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION PET/CT I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION nuevo I-EXPLORATION radiofármaco I-EXPLORATION 68Ga-DOTATATE I-EXPLORATION (CGM I-EXPLORATION Nuclear, I-EXPLORATION Santiago-Chile) I-EXPLORATION recientemente I-EXPLORATION incorporado I-EXPLORATION a I-EXPLORATION nuestro I-EXPLORATION centro. I-EXPLORATION El I-EXPLORATION control I-EXPLORATION de I-EXPLORATION calidad I-EXPLORATION del I-EXPLORATION producto I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION pureza I-EXPLORATION radioquímica I-EXPLORATION superior I-EXPLORATION al I-EXPLORATION 99%. I-EXPLORATION Se I-EXPLORATION inyectaron I-EXPLORATION por I-EXPLORATION vía I-EXPLORATION e.v. I-EXPLORATION 111 I-EXPLORATION MBq I-EXPLORATION (3 I-EXPLORATION mCi) I-EXPLORATION del I-EXPLORATION radiotrazador. I-EXPLORATION Cincuenta I-EXPLORATION minutos I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION se I-EXPLORATION registraron I-EXPLORATION imágenes I-EXPLORATION PET/ I-EXPLORATION CT I-EXPLORATION 3D I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION entero I-EXPLORATION en I-EXPLORATION un I-EXPLORATION aparato I-EXPLORATION Biograph I-EXPLORATION 6 I-EXPLORATION HiRez I-EXPLORATION P3D I-EXPLORATION (Siemens I-EXPLORATION Medical I-EXPLORATION Systems, I-EXPLORATION USA). I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION mostró, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intensa I-EXPLORATION captación I-EXPLORATION del I-EXPLORATION radiofármaco I-EXPLORATION en I-EXPLORATION la I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION un I-EXPLORATION segundo I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION sobreexpresión I-EXPLORATION de I-EXPLORATION receptores I-EXPLORATION de I-EXPLORATION SST I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION un I-EXPLORATION asa I-EXPLORATION de I-EXPLORATION íleon I-EXPLORATION distal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION ileocecal I-EXPLORATION altamente I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION corresponder I-EXPLORATION al I-EXPLORATION tumor I-EXPLORATION primario. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION otros I-EXPLORATION focos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT nueva I-TREATMENT cirugía I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT subcostal I-TREATMENT identificándose I-TREATMENT un I-TREATMENT nodulo I-TREATMENT de I-TREATMENT 16 I-TREATMENT mm I-TREATMENT en I-TREATMENT el I-TREATMENT íleon I-TREATMENT terminal, I-TREATMENT vecino I-TREATMENT a I-TREATMENT la I-TREATMENT válvula I-TREATMENT ileocecal, I-TREATMENT sin I-TREATMENT extensión I-TREATMENT regional I-TREATMENT macroscópica. I-TREATMENT Se I-TREATMENT efectúa I-TREATMENT resección I-TREATMENT del I-TREATMENT íleon I-TREATMENT terminal, I-TREATMENT ciego I-TREATMENT y I-TREATMENT apéndice I-TREATMENT cecal I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT subcostal I-TREATMENT ampliada. I-TREATMENT En I-TREATMENT el I-TREATMENT mismo I-TREATMENT acto I-TREATMENT se I-TREATMENT extirpa I-TREATMENT la I-TREATMENT metástasis I-TREATMENT hepática I-TREATMENT mediante I-TREATMENT hepatectomía I-TREATMENT izquierda. I-TREATMENT Como I-TREATMENT hallazgos I-TREATMENT intraoperatorio I-TREATMENT se I-TREATMENT identifica I-TREATMENT una I-TREATMENT segunda I-TREATMENT metástasis I-TREATMENT de I-TREATMENT 8 I-TREATMENT mm I-TREATMENT del I-TREATMENT segmento I-TREATMENT VII I-TREATMENT del I-TREATMENT hígado I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT reseca I-TREATMENT en I-TREATMENT cuña. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION del I-EXPLORATION íleon I-EXPLORATION terminal I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION mm I-EXPLORATION que I-EXPLORATION infiltraba I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION y I-EXPLORATION con I-EXPLORATION penetración I-EXPLORATION linfovascular, I-EXPLORATION 6 I-EXPLORATION linfonodos I-EXPLORATION regionales I-EXPLORATION sin I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION metástasis I-EXPLORATION hepáticas I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION de I-EXPLORATION también I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado, I-EXPLORATION la I-EXPLORATION ya I-EXPLORATION conocida I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION cm. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sana, I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS previas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS ictericia, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS progresivo. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION hubo I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION transaminasas, I-EXPLORATION gamaglutamiltranspeptidasas, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION INR I-EXPLORATION y I-EXPLORATION disfunción I-EXPLORATION renal. I-EXPLORATION No B-PAST_MEDICAL_HISTORY hubo I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fármacos I-PAST_MEDICAL_HISTORY y B-EXPLORATION los I-EXPLORATION marcadores I-EXPLORATION virales I-EXPLORATION e I-EXPLORATION inmunológicos I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION exceptuando, I-EXPLORATION un I-EXPLORATION título I-EXPLORATION de I-EXPLORATION intensidad I-EXPLORATION menor I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION A. I-EXPLORATION Evolucionó B-TREATMENT rápidamente I-TREATMENT a I-TREATMENT sopor I-TREATMENT profundo, I-TREATMENT requirió I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasiva I-TREATMENT y B-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION encéfalo I-EXPLORATION (TC) I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION edema I-EXPLORATION encefálico I-EXPLORATION con I-EXPLORATION elementos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION HIC. I-EXPLORATION La I-EXPLORATION monitorización I-EXPLORATION electroencefalográfica I-EXPLORATION mostró I-EXPLORATION ritmos I-EXPLORATION lentos I-EXPLORATION y I-EXPLORATION simétricos I-EXPLORATION bilaterales. I-EXPLORATION El I-EXPLORATION INR I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 0 I-EXPLORATION se I-EXPLORATION corrigió I-EXPLORATION a I-EXPLORATION 1, I-EXPLORATION 6 I-EXPLORATION con I-EXPLORATION 40 I-EXPLORATION ug/kg I-EXPLORATION de I-EXPLORATION Factor I-EXPLORATION VII I-EXPLORATION activado I-EXPLORATION recombinante I-EXPLORATION (rFVIIa) I-EXPLORATION previo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION instalación I-EXPLORATION de I-EXPLORATION catéter I-EXPLORATION intraparenquimatoso I-EXPLORATION Raudemic® I-EXPLORATION para I-EXPLORATION medición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION intracraneana I-EXPLORATION (PIC) I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION encefálica. I-EXPLORATION Los I-EXPLORATION valores I-EXPLORATION iniciales I-EXPLORATION de I-EXPLORATION PIC I-EXPLORATION fluctuaron I-EXPLORATION entre I-EXPLORATION 20 I-EXPLORATION y I-EXPLORATION 25 I-EXPLORATION mmHg, I-EXPLORATION con I-EXPLORATION temperatura I-EXPLORATION cerebral I-EXPLORATION de I-EXPLORATION 37°C. I-EXPLORATION El I-EXPLORATION Doppler I-EXPLORATION transcraneano I-EXPLORATION determinó I-EXPLORATION velocidad I-EXPLORATION sistólica I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION pulsatibilidad I-EXPLORATION normales; I-EXPLORATION siendo I-EXPLORATION enlistada I-EXPLORATION para I-EXPLORATION trasplante I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION del I-EXPLORATION King's I-EXPLORATION College8. I-EXPLORATION I-EXPLORATION La B-TREATMENT HIC I-TREATMENT se I-TREATMENT tornó I-TREATMENT refractaria I-TREATMENT a I-TREATMENT medidas I-TREATMENT de I-TREATMENT primera I-TREATMENT línea, I-TREATMENT iniciándose I-TREATMENT hipotermia I-TREATMENT intravascular I-TREATMENT mediante I-TREATMENT catéter I-TREATMENT tipo I-TREATMENT ICY® I-TREATMENT vía I-TREATMENT femoral I-TREATMENT con I-TREATMENT máquina I-TREATMENT Alsius I-TREATMENT CoolGard®, I-TREATMENT disminuyendo I-TREATMENT la I-TREATMENT temperatura I-TREATMENT encefálica I-TREATMENT a I-TREATMENT 33oC. I-TREATMENT Recibió I-TREATMENT sedación I-TREATMENT con I-TREATMENT opiáceos I-TREATMENT (Fentanyl) I-TREATMENT e I-TREATMENT infusión I-TREATMENT continua I-TREATMENT de I-TREATMENT relajante I-TREATMENT muscular I-TREATMENT (vecuronium) I-TREATMENT para I-TREATMENT prevenir I-TREATMENT escalofríos; I-TREATMENT en B-EVOLUTION 3, I-EVOLUTION 5 I-EVOLUTION h I-EVOLUTION se I-EVOLUTION logró I-EVOLUTION la I-EVOLUTION meta I-EVOLUTION de I-EVOLUTION 33oC. I-EVOLUTION A B-TREATMENT las I-TREATMENT 72 I-TREATMENT h, I-TREATMENT se I-TREATMENT le I-TREATMENT ofreció I-TREATMENT un I-TREATMENT injerto I-TREATMENT hepático I-TREATMENT de I-TREATMENT donante I-TREATMENT cadavérico I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT trasplante I-TREATMENT ortotópico I-TREATMENT bajo I-TREATMENT hipotermia I-TREATMENT intravascular I-TREATMENT activa. I-TREATMENT Posteriormente B-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos, I-EVOLUTION y I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION comprobar I-EVOLUTION la I-EVOLUTION perfusión I-EVOLUTION del I-EVOLUTION injerto, I-EVOLUTION se I-EVOLUTION reinició I-EVOLUTION recalentamiento I-EVOLUTION lento I-EVOLUTION controlado I-EVOLUTION alcanzando I-EVOLUTION la I-EVOLUTION normotermia I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 76 I-EVOLUTION h I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION continua I-EVOLUTION en I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION función I-EVOLUTION hepática, I-EVOLUTION completando I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION manera I-EVOLUTION 122 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION hipotermia I-EVOLUTION a I-EVOLUTION 33oC. I-EVOLUTION Desarrolló I-EVOLUTION mioneuropatía I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION crítico I-EVOLUTION y I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION ventilación I-EVOLUTION mecánica I-EVOLUTION durante I-EVOLUTION 15 I-EVOLUTION días, I-EVOLUTION requiriendo B-TREATMENT de I-TREATMENT traqueostomía I-TREATMENT percutánea I-TREATMENT para I-TREATMENT facilitar I-TREATMENT el I-TREATMENT destete I-TREATMENT del I-TREATMENT ventilador I-TREATMENT mecánico. I-TREATMENT I-TREATMENT Luego I-TREATMENT de I-TREATMENT un I-TREATMENT despertar I-TREATMENT lento, I-TREATMENT se I-TREATMENT retiró I-TREATMENT la I-TREATMENT cánula I-TREATMENT de I-TREATMENT traqueostomía I-TREATMENT al I-TREATMENT día I-TREATMENT 37. I-TREATMENT Recibió B-EVOLUTION el I-EVOLUTION alta I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION 69 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION nutritivas, I-EVOLUTION neurológicas I-EVOLUTION y I-EVOLUTION ligada I-EVOLUTION a I-EVOLUTION un I-EVOLUTION programa I-EVOLUTION de I-EVOLUTION rehabilitación I-EVOLUTION física. I-EVOLUTION Actualmente I-EVOLUTION asiste I-EVOLUTION a I-EVOLUTION sus I-EVOLUTION estudios I-EVOLUTION secundarios I-EVOLUTION y I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION en I-EVOLUTION control I-EVOLUTION ambulatorio. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS obesa B-PAST_MEDICAL_HISTORY mórbida I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertensa, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS agosto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS asoció I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rápido I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ortopnea. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION mostró I-EXPLORATION bocio I-EXPLORATION con I-EXPLORATION nodulo I-EXPLORATION sólido I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION (4, I-EXPLORATION 3 I-EXPLORATION x I-EXPLORATION 5, I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 4, I-EXPLORATION 5 I-EXPLORATION cm), I-EXPLORATION hipoecogénico, I-EXPLORATION escasamente I-EXPLORATION vascularizado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION adenopatías I-EXPLORATION cervicales I-EXPLORATION bilaterales I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION reactivo. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION destacó I-EXPLORATION TSH I-EXPLORATION elevada I-EXPLORATION y I-EXPLORATION T4 I-EXPLORATION disminuida. I-EXPLORATION Se B-TREATMENT sospechó I-TREATMENT cáncer I-TREATMENT de I-TREATMENT tiroides, I-TREATMENT inició I-TREATMENT levotiroxina I-TREATMENT y I-TREATMENT se I-TREATMENT programó I-TREATMENT resección I-TREATMENT quirúrgica. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT se I-TREATMENT seccionaron I-TREATMENT los I-TREATMENT músculos I-TREATMENT pretiroideos I-TREATMENT izquierdos I-TREATMENT para I-TREATMENT facilitar I-TREATMENT la I-TREATMENT exploración, I-TREATMENT los I-TREATMENT que I-TREATMENT estaban I-TREATMENT adheridos I-TREATMENT a I-TREATMENT la I-TREATMENT lesión. I-TREATMENT El I-TREATMENT gran I-TREATMENT nodulo I-TREATMENT blanquecino I-TREATMENT se I-TREATMENT proyectaba I-TREATMENT hacia I-TREATMENT esófago I-TREATMENT cervical. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT tiroidectomía I-TREATMENT total. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION rápida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION informó I-EXPLORATION proliferación I-EXPLORATION linfoide I-EXPLORATION atípica I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION linfoma. I-EXPLORATION I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION hipocalcemia I-EVOLUTION sintomática I-EVOLUTION de I-EVOLUTION 7, I-EVOLUTION 6 I-EVOLUTION mg/dl I-EVOLUTION que I-EVOLUTION cedió I-EVOLUTION con I-EVOLUTION calcio I-EVOLUTION oral. I-EVOLUTION Fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION La B-EXPLORATION biopsia I-EXPLORATION definitiva I-EXPLORATION concluyó I-EXPLORATION "infiltrado I-EXPLORATION linfoide I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes, I-EXPLORATION con I-EXPLORATION metaplasia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Hürtle, I-EXPLORATION que I-EXPLORATION comprometió I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION tiroidea I-EXPLORATION y I-EXPLORATION focalmente I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION muscular I-EXPLORATION peritiroideo. I-EXPLORATION Inmunohistoquímica: I-EXPLORATION CD20 I-EXPLORATION (+) I-EXPLORATION difuso, I-EXPLORATION CD3 I-EXPLORATION (+) I-EXPLORATION focal I-EXPLORATION en I-EXPLORATION linfocitos I-EXPLORATION pequeños, I-EXPLORATION CD10 I-EXPLORATION (+) I-EXPLORATION difuso, I-EXPLORATION BCL2 I-EXPLORATION (-) I-EXPLORATION ". I-EXPLORATION Compatible I-EXPLORATION con I-EXPLORATION LNH I-EXPLORATION tiroideo I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes I-EXPLORATION estirpe I-EXPLORATION B, I-EXPLORATION tiroiditis I-EXPLORATION de I-EXPLORATION Hashimoto I-EXPLORATION y I-EXPLORATION metaplasia I-EXPLORATION con I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Hürtle. I-EXPLORATION I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT quimioterapia I-TREATMENT pero I-TREATMENT la I-TREATMENT paciente I-TREATMENT la I-TREATMENT rechazó I-TREATMENT por I-TREATMENT motivos I-TREATMENT religiosos. I-TREATMENT I-TREATMENT Seis B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION consultó I-EVOLUTION en I-EVOLUTION cirugía I-EVOLUTION por I-EVOLUTION recidiva I-EVOLUTION local I-EVOLUTION con I-EVOLUTION sintomatología I-EVOLUTION obstructiva I-EVOLUTION de I-EVOLUTION vía I-EVOLUTION aérea. I-EVOLUTION Fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO hematología I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO pierde I-DERIVED_FROM/TO de I-DERIVED_FROM/TO control. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY morbilidad I-PAST_MEDICAL_HISTORY previa, I-PAST_MEDICAL_HISTORY proveniente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Puerto I-PAST_MEDICAL_HISTORY Varas. I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY sometida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY colecistec-tomía I-PAST_MEDICAL_HISTORY laparoscópica I-PAST_MEDICAL_HISTORY electiva I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY julio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2003 I-PAST_MEDICAL_HISTORY recibiendo I-PAST_MEDICAL_HISTORY anestesia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY halotano. I-PAST_MEDICAL_HISTORY Evolucionó I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY dada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alta. I-PAST_MEDICAL_HISTORY Al B-PRESENT_ILLNESS quinto I-PRESENT_ILLNESS día I-PRESENT_ILLNESS del I-PRESENT_ILLNESS postoperatorio I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alteración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS encefalopatía I-PRESENT_ILLNESS hepática, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS hospitalizó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hepatitis I-PRESENT_ILLNESS fulminante. I-PRESENT_ILLNESS El B-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION viral, I-EXPLORATION metabólico, I-EXPLORATION autoinmune I-EXPLORATION y I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION drogas I-EXPLORATION resultó I-EXPLORATION negativo. I-EXPLORATION Fue B-DERIVED_FROM/TO trasladada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Paciente I-DERIVED_FROM/TO Crítico I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Clínico I-DERIVED_FROM/TO San I-DERIVED_FROM/TO Borja I-DERIVED_FROM/TO Arriarán I-DERIVED_FROM/TO (HCSBA) I-DERIVED_FROM/TO el I-DERIVED_FROM/TO 5 I-DERIVED_FROM/TO de I-DERIVED_FROM/TO agosto I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2003 I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hepatitis I-DERIVED_FROM/TO aguda I-DERIVED_FROM/TO fulminante I-DERIVED_FROM/TO por I-DERIVED_FROM/TO halotano I-DERIVED_FROM/TO y I-DERIVED_FROM/TO se I-DERIVED_FROM/TO activó I-DERIVED_FROM/TO como I-DERIVED_FROM/TO urgencia I-DERIVED_FROM/TO nacional I-DERIVED_FROM/TO para I-DERIVED_FROM/TO trasplante I-DERIVED_FROM/TO hepático. I-DERIVED_FROM/TO Dada B-TREATMENT la I-TREATMENT emergencia I-TREATMENT vital I-TREATMENT se I-TREATMENT efectuó I-TREATMENT un I-TREATMENT trasplante I-TREATMENT hepático I-TREATMENT de I-TREATMENT donante I-TREATMENT cadáver I-TREATMENT ABO I-TREATMENT incompatible I-TREATMENT (donante I-TREATMENT grupo I-TREATMENT A, I-TREATMENT receptor I-TREATMENT grupo I-TREATMENT O) I-TREATMENT el I-TREATMENT 8 I-TREATMENT de I-TREATMENT agosto I-TREATMENT de I-TREATMENT 2003, I-TREATMENT en I-TREATMENT Clínica I-TREATMENT Las I-TREATMENT Condes. I-TREATMENT El I-TREATMENT protocolo I-TREATMENT terapéutico I-TREATMENT consistió I-TREATMENT en I-TREATMENT plasmaféresis I-TREATMENT intra I-TREATMENT y I-TREATMENT postrasplante, I-TREATMENT esplenectomía I-TREATMENT e I-TREATMENT inmunosupresión I-TREATMENT cuádruple, I-TREATMENT con I-TREATMENT metilprednisolona, I-TREATMENT ciclofosfamida, I-TREATMENT timoglobulina I-TREATMENT y I-TREATMENT ciclosporina. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION del I-EXPLORATION explante I-EXPLORATION concluyó I-EXPLORATION necrosis I-EXPLORATION submasiva. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT 5 I-TREATMENT sesiones I-TREATMENT de I-TREATMENT plasmaféresis, I-TREATMENT que I-TREATMENT disminuyó I-TREATMENT significativamente I-TREATMENT el I-TREATMENT título I-TREATMENT de I-TREATMENT isohemoglutininas I-TREATMENT anti I-TREATMENT A. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT su I-TREATMENT incremento I-TREATMENT posterior I-TREATMENT no I-TREATMENT se I-TREATMENT tradujo I-TREATMENT en I-TREATMENT una I-TREATMENT injuria I-TREATMENT significativa I-TREATMENT al I-TREATMENT injerto. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION temprano I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION hemoperitoneo I-EVOLUTION que B-TREATMENT requirió I-TREATMENT cirugía, I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT una I-TREATMENT neumopatía I-TREATMENT aguda. I-TREATMENT Los B-EXPLORATION estudios I-EXPLORATION imagenológicos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION El B-EVOLUTION egreso I-EVOLUTION médico I-EVOLUTION fue I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 54 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION trasplante, I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION y B-TREATMENT con I-TREATMENT terapia I-TREATMENT inmunosupre-sora I-TREATMENT en I-TREATMENT base I-TREATMENT a I-TREATMENT ciclosporina, I-TREATMENT ciclofosfamida I-TREATMENT y I-TREATMENT prednisona. I-TREATMENT En B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION intrahospitalaria I-EVOLUTION presentó I-EVOLUTION infección I-EVOLUTION por I-EVOLUTION citomegalovirus I-EVOLUTION en I-EVOLUTION dos I-EVOLUTION oportunidades I-EVOLUTION tratadas I-EVOLUTION satisfactoriamente, I-EVOLUTION un I-EVOLUTION rechazo I-EVOLUTION agudo I-EVOLUTION moderado I-EVOLUTION corticoide-sensible I-EVOLUTION y I-EVOLUTION un I-EVOLUTION bilioma I-EVOLUTION que B-TREATMENT requirió I-TREATMENT drenaje I-TREATMENT bajo I-TREATMENT tomografía I-TREATMENT computarizada. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION asiste I-EVOLUTION a I-EVOLUTION controles I-EVOLUTION médicos I-EVOLUTION periódicos I-EVOLUTION y I-EVOLUTION cumplió I-EVOLUTION cinco I-EVOLUTION años I-EVOLUTION postrasplante. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION desarrollando I-EVOLUTION una I-EVOLUTION vida I-EVOLUTION laboralmente I-EVOLUTION activa, I-EVOLUTION con I-EVOLUTION pruebas I-EVOLUTION hepáticas I-EVOLUTION normales, I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION inmunosupresión I-EVOLUTION a I-EVOLUTION dosis I-EVOLUTION bajas I-EVOLUTION (ciclosporina I-EVOLUTION 200 I-EVOLUTION mg/día, I-EVOLUTION azatioprina I-EVOLUTION 100 I-EVOLUTION mg/día) I-EVOLUTION y I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION conservada. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY NF1 I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY manifestó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY abundantes I-PAST_MEDICAL_HISTORY efélides I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY todo I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cuerpo, I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY axilar I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY inguinal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY neurofibro-mas I-PAST_MEDICAL_HISTORY discretos. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Emergencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS La I-PRESENT_ILLNESS Serena I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS inicialmente I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS difuso. I-PRESENT_ILLNESS Ingresó B-EXPLORATION en I-EXPLORATION shock I-EXPLORATION séptico I-EXPLORATION y I-EXPLORATION mala I-EXPLORATION condición I-EXPLORATION general. I-EXPLORATION Después B-TREATMENT de I-TREATMENT estabilización I-TREATMENT hemodi-námica I-TREATMENT se I-TREATMENT decidió I-TREATMENT su I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT abdomen I-TREATMENT agudo I-TREATMENT de I-TREATMENT origen I-TREATMENT no I-TREATMENT precisado I-TREATMENT y I-TREATMENT peritonitis I-TREATMENT secundaria. I-TREATMENT No B-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ningún I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION nuestro I-EXPLORATION hospital I-EXPLORATION no I-EXPLORATION cuenta I-EXPLORATION con I-EXPLORATION radiólogo I-EXPLORATION de I-EXPLORATION turno I-EXPLORATION y I-EXPLORATION tampoco I-EXPLORATION ecografía I-EXPLORATION o I-EXPLORATION tomografía I-EXPLORATION de I-EXPLORATION urgencia. I-EXPLORATION El B-TREATMENT abordaje I-TREATMENT del I-TREATMENT abdomen I-TREATMENT se I-TREATMENT realizó I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT mediana. I-TREATMENT Se I-TREATMENT aspiraron I-TREATMENT 3 I-TREATMENT litros I-TREATMENT de I-TREATMENT exudado I-TREATMENT purulento I-TREATMENT y I-TREATMENT en I-TREATMENT la I-TREATMENT exploración I-TREATMENT se I-TREATMENT evidenció I-TREATMENT un I-TREATMENT tumor I-TREATMENT quístico I-TREATMENT de I-TREATMENT 15 I-TREATMENT cm I-TREATMENT de I-TREATMENT diámetro I-TREATMENT que I-TREATMENT se I-TREATMENT originaba I-TREATMENT en I-TREATMENT la I-TREATMENT A- I-TREATMENT porción I-TREATMENT del I-TREATMENT duodeno, I-TREATMENT perforado, I-TREATMENT adherido I-TREATMENT al I-TREATMENT colon I-TREATMENT sigmoides I-TREATMENT y I-TREATMENT cubierto I-TREATMENT de I-TREATMENT epiplón I-TREATMENT mayor. I-TREATMENT El I-TREATMENT tumor I-TREATMENT fue I-TREATMENT resecado I-TREATMENT en I-TREATMENT bloque I-TREATMENT con I-TREATMENT el I-TREATMENT epiplón I-TREATMENT y I-TREATMENT la I-TREATMENT A- I-TREATMENT porción I-TREATMENT del I-TREATMENT duodeno. I-TREATMENT El I-TREATMENT tránsito I-TREATMENT intestinal I-TREATMENT se I-TREATMENT reconstituyó I-TREATMENT mediante I-TREATMENT anastomosis I-TREATMENT término-terminal I-TREATMENT entre I-TREATMENT la I-TREATMENT 3a I-TREATMENT porción I-TREATMENT del I-TREATMENT duodeno I-TREATMENT y I-TREATMENT el I-TREATMENT yeyuno. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION tórpida, I-EVOLUTION con I-EVOLUTION complicaciones: I-EVOLUTION infección I-EVOLUTION del I-EVOLUTION sitio I-EVOLUTION quirúrgico I-EVOLUTION superficial, I-EVOLUTION íleo I-EVOLUTION intestinal I-EVOLUTION prolongado I-EVOLUTION y I-EVOLUTION neumonía I-EVOLUTION nosocomial. I-EVOLUTION Después I-EVOLUTION de I-EVOLUTION 37 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION sólido-quísti-co, I-EXPLORATION parcialmente I-EXPLORATION necrótico I-EXPLORATION y I-EXPLORATION con I-EXPLORATION bajo I-EXPLORATION índice I-EXPLORATION mitótico I-EXPLORATION (1 I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 50 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION aumento I-EXPLORATION mayor). I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION células I-EXPLORATION epiteloides I-EXPLORATION y I-EXPLORATION fusiformes, I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION CD117, I-EXPLORATION CD34 I-EXPLORATION y I-EXPLORATION desmina. I-EXPLORATION La I-EXPLORATION reacción I-EXPLORATION inmunohistoquímica I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION S100, I-EXPLORATION vimentina I-EXPLORATION y I-EXPLORATION acüna-a I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION liso. I-EXPLORATION El I-EXPLORATION tamaño I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION presentación I-EXPLORATION (necrosis I-EXPLORATION y I-EXPLORATION perforación), I-EXPLORATION constituyen I-EXPLORATION indicaciones I-EXPLORATION para I-EXPLORATION terapia I-EXPLORATION con I-EXPLORATION imatinib I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION derivada I-EXPLORATION al I-EXPLORATION Comité I-EXPLORATION Oncológico I-EXPLORATION Regional I-EXPLORATION para I-EXPLORATION iniciar I-EXPLORATION tratamiento I-EXPLORATION pertinente. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION en I-EVOLUTION seguimiento I-EVOLUTION hace I-EVOLUTION 11 I-EVOLUTION meses. I-EVOLUTION Figura I-EVOLUTION 2 I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY hospitalizada B-PRESENT_ILLNESS por I-PRESENT_ILLNESS peritonitis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS no I-PRESENT_ILLNESS precisado. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS La B-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION fue I-EXPLORATION 131/76, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 126 I-EXPLORATION x' I-EXPLORATION y I-EXPLORATION 38, I-EXPLORATION 9eC I-EXPLORATION de I-EXPLORATION temperatura I-EXPLORATION rectal. I-EXPLORATION El I-EXPLORATION abdomen I-EXPLORATION estaba I-EXPLORATION distendido, I-EXPLORATION mate I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION ruidos I-EXPLORATION intestinales I-EXPLORATION a I-EXPLORATION la I-EXPLORATION auscultación. I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION ginecológica I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION reveló I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION intraperitoneal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION estructura I-EXPLORATION quística I-EXPLORATION adyacente I-EXPLORATION al I-EXPLORATION intestino I-EXPLORATION delgado. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION abdominal I-EXPLORATION (TAC), I-EXPLORATION demostró I-EXPLORATION algunas I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION rodeando I-EXPLORATION una I-EXPLORATION estructura I-EXPLORATION tubular I-EXPLORATION quística I-EXPLORATION y I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION peritoneal. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION revelaron I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 25.700 I-EXPLORATION x I-EXPLORATION mm3 I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 356, I-EXPLORATION 06 I-EXPLORATION mg/dl. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT tumor I-TREATMENT quístico I-TREATMENT intestinal I-TREATMENT complicado I-TREATMENT la I-TREATMENT paciente I-TREATMENT fue I-TREATMENT operada. I-TREATMENT La B-EXPLORATION cavidad I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION llena I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION seroso I-EXPLORATION del I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION citología I-EXPLORATION y I-EXPLORATION cultivo. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION reveló I-EXPLORATION múltiples I-EXPLORATION implantes I-EXPLORATION tumorales I-EXPLORATION en I-EXPLORATION el I-EXPLORATION peritoneo I-EXPLORATION parietal I-EXPLORATION y I-EXPLORATION visceral, I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION extensa I-EXPLORATION del I-EXPLORATION epiplón I-EXPLORATION mayor, I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION implantes I-EXPLORATION para I-EXPLORATION biopsia. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION mesenterio I-EXPLORATION del I-EXPLORATION íleon I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION quístico I-EXPLORATION tubular I-EXPLORATION blanquecino I-EXPLORATION rodeado I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION intestinales, I-EXPLORATION que I-EXPLORATION medía I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION por I-EXPLORATION 15 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud. I-EXPLORATION Se B-TREATMENT abrió I-TREATMENT el I-TREATMENT tumor I-TREATMENT aspirándose I-TREATMENT un I-TREATMENT líquido I-TREATMENT oscuro I-TREATMENT y I-TREATMENT espeso I-TREATMENT que I-TREATMENT fue I-TREATMENT enviado I-TREATMENT a I-TREATMENT citología. I-TREATMENT Se I-TREATMENT resecó I-TREATMENT la I-TREATMENT mayor I-TREATMENT cantidad I-TREATMENT posible I-TREATMENT de I-TREATMENT pared I-TREATMENT tumoral I-TREATMENT quedando I-TREATMENT una I-TREATMENT parte I-TREATMENT adherida I-TREATMENT al I-TREATMENT mesenterio, I-TREATMENT la I-TREATMENT resección I-TREATMENT completa I-TREATMENT del I-TREATMENT tumor I-TREATMENT no I-TREATMENT fue I-TREATMENT posible I-TREATMENT por I-TREATMENT la I-TREATMENT diseminación I-TREATMENT peritoneal I-TREATMENT y I-TREATMENT su I-TREATMENT localización I-TREATMENT en I-TREATMENT el I-TREATMENT mesenterio I-TREATMENT del I-TREATMENT íleon. I-TREATMENT La B-EVOLUTION recuperación I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION satisfactoria I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION treinta I-EVOLUTION y I-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION después I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION falleció. I-EVOLUTION La B-EXPLORATION muestras I-EXPLORATION citológicas I-EXPLORATION tomadas I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION del I-EXPLORATION contenido I-EXPLORATION tumoral I-EXPLORATION fueron I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION células I-EXPLORATION neoplásicas. I-EXPLORATION La I-EXPLORATION histopatología I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION arquitectura I-EXPLORATION típica I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION intestinal, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION reconocían I-EXPLORATION capas I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION liso I-EXPLORATION circular I-EXPLORATION y I-EXPLORATION longitudinal I-EXPLORATION bien I-EXPLORATION organizadas, I-EXPLORATION identificándose I-EXPLORATION plexos I-EXPLORATION nerviosos I-EXPLORATION mientéricos I-EXPLORATION entre I-EXPLORATION ambas I-EXPLORATION capas I-EXPLORATION musculares. I-EXPLORATION La I-EXPLORATION superficie I-EXPLORATION interna I-EXPLORATION estaba I-EXPLORATION revestida I-EXPLORATION por I-EXPLORATION un I-EXPLORATION adeno I-EXPLORATION carcinoma I-EXPLORATION mucosecretor I-EXPLORATION moderadamente I-EXPLORATION diferenciado I-EXPLORATION que I-EXPLORATION infiltraba I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION en I-EXPLORATION varias I-EXPLORATION partes I-EXPLORATION y I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendió I-EXPLORATION superficialmente I-EXPLORATION por I-EXPLORATION la I-EXPLORATION serosa. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION intraoperatorios I-EXPLORATION y I-EXPLORATION el I-EXPLORATION informe I-EXPLORATION histopatológico I-EXPLORATION confirmaron I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION en I-EXPLORATION una I-EXPLORATION duplicación I-EXPLORATION intestinal I-EXPLORATION de I-EXPLORATION una I-EXPLORATION paciente I-EXPLORATION adulta. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 31 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY FQ I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY regulares I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY mayo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2000, I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY bilateral, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 2009. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS caracterizó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS descompensación I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS como I-PRESENT_ILLNESS una I-PRESENT_ILLNESS bronquiolitis I-PRESENT_ILLNESS obliterante I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS hospitalizado I-PRESENT_ILLNESS para I-PRESENT_ILLNESS su I-PRESENT_ILLNESS tratamiento. I-PRESENT_ILLNESS Al B-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION refirió I-EVOLUTION un I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION tipo I-EVOLUTION cólico I-EVOLUTION de I-EVOLUTION intensidad I-EVOLUTION progresiva, I-EVOLUTION localizado I-EVOLUTION mayormente I-EVOLUTION en I-EVOLUTION hemiabdomen I-EVOLUTION inferior I-EVOLUTION derecho, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION 3 I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION vómitos I-EVOLUTION alimentarios. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION distendido I-EXPLORATION y I-EXPLORATION sensible I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION bazuqueo. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION tomar I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION moderada I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION superior I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION abundante I-EXPLORATION aire I-EXPLORATION y I-EXPLORATION contenido I-EXPLORATION estercoráceo I-EXPLORATION en I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION marco I-EXPLORATION cólico. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION además I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION más I-EXPLORATION alta I-EXPLORATION del I-EXPLORATION yeyuno I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION proximal I-EXPLORATION del I-EXPLORATION íleon I-EXPLORATION que I-EXPLORATION parecían I-EXPLORATION ocupados I-EXPLORATION y I-EXPLORATION distendidos I-EXPLORATION por I-EXPLORATION material I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fecaloideo, I-EXPLORATION concluyendo I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION SOID. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT Gastrografin® I-TREATMENT (100 I-TREATMENT mi I-TREATMENT diluidos I-TREATMENT en I-TREATMENT 400 I-TREATMENT mi. I-TREATMENT de I-TREATMENT suero I-TREATMENT fisiológico) I-TREATMENT presentando I-TREATMENT al I-TREATMENT cabo I-TREATMENT de I-TREATMENT 2 I-TREATMENT horas, I-TREATMENT gran I-TREATMENT cantidad I-TREATMENT de I-TREATMENT deposiciones I-TREATMENT líquidas I-TREATMENT e I-TREATMENT importante I-TREATMENT disminución I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas. I-TREATMENT La B-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION distensión I-EXPLORATION de I-EXPLORATION algunas I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION en I-EXPLORATION menor I-EXPLORATION grado I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION anterior I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION en I-EXPLORATION el I-EXPLORATION intestino I-EXPLORATION distal I-EXPLORATION y I-EXPLORATION marco I-EXPLORATION colónico. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION suplemento I-EVOLUTION de I-EVOLUTION enzimas I-EVOLUTION pancreáticas, I-EVOLUTION encontrándose I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION tras I-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION su I-EVOLUTION hospitalización I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION nuevos I-EVOLUTION cuadros I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION distensión I-EVOLUTION o I-EVOLUTION constipación. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS indio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertenso B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY ocasional, I-PAST_MEDICAL_HISTORY quien B-PRESENT_ILLNESS se I-PRESENT_ILLNESS levantó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mañana I-PRESENT_ILLNESS previa I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS con I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hemicuerpo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sensibilidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hemicara I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS que I-PRESENT_ILLNESS progresó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS siguientes I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS imposibilidad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS hubo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ingresar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vez I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS llevado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS departamento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS emergencias, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS constató I-PRESENT_ILLNESS una I-PRESENT_ILLNESS presión I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 165/105 I-PRESENT_ILLNESS mmHg, I-PRESENT_ILLNESS pulso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 92 I-PRESENT_ILLNESS latidos I-PRESENT_ILLNESS x' I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS frecuencia I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS x'. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hipoestesia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION maxilar I-EXPLORATION del I-EXPLORATION trigémino I-EXPLORATION derecho I-EXPLORATION como I-EXPLORATION único I-EXPLORATION trastorno I-EXPLORATION objetivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad. I-EXPLORATION La I-EXPLORATION fuerza I-EXPLORATION muscular I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tono I-EXPLORATION estaba I-EXPLORATION conservados I-EXPLORATION a I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION niveles, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION hiperreflexia I-EXPLORATION osteotendinosa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemicuerpo I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION Babinski I-EXPLORATION ipsilateral. I-EXPLORATION Elementos I-EXPLORATION de I-EXPLORATION disfunción I-EXPLORATION cerebelosa I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION al I-EXPLORATION existir I-EXPLORATION disdiadococinesia, I-EXPLORATION dismetría I-EXPLORATION y I-EXPLORATION discronometría I-EXPLORATION al I-EXPLORATION movilizar I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION derechas. I-EXPLORATION La I-EXPLORATION marcha I-EXPLORATION era I-EXPLORATION imposible I-EXPLORATION por I-EXPLORATION la I-EXPLORATION tendencia I-EXPLORATION a I-EXPLORATION caer I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION derecha I-EXPLORATION al I-EXPLORATION tratar I-EXPLORATION de I-EXPLORATION hacerla I-EXPLORATION sin I-EXPLORATION apoyo. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION mostró I-EXPLORATION hemoglobina, I-EXPLORATION conteo I-EXPLORATION diferencial I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION electrolitos I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION una I-EXPLORATION hiperlipidemia I-EXPLORATION dada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION del I-EXPLORATION colesterol I-EXPLORATION total I-EXPLORATION (7, I-EXPLORATION 42 I-EXPLORATION mm/1). I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION transtorácico I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RMN) I-EXPLORATION identificó I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION infarto I-EXPLORATION isquémico I-EXPLORATION subagudo I-EXPLORATION que I-EXPLORATION comprendía I-EXPLORATION el I-EXPLORATION núcleo I-EXPLORATION lenticular I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION interna I-EXPLORATION izquierdos. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT consistió I-TREATMENT en I-TREATMENT anti-agregantes I-TREATMENT plaquetarios, I-TREATMENT estatinas I-TREATMENT y I-TREATMENT fisioterapia. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION egresado I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION después I-EVOLUTION con I-EVOLUTION evidente I-EVOLUTION mejoría. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inercia I-PAST_MEDICAL_HISTORY colónica. I-PAST_MEDICAL_HISTORY En B-TREATMENT mayo I-TREATMENT de I-TREATMENT 2003, I-TREATMENT a I-TREATMENT los I-TREATMENT 46 I-TREATMENT años, I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT colectomía I-TREATMENT total I-TREATMENT laparoscópica I-TREATMENT con I-TREATMENT anastomosis I-TREATMENT ileorrectal I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION taquicardia, I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION e I-EVOLUTION hipotensión. I-EVOLUTION Se B-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION exploradora I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION yeyuno I-EXPLORATION distal I-EXPLORATION e I-EXPLORATION ileon, I-EXPLORATION realizándose I-EXPLORATION resección I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION desde I-EXPLORATION los I-EXPLORATION 120 I-EXPLORATION cm I-EXPLORATION distales I-EXPLORATION al I-EXPLORATION Treitz, I-EXPLORATION además B-TREATMENT de I-TREATMENT una I-TREATMENT yeyunostomía I-TREATMENT terminal I-TREATMENT y I-TREATMENT cierre I-TREATMENT del I-TREATMENT muñón I-TREATMENT rectal. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION informó I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION con I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION enteropatía I-EXPLORATION isquémica I-EXPLORATION aguda. I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION fujos I-EVOLUTION de I-EVOLUTION 4.500 I-EVOLUTION cc/día I-EVOLUTION por I-EVOLUTION yeyunostomía I-EVOLUTION y I-EVOLUTION desnutrición I-EVOLUTION calórico-proteica. I-EVOLUTION Manejada B-TREATMENT inicialmente I-TREATMENT con I-TREATMENT NPTC, I-TREATMENT en I-TREATMENT el I-TREATMENT día I-TREATMENT 12 I-TREATMENT post I-TREATMENT operatorio I-TREATMENT se I-TREATMENT inició I-TREATMENT alimentación I-TREATMENT por I-TREATMENT sonda I-TREATMENT nasoenteral I-TREATMENT y I-TREATMENT en I-TREATMENT el I-TREATMENT día I-TREATMENT 50 I-TREATMENT se I-TREATMENT logró I-TREATMENT alimentación I-TREATMENT oral I-TREATMENT exclusiva. I-TREATMENT Al B-EVOLUTION alta I-EVOLUTION toleró I-EVOLUTION bien I-EVOLUTION régimen I-EVOLUTION oral I-EVOLUTION con I-EVOLUTION suplementos I-EVOLUTION nutricionales. I-EVOLUTION Hasta I-EVOLUTION junio I-EVOLUTION 2008 I-EVOLUTION presentó I-EVOLUTION 17 I-EVOLUTION hospitalizaciones, I-EVOLUTION 4 I-EVOLUTION por I-EVOLUTION cuadros I-EVOLUTION de I-EVOLUTION íleo I-EVOLUTION mecánico, I-EVOLUTION todos B-TREATMENT resueltos I-TREATMENT sin I-TREATMENT necesidad I-TREATMENT de I-TREATMENT cirugía, I-TREATMENT y B-EVOLUTION 13 I-EVOLUTION por I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION deshidratación I-EVOLUTION moderada I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION altos I-EVOLUTION débitos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ostomía, I-EVOLUTION los I-EVOLUTION que B-TREATMENT se I-TREATMENT manejaron I-TREATMENT con I-TREATMENT reposición I-TREATMENT hidroelectrolítica I-TREATMENT y I-TREATMENT ajuste I-TREATMENT de I-TREATMENT fármacos I-TREATMENT para I-TREATMENT disminuir I-TREATMENT fujo I-TREATMENT por I-TREATMENT yeyunostomía I-TREATMENT logrando B-EVOLUTION volumen I-EVOLUTION de I-EVOLUTION deposiciones I-EVOLUTION de I-EVOLUTION 2.000-3.000 I-EVOLUTION cc/día. I-EVOLUTION I-EVOLUTION El I-EVOLUTION 26/06/08 I-EVOLUTION ingresó I-EVOLUTION nuevamente I-EVOLUTION por I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION deshidratación I-EVOLUTION grave. I-EVOLUTION Se I-EVOLUTION constató I-EVOLUTION creatininemia I-EVOLUTION de I-EVOLUTION 4, I-EVOLUTION 39 I-EVOLUTION mg/dl, I-EVOLUTION objetivándose I-EVOLUTION clearence I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 30 I-EVOLUTION ml/min. I-EVOLUTION Dado B-TREATMENT el I-TREATMENT deterioro I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal I-TREATMENT y I-TREATMENT compromiso I-TREATMENT nutricional I-TREATMENT de I-TREATMENT predominio I-TREATMENT calórico I-TREATMENT con I-TREATMENT IMC I-TREATMENT de I-TREATMENT 14, I-TREATMENT 2 I-TREATMENT kg/m2 I-TREATMENT y I-TREATMENT albúmina I-TREATMENT de I-TREATMENT ingreso I-TREATMENT de I-TREATMENT 3, I-TREATMENT 1 I-TREATMENT gr/dl, I-TREATMENT se I-TREATMENT planteó I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT un I-TREATMENT procedimiento I-TREATMENT de I-TREATMENT elongación I-TREATMENT intestinal I-TREATMENT y I-TREATMENT reconstitución I-TREATMENT del I-TREATMENT tránsito I-TREATMENT para I-TREATMENT mejorar I-TREATMENT la I-TREATMENT condición I-TREATMENT clínica I-TREATMENT y I-TREATMENT calidad I-TREATMENT de I-TREATMENT vida I-TREATMENT de I-TREATMENT la I-TREATMENT paciente. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION preoperatorio I-EXPLORATION incluyó I-EXPLORATION una I-EXPLORATION rectoscopia I-EXPLORATION rígida I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION muñón I-EXPLORATION rectal I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION cm. I-EXPLORATION El I-EXPLORATION tránsito I-EXPLORATION intestinal I-EXPLORATION demostró I-EXPLORATION 140 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION sin I-EXPLORATION estrecheces I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas. I-EXPLORATION Por I-EXPLORATION sospecha I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION superior I-EXPLORATION (AMS), I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION Doppler I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION estenosis I-EXPLORATION signifcativa I-EXPLORATION (70%) I-EXPLORATION de I-EXPLORATION la I-EXPLORATION AMS, I-EXPLORATION que B-TREATMENT se I-TREATMENT resolvió I-TREATMENT mediante I-TREATMENT angioplastía I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT endoprótesis. I-TREATMENT Con I-TREATMENT aporte I-TREATMENT de I-TREATMENT régimen I-TREATMENT hipercalórico-hiperproteico I-TREATMENT y I-TREATMENT NPTC I-TREATMENT se I-TREATMENT logró I-TREATMENT optimización I-TREATMENT de I-TREATMENT parámetros I-TREATMENT nutricionales I-TREATMENT (albúmina: I-TREATMENT 3, I-TREATMENT 8 I-TREATMENT mg/dl). I-TREATMENT I-TREATMENT Cinco I-TREATMENT semanas I-TREATMENT luego I-TREATMENT de I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT la I-TREATMENT endoprótesis I-TREATMENT se I-TREATMENT decidió I-TREATMENT operar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente. I-TREATMENT En I-TREATMENT el I-TREATMENT intraoperatorio I-TREATMENT se I-TREATMENT midió I-TREATMENT intestino I-TREATMENT remanente I-TREATMENT con-frmando I-TREATMENT una I-TREATMENT longitud I-TREATMENT de I-TREATMENT 140 I-TREATMENT cm. I-TREATMENT Se I-TREATMENT desmanteló I-TREATMENT la I-TREATMENT yeyunostomía I-TREATMENT y I-TREATMENT se I-TREATMENT practicó I-TREATMENT una I-TREATMENT anastomosis I-TREATMENT mecánica I-TREATMENT término-terminal I-TREATMENT yeyunorectal. I-TREATMENT Luego I-TREATMENT se I-TREATMENT hicieron I-TREATMENT 15 I-TREATMENT secciones I-TREATMENT transversas I-TREATMENT parciales I-TREATMENT con I-TREATMENT cargas I-TREATMENT lineales I-TREATMENT de I-TREATMENT 3, I-TREATMENT 5 I-TREATMENT mm I-TREATMENT para I-TREATMENT seccionar I-TREATMENT la I-TREATMENT mitad I-TREATMENT del I-TREATMENT lumen I-TREATMENT del I-TREATMENT intestino I-TREATMENT en I-TREATMENT forma I-TREATMENT de I-TREATMENT zig-zag I-TREATMENT según I-TREATMENT lo I-TREATMENT descrito I-TREATMENT por I-TREATMENT Kim9. I-TREATMENT La I-TREATMENT longitud I-TREATMENT fnal I-TREATMENT del I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT fue I-TREATMENT de I-TREATMENT 180 I-TREATMENT cm, I-TREATMENT lo I-TREATMENT que I-TREATMENT sumado I-TREATMENT al I-TREATMENT muñón I-TREATMENT rectal I-TREATMENT da I-TREATMENT una I-TREATMENT longitud I-TREATMENT de I-TREATMENT 190 I-TREATMENT cm I-TREATMENT hasta I-TREATMENT el I-TREATMENT ano. I-TREATMENT I-TREATMENT Dentro B-EVOLUTION de I-EVOLUTION los I-EVOLUTION eventos I-EVOLUTION del I-EVOLUTION postoperatorio I-EVOLUTION destacó I-EVOLUTION la I-EVOLUTION formación I-EVOLUTION de I-EVOLUTION colecciones I-EVOLUTION hemáticas I-EVOLUTION intraabdominales, I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION fltración. I-EVOLUTION Por B-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION episodios I-EXPLORATION febriles, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION eco-cardiograma I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION trombo I-EXPLORATION séptico I-EXPLORATION en I-EXPLORATION aurícula I-EXPLORATION derecha I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT para I-TREATMENT endocarditis I-TREATMENT bacteriana. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION progresivo I-EVOLUTION del I-EVOLUTION aporte I-EVOLUTION por I-EVOLUTION vía I-EVOLUTION oral. I-EVOLUTION El B-TREATMENT día I-TREATMENT 34 I-TREATMENT del I-TREATMENT post I-TREATMENT operatorio I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT NPTC, I-TREATMENT logrando I-TREATMENT balance I-TREATMENT hidroelectrolitico I-TREATMENT y I-TREATMENT nutricional I-TREATMENT adecuado I-TREATMENT exclusivamente I-TREATMENT por I-TREATMENT vía I-TREATMENT oral. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION tránsito I-EXPLORATION intestinal I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 98 I-EXPLORATION días I-EXPLORATION post I-EXPLORATION cirugía I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION las I-EXPLORATION enterotomías. I-EXPLORATION I-EXPLORATION Actualmente B-TREATMENT en I-TREATMENT control I-TREATMENT ambulatorio, I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT loperamida I-TREATMENT y I-TREATMENT suplementos I-TREATMENT nutricionales, I-TREATMENT logrando I-TREATMENT adecuado I-TREATMENT balance I-TREATMENT hidroelectrolítico, I-TREATMENT aumento I-TREATMENT de I-TREATMENT peso I-TREATMENT y I-TREATMENT con I-TREATMENT una I-TREATMENT frecuencia I-TREATMENT de I-TREATMENT deposiciones I-TREATMENT de I-TREATMENT 5 I-TREATMENT veces I-TREATMENT por I-TREATMENT día I-TREATMENT con I-TREATMENT escurrimiento I-TREATMENT escaso. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS IMC B-PAST_MEDICAL_HISTORY 21, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY legrado I-PAST_MEDICAL_HISTORY uterino I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY aborto I-PAST_MEDICAL_HISTORY provocado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY trimestre, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 17 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS marzo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dismenorrea I-PRESENT_ILLNESS invalidante, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS del I-PRESENT_ILLNESS uso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS anticonceptivos I-PRESENT_ILLNESS orales, I-PRESENT_ILLNESS polimenorrea I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipermenorrea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS ciclos I-PRESENT_ILLNESS menstruales, I-PRESENT_ILLNESS refriendo I-PRESENT_ILLNESS además I-PRESENT_ILLNESS dispareunia. I-PRESENT_ILLNESS Examen B-EXPLORATION físico I-EXPLORATION general I-EXPLORATION y I-EXPLORATION ginecológico I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION primera I-EXPLORATION consulta. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION ecotomografía I-EXPLORATION transvaginal I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION endometrial I-EXPLORATION ocupada I-EXPLORATION por I-EXPLORATION imagen I-EXPLORATION hiperecogénica I-EXPLORATION lineal I-EXPLORATION con I-EXPLORATION sombra I-EXPLORATION acústica I-EXPLORATION posterior, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION extensa I-EXPLORATION metaplasia I-EXPLORATION ósea. I-EXPLORATION I-EXPLORATION La I-EXPLORATION histeroscopía I-EXPLORATION mostró I-EXPLORATION cavidad I-EXPLORATION uterina I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION poco I-EXPLORATION distensible, I-EXPLORATION revestida I-EXPLORATION en I-EXPLORATION su I-EXPLORATION totalidad I-EXPLORATION por I-EXPLORATION múltiples I-EXPLORATION fragmentos I-EXPLORATION espiculados I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION ósea. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT extracción I-TREATMENT de I-TREATMENT éstos I-TREATMENT con I-TREATMENT asa I-TREATMENT de I-TREATMENT resectoscopio I-TREATMENT asistido I-TREATMENT con I-TREATMENT cucharilla I-TREATMENT N° I-TREATMENT 2 I-TREATMENT y I-TREATMENT pinza I-TREATMENT Randall, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Posteriormente B-EVOLUTION se I-EVOLUTION observó I-EVOLUTION cavidad I-EVOLUTION endometrial I-EVOLUTION sana I-EVOLUTION y I-EVOLUTION ostium I-EVOLUTION tubarios I-EVOLUTION permeables. I-EVOLUTION I-EVOLUTION Su B-EXPLORATION laparoscopía I-EXPLORATION exploradora I-EXPLORATION mostró I-EXPLORATION pelvis I-EXPLORATION sana, I-EXPLORATION útero I-EXPLORATION y I-EXPLORATION anexos I-EXPLORATION normales, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION relación I-EXPLORATION tubo I-EXPLORATION ovárica. I-EXPLORATION Trompas I-EXPLORATION permeables I-EXPLORATION con I-EXPLORATION índigo I-EXPLORATION carmín. I-EXPLORATION I-EXPLORATION Biopsia I-EXPLORATION operatoria I-EXPLORATION estuvo I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION fragmentos I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION óseo I-EXPLORATION maduro, I-EXPLORATION reconociéndose I-EXPLORATION además I-EXPLORATION colonias I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION Actinomyces. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION neoplasia. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION metaplasia I-EXPLORATION ósea I-EXPLORATION del I-EXPLORATION endometrio. I-EXPLORATION Se B-TREATMENT indicaron I-TREATMENT anticonceptivos I-TREATMENT orales I-TREATMENT hasta I-TREATMENT deseo I-TREATMENT de I-TREATMENT embarazo. I-TREATMENT I-TREATMENT Una B-EXPLORATION histerosonografía I-EXPLORATION tres I-EXPLORATION meses I-EXPLORATION post I-EXPLORATION cirugía I-EXPLORATION mostraba I-EXPLORATION cavidad I-EXPLORATION uterina I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION En B-TREATMENT agosto I-TREATMENT de I-TREATMENT 2008 I-TREATMENT consultó I-TREATMENT cursando I-TREATMENT embarazo I-TREATMENT espontáneo I-TREATMENT único I-TREATMENT de I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT gestación I-TREATMENT confirmado I-TREATMENT ecográficamente. I-TREATMENT A I-TREATMENT las I-TREATMENT 39 I-TREATMENT semanas I-TREATMENT de I-TREATMENT gestación, I-TREATMENT se I-TREATMENT obtuvo I-TREATMENT un I-TREATMENT recién I-TREATMENT nacido I-TREATMENT sano I-TREATMENT de I-TREATMENT 3.380 I-TREATMENT g I-TREATMENT mediante I-TREATMENT operación I-TREATMENT cesárea I-TREATMENT por I-TREATMENT prueba I-TREATMENT de I-TREATMENT trabajo I-TREATMENT de I-TREATMENT parto I-TREATMENT fracasada. I-TREATMENT Durante I-TREATMENT la I-TREATMENT misma, I-TREATMENT se I-TREATMENT produjo I-TREATMENT inercia I-TREATMENT uterina I-TREATMENT que I-TREATMENT logró I-TREATMENT ser I-TREATMENT revertida I-TREATMENT con I-TREATMENT uso I-TREATMENT de I-TREATMENT retractores I-TREATMENT en I-TREATMENT altas I-TREATMENT dosis. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY data, I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1999 I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY rechazó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY trisemanal I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2000 I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY secundaria. I-PAST_MEDICAL_HISTORY Tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY eritropoyetina, I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY fólico, I-PAST_MEDICAL_HISTORY atenolol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY losartan. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS pruriginosas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS manos, I-PRESENT_ILLNESS antebrazos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS espalda. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaban I-EXPLORATION hiperpigmentación I-EXPLORATION difusa, I-EXPLORATION erosiones, I-EXPLORATION úlceras I-EXPLORATION y I-EXPLORATION pápulas I-EXPLORATION costrosas, I-EXPLORATION ubicadas I-EXPLORATION preferentemente I-EXPLORATION en I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION manos, I-EXPLORATION antebrazos, I-EXPLORATION tórax I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION región I-EXPLORATION interescapular. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION piel I-EXPLORATION con I-EXPLORATION úlcera I-EXPLORATION y I-EXPLORATION costra I-EXPLORATION fibrinoleucocitaria. I-EXPLORATION El I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION úlcera I-EXPLORATION con I-EXPLORATION haces I-EXPLORATION de I-EXPLORATION colágeno I-EXPLORATION de I-EXPLORATION disposición I-EXPLORATION vertical, I-EXPLORATION epidermis I-EXPLORATION adyacente I-EXPLORATION con I-EXPLORATION hiperortoqueratosis, I-EXPLORATION acantosis I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION espongiosis. I-EXPLORATION La I-EXPLORATION dermis I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION disperso I-EXPLORATION y I-EXPLORATION perivascular I-EXPLORATION superfcial I-EXPLORATION linfocitario, I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION plasmocitos I-EXPLORATION y I-EXPLORATION neutróflos I-EXPLORATION y I-EXPLORATION foco I-EXPLORATION hemorrágico. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION informados I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION colagenosis I-EXPLORATION perforante I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION reactivo. I-EXPLORATION Se B-TREATMENT indicaron I-TREATMENT antihistamínicos I-TREATMENT orales I-TREATMENT y I-TREATMENT clobetasol I-TREATMENT 0, I-TREATMENT 05% I-TREATMENT + I-TREATMENT cloranfenicol I-TREATMENT 2% I-TREATMENT con B-EVOLUTION respuesta I-EVOLUTION parcial I-EVOLUTION a I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY residencia I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY IX I-PAST_MEDICAL_HISTORY región, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY conocidos. I-PAST_MEDICAL_HISTORY Ingresó B-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION sufrir I-EXPLORATION accidente I-EXPLORATION de I-EXPLORATION tránsito I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION energía I-EXPLORATION sin I-EXPLORATION presentar I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION consideración I-EXPLORATION secundarias I-EXPLORATION a I-EXPLORATION el. I-EXPLORATION Luego I-EXPLORATION de I-EXPLORATION una I-EXPLORATION semana, I-EXPLORATION consultó I-EXPLORATION por I-EXPLORATION presentar I-EXPLORATION debilidad I-EXPLORATION progresiva I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION inferiores, I-EXPLORATION dorsalgia I-EXPLORATION de I-EXPLORATION moderada I-EXPLORATION intensidad I-EXPLORATION y I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION orinar. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION se I-EXPLORATION constata I-EXPLORATION con I-EXPLORATION hipoestesia I-EXPLORATION bilateral I-EXPLORATION desde I-EXPLORATION nivel I-EXPLORATION D5 I-EXPLORATION hacia I-EXPLORATION distal, I-EXPLORATION paraparesia I-EXPLORATION moderada, I-EXPLORATION hiperrefexia I-EXPLORATION osteotendínea I-EXPLORATION patelar I-EXPLORATION y I-EXPLORATION aquiliana I-EXPLORATION bilateral I-EXPLORATION con I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Babinski I-EXPLORATION positivo I-EXPLORATION bilateral; I-EXPLORATION se I-EXPLORATION hospitalizó I-EXPLORATION planteándose I-EXPLORATION un I-EXPLORATION trauma I-EXPLORATION raquimedular I-EXPLORATION complicado. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION con I-EXPLORATION radiografía I-EXPLORATION (Rx) I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION dorsal I-EXPLORATION mostraba I-EXPLORATION aplastamiento I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION D3. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION y I-EXPLORATION resonancia I-EXPLORATION nuclear I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION dorsal I-EXPLORATION demostraron I-EXPLORATION múltiples I-EXPLORATION quistes I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION variable I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION paravertebral I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION compromete I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION y I-EXPLORATION elementos I-EXPLORATION posteriores I-EXPLORATION de I-EXPLORATION D2, I-EXPLORATION D3 I-EXPLORATION y I-EXPLORATION D4 I-EXPLORATION e I-EXPLORATION invasión I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION raquídeo I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION aplastamiento I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION D3 I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION probable I-EXPLORATION etiología I-EXPLORATION hidatídica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION anamnesis I-EXPLORATION dirigida I-EXPLORATION donde I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION señaló I-EXPLORATION presentar I-EXPLORATION dorsalgia I-EXPLORATION de I-EXPLORATION tres I-EXPLORATION años I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION con I-EXPLORATION un I-EXPLORATION episodio I-EXPLORATION de I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION fuerzas I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION que I-EXPLORATION revirtió I-EXPLORATION espontáneamente. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION (hemograma, I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION renal) I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Si B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT albendazol I-TREATMENT y I-TREATMENT realizó I-TREATMENT hemilaminectomía I-TREATMENT D3-D4 I-TREATMENT con I-TREATMENT exéresis I-TREATMENT de I-TREATMENT quistes I-TREATMENT confirmando I-TREATMENT el I-TREATMENT estudio I-TREATMENT histopatológico I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT hidatidosis I-TREATMENT ósea. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION recuperando I-EVOLUTION movilidad I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION extremidades I-EVOLUTION inferiores I-EVOLUTION sin I-EVOLUTION déficit I-EVOLUTION esfinteriano. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION demostraron I-EXPLORATION enfermedad I-EXPLORATION hidatídica I-EXPLORATION diseminada. I-EXPLORATION Completa B-TREATMENT cuatro I-TREATMENT ciclos I-TREATMENT de I-TREATMENT albendazol. I-TREATMENT I-TREATMENT Luego B-EVOLUTION de I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION fue I-EVOLUTION nuevamente I-EVOLUTION intervenido I-EVOLUTION quirúrgicamente I-EVOLUTION por I-EVOLUTION absceso I-EVOLUTION dorsal I-EVOLUTION hidatídico I-EVOLUTION y I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION después I-EVOLUTION por I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION paraparesia I-EVOLUTION progresiva I-EVOLUTION con I-EVOLUTION nivel I-EVOLUTION sensitivo I-EVOLUTION en I-EVOLUTION D5 I-EVOLUTION realizándose I-EVOLUTION laminectomía I-EVOLUTION D3-D4 I-EVOLUTION con I-EVOLUTION exéresis I-EVOLUTION de I-EVOLUTION quistes. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY positivo I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS decaimiento, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS conducta I-PRESENT_ILLNESS frontalizada. I-PRESENT_ILLNESS La B-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION resultó I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION VDRL, I-EXPLORATION toxoplasma I-EXPLORATION y I-EXPLORATION VEB I-EXPLORATION (por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION PCR). I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION hematológicos I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION leve I-EXPLORATION con I-EXPLORATION Hb I-EXPLORATION de I-EXPLORATION 10, I-EXPLORATION 3 I-EXPLORATION g/dL I-EXPLORATION (ref. I-EXPLORATION 13, I-EXPLORATION 5-17, I-EXPLORATION 5 I-EXPLORATION g/dL), I-EXPLORATION Hto I-EXPLORATION 30% I-EXPLORATION (ref. I-EXPLORATION 41-53%), I-EXPLORATION leucopenia I-EXPLORATION con I-EXPLORATION 3.100 I-EXPLORATION leucocitos/mm3 I-EXPLORATION (ref. I-EXPLORATION 4.500-11.000/mm3) I-EXPLORATION y I-EXPLORATION linfopenia I-EXPLORATION con I-EXPLORATION 800/mm3 I-EXPLORATION (ref. I-EXPLORATION 1.000-4.800/mm3). I-EXPLORATION LDH I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales I-EXPLORATION (133 I-EXPLORATION U/L I-EXPLORATION [ref. I-EXPLORATION 135-225 I-EXPLORATION U/L] I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 1 I-EXPLORATION mg/dL I-EXPLORATION [ref. I-EXPLORATION 0-1 I-EXPLORATION mg/dL], I-EXPLORATION respectivamente). I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION además I-EXPLORATION severo I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION inmunosupresión I-EXPLORATION con I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 9/mm3. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION revelaron I-EXPLORATION 2 I-EXPLORATION nódulos I-EXPLORATION córtico-subcorticales I-EXPLORATION en I-EXPLORATION zonas I-EXPLORATION frontal I-EXPLORATION media I-EXPLORATION y I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION inflamatorio. I-EXPLORATION No I-EXPLORATION había I-EXPLORATION compromiso I-EXPLORATION pulmonar I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION sitios I-EXPLORATION anatómicos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION estereotáxica I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION tejido I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION gliosis I-EXPLORATION reactiva I-EXPLORATION y I-EXPLORATION extenso I-EXPLORATION infiltrado I-EXPLORATION celular I-EXPLORATION mixto, I-EXPLORATION predominantemente I-EXPLORATION perivascular I-EXPLORATION y I-EXPLORATION zonas I-EXPLORATION con I-EXPLORATION angiotropismo I-EXPLORATION y I-EXPLORATION angiodestruccción I-EXPLORATION compuestas I-EXPLORATION por I-EXPLORATION linfocitos I-EXPLORATION pequeños I-EXPLORATION inmunorreactivos I-EXPLORATION para I-EXPLORATION CD3 I-EXPLORATION (linfocitos I-EXPLORATION T). I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION abundantes I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION atípicas I-EXPLORATION medianas I-EXPLORATION y I-EXPLORATION grandes, I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION vesiculosos I-EXPLORATION y I-EXPLORATION pleomórficos I-EXPLORATION inmunorreactivas I-EXPLORATION para I-EXPLORATION CD20 I-EXPLORATION (linfocitos I-EXPLORATION B). I-EXPLORATION Los I-EXPLORATION linfocitos I-EXPLORATION mostraron I-EXPLORATION reacción I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION pequeña I-EXPLORATION de I-EXPLORATION ARN I-EXPLORATION asociado I-EXPLORATION al I-EXPLORATION VEB I-EXPLORATION EBER-1 I-EXPLORATION mediante I-EXPLORATION hibridización I-EXPLORATION in I-EXPLORATION situ. I-EXPLORATION Estas I-EXPLORATION células I-EXPLORATION mostraron I-EXPLORATION reacción I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION CD30, I-EXPLORATION CD68 I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION S-100. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION microorganismos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION con I-EXPLORATION tinciones I-EXPLORATION de I-EXPLORATION Gram, I-EXPLORATION PAS, I-EXPLORATION Ziehl-Neelsen I-EXPLORATION y I-EXPLORATION Warthin-Starry. I-EXPLORATION I-EXPLORATION La I-EXPLORATION citometría I-EXPLORATION de I-EXPLORATION flujo I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION cerebral I-EXPLORATION reveló I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION atípicas I-EXPLORATION medianas I-EXPLORATION de I-EXPLORATION estirpe I-EXPLORATION B I-EXPLORATION con I-EXPLORATION restricción I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION ligera I-EXPLORATION Kappa, I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION linfoproliferativo. I-EXPLORATION El I-EXPLORATION mielograma I-EXPLORATION y I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION conjunto, I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION GL I-EXPLORATION cerebral I-EXPLORATION grado I-EXPLORATION 3 I-EXPLORATION (linfoma I-EXPLORATION B I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes). I-EXPLORATION I-EXPLORATION El B-TREATMENT caso I-TREATMENT comunicado I-TREATMENT en I-TREATMENT el I-TREATMENT presente I-TREATMENT artículo I-TREATMENT fue I-TREATMENT confirmado I-TREATMENT como I-TREATMENT síndrome I-TREATMENT de I-TREATMENT inmunodeficiencia I-TREATMENT por I-TREATMENT virus I-TREATMENT VIH I-TREATMENT etapa I-TREATMENT C3 I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT antirretroviral. I-TREATMENT El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO solicitó I-DERIVED_FROM/TO posteriormente I-DERIVED_FROM/TO su I-DERIVED_FROM/TO traslado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO para I-DERIVED_FROM/TO continuar I-DERIVED_FROM/TO manejo. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS neumonía. I-PRESENT_ILLNESS Los B-EXPLORATION cultivos I-EXPLORATION y I-EXPLORATION las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION y I-EXPLORATION CMV I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION serologías I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION previos. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT empírico. I-TREATMENT A B-EXPLORATION las I-EXPLORATION dos I-EXPLORATION semanas I-EXPLORATION de I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION presentó I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION empeoramiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION radiológicas I-EXPLORATION basales I-EXPLORATION derechas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION BAL I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION crecimiento I-EXPLORATION bacteriano. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION desarrolló I-EXPLORATION paulatinamente I-EXPLORATION citopenias I-EXPLORATION de I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION series: I-EXPLORATION Hb: I-EXPLORATION 7 I-EXPLORATION g/l; I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos: I-EXPLORATION 1.600/ I-EXPLORATION mm3; I-EXPLORATION plaquetas: I-EXPLORATION 49.000 I-EXPLORATION /mm3. I-EXPLORATION La I-EXPLORATION ferritina I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 4.000 I-EXPLORATION µg/l, I-EXPLORATION trigliceridos I-EXPLORATION 607 I-EXPLORATION mg/dl, I-EXPLORATION fibrinógeno I-EXPLORATION 111%. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION PAMO I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION macrófagos I-EXPLORATION en I-EXPLORATION 10% I-EXPLORATION con I-EXPLORATION hemofa-gocitosis. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION solo I-EXPLORATION presentó I-EXPLORATION ligera I-EXPLORATION hepato I-EXPLORATION esplenomegalia. I-EXPLORATION I-EXPLORATION Se B-TREATMENT le I-TREATMENT administró I-TREATMENT metilprednisona I-TREATMENT a I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT g/día I-TREATMENT por I-TREATMENT tres I-TREATMENT días I-TREATMENT y I-TREATMENT gammaglobulina I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 400 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT 5 I-TREATMENT días. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION persistente I-EVOLUTION y B-TREATMENT requerimiento I-TREATMENT de I-TREATMENT asistencia I-TREATMENT respiratoria I-TREATMENT mecánica. I-TREATMENT Las B-EVOLUTION citopenias I-EVOLUTION no I-EVOLUTION mejoraron. I-EVOLUTION Se B-EXPLORATION repitieron I-EXPLORATION cultivos I-EXPLORATION que I-EXPLORATION siempre I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION a I-EXPLORATION excepción I-EXPLORATION de I-EXPLORATION un I-EXPLORATION BAL I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION el I-EXPLORATION crecimiento I-EXPLORATION significativo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION Acinetobacter I-EXPLORATION baumannii I-EXPLORATION multirresistente I-EXPLORATION que B-TREATMENT recibió I-TREATMENT tratamiento. I-TREATMENT Falleció B-EVOLUTION a I-EVOLUTION los I-EVOLUTION 44 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION con I-EVOLUTION falla I-EVOLUTION multiorgánica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS candidato I-PRESENT_ILLNESS a I-PRESENT_ILLNESS trasplante I-PRESENT_ILLNESS hepático. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS hepatorenal I-PRESENT_ILLNESS que I-PRESENT_ILLNESS motivó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS aporte I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS y I-PRESENT_ILLNESS furosemida, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS obtener I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS diurética. I-PRESENT_ILLNESS A I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esto I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontró I-PRESENT_ILLNESS donante. I-PRESENT_ILLNESS En B-EXPLORATION ese I-EXPLORATION momento I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION soporoso, I-EXPLORATION con I-EXPLORATION escasa I-EXPLORATION respuesta I-EXPLORATION a I-EXPLORATION estímulos I-EXPLORATION verbales, I-EXPLORATION PA I-EXPLORATION 110/60, I-EXPLORATION FC I-EXPLORATION 115 I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION 35x'. I-EXPLORATION Un I-EXPLORATION ecocardiograma I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION mostró I-EXPLORATION buena I-EXPLORATION función I-EXPLORATION ventricular I-EXPLORATION global, I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cuatro I-EXPLORATION cavidades I-EXPLORATION y I-EXPLORATION presión I-EXPLORATION sistólica I-EXPLORATION de I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION (PSAP) I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION mmHg. I-EXPLORATION En I-EXPLORATION pabellón, I-EXPLORATION se I-EXPLORATION intubó I-EXPLORATION e I-EXPLORATION instaló I-EXPLORATION sonda I-EXPLORATION para I-EXPLORATION ETE I-EXPLORATION y I-EXPLORATION CAP I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION PVC I-EXPLORATION de I-EXPLORATION 25 I-EXPLORATION mmHg, I-EXPLORATION PCP I-EXPLORATION 26 I-EXPLORATION mm I-EXPLORATION Hg, I-EXPLORATION RVSI I-EXPLORATION de I-EXPLORATION 987 I-EXPLORATION dinas*segundo/cm5/m2. I-EXPLORATION El I-EXPLORATION IC I-EXPLORATION y I-EXPLORATION PSAP I-EXPLORATION medidas I-EXPLORATION por I-EXPLORATION CAP I-EXPLORATION y I-EXPLORATION ETE I-EXPLORATION fueron I-EXPLORATION respectivamente I-EXPLORATION 4, I-EXPLORATION 7 I-EXPLORATION y I-EXPLORATION 5, I-EXPLORATION 3 I-EXPLORATION 1/ I-EXPLORATION m2, I-EXPLORATION y I-EXPLORATION 49/32 I-EXPLORATION y I-EXPLORATION 48. I-EXPLORATION El I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION fin I-EXPLORATION de I-EXPLORATION diástole I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION indexado I-EXPLORATION (VFDVII) I-EXPLORATION fue I-EXPLORATION 98 I-EXPLORATION ml/m2 I-EXPLORATION (valor I-EXPLORATION normal: I-EXPLORATION 35-75 I-EXPLORATION ml/m2). I-EXPLORATION Se B-TREATMENT aportaron I-TREATMENT fluidos I-TREATMENT de I-TREATMENT manera I-TREATMENT muy I-TREATMENT restringida, I-TREATMENT observándose I-TREATMENT durante I-TREATMENT todo I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT buena I-TREATMENT concordancia I-TREATMENT entre I-TREATMENT los I-TREATMENT valores I-TREATMENT de I-TREATMENT IC I-TREATMENT y I-TREATMENT PSAP I-TREATMENT medidos I-TREATMENT con I-TREATMENT CAP I-TREATMENT y I-TREATMENT ETE. I-TREATMENT Al B-EXPLORATION término I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION la I-EXPLORATION PVC I-EXPLORATION era I-EXPLORATION 14 I-EXPLORATION mmHg, I-EXPLORATION PCP I-EXPLORATION 19 I-EXPLORATION mmHg, I-EXPLORATION PAP I-EXPLORATION 33/22 I-EXPLORATION e I-EXPLORATION IC I-EXPLORATION 5, I-EXPLORATION 1/ I-EXPLORATION m2. I-EXPLORATION El I-EXPLORATION ETE I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION PSAP I-EXPLORATION de I-EXPLORATION 32, I-EXPLORATION IC I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION 1/ I-EXPLORATION m2, I-EXPLORATION y I-EXPLORATION VFDVI67ml/m2. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertenso B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabáquico, I-PAST_MEDICAL_HISTORY programado B-PRESENT_ILLNESS para I-PRESENT_ILLNESS tiroidectomía I-PRESENT_ILLNESS total. I-PRESENT_ILLNESS Inducción B-EXPLORATION anestésica I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION hemodinámicas, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION modificación I-EXPLORATION de I-EXPLORATION onda I-EXPLORATION T I-EXPLORATION y I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION isquemia. I-EXPLORATION La I-EXPLORATION ETE I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION ventricular. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION suspender I-EXPLORATION y I-EXPLORATION realizar I-EXPLORATION coronariografía I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS antecedentes I-PRESENT_ILLNESS mórbidos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS importancia, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rápida I-PRESENT_ILLNESS progresión, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS hemoptoica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION AngioTAC I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION tumoral, I-EXPLORATION intracavitaria I-EXPLORATION en I-EXPLORATION aurícula I-EXPLORATION izquierda I-EXPLORATION infiltrativa I-EXPLORATION a I-EXPLORATION venas I-EXPLORATION pulmonares. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION con I-EXPLORATION ecocardiograma I-EXPLORATION confirmando I-EXPLORATION masa I-EXPLORATION hiperdensa I-EXPLORATION de I-EXPLORATION 43 I-EXPLORATION x I-EXPLORATION 38 I-EXPLORATION mm I-EXPLORATION ocupando I-EXPLORATION el I-EXPLORATION 75% I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION resecó I-EXPLORATION quirúrgicamente I-EXPLORATION cerca I-EXPLORATION de I-EXPLORATION 95% I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION por I-EXPLORATION infiltración I-EXPLORATION a I-EXPLORATION venas I-EXPLORATION pulmonares. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION histológico I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION fusado I-EXPLORATION con I-EXPLORATION algunas I-EXPLORATION células I-EXPLORATION ovaladas, I-EXPLORATION pericitos, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION disponían I-EXPLORATION en I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION sólido, I-EXPLORATION interrumpido I-EXPLORATION por I-EXPLORATION espacios I-EXPLORATION vasculares I-EXPLORATION delgados, I-EXPLORATION revestidos I-EXPLORATION por I-EXPLORATION células I-EXPLORATION endoteliales I-EXPLORATION y I-EXPLORATION aplanadas. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION inmuno-histoquímica I-EXPLORATION demostró I-EXPLORATION reactividad I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION vimentina I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION proliferantes, I-EXPLORATION CD-34 I-EXPLORATION positivo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION endotelio I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION y I-EXPLORATION pericitos, I-EXPLORATION factor I-EXPLORATION VIII I-EXPLORATION positivo I-EXPLORATION sólo I-EXPLORATION en I-EXPLORATION endotelio, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION S-100 I-EXPLORATION y I-EXPLORATION CD-68. I-EXPLORATION Estos I-EXPLORATION hallazgos, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION el I-EXPLORATION claro I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION reticulina I-EXPLORATION en I-EXPLORATION las I-EXPLORATION técnicas I-EXPLORATION argénticas, I-EXPLORATION indicaron I-EXPLORATION el I-EXPLORATION carácter I-EXPLORATION pericítico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neoplasia I-EXPLORATION y I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION su I-EXPLORATION carácter I-EXPLORATION benigno I-EXPLORATION histológico, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION mitótico I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION tres I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 10 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION mayor I-EXPLORATION aumento. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION satisfactoriamente I-EVOLUTION post I-EVOLUTION cirugía I-EVOLUTION y I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION el I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION mes I-EVOLUTION siguiente, I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION consultar I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION dolor I-EVOLUTION cervical I-EVOLUTION intenso I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION odinofagia. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION diseminación I-EXPLORATION con I-EXPLORATION PET-CP I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION zonas I-EXPLORATION hipermetabólicas I-EXPLORATION en I-EXPLORATION pulmón, I-EXPLORATION base I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION hígado, I-EXPLORATION amígdala I-EXPLORATION izquierda, I-EXPLORATION aurícula I-EXPLORATION izquierda, I-EXPLORATION suprarrenal I-EXPLORATION izquierda, I-EXPLORATION cola I-EXPLORATION de I-EXPLORATION páncreas I-EXPLORATION y I-EXPLORATION colon I-EXPLORATION descendente. I-EXPLORATION Esto I-EXPLORATION se I-EXPLORATION explicó I-EXPLORATION por I-EXPLORATION embolización I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION circulación I-EXPLORATION sistémica. I-EXPLORATION I-EXPLORATION Se B-TREATMENT presentó I-TREATMENT caso I-TREATMENT a I-TREATMENT comité I-TREATMENT oncológico I-TREATMENT que I-TREATMENT decidió I-TREATMENT manejo I-TREATMENT paliativo I-TREATMENT y I-TREATMENT del I-TREATMENT dolor. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION de I-EVOLUTION falla I-EVOLUTION multiorgánica. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 73 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY valsartán I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hidroclorotiazida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY trombocitemia I-PAST_MEDICAL_HISTORY esencial I-PAST_MEDICAL_HISTORY bajo I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY inicialmente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hidroxiurea I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY anagrelide. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS mediados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diciembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS porque I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS fatigabilidad, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia, I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna, I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esfuerzo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca I-PRESENT_ILLNESS frecuente I-PRESENT_ILLNESS no I-PRESENT_ILLNESS productiva. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS había I-PRESENT_ILLNESS tenido I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS prurito. I-PRESENT_ILLNESS El B-EXPLORATION electrocardiograma I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fueron I-EXPLORATION normales, I-EXPLORATION salvo I-EXPLORATION elongación I-EXPLORATION aórtica I-EXPLORATION moderada I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION mostró I-EXPLORATION insuficiencia I-EXPLORATION aórtica I-EXPLORATION leve, I-EXPLORATION aurícula I-EXPLORATION y I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION función I-EXPLORATION conservada. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION destacaba I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 29%, I-EXPLORATION macrocitosis, I-EXPLORATION rouleaux I-EXPLORATION ++, I-EXPLORATION VHS I-EXPLORATION 49 I-EXPLORATION mm/hora I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION de I-EXPLORATION 717.000 I-EXPLORATION mm3. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION generales I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Una B-EVOLUTION semana I-EVOLUTION después I-EVOLUTION presentó I-EVOLUTION esputo I-EVOLUTION hemoptoico I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION hospitalizado I-EVOLUTION por I-EVOLUTION sospecha I-EVOLUTION de I-EVOLUTION embolia I-EVOLUTION pulmonar. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION AngioTAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION trombos I-EXPLORATION pero I-EXPLORATION mostró I-EXPLORATION que I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION ascendente, I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION plano I-EXPLORATION valvular I-EXPLORATION aórtico, I-EXPLORATION estaba I-EXPLORATION cubierta I-EXPLORATION por I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION hipodenso, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION por I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION abdominal I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION inferior. I-EXPLORATION También I-EXPLORATION presentaban I-EXPLORATION un I-EXPLORATION halo I-EXPLORATION similar I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION subclavia I-EXPLORATION izquierda, I-EXPLORATION renales I-EXPLORATION y I-EXPLORATION mesentérica I-EXPLORATION superior I-EXPLORATION (AMS). I-EXPLORATION Las I-EXPLORATION arterias I-EXPLORATION renales I-EXPLORATION y I-EXPLORATION mesentéricas I-EXPLORATION estaban I-EXPLORATION estenosadas, I-EXPLORATION el I-EXPLORATION tronco I-EXPLORATION celíaco I-EXPLORATION presentaba I-EXPLORATION dilatación I-EXPLORATION post-estenótica I-EXPLORATION y I-EXPLORATION el I-EXPLORATION flujo I-EXPLORATION sanguíneo I-EXPLORATION por I-EXPLORATION la I-EXPLORATION AMS I-EXPLORATION era I-EXPLORATION filiforme. I-EXPLORATION Existía I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION derrame I-EXPLORATION pericárdico, I-EXPLORATION esplenomegalia I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION perinéfrico I-EXPLORATION bilateral. I-EXPLORATION El I-EXPLORATION cintigrama I-EXPLORATION renal I-EXPLORATION mostró I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION perfusión I-EXPLORATION y I-EXPLORATION función I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION (RD I-EXPLORATION 62%, I-EXPLORATION RI I-EXPLORATION 38%). I-EXPLORATION Los I-EXPLORATION vasos I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION eran I-EXPLORATION normales I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION angioresonancia I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION periaórtico I-EXPLORATION se I-EXPLORATION reforzó I-EXPLORATION con I-EXPLORATION gadolinio I-EXPLORATION concluyéndose I-EXPLORATION que I-EXPLORATION era I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION inflamatorio-fibroso. I-EXPLORATION La I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION AMS I-EXPLORATION era I-EXPLORATION crítica; I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION arterias I-EXPLORATION renales I-EXPLORATION izquierdas I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tronco I-EXPLORATION celíaco I-EXPLORATION presentaban I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION 70% I-EXPLORATION y I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION mesentérica I-EXPLORATION inferior, I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION 50%. I-EXPLORATION Los I-EXPLORATION senos I-EXPLORATION renales I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION perinéfricas I-EXPLORATION estaban I-EXPLORATION ocupados I-EXPLORATION por I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION que I-EXPLORATION envolvía I-EXPLORATION a I-EXPLORATION la I-EXPLORATION aorta. I-EXPLORATION Se B-TREATMENT instaló I-TREATMENT stents I-TREATMENT en I-TREATMENT AMS I-TREATMENT y I-TREATMENT en I-TREATMENT ambas I-TREATMENT arterias I-TREATMENT renales, I-TREATMENT mejorando B-EVOLUTION la I-EVOLUTION perfusión. I-EVOLUTION El B-EXPLORATION radiólogo I-EXPLORATION planteó I-EXPLORATION ECD. I-EXPLORATION El I-EXPLORATION cintigrama I-EXPLORATION óseo I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION dicho I-EXPLORATION diagnóstico I-EXPLORATION al I-EXPLORATION mostrar I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION captación I-EXPLORATION en I-EXPLORATION fémures I-EXPLORATION y I-EXPLORATION tibias. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 60 I-TREATMENT mg/día I-TREATMENT y I-TREATMENT metotrexato I-TREATMENT 10 I-TREATMENT mg I-TREATMENT semanales, I-TREATMENT con B-EVOLUTION mejoría I-EVOLUTION sintomática I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT redujo I-TREATMENT en I-TREATMENT forma I-TREATMENT gradual I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT corticoides I-TREATMENT hasta I-TREATMENT 10 I-TREATMENT mg. I-TREATMENT Tres B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION (marzo I-EVOLUTION de I-EVOLUTION 2008) I-EVOLUTION fue I-EVOLUTION hospitalizado I-EVOLUTION por I-EVOLUTION neumonía I-EVOLUTION y I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION antibiótico. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION (diciembre I-EVOLUTION de I-EVOLUTION 2008) I-EVOLUTION y I-EVOLUTION estando I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION prácticamente I-EVOLUTION asintomático, I-EVOLUTION salvo I-EVOLUTION edema I-EVOLUTION de I-EVOLUTION piernas I-EVOLUTION atribuido I-EVOLUTION al I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION anagrelide, I-EVOLUTION persistía I-EVOLUTION anémico I-EVOLUTION y I-EVOLUTION con I-EVOLUTION leucocitosis. I-EVOLUTION Un B-EXPLORATION scanner I-EXPLORATION mostró I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION grosor I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION periaórtico I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION aorta I-EXPLORATION ascendente I-EXPLORATION como I-EXPLORATION descendente I-EXPLORATION y I-EXPLORATION prolongación I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION arterias I-EXPLORATION ilíacas I-EXPLORATION primitivas. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 18 I-EXPLORATION meses I-EXPLORATION (julio I-EXPLORATION de I-EXPLORATION 2009), I-EXPLORATION por I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION rodillas I-EXPLORATION se I-EXPLORATION tomó I-EXPLORATION radiografías I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION osteoesclerosis I-EXPLORATION en I-EXPLORATION fémures I-EXPLORATION y I-EXPLORATION tibias I-EXPLORATION en I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION localización I-EXPLORATION que I-EXPLORATION las I-EXPLORATION alteraciones I-EXPLORATION del I-EXPLORATION cintigrama I-EXPLORATION óseo I-EXPLORATION y I-EXPLORATION calcificaciones I-EXPLORATION del I-EXPLORATION cartílago I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION condrocalcinosis. I-EXPLORATION Un I-EXPLORATION nuevo I-EXPLORATION scanner, I-EXPLORATION mostró I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION previos I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION (70%) I-EXPLORATION en I-EXPLORATION la I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION inferior. I-EXPLORATION A B-EVOLUTION 28 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION (abril I-EVOLUTION de I-EVOLUTION 2010), I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION cardiaca I-EVOLUTION congestiva. I-EVOLUTION El B-EXPLORATION scanner I-EXPLORATION mostró I-EXPLORATION acentuación I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION perirrenal, I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pleuras I-EXPLORATION bibasales I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pericardio. I-EXPLORATION El I-EXPLORATION ecocardiograma I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION derrame I-EXPLORATION pericárdico I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION iniciales I-EXPLORATION de I-EXPLORATION taponamiento I-EXPLORATION y I-EXPLORATION superficie I-EXPLORATION pericárdica I-EXPLORATION irregular I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION tumoral. I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION mostró I-EXPLORATION bajo I-EXPLORATION voltaje. I-EXPLORATION Fue B-TREATMENT hospitalizado I-TREATMENT efectuándose I-TREATMENT una I-TREATMENT ventana I-TREATMENT pleuro-pericárdica. I-TREATMENT Durante I-TREATMENT la I-TREATMENT operación I-TREATMENT se I-TREATMENT encontró I-TREATMENT el I-TREATMENT pericardio I-TREATMENT a I-TREATMENT tensión I-TREATMENT drenando I-TREATMENT 1.200 I-TREATMENT ml I-TREATMENT de I-TREATMENT un I-TREATMENT líquido I-TREATMENT amarillo I-TREATMENT pardusco. I-TREATMENT El B-EXPLORATION pericardio I-EXPLORATION parietal I-EXPLORATION era I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION visceral I-EXPLORATION estaba I-EXPLORATION infiltrado I-EXPLORATION difusamente I-EXPLORATION por I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION duro. I-EXPLORATION El I-EXPLORATION líquido I-EXPLORATION pericárdico I-EXPLORATION tenía I-EXPLORATION abundantes I-EXPLORATION histiocitos I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION pericárdico I-EXPLORATION parietal I-EXPLORATION resecado, I-EXPLORATION que I-EXPLORATION tenía I-EXPLORATION infiltración I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION citoplasma I-EXPLORATION granular I-EXPLORATION y I-EXPLORATION espumoso I-EXPLORATION y I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION inmunohistoquímico I-EXPLORATION confirmó I-EXPLORATION que I-EXPLORATION dichas I-EXPLORATION células I-EXPLORATION correspondían I-EXPLORATION a I-EXPLORATION histiocitos, I-EXPLORATION CD68 I-EXPLORATION (+), I-EXPLORATION CD1a I-EXPLORATION (-) I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION S100 I-EXPLORATION (-), I-EXPLORATION confirmando I-EXPLORATION la I-EXPLORATION ECD. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION clara I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION procedimiento. I-EVOLUTION I-EVOLUTION Paciente B-PAST_MEDICAL_HISTORY chileno, I-PAST_MEDICAL_HISTORY masculino, B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS de I-PRESENT_ILLNESS viaje I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Cuzco, I-PRESENT_ILLNESS Perú, I-PRESENT_ILLNESS inicia I-PRESENT_ILLNESS súbitamente I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS reposo I-PRESENT_ILLNESS al I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS agrega I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general. I-PRESENT_ILLNESS Se B-TREATMENT diagnostica I-TREATMENT mal I-TREATMENT de I-TREATMENT altura I-TREATMENT agudo, I-TREATMENT recibiendo I-TREATMENT furosemida, I-TREATMENT acetazolamida, I-TREATMENT dexametasona, I-TREATMENT ranitidina I-TREATMENT y I-TREATMENT ceftriaxona. I-TREATMENT B-EVOLUTION En I-EVOLUTION Chile, I-EVOLUTION 6 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION persistir I-EVOLUTION con I-EVOLUTION idéntica I-EVOLUTION sintomatología I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION derivado I-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencia I-EVOLUTION del I-EVOLUTION Hospital I-EVOLUTION Clínico I-EVOLUTION Universidad I-EVOLUTION de I-EVOLUTION Chile I-EVOLUTION por I-EVOLUTION sospecha I-EVOLUTION de I-EVOLUTION tromboembolismo I-EVOLUTION pulmonar. I-EVOLUTION Ingresó B-EXPLORATION afebril, I-EXPLORATION disneico, I-EXPLORATION con I-EXPLORATION tope I-EXPLORATION inspiratorio I-EXPLORATION y I-EXPLORATION distensión I-EXPLORATION abdominal. I-EXPLORATION Tenía B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY apnea-hipopnea I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY sueño, I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY bipolar I-PAST_MEDICAL_HISTORY manejado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY valproico, I-PAST_MEDICAL_HISTORY rinitis I-PAST_MEDICAL_HISTORY alérgica, I-PAST_MEDICAL_HISTORY várices I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY miembros I-PAST_MEDICAL_HISTORY inferiores, I-PAST_MEDICAL_HISTORY apendicectomizado, I-PAST_MEDICAL_HISTORY tabáquico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY paquetes-año, I-PAST_MEDICAL_HISTORY bebedor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY copas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vino I-PAST_MEDICAL_HISTORY diarias I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Signos B-EXPLORATION vitales: I-EXPLORATION Pulso I-EXPLORATION 81, I-EXPLORATION ventilación I-EXPLORATION 18 I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION 102-67 I-EXPLORATION mmHg, I-EXPLORATION temperatura I-EXPLORATION axilar I-EXPLORATION 36°C. I-EXPLORATION Al I-EXPLORATION examen: I-EXPLORATION en I-EXPLORATION decúbito I-EXPLORATION dorsal, I-EXPLORATION consciente, I-EXPLORATION hidratado, I-EXPLORATION bien I-EXPLORATION perfundido, I-EXPLORATION piel I-EXPLORATION blanca, I-EXPLORATION pálida. I-EXPLORATION Destacaba I-EXPLORATION abdomen I-EXPLORATION doloroso I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION bazo I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION várices I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION inferiores. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION hematocrito I-EXPLORATION 27, I-EXPLORATION 1%, I-EXPLORATION hemoglobina I-EXPLORATION 8, I-EXPLORATION 7 I-EXPLORATION g/dl, I-EXPLORATION VCM I-EXPLORATION y I-EXPLORATION CHCM I-EXPLORATION normales, I-EXPLORATION leucocitos I-EXPLORATION 10.100/uL, I-EXPLORATION VHS I-EXPLORATION 28 I-EXPLORATION mm/hr, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION y I-EXPLORATION TTPK I-EXPLORATION normales. I-EXPLORATION Dímero I-EXPLORATION D I-EXPLORATION 4.683 I-EXPLORATION ng/ml I-EXPLORATION (normal I-EXPLORATION < I-EXPLORATION 500), I-EXPLORATION LDH I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION 1.247 I-EXPLORATION (rango: I-EXPLORATION 313-618), I-EXPLORATION proBNP, I-EXPLORATION CK, I-EXPLORATION CK-MB I-EXPLORATION y I-EXPLORATION troponinas I-EXPLORATION normales. I-EXPLORATION Angio-TAC I-EXPLORATION pulmonar I-EXPLORATION descartó I-EXPLORATION tromboembolismo I-EXPLORATION y I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION periesplénico, I-EXPLORATION subcapsular I-EXPLORATION de I-EXPLORATION 17 I-EXPLORATION cm, I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION ingresado I-EVOLUTION a I-EVOLUTION cuidados I-EVOLUTION intermedios I-EVOLUTION con I-EVOLUTION diagnóstico I-EVOLUTION probable I-EVOLUTION de I-EVOLUTION infarto I-EVOLUTION esplénico I-EVOLUTION con I-EVOLUTION transformación I-EVOLUTION hemorrágica. I-EVOLUTION I-EVOLUTION Hemogramas B-EXPLORATION seriados I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION cambios, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecocardiografía I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION crecimiento I-EXPLORATION del I-EXPLORATION hematoma I-EXPLORATION esplénico I-EXPLORATION a I-EXPLORATION 19 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION Ante B-EVOLUTION estabilidad I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION trasladado I-EVOLUTION a I-EVOLUTION sala I-EVOLUTION en I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION La B-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION no I-EXPLORATION sugerían I-EXPLORATION etiologías I-EXPLORATION infecciosas I-EXPLORATION de I-EXPLORATION su I-EXPLORATION hematoma I-EXPLORATION esplénico, I-EXPLORATION y I-EXPLORATION no I-EXPLORATION había I-EXPLORATION elementos I-EXPLORATION sospechosos I-EXPLORATION de I-EXPLORATION síndromes I-EXPLORATION mieloproliferativos, I-EXPLORATION linfoproliferativos I-EXPLORATION u I-EXPLORATION otra I-EXPLORATION neoplasia I-EXPLORATION en I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION tomografía I-EXPLORATION y I-EXPLORATION bioquímicos. I-EXPLORATION Hemogramas I-EXPLORATION previos I-EXPLORATION a I-EXPLORATION este I-EXPLORATION evento I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION Ante I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION esplénico, I-EXPLORATION pese I-EXPLORATION a I-EXPLORATION ser I-EXPLORATION una I-EXPLORATION causa I-EXPLORATION rara, I-EXPLORATION fue I-EXPLORATION estudiado I-EXPLORATION para I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION rasgo I-EXPLORATION falciforme I-EXPLORATION con I-EXPLORATION una I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION inducción I-EXPLORATION de I-EXPLORATION drepanocitos I-EXPLORATION con I-EXPLORATION metabisulfito I-EXPLORATION de I-EXPLORATION sodio I-EXPLORATION al I-EXPLORATION 2%, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION positiva. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT evolución I-TREATMENT intrahospitalaria I-TREATMENT favorable, I-TREATMENT acompañado I-TREATMENT de I-TREATMENT laboratorio I-TREATMENT general I-TREATMENT y I-TREATMENT estudios I-TREATMENT radiológicos I-TREATMENT sin I-TREATMENT progresión, I-TREATMENT se I-TREATMENT decidió I-TREATMENT no I-TREATMENT intervenir I-TREATMENT quirúrgicamente I-TREATMENT y B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION En B-EXPLORATION control I-EXPLORATION ambulatorio I-EXPLORATION por I-EXPLORATION hematología I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION en I-EXPLORATION medio I-EXPLORATION alcalino I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION hemoglobina I-EXPLORATION normal I-EXPLORATION A I-EXPLORATION 54, I-EXPLORATION 8% I-EXPLORATION y I-EXPLORATION 41, I-EXPLORATION 8% I-EXPLORATION de I-EXPLORATION fracción I-EXPLORATION 3, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION hemoglobina I-EXPLORATION S I-EXPLORATION y I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION rasgo I-EXPLORATION falciforme. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos, I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY consultó I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sufrir I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY baja I-PAST_MEDICAL_HISTORY intensidad I-PAST_MEDICAL_HISTORY (pelotazo) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY genital. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION dolor I-EXPLORATION que I-EXPLORATION dificultaba I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION evidenciándose I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION asimétrico I-EXPLORATION testicular I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION asociadas. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION ecotomografía I-EXPLORATION testicular I-EXPLORATION presentándose I-EXPLORATION a I-EXPLORATION control I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION transcurridos I-EXPLORATION 5 I-EXPLORATION meses, I-EXPLORATION constatándose I-EXPLORATION clínicamente I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION indurada I-EXPLORATION en I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION no I-EXPLORATION dolorosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION escrotal; I-EXPLORATION testículo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION pene I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION La I-EXPLORATION ultrasonografía I-EXPLORATION demostró I-EXPLORATION en I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION x I-EXPLORATION 19 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION mm, I-EXPLORATION bien I-EXPLORATION delimitado, I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION hiperecogénicas I-EXPLORATION con I-EXPLORATION sombra I-EXPLORATION acústica I-EXPLORATION posterior. I-EXPLORATION El I-EXPLORATION testículo I-EXPLORATION derecho, I-EXPLORATION epidídimos I-EXPLORATION y I-EXPLORATION cordones I-EXPLORATION espermáticos I-EXPLORATION no I-EXPLORATION presentan I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION su I-EXPLORATION ecoestructura. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION serológico I-EXPLORATION para I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION (α-feto I-EXPLORATION proteína I-EXPLORATION y I-EXPLORATION hormona I-EXPLORATION gonadotropina I-EXPLORATION coriónica I-EXPLORATION sub-unidad I-EXPLORATION β) I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION pelvis, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION tórax I-EXPLORATION las I-EXPLORATION que I-EXPLORATION no I-EXPLORATION demostraron I-EXPLORATION lesiones I-EXPLORATION secundarias. I-EXPLORATION I-EXPLORATION Se B-TREATMENT efectuó I-TREATMENT enucleación I-TREATMENT del I-TREATMENT tumor I-TREATMENT y I-TREATMENT biopsia I-TREATMENT intra-operatoria. I-TREATMENT Se B-EXPLORATION examinó I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION testicular I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION g I-EXPLORATION de I-EXPLORATION 35 I-EXPLORATION x I-EXPLORATION 17 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION presentando I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION subcapsular I-EXPLORATION redondeada, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION amarillenta, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION grumosas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION arenoso. I-EXPLORATION El I-EXPLORATION corte I-EXPLORATION histológico I-EXPLORATION por I-EXPLORATION congelación I-EXPLORATION y I-EXPLORATION diferido I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION nidos I-EXPLORATION y I-EXPLORATION cordones I-EXPLORATION conformados I-EXPLORATION por I-EXPLORATION células I-EXPLORATION ovales I-EXPLORATION a I-EXPLORATION poligonales I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION grandes, I-EXPLORATION excéntricos I-EXPLORATION y I-EXPLORATION con I-EXPLORATION nucléolo I-EXPLORATION prominente, I-EXPLORATION el I-EXPLORATION citoplasma I-EXPLORATION es I-EXPLORATION eosinófilo I-EXPLORATION y I-EXPLORATION abundante, I-EXPLORATION apreciándose I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION polimorfonuclear I-EXPLORATION neutrófilo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION central I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION linfocitos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia I-EXPLORATION en I-EXPLORATION partes I-EXPLORATION formando I-EXPLORATION agregados I-EXPLORATION linfoides. I-EXPLORATION El I-EXPLORATION estroma I-EXPLORATION es I-EXPLORATION en I-EXPLORATION partes I-EXPLORATION hialino I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION degeneración I-EXPLORATION mixoide I-EXPLORATION y I-EXPLORATION abundantes I-EXPLORATION calcificaciones I-EXPLORATION dispuestas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION intersticial I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lumen I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nidos I-EXPLORATION tumorales, I-EXPLORATION concluyéndose I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION contemporánea I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Sertoli I-EXPLORATION calcificado. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION extensión I-EXPLORATION tumoral I-EXPLORATION intratubular, I-EXPLORATION figuras I-EXPLORATION mitóticas, I-EXPLORATION necrosis, I-EXPLORATION acentuada I-EXPLORATION atipía I-EXPLORATION citológica I-EXPLORATION ni I-EXPLORATION extensión I-EXPLORATION tumoral I-EXPLORATION extra-testicular. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION demostró I-EXPLORATION intensa I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION α-inhibina, I-EXPLORATION S-100 I-EXPLORATION y I-EXPLORATION vimentina; I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION (Ki-67) I-EXPLORATION bajo I-EXPLORATION (< I-EXPLORATION 1%). I-EXPLORATION I-EXPLORATION Se B-TREATMENT completó I-TREATMENT la I-TREATMENT cirugía I-TREATMENT realizándose I-TREATMENT orquiectomía I-TREATMENT radical. I-TREATMENT No B-EVOLUTION se I-EVOLUTION registraron I-EVOLUTION complicaciones I-EVOLUTION post-operatorias. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION post-cirugía, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION sano, I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION en I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION tórax-abdomen I-EVOLUTION y I-EVOLUTION pelvis; I-EVOLUTION descartándose I-EVOLUTION en I-EVOLUTION este I-EVOLUTION paciente I-EVOLUTION la I-EVOLUTION asociación I-EVOLUTION con I-EVOLUTION complejo I-EVOLUTION de I-EVOLUTION Carney I-EVOLUTION y I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Peutz-Jeghers. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS domiciliada B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Calama, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY causa I-PAST_MEDICAL_HISTORY desconocida, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY agregó I-PAST_MEDICAL_HISTORY baja I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY kg, I-PAST_MEDICAL_HISTORY cefalea, I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY polineuropático I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY guante I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY calcetín I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY poliartralgias. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS había I-PRESENT_ILLNESS aparecido I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS blando, I-PRESENT_ILLNESS indoloro, I-PRESENT_ILLNESS progresivo, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS hombros, I-PRESENT_ILLNESS antebrazo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS muslos, I-PRESENT_ILLNESS inmovilidad I-PRESENT_ILLNESS articular I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS manos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rodillas, I-PRESENT_ILLNESS postración I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas. I-PRESENT_ILLNESS Fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO para I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO posible I-DERIVED_FROM/TO enfermedad I-DERIVED_FROM/TO reumatológica. I-DERIVED_FROM/TO Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION paciente I-EXPLORATION caquéctica, I-EXPLORATION pálida, I-EXPLORATION postrada. I-EXPLORATION Destacó I-EXPLORATION macroglosia I-EXPLORATION con I-EXPLORATION lengua I-EXPLORATION geográfica, I-EXPLORATION masas I-EXPLORATION gomosas I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION hombros I-EXPLORATION (periarticulares) I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm: I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION shoulder I-EXPLORATION pad, I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION antebrazo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION muslos, I-EXPLORATION manos I-EXPLORATION contracturadas I-EXPLORATION en I-EXPLORATION flexión I-EXPLORATION y I-EXPLORATION rigidez I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION rodillas. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION hemoglobina I-EXPLORATION 8, I-EXPLORATION 7 I-EXPLORATION g/dL, I-EXPLORATION creatinina I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION mg/dL, I-EXPLORATION calcemia I-EXPLORATION 12 I-EXPLORATION mg/dL, I-EXPLORATION albúmina I-EXPLORATION 1, I-EXPLORATION 9 I-EXPLORATION g/L, I-EXPLORATION proteína I-EXPLORATION total I-EXPLORATION 5, I-EXPLORATION 4 I-EXPLORATION g/dL I-EXPLORATION y I-EXPLORATION triglicéridos I-EXPLORATION 450 I-EXPLORATION mg/dL. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION fuerte I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION mieloma I-EXPLORATION múltiple I-EXPLORATION y I-EXPLORATION amiloidosis I-EXPLORATION asociada, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION mielograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION infiltrado I-EXPLORATION de I-EXPLORATION 25% I-EXPLORATION de I-EXPLORATION células I-EXPLORATION plasmáticas. I-EXPLORATION El I-EXPLORATION inmunofenotipo I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION mostró I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION con I-EXPLORATION restricción I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION liviana I-EXPLORATION lambda I-EXPLORATION y I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION mieloma. I-EXPLORATION La I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION pequeño I-EXPLORATION componente I-EXPLORATION M I-EXPLORATION en I-EXPLORATION G1 I-EXPLORATION y I-EXPLORATION cuantificación I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION muy I-EXPLORATION disminuidas, I-EXPLORATION IgA I-EXPLORATION 27, I-EXPLORATION 7 I-EXPLORATION mg/dL, I-EXPLORATION IgG I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION de I-EXPLORATION 8, I-EXPLORATION 8 I-EXPLORATION mg/dL. I-EXPLORATION No I-EXPLORATION fue I-EXPLORATION posible I-EXPLORATION estudiar I-EXPLORATION proteinuria I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION diuresis. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION muslo I-EXPLORATION izquierdo, I-EXPLORATION informó I-EXPLORATION tejido I-EXPLORATION fibroadiposo, I-EXPLORATION escaso I-EXPLORATION tejido I-EXPLORATION muscular I-EXPLORATION estriado I-EXPLORATION y I-EXPLORATION depósitos I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Rojo I-EXPLORATION Congo, I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION amiloidosis. I-EXPLORATION Las I-EXPLORATION radiografías I-EXPLORATION óseas I-EXPLORATION mostraron I-EXPLORATION lesiones I-EXPLORATION líticas I-EXPLORATION en I-EXPLORATION cadera I-EXPLORATION y I-EXPLORATION fémur I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION en I-EXPLORATION correspondencia I-EXPLORATION a I-EXPLORATION masas I-EXPLORATION descritas I-EXPLORATION anteriormente, I-EXPLORATION sin I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION estructuras I-EXPLORATION óseas. I-EXPLORATION Una I-EXPLORATION electromiografía I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION neuropatía I-EXPLORATION por I-EXPLORATION atrapamiento I-EXPLORATION de I-EXPLORATION nervio I-EXPLORATION peroneo I-EXPLORATION y I-EXPLORATION nervio I-EXPLORATION mediano I-EXPLORATION derecho. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION depósitos I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION en I-EXPLORATION hombros I-EXPLORATION (periarticulares), I-EXPLORATION pericardio, I-EXPLORATION pared I-EXPLORATION intestinal, I-EXPLORATION hepatomegalia I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION páncreas. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecocardiograma. I-EXPLORATION Se I-EXPLORATION concluyó I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION mieloma I-EXPLORATION múltiple, I-EXPLORATION amiloidosis I-EXPLORATION asociada I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION terminal. I-EXPLORATION Recibió B-TREATMENT bisfosfonatos, I-TREATMENT con I-TREATMENT reducción I-TREATMENT de I-TREATMENT la I-TREATMENT hipercalcemia I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT melfalan I-TREATMENT 10 I-TREATMENT mg/día I-TREATMENT y I-TREATMENT prednisona I-TREATMENT 40 I-TREATMENT mg/día I-TREATMENT por I-TREATMENT 4 I-TREATMENT días. I-TREATMENT Luego I-TREATMENT se I-TREATMENT agregó I-TREATMENT talidomida I-TREATMENT 50 I-TREATMENT mg/día. I-TREATMENT Lamentablemente, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS ingeniero, B-PAST_MEDICAL_HISTORY previamente I-PAST_MEDICAL_HISTORY sano, I-PAST_MEDICAL_HISTORY presentó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS curso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas, I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS retención I-PRESENT_ILLNESS urinaria, I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS déficits I-PRESENT_ILLNESS sensoriales I-PRESENT_ILLNESS irregulares I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tórax I-PRESENT_ILLNESS y I-PRESENT_ILLNESS abdomen. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY antecedente, I-PAST_MEDICAL_HISTORY comunicó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY tos I-PAST_MEDICAL_HISTORY leve I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 4-5 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY admisión I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY clínica. I-PAST_MEDICAL_HISTORY Una I-PAST_MEDICAL_HISTORY evaluación I-PAST_MEDICAL_HISTORY urológica I-PAST_MEDICAL_HISTORY descartó I-PAST_MEDICAL_HISTORY uropatía I-PAST_MEDICAL_HISTORY obstructiva. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION estaba I-EXPLORATION alerta, I-EXPLORATION febril I-EXPLORATION (38°C), I-EXPLORATION sin I-EXPLORATION déficits I-EXPLORATION en I-EXPLORATION nervios I-EXPLORATION craneales. I-EXPLORATION La I-EXPLORATION fuerza I-EXPLORATION en I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION superiores I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION debilidad I-EXPLORATION moderada I-EXPLORATION en I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION con I-EXPLORATION incapacidad I-EXPLORATION para I-EXPLORATION levantarse I-EXPLORATION desde I-EXPLORATION una I-EXPLORATION posición I-EXPLORATION sentada. I-EXPLORATION Los I-EXPLORATION reflejos I-EXPLORATION plantares I-EXPLORATION eran I-EXPLORATION extensores, I-EXPLORATION había I-EXPLORATION déficit I-EXPLORATION sensorial I-EXPLORATION en I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION y I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION dermatoma I-EXPLORATION D6. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION rutina: I-EXPLORATION hemograma, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva, I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION urocultivos I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION mostró I-EXPLORATION 35 I-EXPLORATION glóbulos I-EXPLORATION blancos I-EXPLORATION por I-EXPLORATION mm3, I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION células I-EXPLORATION mononucleares. I-EXPLORATION La I-EXPLORATION proteínorraquia I-EXPLORATION fue I-EXPLORATION 75 I-EXPLORATION mg/dl. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectaron I-EXPLORATION bandas I-EXPLORATION oligoclonales. I-EXPLORATION La I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION ARN I-EXPLORATION viral I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION PCR-Microarray I-EXPLORATION (Entherpex®, I-EXPLORATION Genomica, I-EXPLORATION España), I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION el I-EXPLORATION LCR I-EXPLORATION sólo I-EXPLORATION para I-EXPLORATION VHH-7. I-EXPLORATION Los I-EXPLORATION herpes I-EXPLORATION virus I-EXPLORATION VHS-1, I-EXPLORATION VHS-2, I-EXPLORATION VHH-6, I-EXPLORATION Epstein-Barr, I-EXPLORATION VVZ, I-EXPLORATION citomegalovirus I-EXPLORATION y I-EXPLORATION también I-EXPLORATION anterovirus I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION test I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION y I-EXPLORATION HTLV-1 I-EXPLORATION fue I-EXPLORATION negativo, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION pruebas I-EXPLORATION inmunológicas I-EXPLORATION para I-EXPLORATION vasculitis I-EXPLORATION y I-EXPLORATION test I-EXPLORATION serológico I-EXPLORATION para I-EXPLORATION Mycoplasma I-EXPLORATION pneumoniae. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RNM) I-EXPLORATION cerebral I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION RNM I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION evidenció I-EXPLORATION lesiones I-EXPLORATION inflamatorias, I-EXPLORATION difusas, I-EXPLORATION extensas I-EXPLORATION en I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION cervical, I-EXPLORATION y I-EXPLORATION dorsal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION médula I-EXPLORATION (ver I-EXPLORATION Figuras I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2). I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT metilprednisolona I-TREATMENT 1 I-TREATMENT g I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 3 I-TREATMENT días I-TREATMENT y I-TREATMENT ganciclovir I-TREATMENT iv I-TREATMENT 300 I-TREATMENT mg I-TREATMENT al I-TREATMENT día. I-TREATMENT A I-TREATMENT las I-TREATMENT 48 I-TREATMENT h I-TREATMENT el I-TREATMENT paciente I-TREATMENT recuperó I-TREATMENT la I-TREATMENT fuerza I-TREATMENT en I-TREATMENT extremidades I-TREATMENT por I-TREATMENT completo; I-TREATMENT la B-EVOLUTION retención I-EVOLUTION urinaria I-EVOLUTION persistió I-EVOLUTION por I-EVOLUTION 1 I-EVOLUTION mes I-EVOLUTION para I-EVOLUTION resolverse I-EVOLUTION por I-EVOLUTION completo I-EVOLUTION en I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION El B-EXPLORATION control I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION días I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION PCR I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION Herpesviridae. I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION 15 I-EXPLORATION células I-EXPLORATION con I-EXPLORATION proteinas I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION repetición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION PCR I-EXPLORATION en I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION LCR, I-EXPLORATION tomada I-EXPLORATION al I-EXPLORATION ingreso, I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION fue I-EXPLORATION mielitis I-EXPLORATION viral I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION HHV-7. I-EXPLORATION I-EXPLORATION Los B-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION evidenciaron I-EVOLUTION un I-EVOLUTION paciente I-EVOLUTION sano, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION desarrollado I-EVOLUTION inmunodeficiencia. I-EVOLUTION I-EVOLUTION Sexo B-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS VIH B-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2000, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY enfermedades I-PAST_MEDICAL_HISTORY marcadoras I-PAST_MEDICAL_HISTORY etapa I-PAST_MEDICAL_HISTORY SIDA, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY antirretroviral I-PAST_MEDICAL_HISTORY (TARV) I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY con: I-PAST_MEDICAL_HISTORY zidovudina, I-PAST_MEDICAL_HISTORY lamivudina, I-PAST_MEDICAL_HISTORY indinavir/ritonavir, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY migraña. I-PAST_MEDICAL_HISTORY Cuarenta B-PRESENT_ILLNESS y I-PRESENT_ILLNESS ocho I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS previas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta, I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS características I-PRESENT_ILLNESS tensionales, I-PRESENT_ILLNESS automedicándose I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ibuprofeno/ergotamina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS agregando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas: I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS parestesias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tercio I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba: I-EXPLORATION palidez I-EXPLORATION cutánea I-EXPLORATION alternante I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION cianosis I-EXPLORATION y I-EXPLORATION frialdad I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION tobillos I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION tibial I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION pedio.. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS originario B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Tamaulipas, I-PAST_MEDICAL_HISTORY México, I-PAST_MEDICAL_HISTORY evaluado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS xerosis I-PRESENT_ILLNESS generalizada, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS incierto. I-PRESENT_ILLNESS Producto B-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY segundo I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY pareja I-PAST_MEDICAL_HISTORY sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY aparentes I-FAMILY_HISTORY de I-FAMILY_HISTORY consanguineidad, I-FAMILY_HISTORY se B-PAST_MEDICAL_HISTORY caracteriza I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY intolerancia I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY calor I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ausencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY sudoración I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nacimiento. I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY refierían I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY heredofamiliares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia. I-FAMILY_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION frenteprominente, I-EXPLORATION hipoplasia I-EXPLORATION del I-EXPLORATION puente I-EXPLORATION nasal, I-EXPLORATION dos I-EXPLORATION incisivos I-EXPLORATION únicos I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION cono, I-EXPLORATION pigmentación I-EXPLORATION periorbitaria, I-EXPLORATION pelo I-EXPLORATION escaso, I-EXPLORATION fino, I-EXPLORATION disperso I-EXPLORATION y I-EXPLORATION frágil I-EXPLORATION así I-EXPLORATION como I-EXPLORATION cejas I-EXPLORATION y I-EXPLORATION pestañas. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION dermatosis I-EXPLORATION diseminada I-EXPLORATION a I-EXPLORATION cabeza, I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION principalmente I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION pápulas I-EXPLORATION puntiformes I-EXPLORATION eritematosas, I-EXPLORATION con I-EXPLORATION eritema I-EXPLORATION difuso I-EXPLORATION en I-EXPLORATION una I-EXPLORATION piel I-EXPLORATION xerótica. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION palma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas I-EXPLORATION sudoríparas I-EXPLORATION y I-EXPLORATION sebáceas. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION obtener I-EXPLORATION el I-EXPLORATION consentimiento I-EXPLORATION informado, I-EXPLORATION obtuvimos I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION cariotipo I-EXPLORATION reportándose I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vez, I-EXPLORATION obtuvimos I-EXPLORATION sangre I-EXPLORATION no I-EXPLORATION coagulada I-EXPLORATION en I-EXPLORATION tubos I-EXPLORATION de I-EXPLORATION EDTA I-EXPLORATION (ácido I-EXPLORATION etilendiaminotetraacético) I-EXPLORATION de I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION de I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION siguiendo I-EXPLORATION los I-EXPLORATION Principios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Declaración I-EXPLORATION de I-EXPLORATION Helsinki. I-EXPLORATION Se I-EXPLORATION extrajo I-EXPLORATION ADN I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION sanguíneas I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION PUREGENER I-EXPLORATION (Systema I-EXPLORATION Gentra). I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mutaciones I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION exones I-EXPLORATION así I-EXPLORATION como I-EXPLORATION las I-EXPLORATION secuencias I-EXPLORATION de I-EXPLORATION los I-EXPLORATION uniones I-EXPLORATION de I-EXPLORATION los I-EXPLORATION intrones-exones I-EXPLORATION fueron I-EXPLORATION amplificados I-EXPLORATION por I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION (reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polimerasa) I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION EDA-A1 I-EXPLORATION en I-EXPLORATION condiciones I-EXPLORATION reportadas I-EXPLORATION previamente. I-EXPLORATION Las I-EXPLORATION condiciones I-EXPLORATION para I-EXPLORATION la I-EXPLORATION amplificación I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 94 I-EXPLORATION °C I-EXPLORATION por I-EXPLORATION 2 I-EXPLORATION minutos, I-EXPLORATION seguido I-EXPLORATION por I-EXPLORATION 35 I-EXPLORATION ciclos I-EXPLORATION de I-EXPLORATION 94°C I-EXPLORATION durante I-EXPLORATION 30 I-EXPLORATION segundos, I-EXPLORATION 55°C I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION segundos I-EXPLORATION y I-EXPLORATION 72°C I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION segundos I-EXPLORATION con I-EXPLORATION una I-EXPLORATION extensión I-EXPLORATION final I-EXPLORATION a I-EXPLORATION 72°C I-EXPLORATION durante I-EXPLORATION 7 I-EXPLORATION minutos. I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION colocados I-EXPLORATION en I-EXPLORATION un I-EXPLORATION gel I-EXPLORATION de I-EXPLORATION agarosa I-EXPLORATION al I-EXPLORATION 1% I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION fueron I-EXPLORATION analizados I-EXPLORATION por I-EXPLORATION la I-EXPLORATION Secuenciadora I-EXPLORATION Automática I-EXPLORATION Directa I-EXPLORATION ABI I-EXPLORATION Prism I-EXPLORATION 310, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION Reacción I-EXPLORATION "ABI I-EXPLORATION PRISM® I-EXPLORATION BigDye™ I-EXPLORATION Terminator I-EXPLORATION Cycle I-EXPLORATION Sequencing' I-EXPLORATION (PE I-EXPLORATION Biosystem) I-EXPLORATION 8. I-EXPLORATION I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION comúnmente I-EXPLORATION la I-EXPLORATION displasia I-EXPLORATION ectodérmica I-EXPLORATION hipohidrótica I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION ligada I-EXPLORATION a I-EXPLORATION X, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION obtener I-EXPLORATION ADN I-EXPLORATION genómico, I-EXPLORATION logrando I-EXPLORATION identificar I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION sinsentido I-EXPLORATION Ala349Thr I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION EDA, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION la I-EXPLORATION correlación I-EXPLORATION clínico-patológica, I-EXPLORATION concluyendo I-EXPLORATION así I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION displasia I-EXPLORATION ectodérmica I-EXPLORATION hipohidrótica.. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS ictal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS cuantitativo I-PRESENT_ILLNESS progresivo. I-PRESENT_ILLNESS Consultó B-EXPLORATION inicialmente I-EXPLORATION en I-EXPLORATION otro I-EXPLORATION hospital I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION mediante I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION encéfalo I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION intraparenquimatoso I-EXPLORATION parietal I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 42 I-EXPLORATION ml, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION hidrocefalia I-EXPLORATION aguda. I-EXPLORATION En I-EXPLORATION pabellón I-EXPLORATION y I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION urgente, I-EXPLORATION se I-EXPLORATION instaló I-EXPLORATION un I-EXPLORATION drenaje I-EXPLORATION ventricular I-EXPLORATION externo I-EXPLORATION (DVE). I-EXPLORATION Se I-EXPLORATION registróuna I-EXPLORATION presión I-EXPLORATION intracraneana I-EXPLORATION (PIC) I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION H2O. I-EXPLORATION Se I-EXPLORATION conectó I-EXPLORATION a I-EXPLORATION ventilación I-EXPLORATION mecánica I-EXPLORATION (VM) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION indicó I-EXPLORATION sedación I-EXPLORATION profunda. I-EXPLORATION Inicialmente, B-EVOLUTION la I-EVOLUTION hipertensión I-EVOLUTION intracraneana I-EVOLUTION se I-EVOLUTION trató I-EVOLUTION con I-EVOLUTION drenaje I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION cefalorraquídeo I-EVOLUTION y I-EVOLUTION sodio I-EVOLUTION hipertónico I-EVOLUTION intravenoso I-EVOLUTION en I-EVOLUTION bolos, I-EVOLUTION según I-EVOLUTION necesidad. I-EVOLUTION Se I-EVOLUTION trasladó I-EVOLUTION a I-EVOLUTION nuestro I-EVOLUTION servicio I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION más I-EVOLUTION tarde. I-EVOLUTION I-EVOLUTION Ingresó I-EVOLUTION intubado I-EVOLUTION y I-EVOLUTION conectado I-EVOLUTION a I-EVOLUTION VM, I-EVOLUTION sedado I-EVOLUTION con I-EVOLUTION propofol I-EVOLUTION 0, I-EVOLUTION 71 I-EVOLUTION mg/kg/h, I-EVOLUTION y I-EVOLUTION hemodinamia I-EVOLUTION apoyada I-EVOLUTION con I-EVOLUTION noradrenalina I-EVOLUTION a I-EVOLUTION 0, I-EVOLUTION 06 I-EVOLUTION μg/kg/min, I-EVOLUTION PIC I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION cm I-EVOLUTION de I-EVOLUTION H2O I-EVOLUTION y I-EVOLUTION presión I-EVOLUTION de I-EVOLUTION perfusión I-EVOLUTION cerebral I-EVOLUTION (PPC) I-EVOLUTION de I-EVOLUTION 80 I-EVOLUTION mmHg. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION coma, I-EXPLORATION con I-EXPLORATION midriasis I-EXPLORATION fija I-EXPLORATION a I-EXPLORATION derecha, I-EXPLORATION reflejos I-EXPLORATION corneales I-EXPLORATION abolidos, I-EXPLORATION reflejos I-EXPLORATION oculocefálicos I-EXPLORATION esbozados, I-EXPLORATION tono I-EXPLORATION y I-EXPLORATION reflejos I-EXPLORATION osteotendíneos I-EXPLORATION disminuidos, I-EXPLORATION reflejos I-EXPLORATION plantares I-EXPLORATION indiferentes I-EXPLORATION bilaterales. I-EXPLORATION I-EXPLORATION Exámenes I-EXPLORATION generales I-EXPLORATION de I-EXPLORATION ingreso: I-EXPLORATION Na+ I-EXPLORATION 146 I-EXPLORATION mEq/L, I-EXPLORATION K+ I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION mEq/L, I-EXPLORATION hematocrito I-EXPLORATION 31%, I-EXPLORATION lactato I-EXPLORATION 1, I-EXPLORATION 4 I-EXPLORATION mmol/L, I-EXPLORATION leucocitos I-EXPLORATION 9.600 I-EXPLORATION por I-EXPLORATION mm3 I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 11, I-EXPLORATION 4 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION La I-EXPLORATION angiografía I-EXPLORATION cerebral I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION vasos I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION malformación I-EXPLORATION arteriovenosa I-EXPLORATION (MAV) I-EXPLORATION parietal I-EXPLORATION mesial I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION rotura I-EXPLORATION reciente, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION tres I-EXPLORATION aneurismas I-EXPLORATION paranidales. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT embolización I-TREATMENT con I-TREATMENT N-butil-cianocrilato I-TREATMENT (Histoacryl®, I-TREATMENT Braun, I-TREATMENT Alemania), I-TREATMENT logrando I-TREATMENT reducir I-TREATMENT el I-TREATMENT nido I-TREATMENT de I-TREATMENT la I-TREATMENT MAV I-TREATMENT y I-TREATMENT excluir I-TREATMENT sus I-TREATMENT aneurismas. I-TREATMENT Después I-TREATMENT del I-TREATMENT procedimiento, I-TREATMENT la I-TREATMENT TC I-TREATMENT de I-TREATMENT encéfalo I-TREATMENT mostró I-TREATMENT el I-TREATMENT Histoacryl® I-TREATMENT correctamente I-TREATMENT situado. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION un I-EVOLUTION incremento I-EVOLUTION del I-EVOLUTION hematoma I-EVOLUTION con I-EVOLUTION acentuado I-EVOLUTION efecto I-EVOLUTION de I-EVOLUTION masa I-EVOLUTION y I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION edema I-EVOLUTION cerebral I-EVOLUTION difuso I-EVOLUTION con I-EVOLUTION obliteración I-EVOLUTION de I-EVOLUTION los I-EVOLUTION surcos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION convexidad, I-EVOLUTION además I-EVOLUTION de I-EVOLUTION herniaciones I-EVOLUTION subfalcina I-EVOLUTION y I-EVOLUTION uncal I-EVOLUTION con I-EVOLUTION desviación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION línea I-EVOLUTION media I-EVOLUTION de I-EVOLUTION 10 I-EVOLUTION mm, I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION glándula I-EVOLUTION pineal. I-EVOLUTION Se B-TREATMENT realizó I-TREATMENT la I-TREATMENT evacuación I-TREATMENT del I-TREATMENT hematoma I-TREATMENT y I-TREATMENT una I-TREATMENT craniectomía I-TREATMENT descompresiva I-TREATMENT frontoparietoccipital I-TREATMENT derecha I-TREATMENT extensa I-TREATMENT de I-TREATMENT 10, I-TREATMENT 2 I-TREATMENT x I-TREATMENT 9, I-TREATMENT 3 I-TREATMENT cm. I-TREATMENT La I-TREATMENT TC I-TREATMENT de I-TREATMENT encéfalo I-TREATMENT de I-TREATMENT control I-TREATMENT al I-TREATMENT día I-TREATMENT siguiente I-TREATMENT mostró I-TREATMENT una I-TREATMENT reducción I-TREATMENT del I-TREATMENT hematoma I-TREATMENT a I-TREATMENT 11 I-TREATMENT ml, I-TREATMENT pero I-TREATMENT aún I-TREATMENT se I-TREATMENT mantenía I-TREATMENT un I-TREATMENT importante I-TREATMENT efecto I-TREATMENT de I-TREATMENT masa, I-TREATMENT con I-TREATMENT desviación I-TREATMENT de I-TREATMENT la I-TREATMENT línea I-TREATMENT media I-TREATMENT de I-TREATMENT 5 I-TREATMENT mm. I-TREATMENT I-TREATMENT A B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION la I-EVOLUTION craniectomía I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION PIC I-EVOLUTION mayores I-EVOLUTION a I-EVOLUTION 20 I-EVOLUTION cm I-EVOLUTION H2O I-EVOLUTION (23 I-EVOLUTION ± I-EVOLUTION 5 I-EVOLUTION cm I-EVOLUTION H2O; I-EVOLUTION media I-EVOLUTION ± I-EVOLUTION DS). I-EVOLUTION Se B-TREATMENT instauró I-TREATMENT un I-TREATMENT manejo I-TREATMENT médico I-TREATMENT escalonado I-TREATMENT de I-TREATMENT la I-TREATMENT HEC, I-TREATMENT con I-TREATMENT sedación I-TREATMENT profunda I-TREATMENT (fentanilo I-TREATMENT 2, I-TREATMENT 86 I-TREATMENT μg/kg/h, I-TREATMENT midazolam I-TREATMENT 0, I-TREATMENT 11 I-TREATMENT mg/kg/h I-TREATMENT y I-TREATMENT propofol I-TREATMENT 1, I-TREATMENT 43 I-TREATMENT mg/kg/h), I-TREATMENT bloqueo I-TREATMENT neuromuscular I-TREATMENT (vecuronio I-TREATMENT 0, I-TREATMENT 09 I-TREATMENT mg/kg/h), I-TREATMENT además I-TREATMENT del I-TREATMENT uso I-TREATMENT frecuente I-TREATMENT de I-TREATMENT bolos I-TREATMENT de I-TREATMENT sodio I-TREATMENT hipertónico I-TREATMENT frente I-TREATMENT a I-TREATMENT cifras I-TREATMENT de I-TREATMENT PIC I-TREATMENT > I-TREATMENT 30 I-TREATMENT cm I-TREATMENT H2O. I-TREATMENT Se B-EVOLUTION descartó I-EVOLUTION actividad I-EVOLUTION epiléptica I-EVOLUTION no I-EVOLUTION convulsiva I-EVOLUTION mediante I-EVOLUTION un I-EVOLUTION electroencefalograma I-EVOLUTION y I-EVOLUTION la I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION encéfalo I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION post I-EVOLUTION craniectomía I-EVOLUTION no I-EVOLUTION mostró I-EVOLUTION cambios I-EVOLUTION significativos. I-EVOLUTION Debido B-TREATMENT a I-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT cifras I-TREATMENT de I-TREATMENT PIC I-TREATMENT > I-TREATMENT a I-TREATMENT 20 I-TREATMENT cm I-TREATMENT H2O, I-TREATMENT se I-TREATMENT decidió I-TREATMENT iniciar I-TREATMENT hipotermia I-TREATMENT terapéutica. I-TREATMENT I-TREATMENT Se I-TREATMENT empleó I-TREATMENT hipotermia I-TREATMENT moderada, I-TREATMENT con I-TREATMENT temperatura I-TREATMENT objetivo I-TREATMENT de I-TREATMENT 33°C, I-TREATMENT mediante I-TREATMENT técnica I-TREATMENT intravascular I-TREATMENT (Alsius, I-TREATMENT Zoll, I-TREATMENT Chelmsford, I-TREATMENT Massachusetts, I-TREATMENT EEUU). I-TREATMENT Se I-TREATMENT midió I-TREATMENT la I-TREATMENT temperatura I-TREATMENT central I-TREATMENT con I-TREATMENT catéter I-TREATMENT intravesical. I-TREATMENT Una I-TREATMENT vez I-TREATMENT conseguida I-TREATMENT la I-TREATMENT hipotermia I-TREATMENT (~12 I-TREATMENT h I-TREATMENT desde I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT HEC I-TREATMENT refractaria), I-TREATMENT se I-TREATMENT logró I-TREATMENT un I-TREATMENT rápido I-TREATMENT control I-TREATMENT de I-TREATMENT la I-TREATMENT PIC I-TREATMENT con I-TREATMENT cifras I-TREATMENT entre I-TREATMENT 9 I-TREATMENT a I-TREATMENT 12 I-TREATMENT cm I-TREATMENT H2O I-TREATMENT (~3 I-TREATMENT desde I-TREATMENT el I-TREATMENT inicio I-TREATMENT del I-TREATMENT procedimiento). I-TREATMENT El I-TREATMENT bloqueo I-TREATMENT neuromuscular I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT en I-TREATMENT infusión I-TREATMENT continua I-TREATMENT los I-TREATMENT primeros I-TREATMENT dos I-TREATMENT días I-TREATMENT de I-TREATMENT hipotermia, I-TREATMENT para I-TREATMENT evitar I-TREATMENT los I-TREATMENT calofríos. I-TREATMENT I-TREATMENT Luego I-TREATMENT de I-TREATMENT 48 I-TREATMENT h I-TREATMENT en I-TREATMENT hipotermia, I-TREATMENT se I-TREATMENT realizaron I-TREATMENT intentos I-TREATMENT programados I-TREATMENT de I-TREATMENT recalentamiento I-TREATMENT a I-TREATMENT una I-TREATMENT tasa I-TREATMENT de I-TREATMENT 0, I-TREATMENT 5°C/h. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT todos I-TREATMENT ellos I-TREATMENT fueron I-TREATMENT interrumpidos I-TREATMENT por I-TREATMENT rebote I-TREATMENT de I-TREATMENT la I-TREATMENT PIC. I-TREATMENT A B-EVOLUTION partir I-EVOLUTION del I-EVOLUTION día I-EVOLUTION 20 I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION edema I-EVOLUTION cerebral I-EVOLUTION en I-EVOLUTION las I-EVOLUTION neuroimágenes, I-EVOLUTION se I-EVOLUTION logró I-EVOLUTION el I-EVOLUTION control I-EVOLUTION definitivo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION PIC. I-EVOLUTION Completó I-EVOLUTION ~13 I-EVOLUTION días I-EVOLUTION en I-EVOLUTION hipotermia I-EVOLUTION moderada, I-EVOLUTION sin I-EVOLUTION evidenciarse I-EVOLUTION arritmias, I-EVOLUTION trastornos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION coagulación I-EVOLUTION o I-EVOLUTION electrolíticos. I-EVOLUTION Presentó B-TREATMENT una I-TREATMENT traqueobronquitis I-TREATMENT asociada I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica, I-TREATMENT resuelta I-TREATMENT satisfactoriamente I-TREATMENT con I-TREATMENT antibioticoterapia. I-TREATMENT I-TREATMENT Se I-TREATMENT suspendió I-TREATMENT progresivamente I-TREATMENT la I-TREATMENT sedación, I-TREATMENT el I-TREATMENT paciente I-TREATMENT adquirió I-TREATMENT vigilia I-TREATMENT y B-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION una I-EVOLUTION hemiparesia I-EVOLUTION leve I-EVOLUTION con I-EVOLUTION heminegligencia I-EVOLUTION y I-EVOLUTION hemianopsia I-EVOLUTION homónima I-EVOLUTION izquierda. I-EVOLUTION Una I-EVOLUTION vez I-EVOLUTION extubado I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION lenguaje I-EVOLUTION apropiado. I-EVOLUTION Se B-TREATMENT inició I-TREATMENT neurorrehabilitación I-TREATMENT y B-EVOLUTION finalmente, I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION 40 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización, I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION Dos I-EVOLUTION años I-EVOLUTION después I-EVOLUTION se I-EVOLUTION encuentraen I-EVOLUTION Rankin I-EVOLUTION 2, I-EVOLUTION con I-EVOLUTION hemiparesia I-EVOLUTION izquierda I-EVOLUTION espástica I-EVOLUTION leve I-EVOLUTION y I-EVOLUTION completando I-EVOLUTION sus I-EVOLUTION estudios I-EVOLUTION universitarios. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY conocidos. I-PAST_MEDICAL_HISTORY Presentó B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS odinofagia, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS precordial I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS reposo. I-PRESENT_ILLNESS Consultó B-EXPLORATION en I-EXPLORATION centro I-EXPLORATION de I-EXPLORATION atención I-EXPLORATION primaria I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION le I-EXPLORATION solicita I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION destacando I-EXPLORATION gran I-EXPLORATION cardiomegalia I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION congestión I-EXPLORATION pulmonar. I-EXPLORATION Se B-PAST_MEDICAL_HISTORY contaba I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY examen I-PAST_MEDICAL_HISTORY físico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY radiografía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tórax I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY ninguna I-PAST_MEDICAL_HISTORY alteración. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue B-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO atención I-DERIVED_FROM/TO terciaria I-DERIVED_FROM/TO al I-DERIVED_FROM/TO cuarto I-DERIVED_FROM/TO día I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO del I-DERIVED_FROM/TO cuadro. I-DERIVED_FROM/TO Hemodinamia B-EVOLUTION siempre I-EVOLUTION estable. I-EVOLUTION Se B-EXPLORATION objetivó I-EXPLORATION en I-EXPLORATION electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION taquicardia I-EXPLORATION auricular I-EXPLORATION intermitente, I-EXPLORATION tratada I-EXPLORATION inicialmente I-EXPLORATION con I-EXPLORATION amiodarona. I-EXPLORATION I-EXPLORATION Ingresó I-EXPLORATION a I-EXPLORATION nuestro I-EXPLORATION servicio I-EXPLORATION hipotenso I-EXPLORATION (84/56 I-EXPLORATION mmHg), I-EXPLORATION taquicárdico I-EXPLORATION (116 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION irregular), I-EXPLORATION afebril, I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION y I-EXPLORATION saturando I-EXPLORATION 92% I-EXPLORATION con I-EXPLORATION oxígeno I-EXPLORATION ambiental, I-EXPLORATION bien I-EXPLORATION perfundido. I-EXPLORATION La I-EXPLORATION faringe I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION algo I-EXPLORATION enrojecida, I-EXPLORATION yugulares I-EXPLORATION ingurgitadas. I-EXPLORATION Sin I-EXPLORATION congestión I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION examen I-EXPLORATION cardíaco I-EXPLORATION demostró I-EXPLORATION tercer I-EXPLORATION ruido I-EXPLORATION y I-EXPLORATION ritmo I-EXPLORATION de I-EXPLORATION galope. I-EXPLORATION Extremidades I-EXPLORATION sin I-EXPLORATION edema. I-EXPLORATION I-EXPLORATION De I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION discreta I-EXPLORATION leucocitosis, I-EXPLORATION PCR I-EXPLORATION baja, I-EXPLORATION enzimas I-EXPLORATION cardíacas I-EXPLORATION y I-EXPLORATION troponinas I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION ecocardiograma I-EXPLORATION realizado I-EXPLORATION en I-EXPLORATION nuestra I-EXPLORATION unidad I-EXPLORATION mostró I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION (VI) I-EXPLORATION severamente I-EXPLORATION dilatado I-EXPLORATION (82/74 I-EXPLORATION mm) I-EXPLORATION con I-EXPLORATION disfunción I-EXPLORATION sistólica I-EXPLORATION global I-EXPLORATION severa I-EXPLORATION [fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION (FE): I-EXPLORATION 20%], I-EXPLORATION hipokinesia I-EXPLORATION difusa, I-EXPLORATION disfunción I-EXPLORATION diastólica I-EXPLORATION tipo I-EXPLORATION III I-EXPLORATION de I-EXPLORATION IV. I-EXPLORATION AI I-EXPLORATION de I-EXPLORATION 49 I-EXPLORATION mm, I-EXPLORATION con I-EXPLORATION disfunción I-EXPLORATION sistólica I-EXPLORATION ventricular I-EXPLORATION derecha, I-EXPLORATION leve I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION derechas I-EXPLORATION e I-EXPLORATION hipertensión I-EXPLORATION pulmonar I-EXPLORATION (HTP) I-EXPLORATION moderada. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION cardiaca I-EXPLORATION que I-EXPLORATION concluyó I-EXPLORATION miocardiopatía I-EXPLORATION dilatada, I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION ni I-EXPLORATION necrosis, I-EXPLORATION con I-EXPLORATION disfunción I-EXPLORATION sistólica I-EXPLORATION severa. I-EXPLORATION I-EXPLORATION Paciente B-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION taquicárdico, I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION en I-EVOLUTION límite I-EVOLUTION bajo, I-EVOLUTION en I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION inhibi I-EVOLUTION dores I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enzima I-EVOLUTION convertidora I-EVOLUTION de I-EVOLUTION angiotensina I-EVOLUTION (IECA) I-EVOLUTION y I-EVOLUTION betabloqueo I-EVOLUTION en I-EVOLUTION dosis I-EVOLUTION bajas. I-EVOLUTION I-EVOLUTION Dentro B-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION solicitado: I-EXPLORATION función I-EXPLORATION tiroidea I-EXPLORATION normal; I-EXPLORATION VHB I-EXPLORATION (-), I-EXPLORATION VHC I-EXPLORATION (-), I-EXPLORATION VIH I-EXPLORATION (-), I-EXPLORATION citomegalovirus I-EXPLORATION (-), I-EXPLORATION Chagas I-EXPLORATION (-), I-EXPLORATION IgM I-EXPLORATION Mycoplasma I-EXPLORATION pneumoniae I-EXPLORATION (+) I-EXPLORATION Se I-EXPLORATION trato I-EXPLORATION con I-EXPLORATION azitromicina I-EXPLORATION por I-EXPLORATION 5 I-EXPLORATION días. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION endomiocárdica I-EXPLORATION que I-EXPLORATION concluyó I-EXPLORATION cambios I-EXPLORATION inespecíficos, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION miocardiopatía I-EXPLORATION dilatada, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION inflamatoria I-EXPLORATION activa. I-EXPLORATION I-EXPLORATION El I-EXPLORATION Holter I-EXPLORATION de I-EXPLORATION ECG I-EXPLORATION evidenció I-EXPLORATION taquicardia I-EXPLORATION auricular I-EXPLORATION incesante I-EXPLORATION sobre I-EXPLORATION 90% I-EXPLORATION del I-EXPLORATION tiempo. I-EXPLORATION Se I-EXPLORATION planteo I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION taquicardiomiopatía. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona, I-TREATMENT bisoprolol I-TREATMENT y I-TREATMENT digitálicos I-TREATMENT no I-TREATMENT fueron I-TREATMENT efectivas I-TREATMENT en I-TREATMENT el I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT taquiarritmia. I-TREATMENT Se I-TREATMENT decidió I-TREATMENT mapeo I-TREATMENT y I-TREATMENT ablación I-TREATMENT de I-TREATMENT taquicardia I-TREATMENT auricular I-TREATMENT incesante I-TREATMENT usando I-TREATMENT el I-TREATMENT sistema I-TREATMENT EnSite I-TREATMENT Navx™. I-TREATMENT Se I-TREATMENT identificó I-TREATMENT y I-TREATMENT realizó I-TREATMENT ablación I-TREATMENT a I-TREATMENT foco I-TREATMENT asociado I-TREATMENT a I-TREATMENT vena I-TREATMENT cava I-TREATMENT superior I-TREATMENT y I-TREATMENT vena I-TREATMENT pulmonar I-TREATMENT superior I-TREATMENT derecha, I-TREATMENT convirtiendo I-TREATMENT a I-TREATMENT ritmo I-TREATMENT sinusal I-TREATMENT con I-TREATMENT 85 I-TREATMENT latidos I-TREATMENT por I-TREATMENT minuto. I-TREATMENT I-TREATMENT Dado B-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 21 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION su I-EVOLUTION admisión. I-EVOLUTION I-EVOLUTION En I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION en I-EVOLUTION capacidad I-EVOLUTION funcional I-EVOLUTION I, I-EVOLUTION ritmo I-EVOLUTION sinusal, I-EVOLUTION con I-EVOLUTION frecuencia I-EVOLUTION cardíaca I-EVOLUTION alrededor I-EVOLUTION de I-EVOLUTION 70 I-EVOLUTION latidos I-EVOLUTION por I-EVOLUTION minuto, I-EVOLUTION regular I-EVOLUTION y I-EVOLUTION normotenso. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION posterior I-EVOLUTION a I-EVOLUTION la I-EVOLUTION ablación, I-EVOLUTION el I-EVOLUTION ecocardiograma I-EVOLUTION evidenció I-EVOLUTION marcada I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION las I-EVOLUTION cámaras I-EVOLUTION cardiacas I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION sistólica I-EVOLUTION del I-EVOLUTION VI I-EVOLUTION y I-EVOLUTION mínimo I-EVOLUTION reflujo I-EVOLUTION mitral. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION capacidad I-EVOLUTION funcional I-EVOLUTION I I-EVOLUTION y I-EVOLUTION el I-EVOLUTION ecocardiograma I-EVOLUTION en I-EVOLUTION límite I-EVOLUTION normal I-EVOLUTION con I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION tórax I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY residencia I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY IX I-PAST_MEDICAL_HISTORY región. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS manifestaciones I-PRESENT_ILLNESS clínicas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS hipertensión I-PRESENT_ILLNESS intracraneana I-PRESENT_ILLNESS (cefalea I-PRESENT_ILLNESS holocránea I-PRESENT_ILLNESS recurrente I-PRESENT_ILLNESS [2-3 I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS por I-PRESENT_ILLNESS semana], I-PRESENT_ILLNESS mareos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS ocasionales) I-PRESENT_ILLNESS e I-PRESENT_ILLNESS irritativa I-PRESENT_ILLNESS (dos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS convulsivas I-PRESENT_ILLNESS tónico-clónicas I-PRESENT_ILLNESS generalizadas). I-PRESENT_ILLNESS El B-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION cerebral I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION intraxial I-EXPLORATION temporal I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION bien I-EXPLORATION delimitado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION severo I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa, I-EXPLORATION desviación I-EXPLORATION de I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION mm, I-EXPLORATION herniación I-EXPLORATION uncal I-EXPLORATION e I-EXPLORATION hidrocefalia. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION mostró I-EXPLORATION además I-EXPLORATION un I-EXPLORATION doble I-EXPLORATION contorno I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia, I-EXPLORATION por I-EXPLORATION desprendimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION germinal, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION impregnación I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION gadolinio. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION demostró I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION papila I-EXPLORATION bilateral, I-EXPLORATION sin I-EXPLORATION evidenciarse I-EXPLORATION déficit I-EXPLORATION motor I-EXPLORATION ni I-EXPLORATION sensitivo I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION resultaron I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION demostrarse I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION quísticas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION (Rx) I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecotomografía I-EXPLORATION abdominal. I-EXPLORATION Se B-TREATMENT planteó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT hidatidosis I-TREATMENT cerebral I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT completa I-TREATMENT e I-TREATMENT intacta I-TREATMENT del I-TREATMENT quiste, I-TREATMENT confirmando I-TREATMENT el I-TREATMENT estudio I-TREATMENT histopatológico I-TREATMENT la I-TREATMENT etiología I-TREATMENT hidatídica I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION asintomático, I-EVOLUTION sin I-EVOLUTION déficit I-EVOLUTION neurológico I-EVOLUTION ni I-EVOLUTION complicaciones I-EVOLUTION post I-EVOLUTION operatorias. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY residencia I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY IX I-PAST_MEDICAL_HISTORY región, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipertensión I-PRESENT_ILLNESS intracraneana I-PRESENT_ILLNESS (cefalea I-PRESENT_ILLNESS recurrente I-PRESENT_ILLNESS y I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS refractaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS papilar I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS acentuado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS fondo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ojo). I-PRESENT_ILLNESS La B-EXPLORATION TC I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION RM I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION formación I-EXPLORATION quística I-EXPLORATION intraxial I-EXPLORATION temporal I-EXPLORATION izquierda, I-EXPLORATION de I-EXPLORATION 60 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION de I-EXPLORATION características I-EXPLORATION similares I-EXPLORATION a I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION anteriores I-EXPLORATION y I-EXPLORATION con I-EXPLORATION moderado I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION adyacente I-EXPLORATION y I-EXPLORATION sistema I-EXPLORATION ventricular, I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION de I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 5 I-EXPLORATION mm. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION lesiones I-EXPLORATION quísticas. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION eosinofilia I-EXPLORATION y I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION hidatídico I-EXPLORATION temporal I-EXPLORATION izquierdo. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT intacta I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT confirmando I-TREATMENT el I-TREATMENT estudio I-TREATMENT histopatológico I-TREATMENT la I-TREATMENT etiología I-TREATMENT hidatídica. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION sin I-EVOLUTION déficit I-EVOLUTION neurológico I-EVOLUTION ni I-EVOLUTION complicaciones I-EVOLUTION post I-EVOLUTION operatorias. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY Child-Pugh I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2004 I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY várices I-PAST_MEDICAL_HISTORY esofágicas I-PAST_MEDICAL_HISTORY ligadas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY erradicadas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 2009 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS desorientación, I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS demostrándose I-PRESENT_ILLNESS anemia I-PRESENT_ILLNESS severa I-PRESENT_ILLNESS con I-PRESENT_ILLNESS hemoglobina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4, I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS g/dL. I-PRESENT_ILLNESS Una B-EXPLORATION primera I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION (EDA) I-EXPLORATION mostró I-EXPLORATION EVA I-EXPLORATION tipo I-EXPLORATION watermelon I-EXPLORATION stomach I-EXPLORATION manejándose B-TREATMENT con I-TREATMENT APC I-TREATMENT y I-TREATMENT transfusiones I-TREATMENT de I-TREATMENT plaquetas, I-TREATMENT plasma I-TREATMENT y I-TREATMENT glóbulos I-TREATMENT rojos, I-TREATMENT en I-TREATMENT unidad I-TREATMENT de I-TREATMENT cuidados I-TREATMENT intermedios. I-TREATMENT I-TREATMENT Dos B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION reinició I-EVOLUTION la I-EVOLUTION disnea, I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION nueva I-EXPLORATION EDA I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION EVA, I-EXPLORATION realizándose B-TREATMENT una I-TREATMENT nueva I-TREATMENT sesión I-TREATMENT de I-TREATMENT APC. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 3, I-EVOLUTION 5 I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION presentó I-EVOLUTION otros I-EVOLUTION tres I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION hematemesis, I-EVOLUTION requiriendo B-TREATMENT en I-TREATMENT todos I-TREATMENT hospitalización, I-TREATMENT transfusiones I-TREATMENT y B-EXPLORATION EDA, I-EXPLORATION encontrando I-EXPLORATION siempre I-EXPLORATION la I-EXPLORATION EVA I-EXPLORATION sangrando I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT hicieron I-TREATMENT 3 I-TREATMENT sesiones I-TREATMENT más I-TREATMENT de I-TREATMENT APC. I-TREATMENT I-TREATMENT De B-EXPLORATION la I-EXPLORATION última I-EXPLORATION hospitalización I-EXPLORATION se I-EXPLORATION dio I-EXPLORATION el I-EXPLORATION alta I-EXPLORATION programando I-EXPLORATION un I-EXPLORATION control I-EXPLORATION endoscópico I-EXPLORATION ambulatorio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION un I-EXPLORATION estómago I-EXPLORATION con I-EXPLORATION sangre I-EXPLORATION fresca I-EXPLORATION y I-EXPLORATION EVA, I-EXPLORATION realizando B-TREATMENT ligadura I-TREATMENT endoscópica I-TREATMENT con I-TREATMENT 8 I-TREATMENT bandas. I-TREATMENT I-TREATMENT Un B-EXPLORATION mes I-EXPLORATION despuês I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION EDA I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION franca I-EXPLORATION reducción I-EXPLORATION del I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION watermelon I-EXPLORATION stomach, I-EXPLORATION realizando B-TREATMENT nuevas I-TREATMENT ligaduras I-TREATMENT al I-TREATMENT antro. I-TREATMENT I-TREATMENT Los B-PRESENT_ILLNESS casos I-PRESENT_ILLNESS fueron I-PRESENT_ILLNESS recolectados I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS retrospectiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentan I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Tabla1; I-PRESENT_ILLNESS sólo I-PRESENT_ILLNESS se I-PRESENT_ILLNESS detalla I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último. I-PRESENT_ILLNESS Eran I-PRESENT_ILLNESS hombres I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS media, I-PRESENT_ILLNESS 4/5 I-PRESENT_ILLNESS heterosexuales, I-PRESENT_ILLNESS todos I-PRESENT_ILLNESS VIH I-PRESENT_ILLNESS negativos. I-PRESENT_ILLNESS Presentaron I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS subagudo; I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS destacó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS apatía, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ánimo I-PRESENT_ILLNESS subido. I-PRESENT_ILLNESS Todos I-PRESENT_ILLNESS tenían I-PRESENT_ILLNESS amnesias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Korsakoff. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS existían I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS piramidales I-PRESENT_ILLNESS discretos; I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS retención I-PRESENT_ILLNESS de I-PRESENT_ILLNESS orina, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS uno I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ellos I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ataxia. I-PRESENT_ILLNESS Cuando I-PRESENT_ILLNESS se I-PRESENT_ILLNESS aplicaron I-PRESENT_ILLNESS las I-PRESENT_ILLNESS pruebas I-PRESENT_ILLNESS Minimental I-PRESENT_ILLNESS test I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Folstein I-PRESENT_ILLNESS (MM), I-PRESENT_ILLNESS que I-PRESENT_ILLNESS mide I-PRESENT_ILLNESS la I-PRESENT_ILLNESS eficiencia I-PRESENT_ILLNESS cognitiva I-PRESENT_ILLNESS global, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Frontal I-PRESENT_ILLNESS Assessment I-PRESENT_ILLNESS Battery I-PRESENT_ILLNESS (FAB), I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evalúa I-PRESENT_ILLNESS las I-PRESENT_ILLNESS funciones I-PRESENT_ILLNESS frontales, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esta I-PRESENT_ILLNESS confirmó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS disejecutivo. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS existía I-PRESENT_ILLNESS laconismo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS o I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS afasia. I-PRESENT_ILLNESS Dos I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS isquemia I-PRESENT_ILLNESS cerebral I-PRESENT_ILLNESS tenían I-PRESENT_ILLNESS factores I-PRESENT_ILLNESS de I-PRESENT_ILLNESS riesgo I-PRESENT_ILLNESS vascular. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-EXPLORATION líquido I-EXPLORATION cefaloraquídeo I-EXPLORATION (LCR) I-EXPLORATION fue I-EXPLORATION siempre I-EXPLORATION inflamatorio I-EXPLORATION y I-EXPLORATION con I-EXPLORATION VDRL I-EXPLORATION reactivo; I-EXPLORATION en I-EXPLORATION uno I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION El I-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION estuvo I-EXPLORATION alterado I-EXPLORATION en I-EXPLORATION 3/3 I-EXPLORATION casos; I-EXPLORATION en I-EXPLORATION cambio I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION estructurales I-EXPLORATION no I-EXPLORATION siempre I-EXPLORATION fueron I-EXPLORATION anormales. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION caso I-EXPLORATION T I-EXPLORATION una I-EXPLORATION angiografía I-EXPLORATION (indicada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION cerebral I-EXPLORATION en I-EXPLORATION un I-EXPLORATION hombre I-EXPLORATION joven I-EXPLORATION con I-EXPLORATION VDRL I-EXPLORATION no I-EXPLORATION reactivo I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION antes I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION LCR) I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION vasculitis. I-EXPLORATION Todos B-TREATMENT recibieron I-TREATMENT altas I-TREATMENT dosis I-TREATMENT de I-TREATMENT penicilina I-TREATMENT sódica I-TREATMENT ev, I-TREATMENT pero B-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION fue I-EVOLUTION parcial I-EVOLUTION y I-EVOLUTION quedaron I-EVOLUTION con I-EVOLUTION secuelas I-EVOLUTION cognitivas. I-EVOLUTION I-EVOLUTION W B-PRESENT_ILLNESS tenía I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS era B-PAST_MEDICAL_HISTORY supervisor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ventas, I-PAST_MEDICAL_HISTORY soltero; I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY promiscuo; I-PAST_MEDICAL_HISTORY fumaba I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bebía I-PAST_MEDICAL_HISTORY poco, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consumía I-PAST_MEDICAL_HISTORY drogas. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS 2° I-PRESENT_ILLNESS semestre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2008 I-PRESENT_ILLNESS aparecieron I-PRESENT_ILLNESS tendencia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS aislarse, I-PRESENT_ILLNESS olvidos, I-PRESENT_ILLNESS insomnio, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS libido, I-PRESENT_ILLNESS disartria, I-PRESENT_ILLNESS cefaleas. I-PRESENT_ILLNESS Existía I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mezcla I-PRESENT_ILLNESS de I-PRESENT_ILLNESS labilidad I-PRESENT_ILLNESS emocional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS apatía. I-PRESENT_ILLNESS Perdió I-PRESENT_ILLNESS su I-PRESENT_ILLNESS trabajo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS abril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2009. I-PRESENT_ILLNESS En B-DERIVED_FROM/TO mayo I-DERIVED_FROM/TO un I-DERIVED_FROM/TO psiquiatra I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO neurólogo, I-DERIVED_FROM/TO quien I-DERIVED_FROM/TO pidió I-DERIVED_FROM/TO una I-DERIVED_FROM/TO batería I-DERIVED_FROM/TO de I-DERIVED_FROM/TO exámenes, I-DERIVED_FROM/TO entre I-DERIVED_FROM/TO ellos I-DERIVED_FROM/TO VDRL I-DERIVED_FROM/TO en I-DERIVED_FROM/TO sangre I-DERIVED_FROM/TO que I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO reactivo. I-DERIVED_FROM/TO El B-EXPLORATION examen I-EXPLORATION general I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION mostraba I-EXPLORATION alerta I-EXPLORATION y I-EXPLORATION colaboraba I-EXPLORATION al I-EXPLORATION examen; I-EXPLORATION destacaban I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION frontal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION afasia I-EXPLORATION no I-EXPLORATION fluente I-EXPLORATION mixta. I-EXPLORATION Existían I-EXPLORATION nistagmo I-EXPLORATION en I-EXPLORATION miradas I-EXPLORATION extremas, I-EXPLORATION paramimesis, I-EXPLORATION enganche I-EXPLORATION digital, I-EXPLORATION tics I-EXPLORATION de I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION hombros. I-EXPLORATION Una I-EXPLORATION discreta I-EXPLORATION ataxia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION marcha, I-EXPLORATION arreflexia I-EXPLORATION tendinosa I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION una I-EXPLORATION retención I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION configuraban I-EXPLORATION una I-EXPLORATION tabes I-EXPLORATION dorsal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION síndrome I-EXPLORATION frontal I-EXPLORATION se I-EXPLORATION expresaba I-EXPLORATION en I-EXPLORATION apatía, I-EXPLORATION abulia I-EXPLORATION y I-EXPLORATION conducta I-EXPLORATION de I-EXPLORATION imitación. I-EXPLORATION Fue I-EXPLORATION incapaz I-EXPLORATION de I-EXPLORATION comprender I-EXPLORATION escenas I-EXPLORATION complejas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION interpretar I-EXPLORATION proverbios; I-EXPLORATION perseveraba I-EXPLORATION con I-EXPLORATION frecuencia. I-EXPLORATION Tenía I-EXPLORATION defectos I-EXPLORATION atencionales I-EXPLORATION (cálculo, I-EXPLORATION retención I-EXPLORATION de I-EXPLORATION cifras, I-EXPLORATION inversión I-EXPLORATION de I-EXPLORATION series I-EXPLORATION automáticas) I-EXPLORATION y I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION afasia I-EXPLORATION no I-EXPLORATION fluente I-EXPLORATION mixta. I-EXPLORATION En I-EXPLORATION MM I-EXPLORATION obtuvo I-EXPLORATION 9/30 I-EXPLORATION puntos, I-EXPLORATION en I-EXPLORATION FAB I-EXPLORATION 3/18 I-EXPLORATION puntos; I-EXPLORATION fue I-EXPLORATION incapaz I-EXPLORATION de I-EXPLORATION abstraer. I-EXPLORATION Rindió I-EXPLORATION mejor I-EXPLORATION en I-EXPLORATION Matrices I-EXPLORATION Progresivas I-EXPLORATION Coloreadas I-EXPLORATION (MPC, I-EXPLORATION 25/36 I-EXPLORATION puntos) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION asociación I-EXPLORATION semántica I-EXPLORATION del I-EXPLORATION 4° I-EXPLORATION excluido I-EXPLORATION (acertó I-EXPLORATION en I-EXPLORATION 7/8 I-EXPLORATION ensayos). I-EXPLORATION No I-EXPLORATION existían I-EXPLORATION agnosias I-EXPLORATION visuales I-EXPLORATION ni I-EXPLORATION espaciales, I-EXPLORATION apraxia I-EXPLORATION constructiva, I-EXPLORATION ideatoria, I-EXPLORATION ideomotora I-EXPLORATION ni I-EXPLORATION del I-EXPLORATION vestir. I-EXPLORATION Tampoco I-EXPLORATION tenía I-EXPLORATION agnosia I-EXPLORATION digital I-EXPLORATION ni I-EXPLORATION desorientación I-EXPLORATION derecha-izquierda. I-EXPLORATION I-EXPLORATION El I-EXPLORATION LCR I-EXPLORATION mostró I-EXPLORATION pleocitosis I-EXPLORATION (130 I-EXPLORATION mononuclea-res, I-EXPLORATION 88% I-EXPLORATION de I-EXPLORATION linfocitos, I-EXPLORATION 10% I-EXPLORATION de I-EXPLORATION polinucleares I-EXPLORATION y I-EXPLORATION 2% I-EXPLORATION de I-EXPLORATION monocitos), I-EXPLORATION glucosa I-EXPLORATION 21 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION 180 I-EXPLORATION mg/dL. I-EXPLORATION El I-EXPLORATION VRDL I-EXPLORATION fue I-EXPLORATION reactivo I-EXPLORATION 1/128. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION mostró I-EXPLORATION atrofia I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION frontotemporal I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION EEG I-EXPLORATION actividad I-EXPLORATION irritativa I-EXPLORATION y I-EXPLORATION lenta I-EXPLORATION en I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION zona. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION fue I-EXPLORATION negativa, I-EXPLORATION y I-EXPLORATION otros I-EXPLORATION exámenes I-EXPLORATION humorales I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (función I-EXPLORATION hepática, I-EXPLORATION coagulación, I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION VHS, I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12, I-EXPLORATION Na, I-EXPLORATION K I-EXPLORATION y I-EXPLORATION Cl, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva, I-EXPLORATION PCR I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simple I-EXPLORATION en I-EXPLORATION LCR). I-EXPLORATION I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT penicilina I-TREATMENT sódica I-TREATMENT 4.000.000 I-TREATMENT ui I-TREATMENT ev I-TREATMENT c/4 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días, I-TREATMENT betametasona I-TREATMENT 4 I-TREATMENT mg I-TREATMENT ev I-TREATMENT c/8 I-TREATMENT horas I-TREATMENT por I-TREATMENT 3 I-TREATMENT días I-TREATMENT y I-TREATMENT fenitoina I-TREATMENT 100 I-TREATMENT mg I-TREATMENT c/8 I-TREATMENT horas. I-TREATMENT El B-EVOLUTION tratamiento I-EVOLUTION fue I-EVOLUTION bien I-EVOLUTION tolerado I-EVOLUTION y I-EVOLUTION parcialmente I-EVOLUTION eficaz. I-EVOLUTION A B-EXPLORATION comienzos I-EXPLORATION de I-EXPLORATION 2010 I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION básico I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION en I-EXPLORATION MM I-EXPLORATION obtuvo I-EXPLORATION 28/30 I-EXPLORATION puntos, I-EXPLORATION en I-EXPLORATION MPC I-EXPLORATION 31/36, I-EXPLORATION en I-EXPLORATION FAB I-EXPLORATION 13/18. I-EXPLORATION Persistía I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION frontal, I-EXPLORATION con I-EXPLORATION actitud I-EXPLORATION pueril, I-EXPLORATION fallas I-EXPLORATION de I-EXPLORATION juicio I-EXPLORATION y I-EXPLORATION de I-EXPLORATION coherencia I-EXPLORATION del I-EXPLORATION discurso. I-EXPLORATION El I-EXPLORATION LCR I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION con I-EXPLORATION serología I-EXPLORATION reactiva I-EXPLORATION a I-EXPLORATION 1/32, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION unido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION crisis I-EXPLORATION convulsivas I-EXPLORATION llevó B-TREATMENT a I-TREATMENT un I-TREATMENT segundo I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT penicilina, I-TREATMENT de I-TREATMENT 21 I-TREATMENT días, I-TREATMENT y I-TREATMENT a I-TREATMENT indicar I-TREATMENT ácido I-TREATMENT valproico I-TREATMENT en I-TREATMENT vez I-TREATMENT de I-TREATMENT fenitoína. I-TREATMENT Fue B-EVOLUTION jubilado I-EVOLUTION por I-EVOLUTION invalidez I-EVOLUTION y I-EVOLUTION vive I-EVOLUTION con I-EVOLUTION sus I-EVOLUTION padres. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Brasil, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dermatitis I-PAST_MEDICAL_HISTORY seborreica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY lupus I-PAST_MEDICAL_HISTORY cutáneo I-PAST_MEDICAL_HISTORY subagudo, I-PAST_MEDICAL_HISTORY fue B-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO desarrollo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO un I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO cutáneo I-DERIVED_FROM/TO abrupto I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO semana I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO localizado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO región I-DERIVED_FROM/TO centrofacial I-DERIVED_FROM/TO y I-DERIVED_FROM/TO torácica I-DERIVED_FROM/TO anterior. I-DERIVED_FROM/TO I-DERIVED_FROM/TO El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS aplicado I-PRESENT_ILLNESS un I-PRESENT_ILLNESS corticoide I-PRESENT_ILLNESS tópico I-PRESENT_ILLNESS (mometasona I-PRESENT_ILLNESS furoato I-PRESENT_ILLNESS al I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 1%) I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS para I-PRESENT_ILLNESS intentar I-PRESENT_ILLNESS controlar I-PRESENT_ILLNESS las I-PRESENT_ILLNESS lesiones. I-PRESENT_ILLNESS Reseñaba B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY pustulosas I-PAST_MEDICAL_HISTORY aisladas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cara I-PAST_MEDICAL_HISTORY ocasionales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enrojecimiento I-PAST_MEDICAL_HISTORY facial I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY calor I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcohol. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Clínicamente B-EXPLORATION mostraba, I-EXPLORATION eritema I-EXPLORATION facial I-EXPLORATION y I-EXPLORATION lesiones I-EXPLORATION pápulo-pustulosas I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION frente, I-EXPLORATION mejillas, I-EXPLORATION región I-EXPLORATION perioral I-EXPLORATION y I-EXPLORATION tórax. I-EXPLORATION Además I-EXPLORATION presentaba I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION comedones I-EXPLORATION y I-EXPLORATION padecía I-EXPLORATION afectación I-EXPLORATION ocular I-EXPLORATION con I-EXPLORATION inyección I-EXPLORATION conjuntival I-EXPLORATION acompañado I-EXPLORATION de I-EXPLORATION fotofobia I-EXPLORATION y I-EXPLORATION lagrimeo. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION fiebre I-EXPLORATION ni I-EXPLORATION otra I-EXPLORATION clínica I-EXPLORATION sistémica. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION bioquímica I-EXPLORATION general I-EXPLORATION y I-EXPLORATION hemograma I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT juicio I-TREATMENT clínico I-TREATMENT de I-TREATMENT rosácea I-TREATMENT fulminans I-TREATMENT con I-TREATMENT afectación I-TREATMENT ocular I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT oral I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 40 I-TREATMENT mg/día, I-TREATMENT metronidazol I-TREATMENT 500 I-TREATMENT mg/12 I-TREATMENT horas, I-TREATMENT isotretinoína I-TREATMENT 50 I-TREATMENT mg/día I-TREATMENT (0, I-TREATMENT 7 I-TREATMENT mg/kg/día), I-TREATMENT y I-TREATMENT lágrimas I-TREATMENT artificiales. I-TREATMENT El I-TREATMENT metronidazol I-TREATMENT y I-TREATMENT la I-TREATMENT prednisona I-TREATMENT se I-TREATMENT suspendieron I-TREATMENT tras I-TREATMENT un I-TREATMENT mes I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT (la I-TREATMENT última I-TREATMENT en I-TREATMENT pauta I-TREATMENT descendente). I-TREATMENT Por I-TREATMENT último, I-TREATMENT la I-TREATMENT isotretinoína I-TREATMENT oral I-TREATMENT se I-TREATMENT retiró I-TREATMENT tras I-TREATMENT tres I-TREATMENT meses I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT realizando I-TREATMENT descenso I-TREATMENT progresivo I-TREATMENT de I-TREATMENT la I-TREATMENT dosis. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION importante I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION completa I-EVOLUTION tras I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION recaídas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION en I-EVOLUTION los I-EVOLUTION posteriores I-EVOLUTION seis I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcoholismo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY policonsumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY drogas, I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ánimo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2005. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS Infectología I-PRESENT_ILLNESS en I-PRESENT_ILLNESS febrero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS tumores I-PRESENT_ILLNESS eritemato-violáceos I-PRESENT_ILLNESS dolorosos, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociados I-PRESENT_ILLNESS a I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general I-PRESENT_ILLNESS y I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna, I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea. I-PRESENT_ILLNESS Por B-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION inicialmente I-EXPLORATION sarcoma I-EXPLORATION de I-EXPLORATION Kaposi I-EXPLORATION (SK) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION ELISA I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION y I-EXPLORATION confirmado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION de I-EXPLORATION Chile. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT extensión I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT cutáneas I-TREATMENT y I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT fiebre I-TREATMENT se I-TREATMENT hospitalizó I-TREATMENT para I-TREATMENT mayor I-TREATMENT estudio. I-TREATMENT Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION en I-EXPLORATION regulares I-EXPLORATION condiciones I-EXPLORATION generales, I-EXPLORATION hipotenso, I-EXPLORATION febril, I-EXPLORATION enflaquecido I-EXPLORATION (índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 17), I-EXPLORATION con I-EXPLORATION adenopatías I-EXPLORATION inguinales I-EXPLORATION induradas, I-EXPLORATION indoloras I-EXPLORATION y I-EXPLORATION poco I-EXPLORATION móviles. I-EXPLORATION Presentaba I-EXPLORATION tumores I-EXPLORATION eritemato-violáceos I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION supraciliar I-EXPLORATION derecho, I-EXPLORATION en I-EXPLORATION mentón I-EXPLORATION y I-EXPLORATION en I-EXPLORATION pierna I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION cara, I-EXPLORATION paladar, I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION extremidades I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION pápulas I-EXPLORATION erite-matosas I-EXPLORATION brillantes I-EXPLORATION y I-EXPLORATION nódulos I-EXPLORATION dolorosos I-EXPLORATION subcutáneos I-EXPLORATION sin I-EXPLORATION cambios I-EXPLORATION de I-EXPLORATION coloración. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION pesquisó I-EXPLORATION visceromegalia. I-EXPLORATION De I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION generales I-EXPLORATION destacaba: I-EXPLORATION hematocrito I-EXPLORATION 28, I-EXPLORATION 3%; I-EXPLORATION leucocitos I-EXPLORATION 6.200 I-EXPLORATION céls/mm3, I-EXPLORATION sin I-EXPLORATION desviación I-EXPLORATION izquierda; I-EXPLORATION VHS I-EXPLORATION 100 I-EXPLORATION mm/h; I-EXPLORATION PCR I-EXPLORATION 9, I-EXPLORATION 1 I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1); I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION normal; I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION normales, I-EXPLORATION excepto I-EXPLORATION por I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION elevada I-EXPLORATION (211 I-EXPLORATION U/L); I-EXPLORATION albúmina I-EXPLORATION 3 I-EXPLORATION g/dl; I-EXPLORATION LDH I-EXPLORATION 159 I-EXPLORATION U/L. I-EXPLORATION Del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION su I-EXPLORATION patología I-EXPLORATION de I-EXPLORATION base I-EXPLORATION tenía I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION de I-EXPLORATION 875.000 I-EXPLORATION copias I-EXPLORATION ARN I-EXPLORATION viral/ml I-EXPLORATION y I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 87, I-EXPLORATION 6 I-EXPLORATION céls/ I-EXPLORATION mm3. I-EXPLORATION Los I-EXPLORATION hemocultivos, I-EXPLORATION urocultivos, I-EXPLORATION RPR, I-EXPLORATION PPD I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION IgG I-EXPLORATION para I-EXPLORATION toxoplasma I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION reevaluar I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico I-EXPLORATION se I-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION AB. I-EXPLORATION Al B-PAST_MEDICAL_HISTORY preguntar I-PAST_MEDICAL_HISTORY dirigidamente I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY extranjero: I-PAST_MEDICAL_HISTORY Bolivia I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY Perú I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY México I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Además I-PAST_MEDICAL_HISTORY vivió I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY casa I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY gatos, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY rasguñaban I-PAST_MEDICAL_HISTORY ocasionalmente. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION solicitó I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION Bartonella I-EXPLORATION henselae I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativa. I-EXPLORATION La I-EXPLORATION nasofibroscopia I-EXPLORATION informó I-EXPLORATION lesiones I-EXPLORATION angiomatosas I-EXPLORATION en I-EXPLORATION fosas I-EXPLORATION nasales, I-EXPLORATION rinofaringe I-EXPLORATION y I-EXPLORATION laringe. I-EXPLORATION La I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION no I-EXPLORATION detectó I-EXPLORATION lesiones. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION mostró I-EXPLORATION hígado I-EXPLORATION normal, I-EXPLORATION leve I-EXPLORATION esplenomegalia, I-EXPLORATION adenopatías I-EXPLORATION inguinales I-EXPLORATION izquierdas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION secundario I-EXPLORATION y I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION paravertebral I-EXPLORATION lumbar. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION Doppler I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores I-EXPLORATION mostró I-EXPLORATION nódulos I-EXPLORATION hipervascularizados I-EXPLORATION inespecíficos I-EXPLORATION en I-EXPLORATION dermis, I-EXPLORATION tejido I-EXPLORATION subcutáneo I-EXPLORATION y I-EXPLORATION plano I-EXPLORATION muscular. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION cutáneas I-EXPLORATION mostró I-EXPLORATION orto-queratosis, I-EXPLORATION hipogranulosis, I-EXPLORATION atrofia I-EXPLORATION epidérmica, I-EXPLORATION exocitosis I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION e I-EXPLORATION hiperpigmentación I-EXPLORATION basal; I-EXPLORATION dermis I-EXPLORATION reticular I-EXPLORATION con I-EXPLORATION proliferación I-EXPLORATION vascular, I-EXPLORATION nodular, I-EXPLORATION multifocal, I-EXPLORATION compuesta I-EXPLORATION por I-EXPLORATION vasos I-EXPLORATION capilares I-EXPLORATION pequeños, I-EXPLORATION endotelio I-EXPLORATION prominente, I-EXPLORATION con I-EXPLORATION extravasación I-EXPLORATION de I-EXPLORATION eritrocitos I-EXPLORATION e I-EXPLORATION infiltrado I-EXPLORATION leve I-EXPLORATION disperso I-EXPLORATION de I-EXPLORATION linfocitos, I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION eritrocitos. I-EXPLORATION Además, I-EXPLORATION había I-EXPLORATION acúmulos I-EXPLORATION eosinófilos, I-EXPLORATION extracelulares, I-EXPLORATION granulares, I-EXPLORATION multifocales. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Warthin-Starry I-EXPLORATION mostró I-EXPLORATION numerosos I-EXPLORATION bacilos, I-EXPLORATION siendo I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION AB. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION envió I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION al I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION microbiología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION Católica I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION PCR I-EXPLORATION universal I-EXPLORATION con I-EXPLORATION amplificación I-EXPLORATION y I-EXPLORATION secuenciación I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION que I-EXPLORATION codifica I-EXPLORATION para I-EXPLORATION la I-EXPLORATION subu-nidad I-EXPLORATION ribosomal I-EXPLORATION 16S. I-EXPLORATION La I-EXPLORATION extracción I-EXPLORATION del I-EXPLORATION ADN I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION subcutáneo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION utilizando I-EXPLORATION un I-EXPLORATION método I-EXPLORATION comercial I-EXPLORATION (QIAamp I-EXPLORATION Tissue I-EXPLORATION kit, I-EXPLORATION Qiagen®), I-EXPLORATION según I-EXPLORATION las I-EXPLORATION recomendaciones I-EXPLORATION del I-EXPLORATION fabricante. I-EXPLORATION La I-EXPLORATION amplificación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION que I-EXPLORATION codifica I-EXPLORATION para I-EXPLORATION el I-EXPLORATION 16S I-EXPLORATION ARNr I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION con I-EXPLORATION partidores I-EXPLORATION universales. I-EXPLORATION Posteriormente, I-EXPLORATION se I-EXPLORATION secuenció I-EXPLORATION el I-EXPLORATION producto I-EXPLORATION amplificado I-EXPLORATION y I-EXPLORATION se I-EXPLORATION evaluó I-EXPLORATION en I-EXPLORATION el I-EXPLORATION analizador I-EXPLORATION genético I-EXPLORATION ABI-310 I-EXPLORATION (Applied-Biosystems, I-EXPLORATION Foster I-EXPLORATION City, I-EXPLORATION CA). I-EXPLORATION Para I-EXPLORATION la I-EXPLORATION comparación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION nucleotídica I-EXPLORATION obtenida I-EXPLORATION con I-EXPLORATION las I-EXPLORATION secuencias I-EXPLORATION depositadas I-EXPLORATION en I-EXPLORATION banco I-EXPLORATION de I-EXPLORATION genes I-EXPLORATION Genebank, I-EXPLORATION se I-EXPLORATION utilizó I-EXPLORATION al I-EXPLORATION programa I-EXPLORATION BLAST. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION homología I-EXPLORATION de I-EXPLORATION 100% I-EXPLORATION sobre I-EXPLORATION 421 I-EXPLORATION pares I-EXPLORATION de I-EXPLORATION bases I-EXPLORATION depositadas I-EXPLORATION con I-EXPLORATION la I-EXPLORATION especie I-EXPLORATION B. I-EXPLORATION quintana I-EXPLORATION cepa I-EXPLORATION Toulouse. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antiretroviral I-TREATMENT para I-TREATMENT el I-TREATMENT VIH I-TREATMENT y I-TREATMENT profilaxis I-TREATMENT para I-TREATMENT Pneumocystis I-TREATMENT jiroveci. I-TREATMENT Se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT AB I-TREATMENT con I-TREATMENT Azitromicina I-TREATMENT 500 I-TREATMENT mg/ I-TREATMENT día I-TREATMENT vo I-TREATMENT y I-TREATMENT Ciprofloxacino I-TREATMENT 500 I-TREATMENT mg I-TREATMENT c/12 I-TREATMENT h I-TREATMENT vo. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION con I-EVOLUTION regresión I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION síntomas I-EVOLUTION sistémicos I-EVOLUTION y I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION cutáneas I-EVOLUTION en I-EVOLUTION pocos I-EVOLUTION días. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY detenido I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY flegmón I-PAST_MEDICAL_HISTORY apendicular I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Dos B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS consultar I-PRESENT_ILLNESS inició I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS vespertino, I-PRESENT_ILLNESS postprandiales I-PRESENT_ILLNESS mediatos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS kilos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS este I-PRESENT_ILLNESS período. I-PRESENT_ILLNESS La B-EXPLORATION endoscopía I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION pliegues I-EXPLORATION gástricos I-EXPLORATION prominentes I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION difusa, I-EXPLORATION lesiones I-EXPLORATION solevantadas I-EXPLORATION sésiles I-EXPLORATION con I-EXPLORATION ulceración I-EXPLORATION central I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION rojo I-EXPLORATION y I-EXPLORATION lesiones I-EXPLORATION ulceradas I-EXPLORATION duodenales, I-EXPLORATION con I-EXPLORATION test I-EXPLORATION de I-EXPLORATION ureasa I-EXPLORATION positivo. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION biopsias I-EXPLORATION informadas I-EXPLORATION como I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION inespecífica I-EXPLORATION y I-EXPLORATION duodenitis. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostró: I-EXPLORATION GOT I-EXPLORATION 50 I-EXPLORATION UI/L, I-EXPLORATION GPT I-EXPLORATION 56 I-EXPLORATION UI/L, I-EXPLORATION GGT I-EXPLORATION 85 I-EXPLORATION UI/L, I-EXPLORATION FA I-EXPLORATION 81 I-EXPLORATION UI/L, I-EXPLORATION hematocrito I-EXPLORATION 55%, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 100%, I-EXPLORATION creatininemia I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION g/dL, I-EXPLORATION calcio I-EXPLORATION total I-EXPLORATION 7, I-EXPLORATION 8 I-EXPLORATION mg/ I-EXPLORATION dL, I-EXPLORATION proteinemia I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION g/dL, I-EXPLORATION albuminemia I-EXPLORATION 2, I-EXPLORATION 3 I-EXPLORATION g/dL I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION 229 I-EXPLORATION UI/ml. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION esteatosis I-EXPLORATION hepática. I-EXPLORATION I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT erradicación I-TREATMENT para I-TREATMENT Helicobacter I-TREATMENT pylori I-TREATMENT durante I-TREATMENT 14 I-TREATMENT días, I-TREATMENT observándose B-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION los I-EVOLUTION vómitos, I-EVOLUTION con I-EVOLUTION intolerancia I-EVOLUTION a I-EVOLUTION alimentación I-EVOLUTION oral, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION hospitalizar I-EVOLUTION para I-EVOLUTION manejo I-EVOLUTION nutricional I-EVOLUTION y I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION macrobiopsias I-EVOLUTION gástricas. I-EVOLUTION I-EVOLUTION A B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION Gastroenterología I-EXPLORATION de I-EXPLORATION nuestro I-EXPLORATION Hospital I-EXPLORATION destacaba I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION hemodinamia I-EXPLORATION estable, I-EXPLORATION afebril, I-EXPLORATION mesomorfo, I-EXPLORATION sin I-EXPLORATION edema, I-EXPLORATION ni I-EXPLORATION palidez. I-EXPLORATION Sin I-EXPLORATION signos I-EXPLORATION carenciales I-EXPLORATION en I-EXPLORATION piel, I-EXPLORATION mucosas I-EXPLORATION ni I-EXPLORATION fanéreos. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION confirmaron I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION g/dL, I-EXPLORATION albuminemia I-EXPLORATION 1, I-EXPLORATION 9 I-EXPLORATION g/dL, I-EXPLORATION proteinuria I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION hemograma I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Evolución I-EXPLORATION y I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION posteriores I-EXPLORATION I-EXPLORATION Se I-EXPLORATION efectúa I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION abdomen-pelvis I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION pliegues I-EXPLORATION gástricos I-EXPLORATION prominentes, I-EXPLORATION enteroclisis I-EXPLORATION por I-EXPLORATION TAC I-EXPLORATION informó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION radiológicas I-EXPLORATION en I-EXPLORATION intestino I-EXPLORATION delgado. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION endoscopía I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION pliegues I-EXPLORATION gástricos I-EXPLORATION difusamente I-EXPLORATION engrosados, I-EXPLORATION algunos I-EXPLORATION erosionados, I-EXPLORATION test I-EXPLORATION de I-EXPLORATION ureasa I-EXPLORATION negativo. I-EXPLORATION Las I-EXPLORATION biopsias I-EXPLORATION fueron I-EXPLORATION informadas I-EXPLORATION como I-EXPLORATION mucosa I-EXPLORATION gástrica I-EXPLORATION con I-EXPLORATION hiperplasia I-EXPLORATION foveolar I-EXPLORATION difusa, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION atrofia I-EXPLORATION glandular I-EXPLORATION con I-EXPLORATION dilataciones I-EXPLORATION quísticas I-EXPLORATION y I-EXPLORATION células I-EXPLORATION mucinosas. I-EXPLORATION Erosión I-EXPLORATION epitelial I-EXPLORATION superficial I-EXPLORATION focal I-EXPLORATION con I-EXPLORATION acúmulos I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION polimorfonucleares, I-EXPLORATION lámina I-EXPLORATION propia I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION escaso I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION linfoplasmocitario, I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION eosinófilos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION endosonografía I-EXPLORATION demostrándose I-EXPLORATION engrosamiento I-EXPLORATION gástrico I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION profunda I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION quísticas. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT extensión I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT el I-TREATMENT riesgo I-TREATMENT de I-TREATMENT transformación I-TREATMENT neoplásica I-TREATMENT y I-TREATMENT la I-TREATMENT no I-TREATMENT disponibilidad I-TREATMENT de I-TREATMENT cetuximab, I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT quirúrgico. I-TREATMENT Se B-EVOLUTION solicitó I-EVOLUTION evaluación I-EVOLUTION por I-EVOLUTION el I-EVOLUTION equipo I-EVOLUTION de I-EVOLUTION nutrición, I-EVOLUTION demostrándose I-EVOLUTION preal-búmina, I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION vitamina I-EVOLUTION B12 I-EVOLUTION y I-EVOLUTION folato I-EVOLUTION eritrocitario I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION rangos I-EVOLUTION normales. I-EVOLUTION Se B-TREATMENT controlaron I-TREATMENT los I-TREATMENT vómitos I-TREATMENT con I-TREATMENT ondasentron, I-TREATMENT logrando I-TREATMENT ingesta I-TREATMENT oral I-TREATMENT adecuada, I-TREATMENT se I-TREATMENT apoyó I-TREATMENT con I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT por I-TREATMENT 7 I-TREATMENT días I-TREATMENT con I-TREATMENT lo I-TREATMENT cual I-TREATMENT aumentó I-TREATMENT la I-TREATMENT albuminemia I-TREATMENT a I-TREATMENT 2, I-TREATMENT 3 I-TREATMENT gr/dl. I-TREATMENT A I-TREATMENT los I-TREATMENT 14 I-TREATMENT días I-TREATMENT de I-TREATMENT su I-TREATMENT ingreso I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT gastrectomía I-TREATMENT total, I-TREATMENT sin I-TREATMENT incidentes I-TREATMENT y B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION En B-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION macroscópico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION operatoria I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION pared I-EXPLORATION gástrica I-EXPLORATION de I-EXPLORATION espesor I-EXPLORATION engrosado I-EXPLORATION homogéneamente, I-EXPLORATION mucosa I-EXPLORATION con I-EXPLORATION pliegues I-EXPLORATION difusamente I-EXPLORATION engrosados, I-EXPLORATION congestivos, I-EXPLORATION algunos I-EXPLORATION con I-EXPLORATION erosión I-EXPLORATION superficial; I-EXPLORATION rodete I-EXPLORATION duodenal I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION polipoide I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION centímetro I-EXPLORATION de I-EXPLORATION eje I-EXPLORATION mayor. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION histología I-EXPLORATION se I-EXPLORATION confirmaron I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION descritos I-EXPLORATION en I-EXPLORATION las I-EXPLORATION biopsias I-EXPLORATION endoscópicas, I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION gástrico I-EXPLORATION difuso, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION duodeno I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION descrita I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION polipoide I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION metaplasia I-EXPLORATION fúndica I-EXPLORATION focal I-EXPLORATION con I-EXPLORATION hiperplasia I-EXPLORATION foveolar I-EXPLORATION y I-EXPLORATION atrofia I-EXPLORATION glandular, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION quística I-EXPLORATION y I-EXPLORATION células I-EXPLORATION mucinosas. I-EXPLORATION Se I-EXPLORATION concluyó I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Ménétrier I-EXPLORATION gástrica I-EXPLORATION difusa I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION duodenal I-EXPLORATION focal. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS oriundo B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Marchigüe, I-PAST_MEDICAL_HISTORY VI I-PAST_MEDICAL_HISTORY Región I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Chile, I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY laboral I-PAST_MEDICAL_HISTORY trabajó I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY faenador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY corderos. I-PAST_MEDICAL_HISTORY Tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY dislipidemia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY quiste I-PAST_MEDICAL_HISTORY hidatídico I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1996. I-PAST_MEDICAL_HISTORY Quince I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY después, I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY vascular I-PAST_MEDICAL_HISTORY encefálico, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY referir I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sintomatología I-PAST_MEDICAL_HISTORY cardiovascular. I-PAST_MEDICAL_HISTORY Dentro B-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION y I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION (TAC) I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ventrículo I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION ruptura. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION además I-EXPLORATION una I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION quistes I-EXPLORATION hepáticos. I-EXPLORATION Tampoco B-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY sugerentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY anafilaxia. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Posteriormente, B-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION precordial I-EVOLUTION opresivo I-EVOLUTION sin I-EVOLUTION irradiación, I-EVOLUTION de I-EVOLUTION intensidad I-EVOLUTION EVA I-EVOLUTION 6/10. I-EVOLUTION Evaluado B-TREATMENT por I-TREATMENT cardiología I-TREATMENT en I-TREATMENT su I-TREATMENT hospital I-TREATMENT base I-TREATMENT se I-TREATMENT indicó I-TREATMENT anticoagulación I-TREATMENT oral I-TREATMENT siendo B-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Instituto I-DERIVED_FROM/TO Nacional I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Tórax I-DERIVED_FROM/TO con I-DERIVED_FROM/TO la I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hidatidosis I-DERIVED_FROM/TO cardiaca. I-DERIVED_FROM/TO I-DERIVED_FROM/TO El B-EXPLORATION paciente I-EXPLORATION ingresó I-EXPLORATION en I-EXPLORATION buenas I-EXPLORATION condiciones I-EXPLORATION generales, I-EXPLORATION afebril I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION hemodinámicas, I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 130/85 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION 90 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION min. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION ingurgitación I-EXPLORATION yugular, I-EXPLORATION roces I-EXPLORATION ni I-EXPLORATION soplos I-EXPLORATION cardiacos I-EXPLORATION (que I-EXPLORATION fueron I-EXPLORATION exhaustivamente I-EXPLORATION buscados) I-EXPLORATION ni I-EXPLORATION tampoco I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION cardiaca. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION pulmonar I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION eosinofilia I-EXPLORATION de I-EXPLORATION 21%, I-EXPLORATION sin I-EXPLORATION leucocitosis. I-EXPLORATION El I-EXPLORATION perfil I-EXPLORATION bioquímico I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION IgG I-EXPLORATION anti-Echinococcus I-EXPLORATION granulosus I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION realizada. I-EXPLORATION I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION electrocardiograma I-EXPLORATION presentaba I-EXPLORATION ritmo I-EXPLORATION sinusal, I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION negativas I-EXPLORATION en I-EXPLORATION DII I-EXPLORATION y I-EXPLORATION alteraciones I-EXPLORATION inespecíficas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION repolarización. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecocardiografía I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION servicio I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION poliquística, I-EXPLORATION ovalada I-EXPLORATION y I-EXPLORATION adherida I-EXPLORATION al I-EXPLORATION macizo I-EXPLORATION de I-EXPLORATION músculos I-EXPLORATION papilares I-EXPLORATION anterolaterales, I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION bien I-EXPLORATION delimitados I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION libre I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION medía I-EXPLORATION 4, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 2 I-EXPLORATION x I-EXPLORATION 2, I-EXPLORATION 7 I-EXPLORATION cm, I-EXPLORATION sin I-EXPLORATION derrame I-EXPLORATION pericárdico. I-EXPLORATION Estos I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION confirmados I-EXPLORATION por I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RNM). I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION preoperatorio I-EXPLORATION fue I-EXPLORATION completado I-EXPLORATION con I-EXPLORATION una I-EXPLORATION coronariografía, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION La B-TREATMENT cirugía I-TREATMENT se I-TREATMENT realizó I-TREATMENT bajo I-TREATMENT esternotomía I-TREATMENT media I-TREATMENT y I-TREATMENT circulación I-TREATMENT extracorpórea, I-TREATMENT poniendo I-TREATMENT principal I-TREATMENT atención I-TREATMENT en I-TREATMENT la I-TREATMENT manipulación I-TREATMENT cardiaca I-TREATMENT para I-TREATMENT no I-TREATMENT lesionar I-TREATMENT el I-TREATMENT quiste. I-TREATMENT Una I-TREATMENT vez I-TREATMENT puesto I-TREATMENT el I-TREATMENT clamp I-TREATMENT aórtico, I-TREATMENT se I-TREATMENT disecó I-TREATMENT la I-TREATMENT superficie I-TREATMENT del I-TREATMENT quiste, I-TREATMENT se I-TREATMENT aisló I-TREATMENT el I-TREATMENT campo I-TREATMENT con I-TREATMENT compresas I-TREATMENT embebidas I-TREATMENT en I-TREATMENT cloruro I-TREATMENT de I-TREATMENT sodio I-TREATMENT al I-TREATMENT 10% I-TREATMENT y I-TREATMENT se I-TREATMENT puncionó I-TREATMENT el I-TREATMENT quiste I-TREATMENT vaciándolo I-TREATMENT parcialmente I-TREATMENT e I-TREATMENT inyectando I-TREATMENT solución I-TREATMENT salina I-TREATMENT hipertónica I-TREATMENT al I-TREATMENT 30%. I-TREATMENT Posteriormente, I-TREATMENT se I-TREATMENT abrió I-TREATMENT el I-TREATMENT quiste I-TREATMENT hacia I-TREATMENT la I-TREATMENT cara I-TREATMENT anterior I-TREATMENT del I-TREATMENT ventrículo I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT se I-TREATMENT vació, I-TREATMENT retirando I-TREATMENT las I-TREATMENT membranas I-TREATMENT y I-TREATMENT vesículas I-TREATMENT hijas. I-TREATMENT Se I-TREATMENT completó I-TREATMENT el I-TREATMENT aseo I-TREATMENT de I-TREATMENT la I-TREATMENT cavidad I-TREATMENT con I-TREATMENT sodio I-TREATMENT hipertónico I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT realizó I-TREATMENT quistectomía I-TREATMENT parcial I-TREATMENT y I-TREATMENT cierre I-TREATMENT por I-TREATMENT capitonaje I-TREATMENT del I-TREATMENT remanente. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION complicaciones I-EVOLUTION intraoperatorias I-EVOLUTION y I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION fue I-EVOLUTION favorable. I-EVOLUTION En I-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION post-quirúrgico, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION asintomático, I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION complicaciones I-EVOLUTION o I-EVOLUTION recidivas I-EVOLUTION y B-EXPLORATION se I-EXPLORATION controlará I-EXPLORATION semestralmente I-EXPLORATION con I-EXPLORATION ecocardiografía I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION E. I-EXPLORATION granulosus. I-EXPLORATION I-EXPLORATION La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS índice I-PRESENT_ILLNESS (PAF19) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (2004) I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS anémico. I-PRESENT_ILLNESS Como B-EXPLORATION parte I-EXPLORATION de I-EXPLORATION su I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION y I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION completa I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION pólipos I-EXPLORATION sésiles I-EXPLORATION (más I-EXPLORATION de I-EXPLORATION 100) I-EXPLORATION y I-EXPLORATION pediculados I-EXPLORATION (más I-EXPLORATION de I-EXPLORATION 15), I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION margen I-EXPLORATION anal I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION ciego. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION cecal I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION proliferativa I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION cuya I-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION tubular I-EXPLORATION moderadamente I-EXPLORATION diferenciado. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION preliminar I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION una I-EXPLORATION PAF I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION cecal. I-EXPLORATION El B-TREATMENT estudio I-TREATMENT de I-TREATMENT etapificación I-TREATMENT con I-TREATMENT TAC I-TREATMENT (tomografía I-TREATMENT abdominal I-TREATMENT computarizada) I-TREATMENT de I-TREATMENT abdomen I-TREATMENT y I-TREATMENT pelvis I-TREATMENT no I-TREATMENT mostró I-TREATMENT signos I-TREATMENT de I-TREATMENT diseminación I-TREATMENT tumoral, I-TREATMENT realizándose I-TREATMENT una I-TREATMENT colectomía I-TREATMENT total I-TREATMENT con I-TREATMENT íleorrectoanastomosis. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION invasión I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION subserosa I-EXPLORATION y I-EXPLORATION compromiso I-EXPLORATION linfonodal. I-EXPLORATION La I-EXPLORATION mucosa I-EXPLORATION del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION resecada I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION centenar I-EXPLORATION de I-EXPLORATION pólipos I-EXPLORATION sésiles I-EXPLORATION y I-EXPLORATION pediculados, I-EXPLORATION abollonados I-EXPLORATION y I-EXPLORATION lisos I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 2 I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor. I-EXPLORATION Por B-TREATMENT tratarse I-TREATMENT de I-TREATMENT una I-TREATMENT paciente I-TREATMENT en I-TREATMENT etapa I-TREATMENT III I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT adyuvante I-TREATMENT en I-TREATMENT base I-TREATMENT a I-TREATMENT 5-fluorouracilo I-TREATMENT y I-TREATMENT leucovorina. I-TREATMENT Hasta B-EVOLUTION la I-EVOLUTION fecha I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION completado I-EVOLUTION 70 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Debido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO historia I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO (poliposis I-DERIVED_FROM/TO colónica I-DERIVED_FROM/TO y I-DERIVED_FROM/TO CCR I-DERIVED_FROM/TO a I-DERIVED_FROM/TO edad I-DERIVED_FROM/TO temprana), I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO al I-DERIVED_FROM/TO registro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tumores I-DERIVED_FROM/TO hereditarios I-DERIVED_FROM/TO para I-DERIVED_FROM/TO definir I-DERIVED_FROM/TO el I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO genético I-DERIVED_FROM/TO apropiado. I-DERIVED_FROM/TO Este I-DERIVED_FROM/TO registro I-DERIVED_FROM/TO incorpora I-DERIVED_FROM/TO a I-DERIVED_FROM/TO pacientes I-DERIVED_FROM/TO con I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO de I-DERIVED_FROM/TO enfermedades I-DERIVED_FROM/TO hereditarias I-DERIVED_FROM/TO (poliposis I-DERIVED_FROM/TO adenomatosa I-DERIVED_FROM/TO familiar, I-DERIVED_FROM/TO síndrome I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Lynch, I-DERIVED_FROM/TO síndrome I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Peutz-Jeghers, I-DERIVED_FROM/TO entre I-DERIVED_FROM/TO otros) I-DERIVED_FROM/TO con I-DERIVED_FROM/TO la I-DERIVED_FROM/TO finalidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO educar I-DERIVED_FROM/TO a I-DERIVED_FROM/TO los I-DERIVED_FROM/TO pacientes I-DERIVED_FROM/TO y I-DERIVED_FROM/TO familiares I-DERIVED_FROM/TO respecto I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO enfermedad, I-DERIVED_FROM/TO predisposición I-DERIVED_FROM/TO de I-DERIVED_FROM/TO desarrollarla I-DERIVED_FROM/TO y I-DERIVED_FROM/TO transmitirla I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO descendencia, I-DERIVED_FROM/TO y I-DERIVED_FROM/TO de I-DERIVED_FROM/TO este I-DERIVED_FROM/TO modo I-DERIVED_FROM/TO prevenir I-DERIVED_FROM/TO el I-DERIVED_FROM/TO desarrollo I-DERIVED_FROM/TO del I-DERIVED_FROM/TO CCR I-DERIVED_FROM/TO en I-DERIVED_FROM/TO aquellos I-DERIVED_FROM/TO familiares I-DERIVED_FROM/TO asintomáticos. I-DERIVED_FROM/TO I-DERIVED_FROM/TO El B-FAMILY_HISTORY análisis I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY genealogía I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY índice I-FAMILY_HISTORY demostró I-FAMILY_HISTORY consanguinidad I-FAMILY_HISTORY de I-FAMILY_HISTORY los I-FAMILY_HISTORY padres, I-FAMILY_HISTORY sin I-FAMILY_HISTORY historia I-FAMILY_HISTORY de I-FAMILY_HISTORY poliposis I-FAMILY_HISTORY o I-FAMILY_HISTORY CCR I-FAMILY_HISTORY en I-FAMILY_HISTORY ellos. I-FAMILY_HISTORY Además I-FAMILY_HISTORY permitió I-FAMILY_HISTORY identificar I-FAMILY_HISTORY a I-FAMILY_HISTORY una I-FAMILY_HISTORY hermana I-FAMILY_HISTORY (de I-FAMILY_HISTORY un I-FAMILY_HISTORY total I-FAMILY_HISTORY de I-FAMILY_HISTORY 12 I-FAMILY_HISTORY hermanos) I-FAMILY_HISTORY que I-FAMILY_HISTORY presentó I-FAMILY_HISTORY CCR, I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY que I-FAMILY_HISTORY identificamos I-FAMILY_HISTORY como I-FAMILY_HISTORY PAF585. I-FAMILY_HISTORY Ella I-FAMILY_HISTORY presentó I-FAMILY_HISTORY un I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY de I-FAMILY_HISTORY colon I-FAMILY_HISTORY derecho I-FAMILY_HISTORY con I-FAMILY_HISTORY invasión I-FAMILY_HISTORY hasta I-FAMILY_HISTORY la I-FAMILY_HISTORY subserosa I-FAMILY_HISTORY y I-FAMILY_HISTORY compromiso I-FAMILY_HISTORY linfonodal I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 53 I-FAMILY_HISTORY años I-FAMILY_HISTORY que I-FAMILY_HISTORY fue I-FAMILY_HISTORY tratado I-FAMILY_HISTORY con I-FAMILY_HISTORY cirugía I-FAMILY_HISTORY y I-FAMILY_HISTORY quimioterapia I-FAMILY_HISTORY adyuvante. I-FAMILY_HISTORY Un I-FAMILY_HISTORY año I-FAMILY_HISTORY después, I-FAMILY_HISTORY la I-FAMILY_HISTORY colonoscopia I-FAMILY_HISTORY de I-FAMILY_HISTORY control I-FAMILY_HISTORY mostró I-FAMILY_HISTORY dos I-FAMILY_HISTORY nuevos I-FAMILY_HISTORY tumores I-FAMILY_HISTORY sincrónicos, I-FAMILY_HISTORY uno I-FAMILY_HISTORY en I-FAMILY_HISTORY colon I-FAMILY_HISTORY sigmoides I-FAMILY_HISTORY a I-FAMILY_HISTORY 35 I-FAMILY_HISTORY cm I-FAMILY_HISTORY del I-FAMILY_HISTORY margen I-FAMILY_HISTORY anal I-FAMILY_HISTORY y I-FAMILY_HISTORY otro I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY en I-FAMILY_HISTORY recto I-FAMILY_HISTORY inferior I-FAMILY_HISTORY (adenocarcinoma I-FAMILY_HISTORY tubular I-FAMILY_HISTORY invasor). I-FAMILY_HISTORY Cabe I-FAMILY_HISTORY destacar I-FAMILY_HISTORY que I-FAMILY_HISTORY el I-FAMILY_HISTORY informe I-FAMILY_HISTORY médico I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY no I-FAMILY_HISTORY registra I-FAMILY_HISTORY la I-FAMILY_HISTORY presencia I-FAMILY_HISTORY de I-FAMILY_HISTORY poliposis I-FAMILY_HISTORY adenomatosa I-FAMILY_HISTORY colónica. I-FAMILY_HISTORY La I-FAMILY_HISTORY paciente I-FAMILY_HISTORY evolucionó I-FAMILY_HISTORY tórpidamente I-FAMILY_HISTORY falleciendo I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 4 I-FAMILY_HISTORY meses I-FAMILY_HISTORY posterior I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY cirugía I-FAMILY_HISTORY debido I-FAMILY_HISTORY a I-FAMILY_HISTORY un I-FAMILY_HISTORY cuadro I-FAMILY_HISTORY séptico I-FAMILY_HISTORY secundario. I-FAMILY_HISTORY I-FAMILY_HISTORY Con I-FAMILY_HISTORY respecto I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY demás I-FAMILY_HISTORY hermanos, I-FAMILY_HISTORY cinco I-FAMILY_HISTORY de I-FAMILY_HISTORY ellos I-FAMILY_HISTORY fallecieron I-FAMILY_HISTORY en I-FAMILY_HISTORY la I-FAMILY_HISTORY infancia I-FAMILY_HISTORY por I-FAMILY_HISTORY accidentes I-FAMILY_HISTORY y I-FAMILY_HISTORY enfermedades I-FAMILY_HISTORY no I-FAMILY_HISTORY relacionadas I-FAMILY_HISTORY al I-FAMILY_HISTORY cáncer. I-FAMILY_HISTORY En I-FAMILY_HISTORY los I-FAMILY_HISTORY cinco I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY vivos, I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY índice I-FAMILY_HISTORY no I-FAMILY_HISTORY declara I-FAMILY_HISTORY más I-FAMILY_HISTORY casos I-FAMILY_HISTORY afectados I-FAMILY_HISTORY de I-FAMILY_HISTORY poliposis I-FAMILY_HISTORY o I-FAMILY_HISTORY CCR, I-FAMILY_HISTORY sin I-FAMILY_HISTORY embargo, I-FAMILY_HISTORY desconocemos I-FAMILY_HISTORY si I-FAMILY_HISTORY ellos I-FAMILY_HISTORY se I-FAMILY_HISTORY han I-FAMILY_HISTORY realizado I-FAMILY_HISTORY estudios I-FAMILY_HISTORY colonoscópicos. I-FAMILY_HISTORY I-FAMILY_HISTORY Estudio B-EXPLORATION genético I-EXPLORATION I-EXPLORATION Obtención I-EXPLORATION del I-EXPLORATION ADN I-EXPLORATION genómico I-EXPLORATION desde I-EXPLORATION sangre I-EXPLORATION periférica: I-EXPLORATION el I-EXPLORATION ADN I-EXPLORATION genómico I-EXPLORATION fue I-EXPLORATION aislado I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION venosa I-EXPLORATION periférica, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION protocolo I-EXPLORATION descrito I-EXPLORATION por I-EXPLORATION Lahiri I-EXPLORATION y I-EXPLORATION Nurnberger I-EXPLORATION (1991 I-EXPLORATION ) I-EXPLORATION 9. I-EXPLORATION I-EXPLORATION Este I-EXPLORATION ADN I-EXPLORATION fue I-EXPLORATION previamente I-EXPLORATION estudiado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION molecular I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION APC, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION resultó I-EXPLORATION negativo8. I-EXPLORATION I-EXPLORATION Análisis I-EXPLORATION mutacional I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION MUTYH: I-EXPLORATION Los I-EXPLORATION 16 I-EXPLORATION exones I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION MUTYH I-EXPLORATION fueron I-EXPLORATION amplificados I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION (reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polimerasa) I-EXPLORATION usando I-EXPLORATION los I-EXPLORATION partidores I-EXPLORATION descritos I-EXPLORATION por I-EXPLORATION Kim I-EXPLORATION y I-EXPLORATION colaboradores, I-EXPLORATION en I-EXPLORATION 200610. I-EXPLORATION Reacciones I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION realizadas I-EXPLORATION en I-EXPLORATION un I-EXPLORATION volumen I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION Ql I-EXPLORATION que I-EXPLORATION contiene I-EXPLORATION 100 I-EXPLORATION ng I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION genómico, I-EXPLORATION 25 I-EXPLORATION pmoles I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION partidor, I-EXPLORATION 0, I-EXPLORATION 2 I-EXPLORATION mM I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dNTPs, I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION mM I-EXPLORATION MgCl2 I-EXPLORATION 1X I-EXPLORATION del I-EXPLORATION amortiguador I-EXPLORATION suministrado I-EXPLORATION por I-EXPLORATION la I-EXPLORATION enzima I-EXPLORATION y I-EXPLORATION 1U I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enzima I-EXPLORATION Platinum I-EXPLORATION Taq I-EXPLORATION ADN I-EXPLORATION polimerasa I-EXPLORATION (Invitrogen, I-EXPLORATION Sao I-EXPLORATION Paulo, I-EXPLORATION Brasil). I-EXPLORATION La I-EXPLORATION amplificación I-EXPLORATION fue I-EXPLORATION realizada I-EXPLORATION con I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION protocolo: I-EXPLORATION una I-EXPLORATION desnaturación I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION min I-EXPLORATION a I-EXPLORATION 95°C, I-EXPLORATION seguido I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION ciclos I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION seg I-EXPLORATION a I-EXPLORATION 95°C, I-EXPLORATION 30 I-EXPLORATION seg I-EXPLORATION a I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION apareamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION partidores I-EXPLORATION (rango I-EXPLORATION 50-58°C), I-EXPLORATION 30 I-EXPLORATION seg I-EXPLORATION a I-EXPLORATION 72°C, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION final I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION min I-EXPLORATION a I-EXPLORATION 72°C. I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION amplificados I-EXPLORATION fueron I-EXPLORATION posteriormente I-EXPLORATION analizados I-EXPLORATION mediante I-EXPLORATION dos I-EXPLORATION técnicas I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION sensibilidad I-EXPLORATION para I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION del I-EXPLORATION ADN, I-EXPLORATION que I-EXPLORATION incluye I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION SSCP I-EXPLORATION (single I-EXPLORATION strand I-EXPLORATION conformation I-EXPLORATION polymorphism) I-EXPLORATION y I-EXPLORATION secuenciación I-EXPLORATION de I-EXPLORATION ADN. I-EXPLORATION Brevemente, I-EXPLORATION los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION fueron I-EXPLORATION desnaturados I-EXPLORATION a I-EXPLORATION 95°C I-EXPLORATION por I-EXPLORATION 5 I-EXPLORATION min, I-EXPLORATION enfriados I-EXPLORATION en I-EXPLORATION hielo I-EXPLORATION por I-EXPLORATION 5 I-EXPLORATION min, I-EXPLORATION y I-EXPLORATION resueltos I-EXPLORATION por I-EXPLORATION electroforesis I-EXPLORATION en I-EXPLORATION geles I-EXPLORATION de I-EXPLORATION poliacrilamida I-EXPLORATION MDE I-EXPLORATION 0, I-EXPLORATION 5X I-EXPLORATION I-EXPLORATION (FMC I-EXPLORATION Bioproducts), I-EXPLORATION aplicando I-EXPLORATION una I-EXPLORATION corriente I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION W I-EXPLORATION a I-EXPLORATION 18°C I-EXPLORATION por I-EXPLORATION 12 I-EXPLORATION h. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION electroforesis, I-EXPLORATION los I-EXPLORATION geles I-EXPLORATION fueron I-EXPLORATION teñidos I-EXPLORATION con I-EXPLORATION nitrato I-EXPLORATION de I-EXPLORATION plata I-EXPLORATION con I-EXPLORATION el I-EXPLORATION fin I-EXPLORATION de I-EXPLORATION visualizar I-EXPLORATION las I-EXPLORATION bandas I-EXPLORATION de I-EXPLORATION ADN. I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION que I-EXPLORATION presentaron I-EXPLORATION una I-EXPLORATION migración I-EXPLORATION anormal I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION al I-EXPLORATION control, I-EXPLORATION fueron I-EXPLORATION secuenciados. I-EXPLORATION Las I-EXPLORATION mutaciones I-EXPLORATION fueron I-EXPLORATION analizadas I-EXPLORATION y I-EXPLORATION confirmadas I-EXPLORATION por I-EXPLORATION dos I-EXPLORATION reacciones I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION independientes I-EXPLORATION y I-EXPLORATION por I-EXPLORATION secuenciación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION hebras I-EXPLORATION de I-EXPLORATION ADN. I-EXPLORATION La I-EXPLORATION mutación I-EXPLORATION se I-EXPLORATION nombró I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION nomenclatura I-EXPLORATION propuesta I-EXPLORATION por I-EXPLORATION la I-EXPLORATION Human I-EXPLORATION Genome I-EXPLORATION Variation I-EXPLORATION Society I-EXPLORATION (www. I-EXPLORATION hgvs.org/mutnomen/). I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY suspendido I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY aspirina I-PAST_MEDICAL_HISTORY caracterizado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY eritema I-PAST_MEDICAL_HISTORY generalizado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY edema I-PAST_MEDICAL_HISTORY glótico. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY primera I-PAST_MEDICAL_HISTORY ocasión I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 1974 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY vuelve I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY repetir I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY única I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 1983, I-PAST_MEDICAL_HISTORY motivo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY vuelve I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY recibir I-PAST_MEDICAL_HISTORY aspirina. I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS en I-PRESENT_ILLNESS noviembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2010 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS angina I-PRESENT_ILLNESS inestable. I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION coronariografía I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION estenosis I-EXPLORATION significativa I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION descendente I-EXPLORATION anterior, I-EXPLORATION ante I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION angioplastía I-EXPLORATION con I-EXPLORATION stent I-EXPLORATION en I-EXPLORATION dicho I-EXPLORATION vaso. I-EXPLORATION Por B-TREATMENT antecedentes I-TREATMENT de I-TREATMENT alergia I-TREATMENT a I-TREATMENT la I-TREATMENT aspirina I-TREATMENT se I-TREATMENT deja I-TREATMENT con I-TREATMENT clopidogrel I-TREATMENT y I-TREATMENT cilostazol. I-TREATMENT Tres B-EVOLUTION semanas I-EVOLUTION posterior I-EVOLUTION a I-EVOLUTION su I-EVOLUTION alta, I-EVOLUTION presenta I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION torácico I-EVOLUTION retroesternal I-EVOLUTION opresivo I-EVOLUTION prolongado I-EVOLUTION y B-EXPLORATION la I-EXPLORATION corona-riografía I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION trombosis I-EXPLORATION intra-stent. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT angioplastía I-TREATMENT con I-TREATMENT balón, I-TREATMENT bajo I-TREATMENT infusión I-TREATMENT de I-TREATMENT tirofibán I-TREATMENT endovenoso, I-TREATMENT consiguiendo B-EVOLUTION un I-EVOLUTION buen I-EVOLUTION resultado I-EVOLUTION clínico. I-EVOLUTION Posterior B-TREATMENT a I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT realiza I-TREATMENT protocolo I-TREATMENT de I-TREATMENT desensibilización I-TREATMENT a I-TREATMENT aspirina, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Desde I-TREATMENT entonces I-TREATMENT se I-TREATMENT mantiene I-TREATMENT con I-TREATMENT aspirina I-TREATMENT y I-TREATMENT clopidrogel. I-TREATMENT Completado B-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION adherencia I-EVOLUTION a I-EVOLUTION la I-EVOLUTION terapia, I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION efectos I-EVOLUTION adversos, I-EVOLUTION y I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION sin I-EVOLUTION angina I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION HAAS. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY (20 I-PAST_MEDICAL_HISTORY paquetes/año) I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS Endoscopia B-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION (EDA) I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION estenosante I-EXPLORATION del I-EXPLORATION esófago I-EXPLORATION a I-EXPLORATION 30 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arcada I-EXPLORATION dentaria. I-EXPLORATION Biopsia I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION escamoso I-EXPLORATION moderadamente I-EXPLORATION diferenciado. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION etapi-ficación I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION infiltrante I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION del I-EXPLORATION esófago I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION largo, I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION cayado I-EXPLORATION aórtico I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION las I-EXPLORATION venas I-EXPLORATION pulmonares I-EXPLORATION derechas; I-EXPLORATION en I-EXPLORATION su I-EXPLORATION aspecto I-EXPLORATION posterior I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION que I-EXPLORATION rodeaba I-EXPLORATION y I-EXPLORATION aparentemente I-EXPLORATION infiltraba I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION en I-EXPLORATION más I-EXPLORATION de I-EXPLORATION un I-EXPLORATION 50% I-EXPLORATION de I-EXPLORATION su I-EXPLORATION circunferencia. I-EXPLORATION Presentaba I-EXPLORATION además I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION pulmonar I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION x I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION caudado, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION localizaciones I-EXPLORATION secundarias I-EXPLORATION (T4NxM1). I-EXPLORATION Considerando B-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT tenía I-TREATMENT un I-TREATMENT cáncer I-TREATMENT metastásico, I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT paliativo I-TREATMENT para I-TREATMENT alivio I-TREATMENT de I-TREATMENT su I-TREATMENT disfagia I-TREATMENT con I-TREATMENT QRT I-TREATMENT concomitante I-TREATMENT con I-TREATMENT cisplatino I-TREATMENT (radioterapia I-TREATMENT 51 I-TREATMENT Gy I-TREATMENT en I-TREATMENT 17 I-TREATMENT fracciones I-TREATMENT de I-TREATMENT 3 I-TREATMENT Gy I-TREATMENT y I-TREATMENT cisplatino I-TREATMENT 40 I-TREATMENT mg/ I-TREATMENT m2 I-TREATMENT semanales). I-TREATMENT I-TREATMENT Dos B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION completado I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION consultó I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencia I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION hematemesis; I-EVOLUTION al I-EVOLUTION ingreso I-EVOLUTION hipotenso I-EVOLUTION y I-EVOLUTION taquicárdico I-EVOLUTION recuperando I-EVOLUTION su I-EVOLUTION hemodinamia I-EVOLUTION mediante I-EVOLUTION aporte I-EVOLUTION de I-EVOLUTION cristaloides. I-EVOLUTION Hematocrito B-EXPLORATION de I-EXPLORATION 21%. I-EXPLORATION AngioTAC I-EXPLORATION mostró I-EXPLORATION reducción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION tumoral I-EXPLORATION esofágica I-EXPLORATION con I-EXPLORATION componente I-EXPLORATION necrótico I-EXPLORATION central I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION activo; I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION eran I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION una I-EXPLORATION FAE. I-EXPLORATION Fue B-TREATMENT llevado I-TREATMENT a I-TREATMENT pabellón I-TREATMENT donde I-TREATMENT se I-TREATMENT implantó I-TREATMENT una I-TREATMENT endoprótesis I-TREATMENT Valiant I-TREATMENT 28 I-TREATMENT x I-TREATMENT 15 I-TREATMENT (Medtronic, I-TREATMENT Minnesota, I-TREATMENT Estados I-TREATMENT Unidos I-TREATMENT de I-TREATMENT Norteamérica) I-TREATMENT en I-TREATMENT aorta I-TREATMENT torácica I-TREATMENT descendente I-TREATMENT proximal, I-TREATMENT distal I-TREATMENT a I-TREATMENT la I-TREATMENT arteria I-TREATMENT subclavia I-TREATMENT izquierda, I-TREATMENT por I-TREATMENT vía I-TREATMENT femoral I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT I-TREATMENT Se I-TREATMENT inició I-TREATMENT cobertura I-TREATMENT antibiótica I-TREATMENT en I-TREATMENT base I-TREATMENT a I-TREATMENT ce-ftriaxona I-TREATMENT y I-TREATMENT clindamicina. I-TREATMENT No B-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION hemorragia I-EVOLUTION digestiva, I-EVOLUTION iniciando I-EVOLUTION alimentación I-EVOLUTION oral I-EVOLUTION progresiva I-EVOLUTION el I-EVOLUTION 4° I-EVOLUTION día I-EVOLUTION postoperatorio, I-EVOLUTION bien I-EVOLUTION tolerado I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION disfagia. I-EVOLUTION Fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 8° I-EVOLUTION día I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION tolerancia I-EVOLUTION oral I-EVOLUTION y I-EVOLUTION afebril. I-EVOLUTION Completó B-TREATMENT 14 I-TREATMENT días I-TREATMENT de I-TREATMENT antibióticos I-TREATMENT endovenosos I-TREATMENT y I-TREATMENT luego I-TREATMENT continuó I-TREATMENT con I-TREATMENT amoxicilina/ácido I-TREATMENT clavulánico I-TREATMENT oral I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT amoxicilina I-TREATMENT en I-TREATMENT forma I-TREATMENT indefinida. I-TREATMENT I-TREATMENT En B-EVOLUTION controles I-EVOLUTION ambulatorios I-EVOLUTION evolucionó I-EVOLUTION adecuadamente, I-EVOLUTION sin I-EVOLUTION disfagia I-EVOLUTION ni I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION progresivo I-EVOLUTION del I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION kg. I-EVOLUTION AngioTAC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION mostró I-EVOLUTION adecuada I-EVOLUTION posición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION endoprótesis I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION fugas, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION metástasis I-EVOLUTION hepática I-EVOLUTION conocida. I-EVOLUTION Continuó I-EVOLUTION con I-EVOLUTION cuidados I-EVOLUTION paliativos I-EVOLUTION y I-EVOLUTION evolucionó I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION importantes I-EVOLUTION hasta I-EVOLUTION un I-EVOLUTION control I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 11 I-EVOLUTION meses I-EVOLUTION post I-EVOLUTION procedimiento I-EVOLUTION en I-EVOLUTION que I-EVOLUTION refirió I-EVOLUTION compromiso I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION disfagia I-EVOLUTION a I-EVOLUTION sólidos I-EVOLUTION y I-EVOLUTION baja I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 10 I-EVOLUTION kilos. I-EVOLUTION EDA B-EXPLORATION demostró I-EXPLORATION lesión I-EXPLORATION esofágica I-EXPLORATION estenosante I-EXPLORATION desde I-EXPLORATION los I-EXPLORATION 30 I-EXPLORATION a I-EXPLORATION 35 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arcada I-EXPLORATION dentaria I-EXPLORATION con I-EXPLORATION exposición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION endoprótesis I-EXPLORATION aórtica. I-EXPLORATION Mantuvo B-EVOLUTION manejo I-EVOLUTION paliativo, I-EVOLUTION falleciendo I-EVOLUTION finalmente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 13 I-EVOLUTION meses I-EVOLUTION post I-EVOLUTION cirugía I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION sepsis I-EVOLUTION ni I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION sangrado. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS occipitales, I-PRESENT_ILLNESS yugulares, I-PRESENT_ILLNESS submandibulares I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inguinales I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sensibles, I-PRESENT_ILLNESS asociadas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS fatiga, I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS máculo-petequiales I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS pies. I-PRESENT_ILLNESS El B-EXPLORATION hemograma I-EXPLORATION mostraba I-EXPLORATION 3.400 I-EXPLORATION leucocitos I-EXPLORATION x I-EXPLORATION mm3, I-EXPLORATION 46% I-EXPLORATION de I-EXPLORATION linfo I-EXPLORATION citos I-EXPLORATION y I-EXPLORATION 50% I-EXPLORATION de I-EXPLORATION neutro I-EXPLORATION filos. I-EXPLORATION La I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION (VHS) I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 2 I-EXPLORATION mg/L I-EXPLORATION y I-EXPLORATION 28 I-EXPLORATION mm/h, I-EXPLORATION respectivamente. I-EXPLORATION El I-EXPLORATION perfil I-EXPLORATION hepático, I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION la I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION alteraciones. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION complementario I-EXPLORATION fue I-EXPLORATION negativo: I-EXPLORATION hemocultivos, I-EXPLORATION urocultivo, I-EXPLORATION coprocultivo, I-EXPLORATION inmunofluorescencia I-EXPLORATION directa I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION respiratorios, I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION Epstein-Barr I-EXPLORATION (VEB), I-EXPLORATION Bartonella I-EXPLORATION hensenlae, I-EXPLORATION parvovirus I-EXPLORATION B-19, I-EXPLORATION citomegalovirus I-EXPLORATION (CMV), I-EXPLORATION Toxoplasma I-EXPLORATION gondii I-EXPLORATION y I-EXPLORATION ELISA I-EXPLORATION para I-EXPLORATION VIH. I-EXPLORATION No I-EXPLORATION hubo I-EXPLORATION hallazgos I-EXPLORATION significativos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION eco I-EXPLORATION cardiografía I-EXPLORATION transtorácica. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION mostró I-EXPLORATION adenopatías I-EXPLORATION bilaterales, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION los I-EXPLORATION triángulos I-EXPLORATION cervicales I-EXPLORATION anteriores I-EXPLORATION y I-EXPLORATION posteriores, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION inespecífico. I-EXPLORATION I-EXPLORATION Durante B-EVOLUTION la I-EVOLUTION hospitalización I-EVOLUTION apareció I-EVOLUTION un I-EVOLUTION exantema I-EVOLUTION máculo-papular I-EVOLUTION en I-EVOLUTION la I-EVOLUTION región I-EVOLUTION malar, I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION extremidades I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION artralgias. I-EVOLUTION Los B-EXPLORATION anticuerpos I-EXPLORATION anti-nucleares I-EXPLORATION (ANA) I-EXPLORATION y I-EXPLORATION anti-DNA I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION los I-EXPLORATION anticuerpos I-EXPLORATION anti-antígenos I-EXPLORATION nucleares I-EXPLORATION extraíbles I-EXPLORATION (ENA) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION (FR) I-EXPLORATION no I-EXPLORATION presentaron I-EXPLORATION alteraciones. I-EXPLORATION Los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION complemento I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION C4 I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 131 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION 45 I-EXPLORATION mg/dL I-EXPLORATION respectivamente. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION adenopatía I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION distorsión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arquitectura, I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION fibrinoide I-EXPLORATION y I-EXPLORATION restos I-EXPLORATION apoptóticos I-EXPLORATION rodeados I-EXPLORATION de I-EXPLORATION abundantes I-EXPLORATION histiocitos, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION linfadenitis I-EXPLORATION necrotizante I-EXPLORATION histiocitaria. I-EXPLORATION El B-EVOLUTION cuadro I-EVOLUTION se I-EVOLUTION resolvió I-EVOLUTION espontáneamente I-EVOLUTION en I-EVOLUTION 1 I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION recurrencias. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY poliartralgias I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY activo. I-PAST_MEDICAL_HISTORY Refiere B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS sudo-ración I-PRESENT_ILLNESS nocturna, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS poliartralgias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS sensible. I-PRESENT_ILLNESS Relata B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hermana I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY EKF I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY contacto I-PAST_MEDICAL_HISTORY directo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY gato. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS le I-PRESENT_ILLNESS realizaron I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS que I-PRESENT_ILLNESS mostraba I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS linfonodos I-PRESENT_ILLNESS cervicales I-PRESENT_ILLNESS a I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Le B-TREATMENT indicaron I-TREATMENT amoxicilina-ácido I-TREATMENT clavulánico I-TREATMENT durante I-TREATMENT 5 I-TREATMENT días I-TREATMENT sin I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT hospitalizó. I-TREATMENT En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION cervical I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION sensible I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION visceromegalia. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION mostró I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 56 I-EXPLORATION mm/h I-EXPLORATION y I-EXPLORATION la I-EXPLORATION PCR I-EXPLORATION y I-EXPLORATION ferritina I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 77 I-EXPLORATION mg/L I-EXPLORATION y I-EXPLORATION 1.789 I-EXPLORATION ng/mL I-EXPLORATION respectivamente. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cuello, I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION constatar I-EXPLORATION adenopatías I-EXPLORATION cervicales I-EXPLORATION y I-EXPLORATION mediastínicas, I-EXPLORATION reveló I-EXPLORATION opacidades I-EXPLORATION pulmonares I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION esmerilado. I-EXPLORATION Paralelamente, I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION VIH, I-EXPLORATION VEB, I-EXPLORATION CMV, I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION sífilis I-EXPLORATION y I-EXPLORATION Toxoplasma I-EXPLORATION gondii. I-EXPLORATION La I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION Bartonella I-EXPLORATION hensenlae I-EXPLORATION fue I-EXPLORATION negativa, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION la I-EXPLORATION IgG I-EXPLORATION resultó I-EXPLORATION positiva I-EXPLORATION (1/64). I-EXPLORATION Se I-EXPLORATION indicó I-EXPLORATION azitromicina I-EXPLORATION lg I-EXPLORATION al I-EXPLORATION día I-EXPLORATION durante I-EXPLORATION 6 I-EXPLORATION días, I-EXPLORATION sin I-EXPLORATION respuesta. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunológico I-EXPLORATION fue I-EXPLORATION prácticamente I-EXPLORATION normal, I-EXPLORATION solamente I-EXPLORATION con I-EXPLORATION un I-EXPLORATION ANA I-EXPLORATION positivo I-EXPLORATION a I-EXPLORATION título I-EXPLORATION bajo I-EXPLORATION (1/40). I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION adenopatía I-EXPLORATION cervical. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION para I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION bacterias I-EXPLORATION resultaron I-EXPLORATION negativos, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION reveló I-EXPLORATION linfadenitis I-EXPLORATION necrotizante I-EXPLORATION histiocitaria. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT prednisona I-TREATMENT 30 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT tres I-TREATMENT semanas I-TREATMENT con I-TREATMENT disminución I-TREATMENT progresiva I-TREATMENT de I-TREATMENT las I-TREATMENT dosis I-TREATMENT completando I-TREATMENT 45 I-TREATMENT días I-TREATMENT de I-TREATMENT terapia. I-TREATMENT Los B-EVOLUTION síntomas I-EVOLUTION desaparecen I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION Dos B-EXPLORATION meses I-EXPLORATION después I-EXPLORATION asiste I-EXPLORATION a I-EXPLORATION control I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION esmerilado. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION pulmonar I-EXPLORATION revelando I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION neumonía I-EXPLORATION intersticial I-EXPLORATION usual I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION tardía. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION sintoma-tología I-EVOLUTION respiratoria I-EVOLUTION ni I-EVOLUTION alteraciones I-EVOLUTION significativas I-EVOLUTION en I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION función I-EVOLUTION pulmonar. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION mostró I-EXPLORATION tumor I-EXPLORATION ovárico I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 13 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION ascitis. I-EXPLORATION Resto I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Cal25 I-EXPLORATION = I-EXPLORATION 2.526 I-EXPLORATION (U/ml). I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT cirugía I-TREATMENT oncoló I-TREATMENT gica. I-TREATMENT Cal25 B-EXPLORATION post-operatorio I-EXPLORATION 174 I-EXPLORATION (U/ml). I-EXPLORATION Biopsia I-EXPLORATION mostró I-EXPLORATION adenocarcinoma I-EXPLORATION endometrioide I-EXPLORATION Grado I-EXPLORATION 3. I-EXPLORATION Etapificada I-EXPLORATION como I-EXPLORATION IC, I-EXPLORATION se I-EXPLORATION tomó I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION ascitis I-EXPLORATION para I-EXPLORATION block I-EXPLORATION celular I-EXPLORATION y I-EXPLORATION se I-EXPLORATION cultivó I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION QS I-EXPLORATION in I-EXPLORATION vitro. I-EXPLORATION Se B-TREATMENT administró I-TREATMENT QMT I-TREATMENT de I-TREATMENT carboplatino-paclitaxel, I-TREATMENT con I-TREATMENT normalización I-TREATMENT del I-TREATMENT Cal25. I-TREATMENT El B-EVOLUTION seguimiento I-EVOLUTION a I-EVOLUTION tres I-EVOLUTION años I-EVOLUTION fue I-EVOLUTION normal. I-EVOLUTION Estudio B-EXPLORATION in I-EXPLORATION vitro I-EXPLORATION mostró I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION citotoxicidad I-EXPLORATION al I-EXPLORATION esquema I-EXPLORATION carboplatino-paclitaxel I-EXPLORATION mayor I-EXPLORATION al I-EXPLORATION 70%, I-EXPLORATION correlacionándose I-EXPLORATION con I-EXPLORATION la I-EXPLORATION respuesta I-EXPLORATION clínica. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento, I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY (IMC I-PAST_MEDICAL_HISTORY 32) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY suspendido. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS persistentes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS kilos I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS período. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS hubo I-PRESENT_ILLNESS evidencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hemorragia I-PRESENT_ILLNESS gastrointestinal I-PRESENT_ILLNESS o I-PRESENT_ILLNESS anemia. I-PRESENT_ILLNESS B-EXPLORATION La I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION gástrico I-EXPLORATION submucoso, I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION antro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION curvatura I-EXPLORATION menor I-EXPLORATION y I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION lumen I-EXPLORATION antral. I-EXPLORATION La I-EXPLORATION mucosa, I-EXPLORATION examinada I-EXPLORATION por I-EXPLORATION endoscopia, I-EXPLORATION era I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION gástrica I-EXPLORATION homogénea, I-EXPLORATION hiperecogénica I-EXPLORATION y I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION definidos. I-EXPLORATION El I-EXPLORATION estudió I-EXPLORATION se I-EXPLORATION completó I-EXPLORATION con I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION con I-EXPLORATION densidad I-EXPLORATION grasa, I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION ocupando I-EXPLORATION una I-EXPLORATION parte I-EXPLORATION importante I-EXPLORATION del I-EXPLORATION lumen I-EXPLORATION antral I-EXPLORATION gástrico, I-EXPLORATION con I-EXPLORATION baja I-EXPLORATION captura I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION fue I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION GIST I-EXPLORATION con I-EXPLORATION diferenciación I-EXPLORATION lipomatosa I-EXPLORATION o I-EXPLORATION un I-EXPLORATION lipoma I-EXPLORATION gástrico. I-EXPLORATION La I-EXPLORATION resección I-EXPLORATION quirúrgica I-EXPLORATION fue I-EXPLORATION recomendada. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT gastrectomía I-TREATMENT subtotal I-TREATMENT distal I-TREATMENT laparoscópica. I-TREATMENT Se I-TREATMENT utilizaron I-TREATMENT 5 I-TREATMENT trocares; I-TREATMENT supraumbilical I-TREATMENT de I-TREATMENT 12 I-TREATMENT mm I-TREATMENT para I-TREATMENT el I-TREATMENT laparoscopio, I-TREATMENT subxifoideo I-TREATMENT de I-TREATMENT 5 I-TREATMENT mm I-TREATMENT para I-TREATMENT separación I-TREATMENT hepática I-TREATMENT y I-TREATMENT trocares I-TREATMENT subcostal I-TREATMENT izquierdo I-TREATMENT de I-TREATMENT 12 I-TREATMENT mm, I-TREATMENT flanco I-TREATMENT derecho I-TREATMENT de I-TREATMENT 12 I-TREATMENT mm I-TREATMENT y I-TREATMENT flanco I-TREATMENT izquierdo I-TREATMENT de I-TREATMENT 10 I-TREATMENT mm. I-TREATMENT En I-TREATMENT el I-TREATMENT intraoperatorio, I-TREATMENT se I-TREATMENT confirmó I-TREATMENT una I-TREATMENT gran I-TREATMENT masa I-TREATMENT antral I-TREATMENT sin I-TREATMENT compromiso I-TREATMENT de I-TREATMENT la I-TREATMENT serosa. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT endoscopia I-TREATMENT intraoperatoria I-TREATMENT para I-TREATMENT definir I-TREATMENT el I-TREATMENT margen I-TREATMENT proximal I-TREATMENT de I-TREATMENT resección. I-TREATMENT Se I-TREATMENT seccionó I-TREATMENT el I-TREATMENT duodeno I-TREATMENT y I-TREATMENT el I-TREATMENT estómago I-TREATMENT con I-TREATMENT cargas I-TREATMENT lineares I-TREATMENT de I-TREATMENT 60 I-TREATMENT mm I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT linfadenectomía I-TREATMENT D1. I-TREATMENT La I-TREATMENT pieza I-TREATMENT fue I-TREATMENT extraída I-TREATMENT por I-TREATMENT una I-TREATMENT incisión I-TREATMENT Pfannenstiel I-TREATMENT y I-TREATMENT los I-TREATMENT márgenes I-TREATMENT negativos I-TREATMENT fueron I-TREATMENT confirmados I-TREATMENT por I-TREATMENT biopsia I-TREATMENT rápida. I-TREATMENT Se I-TREATMENT reconstruyó I-TREATMENT el I-TREATMENT tránsito I-TREATMENT con I-TREATMENT una I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux I-TREATMENT de I-TREATMENT 50 I-TREATMENT cm I-TREATMENT de I-TREATMENT largo, I-TREATMENT realizando I-TREATMENT la I-TREATMENT anastomosis I-TREATMENT gastro-yeyunal I-TREATMENT y I-TREATMENT yeyuno-yeyunal I-TREATMENT en I-TREATMENT forma I-TREATMENT mecánica I-TREATMENT e I-TREATMENT intracorpórea. I-TREATMENT El B-EVOLUTION tiempo I-EVOLUTION operatorio I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION h I-EVOLUTION y I-EVOLUTION el I-EVOLUTION sangrado I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 200 I-EVOLUTION cc. I-EVOLUTION I-EVOLUTION La I-EVOLUTION recuperación I-EVOLUTION post I-EVOLUTION operatoria I-EVOLUTION fue I-EVOLUTION sin I-EVOLUTION incidentes. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION realimentó I-EVOLUTION con I-EVOLUTION líquidos I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 5o I-EVOLUTION día I-EVOLUTION post I-EVOLUTION operatorio. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION macroscópico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION fue I-EXPLORATION consistente I-EXPLORATION con I-EXPLORATION tumor I-EXPLORATION gástrico I-EXPLORATION submucoso, I-EXPLORATION de I-EXPLORATION 11, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 6x7 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION apariencia I-EXPLORATION lipomatosa. I-EXPLORATION La I-EXPLORATION microscopía I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION lipoma I-EXPLORATION gástrico I-EXPLORATION benigno I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION libres I-EXPLORATION y I-EXPLORATION 15 I-EXPLORATION linfonodos I-EXPLORATION perigástricos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS institución I-PRESENT_ILLNESS por I-PRESENT_ILLNESS síncope I-PRESENT_ILLNESS recurrente. I-PRESENT_ILLNESS Estando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS reposo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS casa, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hora I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS finalizado I-PRESENT_ILLNESS entrenamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS boxeo, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS súbito I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS un I-PRESENT_ILLNESS minuto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS recuperación I-PRESENT_ILLNESS completa I-PRESENT_ILLNESS posterior. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS las I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS siguientes I-PRESENT_ILLNESS repitió I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS sincopales I-PRESENT_ILLNESS de I-PRESENT_ILLNESS similares I-PRESENT_ILLNESS características I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS oportunidades. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hall I-PRESENT_ILLNESS de I-PRESENT_ILLNESS acceso I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS sincopal, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS trasladado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS box I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS para I-PRESENT_ILLNESS evaluación I-PRESENT_ILLNESS inmediata. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 126/82 I-EXPLORATION mmHg, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 82 I-EXPLORATION lpm, I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION 99% I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION axilar I-EXPLORATION de I-EXPLORATION 36°C. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refería I-EXPLORATION comorbilidades I-EXPLORATION significativas I-EXPLORATION ni I-EXPLORATION antecedentes I-EXPLORATION familiares I-EXPLORATION de I-EXPLORATION cardiopatía. I-EXPLORATION Durante I-EXPLORATION realización I-EXPLORATION del I-EXPLORATION ECG I-EXPLORATION inicial I-EXPLORATION paciente I-EXPLORATION repitió I-EXPLORATION síncope, I-EXPLORATION objetivándose I-EXPLORATION en I-EXPLORATION el I-EXPLORATION trazado I-EXPLORATION fibrilación I-EXPLORATION ventricular. I-EXPLORATION Se I-EXPLORATION iniciaron I-EXPLORATION maniobras I-EXPLORATION de I-EXPLORATION reanimación I-EXPLORATION y I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION convirtió I-EXPLORATION a I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION después I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION segundos. I-EXPLORATION Se I-EXPLORATION repitió I-EXPLORATION un I-EXPLORATION ECG, I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION incompleto I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecha, I-EXPLORATION supradesnivel I-EXPLORATION del I-EXPLORATION ST I-EXPLORATION e I-EXPLORATION inversión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION T I-EXPLORATION en I-EXPLORATION precordiales I-EXPLORATION derechas, I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION patrón I-EXPLORATION Bragada I-EXPLORATION tipo I-EXPLORATION 1. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION pocos I-EXPLORATION minutos I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION nuevo I-EXPLORATION episodio I-EXPLORATION de I-EXPLORATION fibrilación I-EXPLORATION ventricular I-EXPLORATION y I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION inmediata I-EXPLORATION desfibrilación I-EXPLORATION con I-EXPLORATION 200 I-EXPLORATION Joules I-EXPLORATION de I-EXPLORATION corriente I-EXPLORATION bifásica, I-EXPLORATION dando I-EXPLORATION salida I-EXPLORATION a I-EXPLORATION ritmo I-EXPLORATION sinusal. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT hospitalizado I-TREATMENT en I-TREATMENT Unidad I-TREATMENT Coronaria, I-TREATMENT donde I-TREATMENT fue I-TREATMENT sedado I-TREATMENT con I-TREATMENT lorazepam I-TREATMENT y I-TREATMENT se I-TREATMENT decidió I-TREATMENT iniciar I-TREATMENT infusión I-TREATMENT de I-TREATMENT isoproterenol I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 0, I-TREATMENT 25 I-TREATMENT ug/min. I-TREATMENT Se B-EXPLORATION registra I-EXPLORATION ECG I-EXPLORATION durante I-EXPLORATION infusión I-EXPLORATION de I-EXPLORATION isoproterenol, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION regresión I-EXPLORATION del I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION Brugada I-EXPLORATION dado I-EXPLORATION por I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION V1-V2, I-EXPLORATION desaparición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION restauración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polaridad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION T. I-EXPLORATION Ecocardiograma I-EXPLORATION descartó I-EXPLORATION patología I-EXPLORATION estructural I-EXPLORATION y I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION alteraciones I-EXPLORATION significativas I-EXPLORATION del I-EXPLORATION medio I-EXPLORATION interno. I-EXPLORATION Evolucionó B-EVOLUTION favorablemente, I-EVOLUTION suspendiendo I-EVOLUTION infusión I-EVOLUTION antiarrítmica I-EVOLUTION al I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION e I-EVOLUTION implantando I-EVOLUTION cardiodesfibrilador I-EVOLUTION bicameral I-EVOLUTION (Protecta I-EVOLUTION CRT-D, I-EVOLUTION Medtronic) I-EVOLUTION sin I-EVOLUTION incidentes. I-EVOLUTION Fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION sin I-EVOLUTION medicación I-EVOLUTION antiarrítmica. I-EVOLUTION En I-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION no I-EVOLUTION se I-EVOLUTION registraron I-EVOLUTION eventos I-EVOLUTION arrítmicos I-EVOLUTION en I-EVOLUTION chequeo I-EVOLUTION del I-EVOLUTION dispositivo. I-EVOLUTION I-EVOLUTION La B-EXPLORATION isquemia I-EXPLORATION en I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION es I-EXPLORATION una I-EXPLORATION complicación I-EXPLORATION a I-EXPLORATION largo I-EXPLORATION plazo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION diabetes. I-EXPLORATION Los I-EXPLORATION pacientes I-EXPLORATION evolucionan I-EXPLORATION con I-EXPLORATION claudicación I-EXPLORATION intermitente I-EXPLORATION y, I-EXPLORATION posteriormente, I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION de I-EXPLORATION reposo I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad10, I-EXPLORATION 11. I-EXPLORATION Pueden I-EXPLORATION presentar I-EXPLORATION alteraciones I-EXPLORATION tróficas I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades, I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION uñas, I-EXPLORATION xerosis, I-EXPLORATION edema, I-EXPLORATION linfangitis, I-EXPLORATION pulsos I-EXPLORATION disminuidos, I-EXPLORATION piel I-EXPLORATION fría, I-EXPLORATION eritema, I-EXPLORATION palidez I-EXPLORATION o I-EXPLORATION cianosis. I-EXPLORATION Finalmente, I-EXPLORATION aparecen I-EXPLORATION úlceras I-EXPLORATION y I-EXPLORATION necrosis12, I-EXPLORATION 13. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION Doppler I-EXPLORATION y I-EXPLORATION la I-EXPLORATION angiografía I-EXPLORATION permiten I-EXPLORATION cuantificar I-EXPLORATION la I-EXPLORATION magnitud I-EXPLORATION del I-EXPLORATION deterioro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION circulación I-EXPLORATION arterial. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT incluye I-TREATMENT ejercicio I-TREATMENT físico, I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT diabetes I-TREATMENT y I-TREATMENT de I-TREATMENT los I-TREATMENT otros I-TREATMENT factores I-TREATMENT de I-TREATMENT riesgo14. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT definitivo I-TREATMENT es I-TREATMENT la I-TREATMENT revascularización15. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS retroesternal I-PRESENT_ILLNESS opresivo, I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS 10/10, I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS epigastrio, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS min I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS profusa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS palpitaciones. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Refería I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS similares I-PRESENT_ILLNESS características I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes, I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS motivó I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS evaluada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS electrocardiograma I-PRESENT_ILLNESS (ECG) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS enzimas I-PRESENT_ILLNESS cardiacas; I-PRESENT_ILLNESS no I-PRESENT_ILLNESS impresionando I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS coronario, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS derivó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio. I-PRESENT_ILLNESS Dentro B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY data I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY precisada, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY atenolol I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mama I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY radioterapia. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY ni B-FAMILY_HISTORY tenía I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY cardiopatía I-FAMILY_HISTORY coronaria. I-FAMILY_HISTORY I-FAMILY_HISTORY Al B-EXPLORATION ingreso, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION sudorosa, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION dolor. I-EXPLORATION La I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION era I-EXPLORATION 100/60 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION su I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION 87 I-EXPLORATION lpm. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaban I-EXPLORATION yugulares I-EXPLORATION colapsables I-EXPLORATION en I-EXPLORATION inspiración, I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION cardiaca I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION soplos I-EXPLORATION ni I-EXPLORATION galope I-EXPLORATION y I-EXPLORATION había I-EXPLORATION sensibilidad I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION epigástrica. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION no I-EXPLORATION era I-EXPLORATION destacable. I-EXPLORATION Al B-PRESENT_ILLNESS interrogatorio, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS similares I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS clara I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS esfuerzos I-PRESENT_ILLNESS físicos, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS principio I-PRESENT_ILLNESS eran I-PRESENT_ILLNESS esporádicos I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS que I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS se I-PRESENT_ILLNESS hicieron I-PRESENT_ILLNESS más I-PRESENT_ILLNESS frecuentes, I-PRESENT_ILLNESS casi I-PRESENT_ILLNESS diarios. I-PRESENT_ILLNESS El B-EXPLORATION ECG I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION discreto I-EXPLORATION supradesnivel I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION (SDST) I-EXPLORATION anteroseptal I-EXPLORATION con I-EXPLORATION inversión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION T I-EXPLORATION de I-EXPLORATION V1 I-EXPLORATION a I-EXPLORATION V3, I-EXPLORATION que I-EXPLORATION ya I-EXPLORATION era I-EXPLORATION evidente I-EXPLORATION en I-EXPLORATION ECG I-EXPLORATION tomado I-EXPLORATION 2 I-EXPLORATION días I-EXPLORATION antes I-EXPLORATION y I-EXPLORATION que I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION evolutivo. I-EXPLORATION I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION silueta I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION congestión I-EXPLORATION pulmonar. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT admitida I-TREATMENT a I-TREATMENT la I-TREATMENT unidad I-TREATMENT coronaria, I-TREATMENT con I-TREATMENT terapia I-TREATMENT de I-TREATMENT síndrome I-TREATMENT coronario I-TREATMENT agudo I-TREATMENT sin I-TREATMENT SDST. I-TREATMENT La B-EXPLORATION troponina I-EXPLORATION I I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 07 I-EXPLORATION pg/ml I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 05) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION CK I-EXPLORATION total I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 117 I-EXPLORATION U/L I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fracción I-EXPLORATION MB I-EXPLORATION de I-EXPLORATION 25. I-EXPLORATION I-EXPLORATION A B-EVOLUTION las I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION crisis I-EVOLUTION de I-EVOLUTION angor I-EVOLUTION intenso, I-EVOLUTION 10/10, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION disnea, I-EVOLUTION palpitaciones, I-EVOLUTION cefalea, I-EVOLUTION sudoración I-EVOLUTION y I-EVOLUTION enrojecimiento I-EVOLUTION facial. I-EVOLUTION Se B-EXPLORATION constató I-EXPLORATION alza I-EXPLORATION de I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION hasta I-EXPLORATION 260/130 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION al I-EXPLORATION monitor I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION taquicardia I-EXPLORATION sinusal I-EXPLORATION con I-EXPLORATION extrasistolía I-EXPLORATION supraventricular I-EXPLORATION y I-EXPLORATION ventricular I-EXPLORATION frecuentes, I-EXPLORATION y I-EXPLORATION conducción I-EXPLORATION aberrante I-EXPLORATION con I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION completo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 5 I-EXPLORATION min I-EXPLORATION de I-EXPLORATION duración. I-EXPLORATION No I-EXPLORATION hubo I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION hipotensión I-EXPLORATION ni I-EXPLORATION síncope. I-EXPLORATION Dado I-EXPLORATION las I-EXPLORATION características I-EXPLORATION del I-EXPLORATION episodio I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION feocromocitoma. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT heparina, I-TREATMENT se I-TREATMENT aportó I-TREATMENT solución I-TREATMENT fisiológica I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT doxazosina I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h. I-TREATMENT Se B-EXPLORATION midió I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION crisis I-EXPLORATION catecolaminas I-EXPLORATION plasmáticas I-EXPLORATION y I-EXPLORATION metanefrinas I-EXPLORATION urinarias I-EXPLORATION (previo I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION doxazosina), I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION marcadamente I-EXPLORATION elevadas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION de I-EXPLORATION abdomen, I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico, I-EXPLORATION evidenciando I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION suprarrenal I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION I-EXPLORATION El I-EXPLORATION cintigrama I-EXPLORATION con I-EXPLORATION 123-I-metaiodobencilguanidina I-EXPLORATION (MIBG) I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION descrita I-EXPLORATION y I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION metástasis. I-EXPLORATION I-EXPLORATION Adicionalmente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION transtorácico, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION izquierda I-EXPLORATION leve I-EXPLORATION y I-EXPLORATION compromiso I-EXPLORATION leve I-EXPLORATION de I-EXPLORATION la I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION global, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION (FE) I-EXPLORATION estimada I-EXPLORATION por I-EXPLORATION Simpson I-EXPLORATION de I-EXPLORATION 42%, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION coronariografía I-EXPLORATION sin I-EXPLORATION incidentes I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION procedimiento, I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION coronaria. I-EXPLORATION La I-EXPLORATION disfunción I-EXPLORATION ventricular I-EXPLORATION fue I-EXPLORATION asumida I-EXPLORATION en I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION daño I-EXPLORATION miocárdico I-EXPLORATION por I-EXPLORATION catecolaminas. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT se I-TREATMENT preparó I-TREATMENT para I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT bloqueo I-TREATMENT α I-TREATMENT y I-TREATMENT β-adrenérgico I-TREATMENT escalonado I-TREATMENT con I-TREATMENT doxazosina I-TREATMENT y, I-TREATMENT luego I-TREATMENT de I-TREATMENT 2 I-TREATMENT días, I-TREATMENT propanolol. I-TREATMENT La I-TREATMENT cirugía I-TREATMENT se I-TREATMENT realizó I-TREATMENT 11 I-TREATMENT días I-TREATMENT después, I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT hemodinámicas I-TREATMENT significativas I-TREATMENT y I-TREATMENT cursó I-TREATMENT con I-TREATMENT un I-TREATMENT postoperatorio I-TREATMENT favorable. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones. I-EVOLUTION Desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION clínico, I-EVOLUTION cursó I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION progresiva I-EVOLUTION en I-EVOLUTION la I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION antihipertensivos I-EVOLUTION y I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION ventricular I-EVOLUTION en I-EVOLUTION ecocardiografía I-EVOLUTION de I-EVOLUTION control. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY suspendido, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY celiaca, I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY iodo I-PAST_MEDICAL_HISTORY radioactivo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Graves. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION julio I-EXPLORATION de I-EXPLORATION 2007 I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION vasculitis I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION ANCA I-EXPLORATION (GPA), I-EXPLORATION en I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION vías I-EXPLORATION aéreas I-EXPLORATION superiores I-EXPLORATION (VAS), I-EXPLORATION masa I-EXPLORATION palpable I-EXPLORATION supraclavicular I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hipogastrio10. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION incluyen I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION eritrosedimentación I-EXPLORATION (VSG) I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION 120 I-EXPLORATION mm, I-EXPLORATION ANCA I-EXPLORATION c I-EXPLORATION positivos, I-EXPLORATION el I-EXPLORATION enzimoinmunoensayo I-EXPLORATION (ELISA) I-EXPLORATION reveló I-EXPLORATION especificidad I-EXPLORATION para I-EXPLORATION el I-EXPLORATION antígeno I-EXPLORATION proteinasa I-EXPLORATION 3 I-EXPLORATION (PR3), I-EXPLORATION sin I-EXPLORATION microhematuria I-EXPLORATION o I-EXPLORATION insuficiencia I-EXPLORATION renal. I-EXPLORATION Presentó I-EXPLORATION masa I-EXPLORATION pulmonar I-EXPLORATION apical I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION central I-EXPLORATION sin I-EXPLORATION cavitación. I-EXPLORATION Se I-EXPLORATION tomó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION supraclavicular I-EXPLORATION cuya I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informó I-EXPLORATION infamación I-EXPLORATION granulomatosa I-EXPLORATION necrotizante. I-EXPLORATION En I-EXPLORATION base I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION expuesto I-EXPLORATION previamente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION GPA I-EXPLORATION temprana I-EXPLORATION sistémica I-EXPLORATION del I-EXPLORATION EUVAS I-EXPLORATION (Registro I-EXPLORATION Europeo I-EXPLORATION de I-EXPLORATION vasculitis) I-EXPLORATION o I-EXPLORATION localizada I-EXPLORATION dado I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION renal. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ciclofosfamida I-TREATMENT y I-TREATMENT prednisolona I-TREATMENT con I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT clínica. I-TREATMENT I-TREATMENT Presentó B-EVOLUTION recaídas I-EVOLUTION con I-EVOLUTION síntomas I-EVOLUTION respiratorios I-EVOLUTION y I-EVOLUTION nódulos I-EVOLUTION pulmonares, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION curva I-EVOLUTION flujo I-EVOLUTION volumen I-EVOLUTION (CFV) I-EVOLUTION normal, I-EVOLUTION estando I-EVOLUTION bajo I-EVOLUTION tratamiento I-EVOLUTION inmunosupresor I-EVOLUTION durante I-EVOLUTION los I-EVOLUTION años I-EVOLUTION 2008, I-EVOLUTION 2009 I-EVOLUTION y I-EVOLUTION 2010. I-EVOLUTION Se B-TREATMENT interpretó I-TREATMENT como I-TREATMENT enfermedad I-TREATMENT refractaria I-TREATMENT y I-TREATMENT se I-TREATMENT rotó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT micofenolato I-TREATMENT 3 I-TREATMENT g/día I-TREATMENT que I-TREATMENT es I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT está I-TREATMENT en I-TREATMENT la I-TREATMENT actualidad. I-TREATMENT I-TREATMENT A B-EVOLUTION inicios I-EVOLUTION de I-EVOLUTION mayo I-EVOLUTION de I-EVOLUTION 2011 I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION disnea I-EVOLUTION de I-EVOLUTION esfuerzo, I-EVOLUTION estridor I-EVOLUTION inspiratorio, I-EVOLUTION sibilancias I-EVOLUTION y I-EVOLUTION expectoración I-EVOLUTION hemoptoica. I-EVOLUTION Presentó B-EXPLORATION analítica I-EXPLORATION normal I-EXPLORATION que I-EXPLORATION incluyó I-EXPLORATION VSG I-EXPLORATION y I-EXPLORATION ANCA. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION CFV I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION aplanamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION flujos I-EXPLORATION inspiratorio I-EXPLORATION y I-EXPLORATION espiratorio, I-EXPLORATION descripto I-EXPLORATION como I-EXPLORATION curva I-EXPLORATION cajón. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION laringe I-EXPLORATION y I-EXPLORATION tráquea I-EXPLORATION mostró I-EXPLORATION ESG I-EXPLORATION con I-EXPLORATION indemnidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION anillos I-EXPLORATION traqueales. I-EXPLORATION La I-EXPLORATION fibrobroncoscopía I-EXPLORATION mostró I-EXPLORATION indemnidad I-EXPLORATION de I-EXPLORATION cuerdas I-EXPLORATION vocales I-EXPLORATION y I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION sub-glótico I-EXPLORATION mucosa I-EXPLORATION friable I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION granulomas I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION actividad I-EXPLORATION local I-EXPLORATION con I-EXPLORATION una I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION mm. I-EXPLORATION I-EXPLORATION A I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION encontrarse I-EXPLORATION con I-EXPLORATION altas I-EXPLORATION dosis I-EXPLORATION de I-EXPLORATION inmunosupresores, I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION intercurrencia I-EXPLORATION con I-EXPLORATION una I-EXPLORATION ESG, I-EXPLORATION siendo I-EXPLORATION dificultoso I-EXPLORATION diferenciar, I-EXPLORATION si I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION recaída I-EXPLORATION o I-EXPLORATION la I-EXPLORATION cicatrización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION prexistente. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT duda I-TREATMENT se I-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tres I-TREATMENT pulsos I-TREATMENT de I-TREATMENT solumedrol I-TREATMENT de I-TREATMENT un I-TREATMENT gramo I-TREATMENT e I-TREATMENT inició I-TREATMENT plasmáferesis I-TREATMENT con I-TREATMENT el I-TREATMENT objetivo I-TREATMENT de I-TREATMENT remover I-TREATMENT complejos I-TREATMENT antígeno-anticuerpo. I-TREATMENT En I-TREATMENT la I-TREATMENT analítica I-TREATMENT tuvo I-TREATMENT recuento I-TREATMENT de I-TREATMENT CD20 I-TREATMENT normales I-TREATMENT por I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT administraron I-TREATMENT 4 I-TREATMENT dosis I-TREATMENT de I-TREATMENT rituximab I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 375 I-TREATMENT mg/m2/semana I-TREATMENT durante I-TREATMENT 4 I-TREATMENT semanas I-TREATMENT con I-TREATMENT excelente I-TREATMENT tolerancia. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT broncoscopia I-TREATMENT rígida I-TREATMENT terapéutica I-TREATMENT (con I-TREATMENT dilatación I-TREATMENT y I-TREATMENT electrocauterio). I-TREATMENT Normalizó B-EVOLUTION la I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION la I-EVOLUTION espirometría I-EVOLUTION y I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION a I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION del I-EVOLUTION evento. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS multípara B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5, I-PAST_MEDICAL_HISTORY IMC I-PAST_MEDICAL_HISTORY 25, I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY kg/m2, I-PAST_MEDICAL_HISTORY puérpera I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY (parto I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY institución), I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY levotiroxina I-PAST_MEDICAL_HISTORY 75 I-PAST_MEDICAL_HISTORY mcg/día. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS general I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Santiago I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS retroesternal I-PRESENT_ILLNESS opresivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS súbito I-PRESENT_ILLNESS y I-PRESENT_ILLNESS máxima I-PRESENT_ILLNESS intensidad. I-PRESENT_ILLNESS Ingresa B-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION hemodinámico, I-EXPLORATION afebril, I-EXPLORATION con I-EXPLORATION examen I-EXPLORATION cardiopulmonar I-EXPLORATION normal. I-EXPLORATION Electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION muestra I-EXPLORATION infradesnivel I-EXPLORATION del I-EXPLORATION ST I-EXPLORATION difuso. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT manejo I-TREATMENT médico I-TREATMENT con I-TREATMENT aspirina, I-TREATMENT morfina I-TREATMENT y I-TREATMENT nitroglicerina I-TREATMENT sublingual; I-TREATMENT y B-EXPLORATION se I-EXPLORATION solicitan I-EXPLORATION enzimas I-EXPLORATION cardíacas I-EXPLORATION y I-EXPLORATION dímero I-EXPLORATION D. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION evidencian: I-EXPLORATION hemoglobina I-EXPLORATION 14, I-EXPLORATION 9 I-EXPLORATION g/dL, I-EXPLORATION hematocrito I-EXPLORATION 43, I-EXPLORATION 7%, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION 288.000/uL, I-EXPLORATION eosinóflos I-EXPLORATION 2, I-EXPLORATION 9%, I-EXPLORATION VHS I-EXPLORATION 17 I-EXPLORATION mm/h, I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 43 I-EXPLORATION mg/dL, I-EXPLORATION troponina I-EXPLORATION 0, I-EXPLORATION 45 I-EXPLORATION ng/ml, I-EXPLORATION creatincinasa I-EXPLORATION (CK) I-EXPLORATION 72 I-EXPLORATION U/L, I-EXPLORATION Ck-mb I-EXPLORATION 2, I-EXPLORATION 8 I-EXPLORATION U/L; I-EXPLORATION dímero I-EXPLORATION D I-EXPLORATION 554 I-EXPLORATION ng/ml. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicita I-EXPLORATION AngioTAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION por I-EXPLORATION un I-EXPLORATION dímero I-EXPLORATION D I-EXPLORATION elevado, I-EXPLORATION que I-EXPLORATION descarta I-EXPLORATION tromboembolismo I-EXPLORATION pulmonar. I-EXPLORATION I-EXPLORATION Persiste I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION y I-EXPLORATION ECG I-EXPLORATION de I-EXPLORATION control I-EXPLORATION evidencia I-EXPLORATION QS I-EXPLORATION en I-EXPLORATION AVL, I-EXPLORATION qR I-EXPLORATION en I-EXPLORATION DI I-EXPLORATION y I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION la I-EXPLORATION amplitud I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION R I-EXPLORATION en I-EXPLORATION V4-V6. I-EXPLORATION Enzimas I-EXPLORATION cardiacas I-EXPLORATION de I-EXPLORATION control I-EXPLORATION con I-EXPLORATION troponina I-EXPLORATION > I-EXPLORATION 50 I-EXPLORATION ng/ml, I-EXPLORATION CK I-EXPLORATION 3.800 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION Ck-mb I-EXPLORATION > I-EXPLORATION 300 I-EXPLORATION U/L. I-EXPLORATION Coronariografía I-EXPLORATION muestra I-EXPLORATION disección I-EXPLORATION de I-EXPLORATION tronco I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION coronaria I-EXPLORATION izquierda, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION a I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION circunfleja I-EXPLORATION (Cx) I-EXPLORATION proximal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION rama I-EXPLORATION marginal I-EXPLORATION pequeña. I-EXPLORATION Arteria I-EXPLORATION descendente I-EXPLORATION anterior I-EXPLORATION (ADA) I-EXPLORATION y I-EXPLORATION coronaria I-EXPLORATION derecha I-EXPLORATION sin I-EXPLORATION lesiones. I-EXPLORATION Se B-TREATMENT instala I-TREATMENT balón I-TREATMENT de I-TREATMENT contrapulsación I-TREATMENT aórtica I-TREATMENT y I-TREATMENT se I-TREATMENT traslada I-TREATMENT a I-TREATMENT cirugía, I-TREATMENT donde I-TREATMENT se I-TREATMENT realiza I-TREATMENT bypass I-TREATMENT con I-TREATMENT arteria I-TREATMENT mamaria I-TREATMENT interna I-TREATMENT (LIMA) I-TREATMENT a I-TREATMENT ADA I-TREATMENT y I-TREATMENT puente I-TREATMENT safeno I-TREATMENT a I-TREATMENT lateral I-TREATMENT Cx, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT I-TREATMENT Evoluciona B-EVOLUTION favorablemente I-EVOLUTION en I-EVOLUTION el I-EVOLUTION post I-EVOLUTION operatorio, I-EVOLUTION con B-TREATMENT retiro I-TREATMENT de I-TREATMENT drogas I-TREATMENT vasoactivas I-TREATMENT y I-TREATMENT balón I-TREATMENT de I-TREATMENT contrapulsación I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT h. I-TREATMENT I-TREATMENT Ecocardiograma B-EXPLORATION de I-EXPLORATION control I-EXPLORATION con I-EXPLORATION acinesia I-EXPLORATION no I-EXPLORATION adelgazada I-EXPLORATION anterolateral I-EXPLORATION con I-EXPLORATION fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION de I-EXPLORATION 42%. I-EXPLORATION Se B-TREATMENT optimiza I-TREATMENT control I-TREATMENT farmacológico I-TREATMENT de I-TREATMENT insuficiencia I-TREATMENT cardíaca I-TREATMENT con I-TREATMENT bisoprolol I-TREATMENT 1, I-TREATMENT 25 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT espironolactona I-TREATMENT 25 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT enalapril I-TREATMENT 5 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h I-TREATMENT y I-TREATMENT atorvastatina I-TREATMENT 40 I-TREATMENT mg I-TREATMENT al I-TREATMENT día. I-TREATMENT Se B-DERIVED_FROM/TO traslada I-DERIVED_FROM/TO al I-DERIVED_FROM/TO quinto I-DERIVED_FROM/TO día I-DERIVED_FROM/TO post I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO a I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO por I-DERIVED_FROM/TO motivos I-DERIVED_FROM/TO previsionales. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-EVOLUTION controla I-EVOLUTION en I-EVOLUTION policlínico I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION alta, I-EVOLUTION encontrándose I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION asintomática, I-EVOLUTION sin I-EVOLUTION angina, I-EVOLUTION en I-EVOLUTION capacidad I-EVOLUTION funcional I-EVOLUTION I, I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION ya I-EVOLUTION descrito, I-EVOLUTION sin I-EVOLUTION lactancia I-EVOLUTION materna. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS intensas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS impedían I-PRESENT_ILLNESS deambular. I-PRESENT_ILLNESS Destacaba B-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY T4 I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mcg/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bypass I-PAST_MEDICAL_HISTORY intestinal I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY adelgazamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 70 I-PAST_MEDICAL_HISTORY Kg I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY entonces. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY deposiciones I-PAST_MEDICAL_HISTORY pastosas I-PAST_MEDICAL_HISTORY diarias. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION vigil, I-EXPLORATION eupneica I-EXPLORATION y I-EXPLORATION apirética. I-EXPLORATION Presentaba I-EXPLORATION adelgazamiento I-EXPLORATION con I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION (IMC) I-EXPLORATION de I-EXPLORATION 19. I-EXPLORATION Tenía I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION hidratación I-EXPLORATION y I-EXPLORATION sus I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION (TA) I-EXPLORATION eran I-EXPLORATION 120/70 I-EXPLORATION mmHg. I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION neuromuscular I-EXPLORATION mostró I-EXPLORATION hipotonía I-EXPLORATION generalizada, I-EXPLORATION paresia I-EXPLORATION de I-EXPLORATION cuatro I-EXPLORATION miembros I-EXPLORATION sin I-EXPLORATION fasciculaciones I-EXPLORATION y I-EXPLORATION reflejos I-EXPLORATION osteotendinosos I-EXPLORATION presentes. I-EXPLORATION Presentaba I-EXPLORATION un I-EXPLORATION potasio I-EXPLORATION plasmático I-EXPLORATION (K+pl) I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 1 I-EXPLORATION mEq/L I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION CK. I-EXPLORATION La I-EXPLORATION dosificación I-EXPLORATION de I-EXPLORATION TSH I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION inició I-EXPLORATION reposición I-EXPLORATION hidroelectrolítica I-EXPLORATION con I-EXPLORATION mejoría I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paresia I-EXPLORATION muscular, I-EXPLORATION disminución I-EXPLORATION progresiva I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mialgias I-EXPLORATION y I-EXPLORATION normalización I-EXPLORATION de I-EXPLORATION los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION K+pl I-EXPLORATION y I-EXPLORATION CK. I-EXPLORATION La I-EXPLORATION hipopotasemia I-EXPLORATION se I-EXPLORATION atribuyó I-EXPLORATION a I-EXPLORATION las I-EXPLORATION pérdidas I-EXPLORATION de I-EXPLORATION origen I-EXPLORATION digestivo, I-EXPLORATION secundarias I-EXPLORATION al I-EXPLORATION procedimiento I-EXPLORATION quirúrgico. I-EXPLORATION Si I-EXPLORATION bien I-EXPLORATION la I-EXPLORATION severidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION puede I-EXPLORATION ser I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION las I-EXPLORATION manifestaciones I-EXPLORATION neuromusculares, I-EXPLORATION el I-EXPLORATION hallazgo I-EXPLORATION de I-EXPLORATION niveles I-EXPLORATION elevados I-EXPLORATION de I-EXPLORATION CK I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION RM I-EXPLORATION asociada. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS paresia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS distal I-PRESENT_ILLNESS e I-PRESENT_ILLNESS instalación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS Destacaba B-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY hipertensa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enalapril, I-PAST_MEDICAL_HISTORY atenolol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY furosemida. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY hipopotasemia I-PAST_MEDICAL_HISTORY asintomática I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY indicó I-PAST_MEDICAL_HISTORY suplemento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY potasio I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY oral. I-PAST_MEDICAL_HISTORY Presentaba B-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION apirética I-EXPLORATION y I-EXPLORATION con I-EXPLORATION TA I-EXPLORATION de I-EXPLORATION 150/90 I-EXPLORATION mmHg. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION neuromuscular I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION cuadriparesia I-EXPLORATION a I-EXPLORATION predominio I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores, I-EXPLORATION con I-EXPLORATION reflejos I-EXPLORATION osteotendinosos I-EXPLORATION conservados. I-EXPLORATION El I-EXPLORATION K+pl I-EXPLORATION era I-EXPLORATION 1, I-EXPLORATION 4 I-EXPLORATION mEq/L, I-EXPLORATION con I-EXPLORATION potasiuria I-EXPLORATION en I-EXPLORATION muestra I-EXPLORATION aislada I-EXPLORATION de I-EXPLORATION 26, I-EXPLORATION 7 I-EXPLORATION mEq/L I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION CK. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT diurético I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT reposición I-TREATMENT hidroelectrolítica I-TREATMENT obteniéndose B-EVOLUTION una I-EVOLUTION rápida I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION K+pl I-EVOLUTION y I-EVOLUTION CK. I-EVOLUTION En B-EXPLORATION este I-EXPLORATION caso, I-EXPLORATION a I-EXPLORATION diferencia I-EXPLORATION de I-EXPLORATION los I-EXPLORATION anteriores, I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hipopotasemia I-EXPLORATION fueron I-EXPLORATION las I-EXPLORATION pérdidas I-EXPLORATION renales I-EXPLORATION de I-EXPLORATION potasio, I-EXPLORATION secundarias I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION diuréticos I-EXPLORATION de I-EXPLORATION asa. I-EXPLORATION El I-EXPLORATION hallazgo I-EXPLORATION de I-EXPLORATION 26, I-EXPLORATION 7 I-EXPLORATION mEq/L I-EXPLORATION de I-EXPLORATION potasiuria I-EXPLORATION en I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION aislada, I-EXPLORATION es I-EXPLORATION concordante I-EXPLORATION con I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION renal I-EXPLORATION del I-EXPLORATION disturbio. I-EXPLORATION I-EXPLORATION Mujer, B-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Cinco B-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY trató I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY cervicouterino. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS un I-PRESENT_ILLNESS control I-PRESENT_ILLNESS rutinario, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontró I-PRESENT_ILLNESS hidronefrosis I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS atrofia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS riñón I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS Se B-TREATMENT instalaron I-TREATMENT catéteres I-TREATMENT ureterales I-TREATMENT y I-TREATMENT se I-TREATMENT intentó I-TREATMENT infructuosamente I-TREATMENT efectuar I-TREATMENT ureterolisis. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION retroperitoneal I-EXPLORATION reveló I-EXPLORATION FRP I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION tumor. I-EXPLORATION Se B-TREATMENT prescribió I-TREATMENT defazacort I-TREATMENT 30 I-TREATMENT mg/día I-TREATMENT y I-TREATMENT colchicina I-TREATMENT 1, I-TREATMENT 0 I-TREATMENT mg/día. I-TREATMENT Al B-EVOLUTION año I-EVOLUTION la I-EVOLUTION masa I-EVOLUTION retroperitoneal I-EVOLUTION había I-EVOLUTION desaparecido I-EVOLUTION y I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION era I-EVOLUTION normal. I-EVOLUTION A I-EVOLUTION 16 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION FRP, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION cáncer. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY IC I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY 2008 I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dilatación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY VI I-PAST_MEDICAL_HISTORY (FE I-PAST_MEDICAL_HISTORY 35%) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY ecocardiograma. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS coronariografía I-PRESENT_ILLNESS demostró I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS vasos, I-PRESENT_ILLNESS realizándose I-PRESENT_ILLNESS angioplastía I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS arteria I-PRESENT_ILLNESS descendente I-PRESENT_ILLNESS anterior. I-PRESENT_ILLNESS En B-EXPLORATION enero I-EXPLORATION de I-EXPLORATION 2013 I-EXPLORATION se I-EXPLORATION hospitalizó I-EXPLORATION con I-EXPLORATION IC I-EXPLORATION descompensada, I-EXPLORATION con I-EXPLORATION FE I-EXPLORATION 20% I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ecocardiograma. I-EXPLORATION Un I-EXPLORATION SPECT I-EXPLORATION miocàrdico I-EXPLORATION descartó I-EXPLORATION isquemia. I-EXPLORATION En B-EVOLUTION julio I-EVOLUTION de I-EVOLUTION 2013 I-EVOLUTION se I-EVOLUTION re-hospitalizó, I-EVOLUTION en I-EVOLUTION CF I-EVOLUTION IV, I-EVOLUTION compensándose B-TREATMENT con I-TREATMENT infusión I-TREATMENT de I-TREATMENT levosimendan I-TREATMENT 0, I-TREATMENT 1 I-TREATMENT mg/kg/min. I-TREATMENT En I-TREATMENT agosto I-TREATMENT de I-TREATMENT 2013, I-TREATMENT por I-TREATMENT la I-TREATMENT severa I-TREATMENT disfunción I-TREATMENT ventricular I-TREATMENT y I-TREATMENT escasa I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT trasplante, I-TREATMENT se I-TREATMENT implantó I-TREATMENT un I-TREATMENT HVAD I-TREATMENT con I-TREATMENT técnica I-TREATMENT mínimamente I-TREATMENT invasiva. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION post I-EVOLUTION operatoria I-EVOLUTION ocurrió I-EVOLUTION sin I-EVOLUTION incidentes, I-EVOLUTION alcanzando I-EVOLUTION un I-EVOLUTION índice I-EVOLUTION cardiaco I-EVOLUTION de I-EVOLUTION 2, I-EVOLUTION 5 I-EVOLUTION L/m2 I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION post-implante. I-EVOLUTION Egresó I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION post-cirugía, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 9 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION permanece I-EVOLUTION en I-EVOLUTION CF I-EVOLUTION I. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mesenquimopatía I-PAST_MEDICAL_HISTORY indiferenciada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY nariz I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY silla I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY montar, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY condritis. I-PAST_MEDICAL_HISTORY Anticuerpos I-PAST_MEDICAL_HISTORY antinucleares I-PAST_MEDICAL_HISTORY (ANA) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anti-Ro I-PAST_MEDICAL_HISTORY +. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS alopecia, I-PRESENT_ILLNESS artritis, I-PRESENT_ILLNESS úlceras I-PRESENT_ILLNESS orales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS nasales. I-PRESENT_ILLNESS Presentaba B-EXPLORATION soplo I-EXPLORATION aórtico I-EXPLORATION sistólico I-EXPLORATION V/VI I-EXPLORATION irradiado I-EXPLORATION al I-EXPLORATION cuello. I-EXPLORATION Tenía I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION eritrosedimentación I-EXPLORATION (VHS) I-EXPLORATION 64 I-EXPLORATION mm/h, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION 5 I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 10 I-EXPLORATION mg/L), I-EXPLORATION creatininemia I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION mg/dl, I-EXPLORATION ANA I-EXPLORATION 1/160 I-EXPLORATION moteado, I-EXPLORATION anti-Ro I-EXPLORATION 22, I-EXPLORATION 5 I-EXPLORATION U I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 15), I-EXPLORATION anti-B2 I-EXPLORATION glicoproteína I-EXPLORATION 1 I-EXPLORATION IgM I-EXPLORATION 31, I-EXPLORATION 2 I-EXPLORATION MPL I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 8) I-EXPLORATION e I-EXPLORATION IgG I-EXPLORATION 17 I-EXPLORATION GPL I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 8), I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION normal. I-EXPLORATION Ecocardiograma: I-EXPLORATION aceleración I-EXPLORATION del I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION aorta I-EXPLORATION torácica I-EXPLORATION y I-EXPLORATION vasos I-EXPLORATION del I-EXPLORATION cuello. I-EXPLORATION aTAC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION cuello I-EXPLORATION y I-EXPLORATION cerebral: I-EXPLORATION engrosamiento I-EXPLORATION segmentario I-EXPLORATION y I-EXPLORATION realce I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION aórtica I-EXPLORATION y I-EXPLORATION sus I-EXPLORATION ramas I-EXPLORATION principales, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION estenosis I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION alternadas. I-EXPLORATION Estenosis I-EXPLORATION moderada I-EXPLORATION de I-EXPLORATION carótida I-EXPLORATION derecha, I-EXPLORATION origen I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION celíaco I-EXPLORATION y I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION superior. I-EXPLORATION Vasos I-EXPLORATION cerebrales I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT corticoides, I-TREATMENT hidroxicloroquina I-TREATMENT y I-TREATMENT 6 I-TREATMENT pulsos I-TREATMENT de I-TREATMENT ciclofosfamida, I-TREATMENT luego I-TREATMENT azatioprina I-TREATMENT y I-TREATMENT prednisona. I-TREATMENT El B-EVOLUTION control I-EVOLUTION a I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION demostró I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION inflamación I-EVOLUTION de I-EVOLUTION aorta I-EVOLUTION abdominal, I-EVOLUTION tronco I-EVOLUTION celíaco I-EVOLUTION y I-EVOLUTION arteria I-EVOLUTION mesentérica I-EVOLUTION superior, I-EVOLUTION estenosis I-EVOLUTION de I-EVOLUTION 50% I-EVOLUTION del I-EVOLUTION origen I-EVOLUTION del I-EVOLUTION tronco I-EVOLUTION celíaco I-EVOLUTION con I-EVOLUTION dilatación I-EVOLUTION post I-EVOLUTION estenótica I-EVOLUTION y I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios. I-EVOLUTION A I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION con I-EVOLUTION exámenes I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY cigarrillos/día I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY adolescencia, I-PAST_MEDICAL_HISTORY hospitalizado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS síncope I-PRESENT_ILLNESS recurrente. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso, I-EXPLORATION se I-EXPLORATION registró I-EXPLORATION TV I-EXPLORATION monoforma I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION de I-EXPLORATION 233 I-EXPLORATION lpm I-EXPLORATION en I-EXPLORATION trazado I-EXPLORATION de I-EXPLORATION monitor, I-EXPLORATION que I-EXPLORATION convirtió I-EXPLORATION espontáneamente I-EXPLORATION a I-EXPLORATION ritmo I-EXPLORATION sinusal. I-EXPLORATION El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY consumidor I-PAST_MEDICAL_HISTORY ocasional I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cocaína I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso. I-PAST_MEDICAL_HISTORY Negó B-PRESENT_ILLNESS tener I-PRESENT_ILLNESS angina I-PRESENT_ILLNESS o I-PRESENT_ILLNESS disnea. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION ECG I-EXPLORATION post-conversión I-EXPLORATION a I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION (-) I-EXPLORATION en I-EXPLORATION las I-EXPLORATION derivaciones I-EXPLORATION precordiales I-EXPLORATION y I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION inferior. I-EXPLORATION La I-EXPLORATION troponina I-EXPLORATION I I-EXPLORATION alcanzó I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION máximo I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION ng/ml I-EXPLORATION [VN I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION ng/ml]. I-EXPLORATION Un I-EXPLORATION ecocardiograma I-EXPLORATION reveló I-EXPLORATION leve I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION diámetros I-EXPLORATION internos I-EXPLORATION del I-EXPLORATION VI, I-EXPLORATION disquinesia I-EXPLORATION apical I-EXPLORATION y I-EXPLORATION lateroapical I-EXPLORATION con I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION global I-EXPLORATION levemente I-EXPLORATION disminuida I-EXPLORATION [FE I-EXPLORATION 45%, I-EXPLORATION Simpson]. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION anormalidades. I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION coronaria, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION angiográfico I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION arterias I-EXPLORATION coronarias I-EXPLORATION normales. I-EXPLORATION Para I-EXPLORATION avanzar I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION diagnóstico, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION RC. I-EXPLORATION Las I-EXPLORATION imágenes I-EXPLORATION con I-EXPLORATION secuencias I-EXPLORATION de I-EXPLORATION eco-gradiente I-EXPLORATION en I-EXPLORATION 4-cavidades I-EXPLORATION y I-EXPLORATION eje I-EXPLORATION corto, I-EXPLORATION mostraron I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION [VDVD/ASC I-EXPLORATION 122/m2] I-EXPLORATION con I-EXPLORATION acentuada I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION espesor I-EXPLORATION parietal I-EXPLORATION especialmente I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral, I-EXPLORATION microaneurismas I-EXPLORATION (flechas I-EXPLORATION amarillas), I-EXPLORATION disquinesia I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION basal I-EXPLORATION e I-EXPLORATION inferior I-EXPLORATION (flechas I-EXPLORATION azules) I-EXPLORATION y I-EXPLORATION función I-EXPLORATION global I-EXPLORATION severamente I-EXPLORATION disminuida I-EXPLORATION (FE I-EXPLORATION 19%). I-EXPLORATION Al I-EXPLORATION mismo I-EXPLORATION tiempo, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION leve I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION diámetros I-EXPLORATION internos I-EXPLORATION del I-EXPLORATION VI I-EXPLORATION con I-EXPLORATION moderada I-EXPLORATION diminución I-EXPLORATION de I-EXPLORATION su I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION global I-EXPLORATION (FE I-EXPLORATION 38%), I-EXPLORATION dos I-EXPLORATION zonas I-EXPLORATION con I-EXPLORATION disquinesia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION apical I-EXPLORATION con I-EXPLORATION adelgazamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION miocárdica I-EXPLORATION (flechas I-EXPLORATION azules) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION aquinesia I-EXPLORATION con I-EXPLORATION miocardio I-EXPLORATION adelgazado I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION (flecha I-EXPLORATION roja) I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION grasa I-EXPLORATION adyacente I-EXPLORATION (flecha I-EXPLORATION verde). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION axial I-EXPLORATION potenciada I-EXPLORATION en I-EXPLORATION T1, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION infiltración I-EXPLORATION grasa I-EXPLORATION subepicárdica I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION del I-EXPLORATION VD, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION y I-EXPLORATION ápex I-EXPLORATION del I-EXPLORATION VI I-EXPLORATION (flechas I-EXPLORATION verdes). I-EXPLORATION A I-EXPLORATION su I-EXPLORATION vez, I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION 4-cavidades I-EXPLORATION con I-EXPLORATION secuencias I-EXPLORATION de I-EXPLORATION inversión-recuperación I-EXPLORATION para I-EXPLORATION evaluar I-EXPLORATION viabilidad, I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION gadolinio I-EXPLORATION endovenoso, I-EXPLORATION mostró I-EXPLORATION extensa I-EXPLORATION área I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION (realce I-EXPLORATION tardío) I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION y I-EXPLORATION región I-EXPLORATION subtricuspídea I-EXPLORATION (flechas I-EXPLORATION naranjas). I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION descritos I-EXPLORATION son I-EXPLORATION diagnósticos I-EXPLORATION para I-EXPLORATION DAVD I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION VI, I-EXPLORATION en I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tres I-EXPLORATION criterios I-EXPLORATION diagnósticos I-EXPLORATION mayores: I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION invertidas I-EXPLORATION en I-EXPLORATION derivaciones I-EXPLORATION precordiales I-EXPLORATION derechas I-EXPLORATION (V1 I-EXPLORATION a I-EXPLORATION V6) I-EXPLORATION en I-EXPLORATION individuo I-EXPLORATION > I-EXPLORATION 14 I-EXPLORATION años I-EXPLORATION sin I-EXPLORATION bloqueo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecho, I-EXPLORATION disquinesia I-EXPLORATION regionales I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION más I-EXPLORATION cociente I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION telediastólico I-EXPLORATION del I-EXPLORATION VD I-EXPLORATION > I-EXPLORATION 110 I-EXPLORATION ml/m2 I-EXPLORATION (varones); I-EXPLORATION TV I-EXPLORATION documentada. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT incluyó I-TREATMENT la I-TREATMENT implantación I-TREATMENT de I-TREATMENT un I-TREATMENT CDI. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY coronaria, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY uropatía I-PAST_MEDICAL_HISTORY obstructiva, I-PAST_MEDICAL_HISTORY portador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY cistostomía I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY fue B-PRESENT_ILLNESS hospitalizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS medicina I-PRESENT_ILLNESS interna I-PRESENT_ILLNESS para I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cambio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS catéter I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hemodiálisis, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS contexto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS catéter I-PRESENT_ILLNESS disfuncional; I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS embargo, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS llamó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS atención I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cistostomía I-PRESENT_ILLNESS que I-PRESENT_ILLNESS estaba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS estado, I-PRESENT_ILLNESS objetivándose I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS orina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS color I-PRESENT_ILLNESS púrpura I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS bolsa I-PRESENT_ILLNESS colectora. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Dentro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS medicamentos I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS usaba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS crónica, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS destacó I-PRESENT_ILLNESS ninguno I-PRESENT_ILLNESS que I-PRESENT_ILLNESS pudiese I-PRESENT_ILLNESS relacionarse I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cambio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS coloración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS orina. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION buenas I-EXPLORATION condiciones I-EXPLORATION generales, I-EXPLORATION afebril, I-EXPLORATION hemodinámicamente I-EXPLORATION estable, I-EXPLORATION con I-EXPLORATION cistostomía I-EXPLORATION in I-EXPLORATION situ, I-EXPLORATION funcionante, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION deficiente I-EXPLORATION autocuidado, I-EXPLORATION sucia I-EXPLORATION y I-EXPLORATION de I-EXPLORATION muy I-EXPLORATION mal I-EXPLORATION olor. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION sedimento I-EXPLORATION urinario I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION leucocitos I-EXPLORATION 5-10 I-EXPLORATION x I-EXPLORATION campo I-EXPLORATION [valor I-EXPLORATION normal I-EXPLORATION (VN): I-EXPLORATION 1-5], I-EXPLORATION abundantes I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION fosfatos I-EXPLORATION amorfos I-EXPLORATION abundantes I-EXPLORATION x I-EXPLORATION campo. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION completo I-EXPLORATION destacó I-EXPLORATION el I-EXPLORATION color I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION turbio, I-EXPLORATION pH I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 8 I-EXPLORATION [VN: I-EXPLORATION 4, I-EXPLORATION 5-8, I-EXPLORATION 0] I-EXPLORATION y I-EXPLORATION nitritos I-EXPLORATION positivos. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION urocultivo I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION 100.000 I-EXPLORATION UFC/ml I-EXPLORATION de I-EXPLORATION Citrobacter I-EXPLORATION freundii I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION cefadroxilo, I-EXPLORATION ciprofloxacino I-EXPLORATION y I-EXPLORATION nitrofurantoína. I-EXPLORATION Entre I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION sangre, I-EXPLORATION destacó I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 10.600 I-EXPLORATION x I-EXPLORATION mm3 I-EXPLORATION [VN: I-EXPLORATION 4.000-9.000], I-EXPLORATION una I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 34 I-EXPLORATION mg/dL I-EXPLORATION [VN: I-EXPLORATION 0-5] I-EXPLORATION y I-EXPLORATION una I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 54 I-EXPLORATION mm/h I-EXPLORATION [VN: I-EXPLORATION 2-10]. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION prostática, I-EXPLORATION procedimiento I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION técnicamente I-EXPLORATION limitado I-EXPLORATION por I-EXPLORATION parcial I-EXPLORATION distensión I-EXPLORATION vesical, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION volumen I-EXPLORATION al I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION 26 I-EXPLORATION cc, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION posible I-EXPLORATION evaluar I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION prostática. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT 2 I-TREATMENT g/día I-TREATMENT endovenoso I-TREATMENT y I-TREATMENT se I-TREATMENT solicitó I-TREATMENT evaluación I-TREATMENT por I-TREATMENT urología, I-TREATMENT quienes I-TREATMENT decidieron I-TREATMENT realizar I-TREATMENT un I-TREATMENT recambio I-TREATMENT de I-TREATMENT la I-TREATMENT cistostomía, I-TREATMENT en I-TREATMENT contexto I-TREATMENT de I-TREATMENT la I-TREATMENT infección I-TREATMENT urinaria I-TREATMENT y I-TREATMENT el I-TREATMENT aspecto I-TREATMENT mal I-TREATMENT cuidado I-TREATMENT de I-TREATMENT ésta. I-TREATMENT I-TREATMENT Con B-EVOLUTION el I-EVOLUTION transcurso I-EVOLUTION de I-EVOLUTION los I-EVOLUTION días, I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION un I-EVOLUTION aclaramiento I-EVOLUTION progresivo I-EVOLUTION del I-EVOLUTION color I-EVOLUTION de I-EVOLUTION la I-EVOLUTION orina, I-EVOLUTION retornando I-EVOLUTION a I-EVOLUTION su I-EVOLUTION color I-EVOLUTION natural I-EVOLUTION tras I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION antibioterapia. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS chofer, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS pantorrilla I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS poplítea I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS metros I-PRESENT_ILLNESS de I-PRESENT_ILLNESS marcha. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY claudicación I-PAST_MEDICAL_HISTORY intermitente. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destaca I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION temperatura I-EXPLORATION en I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION pierna I-EXPLORATION y I-EXPLORATION pie I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION poplíteo I-EXPLORATION y I-EXPLORATION distal I-EXPLORATION en I-EXPLORATION esa I-EXPLORATION extremidad. I-EXPLORATION En I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION derecha I-EXPLORATION pulsos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION vascular I-EXPLORATION no I-EXPLORATION invasivo I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION obliteración I-EXPLORATION femoro-poplítea I-EXPLORATION izquierda, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION hospitaliza I-EXPLORATION para I-EXPLORATION angiografía. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION estudio I-EXPLORATION angiográfico I-EXPLORATION ; I-EXPLORATION observándose I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION izquierda I-EXPLORATION en I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION largo, I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 93%, I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION lisa, I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION compresión I-EXPLORATION extrínseca. I-EXPLORATION Resto I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION arterial I-EXPLORATION sano, I-EXPLORATION sin I-EXPLORATION imágenes I-EXPLORATION endoluminales. I-EXPLORATION I-EXPLORATION Llama B-EVOLUTION la I-EVOLUTION atención I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION pulso I-EVOLUTION poplíteo I-EVOLUTION y I-EVOLUTION distal I-EVOLUTION en I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION afectada I-EVOLUTION al I-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION del I-EVOLUTION estudio. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION post I-EVOLUTION angiografía I-EVOLUTION se I-EVOLUTION indica I-EVOLUTION marcha I-EVOLUTION al I-EVOLUTION paciente, I-EVOLUTION reproduciendo I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION pantorrilla I-EVOLUTION izquierda. I-EVOLUTION Examinado B-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION se I-EXPLORATION pesquisa I-EXPLORATION nuevamente I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION poplíteo I-EXPLORATION y I-EXPLORATION distal. I-EXPLORATION Estudio I-EXPLORATION no I-EXPLORATION invasivo I-EXPLORATION PVR I-EXPLORATION (registro I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION pulsos) I-EXPLORATION y I-EXPLORATION PPG I-EXPLORATION muestra I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION curvas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION poplítea I-EXPLORATION a I-EXPLORATION distal I-EXPLORATION con I-EXPLORATION PPG I-EXPLORATION plano I-EXPLORATION en I-EXPLORATION ortejos.. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION hipótesis I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION atrapamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION que I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION compresión I-EXPLORATION extrínseca I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION por I-EXPLORATION estructura I-EXPLORATION alguna, I-EXPLORATION destacando I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION hiperintensa I-EXPLORATION en I-EXPLORATION secuencia I-EXPLORATION T1que I-EXPLORATION determina I-EXPLORATION estenosis I-EXPLORATION y I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION hematoma. I-EXPLORATION Estudio I-EXPLORATION con I-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION (AngioTC I-EXPLORATION de I-EXPLORATION EEII) I-EXPLORATION muestra I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION izquierda, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION estenosis, I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION densidad I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared, I-EXPLORATION sin I-EXPLORATION realce I-EXPLORATION con I-EXPLORATION el I-EXPLORATION contraste I-EXPLORATION endovenoso, I-EXPLORATION que I-EXPLORATION hace I-EXPLORATION plantear I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION degeneración I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea. I-EXPLORATION I-EXPLORATION Intervenido B-TREATMENT quirúrgicamente I-TREATMENT mediante I-TREATMENT abordaje I-TREATMENT posterior, I-TREATMENT se I-TREATMENT realiza I-TREATMENT puente I-TREATMENT poplíteo I-TREATMENT con I-TREATMENT vena I-TREATMENT safena I-TREATMENT invertida, I-TREATMENT resecando I-TREATMENT la I-TREATMENT arteria I-TREATMENT poplítea I-TREATMENT en I-TREATMENT su I-TREATMENT tercio I-TREATMENT medio, I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT aprecia I-TREATMENT de I-TREATMENT coloración I-TREATMENT violácea I-TREATMENT y I-TREATMENT contorno I-TREATMENT irregular. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION enviada I-EXPLORATION a I-EXPLORATION biopsia I-EXPLORATION concluye I-EXPLORATION “degeneración I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION la I-EXPLORATION media”. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION con I-EVOLUTION pulsos I-EVOLUTION conservados I-EVOLUTION y I-EVOLUTION simétricos I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION EEII, I-EVOLUTION sin I-EVOLUTION claudicación I-EVOLUTION intermitente I-EVOLUTION y I-EVOLUTION pudiendo I-EVOLUTION reintegrarse I-EVOLUTION rápidamente I-EVOLUTION a I-EVOLUTION sus I-EVOLUTION labores I-EVOLUTION habituales. I-EVOLUTION I-EVOLUTION En I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION examen I-EVOLUTION físico I-EVOLUTION y I-EVOLUTION estudio I-EVOLUTION vascular I-EVOLUTION no I-EVOLUTION invasivo I-EVOLUTION normal I-EVOLUTION a I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS palpebral I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS sonarse I-PRESENT_ILLNESS la I-PRESENT_ILLNESS nariz I-PRESENT_ILLNESS (maniobra I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Valsalva). I-PRESENT_ILLNESS Esa I-PRESENT_ILLNESS misma I-PRESENT_ILLNESS madrugada I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sufrido I-PRESENT_ILLNESS una I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS de I-PRESENT_ILLNESS altura I-PRESENT_ILLNESS golpeándose I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS lateral I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS nariz, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS altura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS huesos I-PRESENT_ILLNESS propios, I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS epistaxis I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS y I-PRESENT_ILLNESS autolimitada. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION oftalmológico I-EXPLORATION reveló I-EXPLORATION visión I-EXPLORATION 20/20 I-EXPLORATION en I-EXPLORATION cada I-EXPLORATION ojo, I-EXPLORATION reflejos I-EXPLORATION pupilares I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION motilidad I-EXPLORATION ocular I-EXPLORATION conservada, I-EXPLORATION sin I-EXPLORATION edema I-EXPLORATION ni I-EXPLORATION hiperemia I-EXPLORATION conjuntival, I-EXPLORATION sólo I-EXPLORATION discreta I-EXPLORATION equimosis I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION medial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hemicara I-EXPLORATION izquierda I-EXPLORATION acompañada I-EXPLORATION de I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION palpebral I-EXPLORATION crepitante I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION El I-EXPLORATION marco I-EXPLORATION óseo I-EXPLORATION orbitario I-EXPLORATION y I-EXPLORATION la I-EXPLORATION pirámide I-EXPLORATION nasal I-EXPLORATION estaban I-EXPLORATION sin I-EXPLORATION dolor. I-EXPLORATION Los I-EXPLORATION signos I-EXPLORATION vitales I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION cráneo-facial I-EXPLORATION corroboró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION enfisema I-EXPLORATION subcutáneo I-EXPLORATION y I-EXPLORATION orbitario, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION fractura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lámina I-EXPLORATION papirácea I-EXPLORATION del I-EXPLORATION etmoides I-EXPLORATION ipsilateral. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION hospitalizado I-EVOLUTION y I-EVOLUTION observado I-EVOLUTION por I-EVOLUTION 24 I-EVOLUTION h, I-EVOLUTION posteriormente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION la I-EVOLUTION precaución I-EVOLUTION de I-EVOLUTION evitar I-EVOLUTION maniobras I-EVOLUTION que I-EVOLUTION pudieran I-EVOLUTION aumentar I-EVOLUTION la I-EVOLUTION presión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION vía I-EVOLUTION aérea I-EVOLUTION superior, I-EVOLUTION durante I-EVOLUTION dos I-EVOLUTION semanas. I-EVOLUTION El I-EVOLUTION enfisema I-EVOLUTION se I-EVOLUTION resolvió I-EVOLUTION espontáneamente I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION durante I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION siguientes I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION desarrolló I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS caucásico, I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY CUC I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY compatible. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mesalazina I-PAST_MEDICAL_HISTORY 1.000 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY c/8 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY prednisona I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY decrecientes I-PAST_MEDICAL_HISTORY (5 I-PAST_MEDICAL_HISTORY mg/día), I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY actividad I-PAST_MEDICAL_HISTORY inflamatoria I-PAST_MEDICAL_HISTORY actual. I-PAST_MEDICAL_HISTORY Tres B-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS intensa I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS agregándose I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS trastorno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lenguaje. I-PRESENT_ILLNESS Sin I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS fotofobia I-PRESENT_ILLNESS o I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS visuales. I-PRESENT_ILLNESS No B-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION signología I-EXPLORATION focal I-EXPLORATION ni I-EXPLORATION movimientos I-EXPLORATION anormales. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION examen, I-EXPLORATION afebril, I-EXPLORATION normotenso, I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION 98% I-EXPLORATION ambiental, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION perfusión. I-EXPLORATION Ritmo I-EXPLORATION cardiaco I-EXPLORATION regular I-EXPLORATION de I-EXPLORATION 88 I-EXPLORATION lpm. I-EXPLORATION Sin I-EXPLORATION alteraciones I-EXPLORATION pleuropulmonares. I-EXPLORATION Abdomen I-EXPLORATION indoloro. I-EXPLORATION Neurológicamente I-EXPLORATION estaba I-EXPLORATION vigil I-EXPLORATION pero I-EXPLORATION confuso, I-EXPLORATION con I-EXPLORATION afasia I-EXPLORATION fluente I-EXPLORATION y I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION comprensión. I-EXPLORATION Sin I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION oculomotricidad. I-EXPLORATION Sector I-EXPLORATION espinal I-EXPLORATION y I-EXPLORATION meníngeo I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Valoración I-EXPLORATION general I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION a I-EXPLORATION destacar. I-EXPLORATION I-EXPLORATION Tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION encéfalo I-EXPLORATION mostró I-EXPLORATION imagen I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION cortical I-EXPLORATION con I-EXPLORATION infarto I-EXPLORATION parenquimatoso I-EXPLORATION temporo-basal I-EXPLORATION izquierdo. I-EXPLORATION Resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION con I-EXPLORATION angiorresonancia I-EXPLORATION en I-EXPLORATION tiempo I-EXPLORATION venoso I-EXPLORATION informó I-EXPLORATION infarto I-EXPLORATION hemorrágico I-EXPLORATION temporal I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION seno I-EXPLORATION venoso I-EXPLORATION sigmoideo I-EXPLORATION homolateral.. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION trombofilias I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (proteínas I-EXPLORATION C, I-EXPLORATION S, I-EXPLORATION antitrombina I-EXPLORATION III, I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION activada, I-EXPLORATION homocisteinemia, I-EXPLORATION factor I-EXPLORATION 20210A, I-EXPLORATION FV I-EXPLORATION Leiden, I-EXPLORATION metil I-EXPLORATION tetra I-EXPLORATION hidro I-EXPLORATION folato I-EXPLORATION reductasa, I-EXPLORATION lipoproteína I-EXPLORATION (a), I-EXPLORATION factor I-EXPLORATION VIII, I-EXPLORATION anticuerpos I-EXPLORATION anticardiolipinas, I-EXPLORATION anti I-EXPLORATION beta2 I-EXPLORATION glicoproteína, I-EXPLORATION inhibidor I-EXPLORATION lúpico, I-EXPLORATION inhibidor I-EXPLORATION del I-EXPLORATION activador I-EXPLORATION tisular I-EXPLORATION del I-EXPLORATION plasminógeno). I-EXPLORATION Todos I-EXPLORATION fueron I-EXPLORATION solicitados I-EXPLORATION posteriormente I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION del I-EXPLORATION tratamiento I-EXPLORATION anticoagulante. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT anticoagulación I-TREATMENT con I-TREATMENT enoxaparina I-TREATMENT (1 I-TREATMENT mg/Kg I-TREATMENT subcutánea I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h) I-TREATMENT con I-TREATMENT buena I-TREATMENT evolución. I-TREATMENT Se I-TREATMENT mantuvo I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT CUC I-TREATMENT con I-TREATMENT mesalazina I-TREATMENT y I-TREATMENT prednisona. I-TREATMENT Se B-EVOLUTION otorgó I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 10º I-EVOLUTION día, I-EVOLUTION asintomático, I-EVOLUTION continuando B-TREATMENT anticoagulación I-TREATMENT con I-TREATMENT enoxaparina I-TREATMENT subcutánea I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT con I-TREATMENT dicumarínicos I-TREATMENT por I-TREATMENT vía I-TREATMENT oral. I-TREATMENT I-TREATMENT Paciente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sexo I-PAST_MEDICAL_HISTORY masculino I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol. I-PAST_MEDICAL_HISTORY Diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2002 I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 48 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY estudió I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2004, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY PCR I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY VHC I-PAST_MEDICAL_HISTORY positiva, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY carga I-PAST_MEDICAL_HISTORY viral I-PAST_MEDICAL_HISTORY 280.998 I-PAST_MEDICAL_HISTORY UI/ml I-PAST_MEDICAL_HISTORY (Log I-PAST_MEDICAL_HISTORY 5, I-PAST_MEDICAL_HISTORY 45) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY genotipo I-PAST_MEDICAL_HISTORY 3a. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY Derivado B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO el I-DERIVED_FROM/TO 2005 I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO compatibles I-DERIVED_FROM/TO con I-DERIVED_FROM/TO hepatocarcinoma. I-DERIVED_FROM/TO Quimioembolización B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY octubre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2005, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY quimioembolizaciones I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcoholizaciones I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY julio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2006 I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY trasplantado. I-PAST_MEDICAL_HISTORY Post B-TREATMENT trasplante I-TREATMENT se I-TREATMENT inició I-TREATMENT inmunosupresión I-TREATMENT con I-TREATMENT prednisona I-TREATMENT y I-TREATMENT ciclosporina. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION post I-EVOLUTION trasplante, I-EVOLUTION con I-EVOLUTION transaminasas I-EVOLUTION hasta I-EVOLUTION 12 I-EVOLUTION veces I-EVOLUTION el I-EVOLUTION valor I-EVOLUTION normal, I-EVOLUTION se I-EVOLUTION planteó I-EVOLUTION rechazo I-EVOLUTION vs I-EVOLUTION reactivación I-EVOLUTION de I-EVOLUTION VHC. I-EVOLUTION Se B-TREATMENT agregó I-TREATMENT sirolimus. I-TREATMENT Biopsia B-EXPLORATION hepática I-EXPLORATION mostró I-EXPLORATION esteatosis I-EXPLORATION y I-EXPLORATION hepatitis I-EXPLORATION aguda I-EXPLORATION leve, I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION de I-EXPLORATION especificidad. I-EXPLORATION Carga I-EXPLORATION viral I-EXPLORATION 3.000.694 I-EXPLORATION UI/ml I-EXPLORATION (Log I-EXPLORATION 6, I-EXPLORATION 48). I-EXPLORATION Persistió B-EVOLUTION con I-EVOLUTION transaminasas I-EVOLUTION 1, I-EVOLUTION 5 I-EVOLUTION a I-EVOLUTION 3 I-EVOLUTION veces I-EVOLUTION el I-EVOLUTION valor I-EVOLUTION normal. I-EVOLUTION Debido I-EVOLUTION a I-EVOLUTION pancitopenia I-EVOLUTION se I-EVOLUTION suspendió I-EVOLUTION sirolimus. I-EVOLUTION A B-TREATMENT los I-TREATMENT 3 I-TREATMENT años I-TREATMENT y I-TREATMENT medio I-TREATMENT post I-TREATMENT trasplante I-TREATMENT se I-TREATMENT vuelve I-TREATMENT a I-TREATMENT plantear I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT VHC I-TREATMENT con B-EXPLORATION nueva I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION hepatitis I-EXPLORATION crónica I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION inflamación I-EXPLORATION portal I-EXPLORATION de I-EXPLORATION interfase I-EXPLORATION y I-EXPLORATION lobulillar, I-EXPLORATION fibrosis I-EXPLORATION perisinusoideal I-EXPLORATION leve, I-EXPLORATION colangitis I-EXPLORATION linfocítica I-EXPLORATION focal I-EXPLORATION y I-EXPLORATION esteatosis I-EXPLORATION hepática I-EXPLORATION mínima. I-EXPLORATION En B-EVOLUTION ese I-EVOLUTION momento I-EVOLUTION evoluciona I-EVOLUTION con I-EVOLUTION colestasia, I-EVOLUTION que I-EVOLUTION resulta I-EVOLUTION ser I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION estenosis I-EVOLUTION de I-EVOLUTION anastomosis I-EVOLUTION biliar. I-EVOLUTION Se I-EVOLUTION controló I-EVOLUTION con I-EVOLUTION nueva I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION con I-EVOLUTION 355.882 I-EVOLUTION UI/ml I-EVOLUTION (Log I-EVOLUTION 5, I-EVOLUTION 55) I-EVOLUTION en I-EVOLUTION octubre I-EVOLUTION de I-EVOLUTION 2010. I-EVOLUTION Con B-EXPLORATION intención I-EXPLORATION de I-EXPLORATION iniciar I-EXPLORATION tratamiento I-EXPLORATION en I-EXPLORATION marzo I-EXPLORATION de I-EXPLORATION 2011 I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION nueva I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION la I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativa; I-EXPLORATION además I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION PCR I-EXPLORATION para I-EXPLORATION VHC, I-EXPLORATION también I-EXPLORATION negativa, I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION con I-EXPLORATION nueva I-EXPLORATION muestra. I-EXPLORATION En B-TREATMENT ese I-TREATMENT momento I-TREATMENT perfil I-TREATMENT hepático I-TREATMENT normal, I-TREATMENT recibiendo I-TREATMENT inmunosupresión I-TREATMENT con I-TREATMENT ciclosporina I-TREATMENT 100 I-TREATMENT mg I-TREATMENT al I-TREATMENT día. I-TREATMENT Se B-EVOLUTION interpretó I-EVOLUTION como I-EVOLUTION eliminación I-EVOLUTION espontánea I-EVOLUTION del I-EVOLUTION VHC. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY cutáneas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY que, I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY dos, I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY piodermitis, I-PAST_MEDICAL_HISTORY sarna I-PAST_MEDICAL_HISTORY corporis, I-PAST_MEDICAL_HISTORY candidiasis I-PAST_MEDICAL_HISTORY esofágica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY cuadros I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abscesos I-PAST_MEDICAL_HISTORY cutáneos I-PAST_MEDICAL_HISTORY ubicados I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY codo I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones, I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY dorso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mano I-PAST_MEDICAL_HISTORY izquierda, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY deja I-PAST_MEDICAL_HISTORY secuelas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY movilidad I-PAST_MEDICAL_HISTORY extensora I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY tendinoso, I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dorso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mano I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY escapular I-PAST_MEDICAL_HISTORY izquierda, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cultivo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY resultó I-PAST_MEDICAL_HISTORY positivo I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY Staphylococcus I-PAST_MEDICAL_HISTORY aureus I-PAST_MEDICAL_HISTORY multisensible. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS glúteo I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS se B-TREATMENT diagnosticó I-TREATMENT celulitis I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT clindamicina I-TREATMENT y I-TREATMENT cefazolina. I-TREATMENT Al B-EVOLUTION séptimo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION presentó I-EVOLUTION necrosis I-EVOLUTION distal I-EVOLUTION del I-EVOLUTION pulpejo I-EVOLUTION del I-EVOLUTION cuarto I-EVOLUTION dedo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mano I-EVOLUTION derecha, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION dejó I-EVOLUTION a I-EVOLUTION evolución I-EVOLUTION natural I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION encontrarse I-EVOLUTION fuera I-EVOLUTION de I-EVOLUTION alcance I-EVOLUTION quirúrgico. I-EVOLUTION Luego B-TREATMENT de I-TREATMENT 12 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT se I-TREATMENT cambió I-TREATMENT esquema I-TREATMENT debido I-TREATMENT a I-TREATMENT mala I-TREATMENT respuesta I-TREATMENT clínica, I-TREATMENT iniciándose I-TREATMENT metronidazol, I-TREATMENT ceftriaxona I-TREATMENT y I-TREATMENT vancomicina. I-TREATMENT Se B-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION inmunológicos I-EXPLORATION e I-EXPLORATION infecciosos, I-EXPLORATION en I-EXPLORATION busca I-EXPLORATION de I-EXPLORATION una I-EXPLORATION patología I-EXPLORATION subyacente, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Tabla I-EXPLORATION 1 I-EXPLORATION (A), I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION del I-EXPLORATION factor I-EXPLORATION reumatoide, I-EXPLORATION ANCA-p, I-EXPLORATION ANCA-c, I-EXPLORATION anti I-EXPLORATION ANA, I-EXPLORATION anti I-EXPLORATION ENA, I-EXPLORATION anti-DNA, I-EXPLORATION anticardiolipina, I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Coombs I-EXPLORATION indirecto, I-EXPLORATION antígenos I-EXPLORATION de I-EXPLORATION VHB I-EXPLORATION y I-EXPLORATION VHC I-EXPLORATION fueron I-EXPLORATION negativos; I-EXPLORATION destacaron I-EXPLORATION valores I-EXPLORATION elevados I-EXPLORATION de I-EXPLORATION IgE I-EXPLORATION sérica I-EXPLORATION (3.740 I-EXPLORATION UI/ml) I-EXPLORATION y I-EXPLORATION precipitación I-EXPLORATION en I-EXPLORATION frío I-EXPLORATION de I-EXPLORATION crioglobulinas I-EXPLORATION positiva. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION además I-EXPLORATION ecografía I-EXPLORATION glútea I-EXPLORATION izquierda, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION inflamatorio, I-EXPLORATION sin I-EXPLORATION colecciones. I-EXPLORATION Tomografía I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION sugirió I-EXPLORATION fibrosis I-EXPLORATION basal I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION pleural I-EXPLORATION e I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION periférica I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION hemitórax. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION manos, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION cintura I-EXPLORATION escapular, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION dorsolumbar, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION codos, I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION ecocardiograma I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION Biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION zona I-EXPLORATION medial I-EXPLORATION del I-EXPLORATION brazo I-EXPLORATION derecho I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION dermatitis I-EXPLORATION crónica I-EXPLORATION en I-EXPLORATION granulación I-EXPLORATION con I-EXPLORATION calcificación I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION distrófica, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION vasculitis. I-EXPLORATION Una B-EVOLUTION vez I-EVOLUTION completado I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION antibiótico I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION sospecha I-EVOLUTION diagnóstica I-EVOLUTION de I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION hiper I-EVOLUTION IgE I-EVOLUTION y I-EVOLUTION crioglobulinemia. I-EVOLUTION I-EVOLUTION Un I-EVOLUTION mes I-EVOLUTION posterior I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION nuevo I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION glúteo I-EVOLUTION izquierdo, I-EVOLUTION calor I-EVOLUTION local I-EVOLUTION y I-EVOLUTION supuración. I-EVOLUTION Se B-TREATMENT realizó I-TREATMENT drenaje I-TREATMENT manual I-TREATMENT y I-TREATMENT pasivo I-TREATMENT con I-TREATMENT penrose. I-TREATMENT Fue I-TREATMENT hospitalizado I-TREATMENT por I-TREATMENT absceso I-TREATMENT en I-TREATMENT glúteo I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT y I-TREATMENT clindamicina. I-TREATMENT Se B-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION que I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Tabla I-EXPLORATION 1 I-EXPLORATION (B) I-EXPLORATION donde I-EXPLORATION nuevamente I-EXPLORATION destacó I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION IgE I-EXPLORATION elevados, I-EXPLORATION una I-EXPLORATION primera I-EXPLORATION muestra I-EXPLORATION con I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION 4.170 I-EXPLORATION UI/ml I-EXPLORATION y I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION muestra I-EXPLORATION el I-EXPLORATION día I-EXPLORATION siguiente I-EXPLORATION de I-EXPLORATION 4.210 I-EXPLORATION UI/ml. I-EXPLORATION Se I-EXPLORATION aplicó I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION Grimbacher9 I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION consignó I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION IgE, I-EXPLORATION candidiasis I-EXPLORATION sistémica, I-EXPLORATION infecciones I-EXPLORATION graves, I-EXPLORATION infecciones I-EXPLORATION cutáneas I-EXPLORATION recurrentes, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION paladar I-EXPLORATION alto, I-EXPLORATION dientes I-EXPLORATION primarios I-EXPLORATION retenidos, I-EXPLORATION hiperextensibilidad I-EXPLORATION articular, I-EXPLORATION nariz I-EXPLORATION amplia I-EXPLORATION con I-EXPLORATION distancia I-EXPLORATION interalar I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION DS I-EXPLORATION y I-EXPLORATION facies I-EXPLORATION característica, I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION dio I-EXPLORATION un I-EXPLORATION resultado I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION puntos, I-EXPLORATION confirmándose I-EXPLORATION clínicamente I-EXPLORATION el I-EXPLORATION diagnóstico. I-EXPLORATION Tras B-TREATMENT 21 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT se I-TREATMENT dio I-TREATMENT de I-TREATMENT alta, I-TREATMENT utilizando I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT con I-TREATMENT trimetoprim/sulfametoxazol. I-TREATMENT En B-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable I-EVOLUTION sin I-EVOLUTION nuevos I-EVOLUTION cuadros I-EVOLUTION de I-EVOLUTION infecciones I-EVOLUTION cutáneas, I-EVOLUTION sistémicas I-EVOLUTION o I-EVOLUTION eventos I-EVOLUTION trombóticos. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano, I-PAST_MEDICAL_HISTORY sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY diabetes, I-FAMILY_HISTORY comenzó B-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS temblor, I-PRESENT_ILLNESS sudoración, I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS y I-PRESENT_ILLNESS síncope I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS que I-PRESENT_ILLNESS aparecían I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ayunas, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ejercicio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cedían I-PRESENT_ILLNESS al I-PRESENT_ILLNESS comer. I-PRESENT_ILLNESS Estuvo B-TREATMENT en I-TREATMENT control I-TREATMENT neurológico I-TREATMENT por I-TREATMENT probable I-TREATMENT epilepsia, I-TREATMENT tratándose I-TREATMENT con I-TREATMENT carbamazepina I-TREATMENT algunas I-TREATMENT semanas, I-TREATMENT sin I-TREATMENT otros I-TREATMENT fármacos. I-TREATMENT Por B-PRESENT_ILLNESS un I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS pesquisándose I-PRESENT_ILLNESS hipoglicemia I-PRESENT_ILLNESS recurrente, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS menor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS mg/dl, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS hospitalizado. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION sin I-EXPLORATION acantosis I-EXPLORATION nigricans I-EXPLORATION y I-EXPLORATION el I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 25, I-EXPLORATION 6 I-EXPLORATION kg/m2. I-EXPLORATION La I-EXPLORATION función I-EXPLORATION tiroidea I-EXPLORATION y I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION cortisol I-EXPLORATION matinal I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Una I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION tolerancia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION glucosa I-EXPLORATION oral I-EXPLORATION (PTGO) I-EXPLORATION informó I-EXPLORATION glicemia I-EXPLORATION basal I-EXPLORATION de I-EXPLORATION 88 I-EXPLORATION y I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 120 I-EXPLORATION min I-EXPLORATION 185 I-EXPLORATION mg/dl, I-EXPLORATION e I-EXPLORATION insulinemia I-EXPLORATION basal I-EXPLORATION de I-EXPLORATION 2.759 I-EXPLORATION y I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 120 I-EXPLORATION min I-EXPLORATION de I-EXPLORATION 5.942 I-EXPLORATION µUI/ml I-EXPLORATION (MEIA, I-EXPLORATION Axym, I-EXPLORATION Abbott). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION test I-EXPLORATION de I-EXPLORATION ayuno I-EXPLORATION presentando I-EXPLORATION glicemia I-EXPLORATION de I-EXPLORATION 46 I-EXPLORATION mg/dl I-EXPLORATION e I-EXPLORATION insulinemia I-EXPLORATION de I-EXPLORATION 588 I-EXPLORATION µUI/ml I-EXPLORATION (RIA, I-EXPLORATION Diagnostic I-EXPLORATION Products, I-EXPLORATION Co I-EXPLORATION [DPC]) I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 15 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION ayuno, I-EXPLORATION con I-EXPLORATION sintomatología I-EXPLORATION asociada. I-EXPLORATION Una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION test I-EXPLORATION de I-EXPLORATION estimulación I-EXPLORATION intraarterial I-EXPLORATION selectiva I-EXPLORATION con I-EXPLORATION calcio I-EXPLORATION para I-EXPLORATION localización I-EXPLORATION de I-EXPLORATION insulinomas I-EXPLORATION según I-EXPLORATION protocolo2, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION no I-EXPLORATION permitió I-EXPLORATION la I-EXPLORATION localización I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION arteriografía I-EXPLORATION se I-EXPLORATION describió I-EXPLORATION una I-EXPLORATION posible I-EXPLORATION lesión I-EXPLORATION nodular I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas, I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 1, I-EXPLORATION 4 I-EXPLORATION cm, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION laparatomía I-EXPLORATION exploratoria I-EXPLORATION que I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tumor. I-EXPLORATION Se I-EXPLORATION midieron I-EXPLORATION los I-EXPLORATION anticuerpos I-EXPLORATION antiinsulina I-EXPLORATION mediante I-EXPLORATION inmunoensayo I-EXPLORATION enzimático I-EXPLORATION (ELISA) I-EXPLORATION con I-EXPLORATION kits I-EXPLORATION comerciales I-EXPLORATION Medizym® I-EXPLORATION (Medipan I-EXPLORATION GmbH, I-EXPLORATION Berlín, I-EXPLORATION Alemania) I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION positivos. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION antitiroideos I-EXPLORATION y I-EXPLORATION antinucleares I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION No I-EXPLORATION presentó I-EXPLORATION manifestaciones I-EXPLORATION de I-EXPLORATION otra I-EXPLORATION enfermedad I-EXPLORATION autoinmune. I-EXPLORATION I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT dieta I-TREATMENT restringida I-TREATMENT en I-TREATMENT carbohidratos I-TREATMENT refinados I-TREATMENT y I-TREATMENT comidas I-TREATMENT frecuentes I-TREATMENT en I-TREATMENT pequeñas I-TREATMENT cantidades, I-TREATMENT manteniéndose I-TREATMENT asintomático, I-TREATMENT sin I-TREATMENT presentar I-TREATMENT nuevas I-TREATMENT hipoglicemias. I-TREATMENT Al B-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION PTGO I-EVOLUTION que I-EVOLUTION informó I-EVOLUTION glicemia I-EVOLUTION basal I-EVOLUTION 84 I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 120 I-EVOLUTION min I-EVOLUTION 240 I-EVOLUTION mg/dl I-EVOLUTION e I-EVOLUTION insulinemia I-EVOLUTION basal I-EVOLUTION de I-EVOLUTION 434 I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 120 I-EVOLUTION min I-EVOLUTION de I-EVOLUTION 793 I-EVOLUTION µUI/ml I-EVOLUTION (RIA). I-EVOLUTION Se I-EVOLUTION mantenía I-EVOLUTION asintomático I-EVOLUTION después I-EVOLUTION de I-EVOLUTION tres I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Una B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sana I-PAST_MEDICAL_HISTORY ingresó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alteración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pruebas I-PRESENT_ILLNESS hepáticas. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION decaída I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION pancitopenia I-EXPLORATION (hemoglobina I-EXPLORATION 10 I-EXPLORATION gr%, I-EXPLORATION leucocitos I-EXPLORATION 1.900/uL, I-EXPLORATION plaquetas I-EXPLORATION 43.000/mL) I-EXPLORATION y I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION (GOT I-EXPLORATION 1.800 I-EXPLORATION U/L, I-EXPLORATION GPT I-EXPLORATION 1.300 I-EXPLORATION U/L). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION enfermedades I-EXPLORATION infecciosas I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION (hemocultivo, I-EXPLORATION urocultivo, I-EXPLORATION virus I-EXPLORATION hepatotropos, I-EXPLORATION mycoplasma, I-EXPLORATION toxoplasma, I-EXPLORATION leptospira, I-EXPLORATION bartonella, I-EXPLORATION brucella, I-EXPLORATION rubéola, I-EXPLORATION sarampión, I-EXPLORATION VIH, I-EXPLORATION parvovirus I-EXPLORATION B19, I-EXPLORATION citomegalovirus I-EXPLORATION y I-EXPLORATION Epstein I-EXPLORATION Barr). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION reumatológico I-EXPLORATION donde I-EXPLORATION resultó I-EXPLORATION ANA I-EXPLORATION 1: I-EXPLORATION 40 I-EXPLORATION patrón I-EXPLORATION moteado I-EXPLORATION y I-EXPLORATION anti I-EXPLORATION DNA I-EXPLORATION por I-EXPLORATION FARR, I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION ENA I-EXPLORATION negativos I-EXPLORATION con I-EXPLORATION complemento I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION continuó I-EXPLORATION con I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION en I-EXPLORATION deterioro. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION linfonodos I-EXPLORATION pequeños I-EXPLORATION difusos, I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION laminar I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION hepatoesplenomegalia. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION linfonodos I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION adenitis I-EXPLORATION no I-EXPLORATION específica. I-EXPLORATION Los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION ferritina I-EXPLORATION resultaron I-EXPLORATION en I-EXPLORATION 23.460 I-EXPLORATION U/L. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION medular I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION hiperplasia I-EXPLORATION linfoide I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION abundantes I-EXPLORATION hemofagocitos. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT protocolo I-TREATMENT HLH I-TREATMENT 04 I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica, I-TREATMENT con I-TREATMENT normalización I-TREATMENT de I-TREATMENT pruebas I-TREATMENT hepáticas I-TREATMENT y I-TREATMENT descenso I-TREATMENT de I-TREATMENT la I-TREATMENT ferritina I-TREATMENT hasta I-TREATMENT valores I-TREATMENT normales. I-TREATMENT Al B-EVOLUTION momento I-EVOLUTION de I-EVOLUTION redactar I-EVOLUTION este I-EVOLUTION reporte I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION lleva I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION dispone I-EVOLUTION de I-EVOLUTION hermanos I-EVOLUTION HLA I-EVOLUTION compatibles. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos; I-PAST_MEDICAL_HISTORY consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS asintomática I-PRESENT_ILLNESS en I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Se B-TREATMENT trató I-TREATMENT como I-TREATMENT piodermia I-TREATMENT con I-TREATMENT múltiples I-TREATMENT antibióticos I-TREATMENT orales, I-TREATMENT sin I-TREATMENT respuesta. I-TREATMENT Al B-EXPLORATION examen, I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION eritematoso I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 8 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION pequeñas I-EXPLORATION ulceraciones I-EXPLORATION y I-EXPLORATION erosiones. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION compresión I-EXPLORATION no I-EXPLORATION hubo I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION exudado I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION granos. I-EXPLORATION Además, I-EXPLORATION presentaba I-EXPLORATION dos I-EXPLORATION adenopatías I-EXPLORATION inguinales I-EXPLORATION ipsilaterales, I-EXPLORATION no I-EXPLORATION dolorosas, I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 1 I-EXPLORATION cm. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palparon I-EXPLORATION otras I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION visceromegalia. I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION cutáneo I-EXPLORATION y I-EXPLORATION de I-EXPLORATION un I-EXPLORATION actinomicetoma, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION serológicos, I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION (TAC-TAP), I-EXPLORATION múltiples I-EXPLORATION cultivos I-EXPLORATION bacterianos-micológicos I-EXPLORATION y I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel. I-EXPLORATION Tenía I-EXPLORATION hemograma, I-EXPLORATION deshidrogensa I-EXPLORATION láctica I-EXPLORATION (LDH) I-EXPLORATION y I-EXPLORATION calcio I-EXPLORATION sérico I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales; I-EXPLORATION además I-EXPLORATION de I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION HTLV-1 I-EXPLORATION negativa. I-EXPLORATION El I-EXPLORATION TAC-TAP I-EXPLORATION mostró I-EXPLORATION sólo I-EXPLORATION las I-EXPLORATION adenopatías I-EXPLORATION ipsilaterales I-EXPLORATION pesquisadas I-EXPLORATION clínicamente. I-EXPLORATION I-EXPLORATION La I-EXPLORATION histopatología I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION dérmico I-EXPLORATION ulcerado, I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION grandes, I-EXPLORATION con I-EXPLORATION pleomorfismo I-EXPLORATION nuclear I-EXPLORATION y I-EXPLORATION mitosis I-EXPLORATION atípicas. I-EXPLORATION Además, I-EXPLORATION había I-EXPLORATION abundantes I-EXPLORATION eosinófilos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION (IHQ) I-EXPLORATION mostró I-EXPLORATION reacción I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION CD30 I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION grandes I-EXPLORATION y I-EXPLORATION reacción I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION ALK-1 I-EXPLORATION y I-EXPLORATION CD25. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION además I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION arquitectura I-EXPLORATION y I-EXPLORATION celularidad I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION todos I-EXPLORATION estos I-EXPLORATION elementos I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION un I-EXPLORATION LACGPC. I-EXPLORATION Se B-TREATMENT planteó I-TREATMENT realizar I-TREATMENT radioterapia I-TREATMENT (RT) I-TREATMENT local, I-TREATMENT pero I-TREATMENT cuando I-TREATMENT la I-TREATMENT paciente I-TREATMENT volvió I-TREATMENT a I-TREATMENT consultar I-TREATMENT al I-TREATMENT mes, I-TREATMENT presentaba I-TREATMENT clara I-TREATMENT disminución I-TREATMENT de I-TREATMENT tamaño I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT del I-TREATMENT muslo, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento. I-TREATMENT Se B-EVOLUTION controló I-EVOLUTION cada I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION en I-EVOLUTION regresión I-EVOLUTION total. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS comunica I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS fumador, I-PRESENT_ILLNESS evaluado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sala I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS moderada. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY rinitis I-PAST_MEDICAL_HISTORY alérgica, I-PAST_MEDICAL_HISTORY tampoco I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY medicamentos; I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY niega I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antiinflamatorios I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY esteroidales, I-PAST_MEDICAL_HISTORY antibioterapia I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cocaína I-PAST_MEDICAL_HISTORY u I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY drogas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abuso. I-PAST_MEDICAL_HISTORY La B-EXPLORATION hemodinamia I-EXPLORATION y I-EXPLORATION oximetría I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION segmentario I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION crépitos I-EXPLORATION en I-EXPLORATION base I-EXPLORATION pulmonar I-EXPLORATION izquierda, I-EXPLORATION sin I-EXPLORATION sibilancias I-EXPLORATION ni I-EXPLORATION otros I-EXPLORATION ruidos I-EXPLORATION agregados; I-EXPLORATION sin I-EXPLORATION hipocratismo I-EXPLORATION digital I-EXPLORATION ni I-EXPLORATION otros I-EXPLORATION signos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION patología I-EXPLORATION pulmonar I-EXPLORATION previa I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION consolidación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION inferior I-EXPLORATION izquierdo I-EXPLORATION (LII). I-EXPLORATION Dentro I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacaba I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 13.200 I-EXPLORATION cel/dL, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION eritrosedimentación I-EXPLORATION (VHS) I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION mm, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 5), I-EXPLORATION perfil I-EXPLORATION bioquímico I-EXPLORATION normal. I-EXPLORATION Con B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT se I-TREATMENT decidió I-TREATMENT hospitalización I-TREATMENT y I-TREATMENT se I-TREATMENT dio I-TREATMENT inicio I-TREATMENT a I-TREATMENT antibioterapia I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT 2 I-TREATMENT g/día I-TREATMENT ev I-TREATMENT y I-TREATMENT levofloxacino I-TREATMENT 500 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT vo. I-TREATMENT Posterior B-EVOLUTION a I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION tratamiento, I-EVOLUTION no I-EVOLUTION hubo I-EVOLUTION mejoría I-EVOLUTION clínica. I-EVOLUTION Estudios B-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION con I-EXPLORATION hemograma I-EXPLORATION mostraron I-EXPLORATION hematocrito I-EXPLORATION 38%, I-EXPLORATION hemoglobina I-EXPLORATION 12 I-EXPLORATION g/dL, I-EXPLORATION VCM I-EXPLORATION 89, I-EXPLORATION leucocitos I-EXPLORATION 12.500 I-EXPLORATION cel/mm3, I-EXPLORATION eosinófilos I-EXPLORATION 16, I-EXPLORATION 9%, I-EXPLORATION plaquetas I-EXPLORATION 234, I-EXPLORATION 000 I-EXPLORATION cel/mm3, I-EXPLORATION VHS I-EXPLORATION 35 I-EXPLORATION mm, I-EXPLORATION PCR I-EXPLORATION 15 I-EXPLORATION (límite I-EXPLORATION < I-EXPLORATION 5) I-EXPLORATION Ig I-EXPLORATION E I-EXPLORATION 128, I-EXPLORATION 2 I-EXPLORATION UI/ml. I-EXPLORATION Tomografía I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION (TAC) I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION mayor I-EXPLORATION consolidación I-EXPLORATION de I-EXPLORATION LII I-EXPLORATION y I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION (LSI), I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION opacidades I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION esmerilado, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION izquierdo I-EXPLORATION moderado. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION broncoscopia I-EXPLORATION flexible I-EXPLORATION con I-EXPLORATION lavado I-EXPLORATION broncoalveolar I-EXPLORATION (LBA) I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 107 I-EXPLORATION células, I-EXPLORATION con I-EXPLORATION 95% I-EXPLORATION de I-EXPLORATION eosinófilos I-EXPLORATION ; I-EXPLORATION los I-EXPLORATION cultivos, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION medios I-EXPLORATION corrientes I-EXPLORATION como I-EXPLORATION micobacterias, I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION galactomanano I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION transbronquial I-EXPLORATION mostró I-EXPLORATION numerosos I-EXPLORATION granulocitos I-EXPLORATION eosinófilos I-EXPLORATION en I-EXPLORATION alvéolos I-EXPLORATION e I-EXPLORATION intersticio, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION cierto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION intersticial. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION arrojó I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION x I-EXPLORATION 103 I-EXPLORATION células, I-EXPLORATION con I-EXPLORATION 85% I-EXPLORATION de I-EXPLORATION eosinófilos, I-EXPLORATION proteínas I-EXPLORATION 4, I-EXPLORATION 1 I-EXPLORATION mg/dL, I-EXPLORATION glucosa I-EXPLORATION 75 I-EXPLORATION mg/dL, I-EXPLORATION lactato I-EXPLORATION deshidrogenasa I-EXPLORATION 232 I-EXPLORATION y I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 37. I-EXPLORATION I-EXPLORATION Dentro I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION complementario, I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION anticuerpo I-EXPLORATION antinucleares I-EXPLORATION (ANA), I-EXPLORATION anti I-EXPLORATION DNA, I-EXPLORATION anti-citoplasma I-EXPLORATION de I-EXPLORATION neutrófilos I-EXPLORATION (ANCA), I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION (VIH) I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION se I-EXPLORATION descarto I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION parásitos I-EXPLORATION (Ascaris I-EXPLORATION lumbricoide, I-EXPLORATION Trichinella, I-EXPLORATION Fasciola, I-EXPLORATION Schistosoma I-EXPLORATION y I-EXPLORATION Strongyloides), I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION Aspergillus I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION Dado B-TREATMENT el I-TREATMENT hallazgo I-TREATMENT de I-TREATMENT la I-TREATMENT neumonía I-TREATMENT eosinofílica, I-TREATMENT asociado I-TREATMENT a I-TREATMENT al I-TREATMENT presencia I-TREATMENT de I-TREATMENT eosinofilia I-TREATMENT periférica, I-TREATMENT en I-TREATMENT ausencia I-TREATMENT de I-TREATMENT causas I-TREATMENT infecciosas I-TREATMENT o I-TREATMENT secundarias I-TREATMENT a I-TREATMENT drogas I-TREATMENT o I-TREATMENT fármacos, I-TREATMENT se I-TREATMENT planteó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT NEC, I-TREATMENT iniciándose I-TREATMENT prednisona I-TREATMENT 1 I-TREATMENT mg/kg I-TREATMENT peso, I-TREATMENT obteniendo I-TREATMENT una I-TREATMENT disminución I-TREATMENT de I-TREATMENT la I-TREATMENT fiebre I-TREATMENT al I-TREATMENT segundo I-TREATMENT día I-TREATMENT y I-TREATMENT disminución I-TREATMENT de I-TREATMENT los I-TREATMENT requerimientos I-TREATMENT de I-TREATMENT oxígeno I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT eosinofilia I-TREATMENT a I-TREATMENT los I-TREATMENT 5 I-TREATMENT días I-TREATMENT y I-TREATMENT una I-TREATMENT resolución I-TREATMENT de I-TREATMENT las I-TREATMENT condensaciones I-TREATMENT pulmonares I-TREATMENT y I-TREATMENT al I-TREATMENT mes I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT logrando I-TREATMENT suspender I-TREATMENT de I-TREATMENT manera I-TREATMENT escalonada I-TREATMENT los I-TREATMENT corticoides. I-TREATMENT Dentro B-EVOLUTION del I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION dos I-EVOLUTION recurrencias I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION respiratorio, I-EVOLUTION de I-EVOLUTION similares I-EVOLUTION características, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION a I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION corticoides. I-EVOLUTION Actualmente B-TREATMENT se I-TREATMENT encuentra I-TREATMENT con I-TREATMENT dosis I-TREATMENT de I-TREATMENT mantención I-TREATMENT de I-TREATMENT 5 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT de I-TREATMENT prednisona, I-TREATMENT lo I-TREATMENT que I-TREATMENT confirma I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT NEC. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS chilena, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Sjögren, I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY únicamente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lágrimas I-PAST_MEDICAL_HISTORY artificiales. I-PAST_MEDICAL_HISTORY Tiene I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY vitíligo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hermana I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Sjögren. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY medicamentos I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY tabaquismo. I-PAST_MEDICAL_HISTORY Sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY digestivo. I-FAMILY_HISTORY Niega B-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hemorragia I-PRESENT_ILLNESS digestiva, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS diarrea, I-PRESENT_ILLNESS fatiga I-PRESENT_ILLNESS o I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS Fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO Reumatología I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Dermatología I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Padre I-DERIVED_FROM/TO Hurtado I-DERIVED_FROM/TO debido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO aparición I-DERIVED_FROM/TO de I-DERIVED_FROM/TO bandas I-DERIVED_FROM/TO hiperpigmentadas I-DERIVED_FROM/TO en I-DERIVED_FROM/TO uñas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO los I-DERIVED_FROM/TO pies I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO hacía I-DERIVED_FROM/TO 5 I-DERIVED_FROM/TO años, I-DERIVED_FROM/TO seguidas I-DERIVED_FROM/TO por I-DERIVED_FROM/TO las I-DERIVED_FROM/TO uñas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO las I-DERIVED_FROM/TO manos. I-DERIVED_FROM/TO Hacía B-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS habían I-PRESENT_ILLNESS aparecido I-PRESENT_ILLNESS máculas I-PRESENT_ILLNESS color I-PRESENT_ILLNESS café I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mucosa I-PRESENT_ILLNESS oral, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hiperpigmentación I-PRESENT_ILLNESS periungueal I-PRESENT_ILLNESS progresiva. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION oral I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION mácula I-EXPLORATION café I-EXPLORATION en I-EXPLORATION labio I-EXPLORATION inferior I-EXPLORATION hacia I-EXPLORATION comisura I-EXPLORATION labial I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION uñas I-EXPLORATION de I-EXPLORATION manos I-EXPLORATION y I-EXPLORATION pies I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION máculas I-EXPLORATION café I-EXPLORATION periungueales I-EXPLORATION y I-EXPLORATION melanoniquia. I-EXPLORATION I-EXPLORATION La I-EXPLORATION histopatología I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION oral I-EXPLORATION mostró I-EXPLORATION acantosis I-EXPLORATION leve I-EXPLORATION e I-EXPLORATION hipermelanosis. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION dermoepidérmica I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION numerosos I-EXPLORATION melanófagos, I-EXPLORATION con I-EXPLORATION capilares I-EXPLORATION prominentes I-EXPLORATION en I-EXPLORATION dermis. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron: I-EXPLORATION Leucopenia I-EXPLORATION leve I-EXPLORATION (3, I-EXPLORATION 700/uL I-EXPLORATION con I-EXPLORATION 1, I-EXPLORATION 370/uL I-EXPLORATION linfocitos). I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION hemograma, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION eritrosedimentasión, I-EXPLORATION hormonas I-EXPLORATION tiroideas, I-EXPLORATION cortisol I-EXPLORATION plasmático I-EXPLORATION y I-EXPLORATION ACTH I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION anti-Ro I-EXPLORATION (43, I-EXPLORATION 7 I-EXPLORATION U/mL) I-EXPLORATION y I-EXPLORATION anti-La I-EXPLORATION (> I-EXPLORATION 48 I-EXPLORATION U/mL) I-EXPLORATION fueron I-EXPLORATION positivos, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION también I-EXPLORATION los I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (1/2560) I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION moteado. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION anti-dsDNA, I-EXPLORATION anti-Sm I-EXPLORATION y I-EXPLORATION anticardiolipinas I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION factor I-EXPLORATION reumatoideo, I-EXPLORATION anticoagulante I-EXPLORATION lúpico I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cuantificación I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION resultaron I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION endoscopía I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION y I-EXPLORATION colonoscopía, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION muestran I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION pólipos, I-EXPLORATION hiperpigmentación I-EXPLORATION u I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION en I-EVOLUTION seguimiento I-EVOLUTION clínico, I-EVOLUTION sin I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION nuevas I-EVOLUTION lesiones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS género I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY excepción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY proctitis I-PAST_MEDICAL_HISTORY ulcerosa I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 1994. I-PAST_MEDICAL_HISTORY Inicialmente B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS líquidas I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mucosidades. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION inflamatorio I-EXPLORATION continuo I-EXPLORATION del I-EXPLORATION recto I-EXPLORATION con I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION friable I-EXPLORATION y I-EXPLORATION pequeñas I-EXPLORATION erosiones I-EXPLORATION cubiertas I-EXPLORATION por I-EXPLORATION fibrina I-EXPLORATION (Subíndice I-EXPLORATION Endoscópico I-EXPLORATION Mayo I-EXPLORATION 2). I-EXPLORATION En I-EXPLORATION las I-EXPLORATION biopsias I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION inflamación I-EXPLORATION aguda I-EXPLORATION (criptitis I-EXPLORATION y I-EXPLORATION abscesos I-EXPLORATION crípticos) I-EXPLORATION y I-EXPLORATION crónica I-EXPLORATION reflejada I-EXPLORATION como I-EXPLORATION alteraciones I-EXPLORATION estructurales I-EXPLORATION de I-EXPLORATION las I-EXPLORATION criptas I-EXPLORATION (acortamiento I-EXPLORATION y I-EXPLORATION ramificación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION caliciformes). I-EXPLORATION La B-TREATMENT paciente I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT mesalazina I-TREATMENT oral I-TREATMENT (3 I-TREATMENT g/día) I-TREATMENT y I-TREATMENT rectal I-TREATMENT (supositorios I-TREATMENT de I-TREATMENT 500 I-TREATMENT mg/noche), I-TREATMENT con I-TREATMENT remisión I-TREATMENT clínica I-TREATMENT y I-TREATMENT endoscópica I-TREATMENT (curación I-TREATMENT de I-TREATMENT la I-TREATMENT mucosa) I-TREATMENT (colonoscopia I-TREATMENT 2007, I-TREATMENT Subíndice I-TREATMENT Endoscópico I-TREATMENT Mayo I-TREATMENT 0). I-TREATMENT Posteriormente, B-EVOLUTION abandona I-EVOLUTION tratamiento I-EVOLUTION y I-EVOLUTION control, I-EVOLUTION manteniéndose I-EVOLUTION asintomática I-EVOLUTION hasta I-EVOLUTION agosto I-EVOLUTION de I-EVOLUTION 2015 I-EVOLUTION donde I-EVOLUTION consulta I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION desde I-EVOLUTION hace I-EVOLUTION un I-EVOLUTION mes I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION malestar I-EVOLUTION abdominal I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION deposiciones I-EVOLUTION líquidas I-EVOLUTION una I-EVOLUTION a I-EVOLUTION dos I-EVOLUTION veces I-EVOLUTION al I-EVOLUTION día I-EVOLUTION sin I-EVOLUTION sangre I-EVOLUTION ni I-EVOLUTION mucosidades. I-EVOLUTION No I-EVOLUTION refería I-EVOLUTION compromiso I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION fiebre, I-EVOLUTION baja I-EVOLUTION de I-EVOLUTION peso, I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y/o I-EVOLUTION articular. I-EVOLUTION Sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo, I-PAST_MEDICAL_HISTORY transgresión I-PAST_MEDICAL_HISTORY alimentaria I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fármacos I-PAST_MEDICAL_HISTORY (específicamente I-PAST_MEDICAL_HISTORY antiinflamatorios I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY esteroidales, I-PAST_MEDICAL_HISTORY antibióticos, I-PAST_MEDICAL_HISTORY inhibidores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY bomba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY protones, I-PAST_MEDICAL_HISTORY hormonas I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY antidepresivos). I-PAST_MEDICAL_HISTORY Se B-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION que I-EXPLORATION incluyó I-EXPLORATION hemograma, I-EXPLORATION VHS, I-EXPLORATION PCR I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION hepático, I-EXPLORATION todos I-EXPLORATION normales. I-EXPLORATION Además, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION enfermedad I-EXPLORATION celíaca I-EXPLORATION con I-EXPLORATION anticuerpos I-EXPLORATION anti-transglutaminasa I-EXPLORATION negativos I-EXPLORATION e I-EXPLORATION inmunoglobulina I-EXPLORATION A I-EXPLORATION en I-EXPLORATION valores I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION completa I-EXPLORATION donde I-EXPLORATION sólo I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION erosiones I-EXPLORATION mínimas I-EXPLORATION e I-EXPLORATION inespecíficas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION recto. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION escalonadas I-EXPLORATION de I-EXPLORATION íleon, I-EXPLORATION colon I-EXPLORATION y I-EXPLORATION recto I-EXPLORATION en I-EXPLORATION frascos I-EXPLORATION separados I-EXPLORATION las I-EXPLORATION cuales I-EXPLORATION fueron I-EXPLORATION consistentes I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION CL I-EXPLORATION dado I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION > I-EXPLORATION 40 I-EXPLORATION linfocitos/100 I-EXPLORATION células I-EXPLORATION epiteliales I-EXPLORATION en I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION obtenidas I-EXPLORATION desde I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION a I-EXPLORATION recto. I-EXPLORATION Además, I-EXPLORATION se I-EXPLORATION describieron I-EXPLORATION alteraciones I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION CU I-EXPLORATION (leve I-EXPLORATION distorsión I-EXPLORATION de I-EXPLORATION arquitectura I-EXPLORATION glandular, I-EXPLORATION criptitis I-EXPLORATION y I-EXPLORATION microabscesos) I-EXPLORATION exclusivamente I-EXPLORATION en I-EXPLORATION sigmoides I-EXPLORATION y I-EXPLORATION recto. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT budesonida I-TREATMENT 9 I-TREATMENT mg/día, I-TREATMENT presentando I-TREATMENT una I-TREATMENT respuesta I-TREATMENT favorable I-TREATMENT a I-TREATMENT la I-TREATMENT semana I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT un I-TREATMENT descenso I-TREATMENT progresivo I-TREATMENT del I-TREATMENT fármaco I-TREATMENT hasta I-TREATMENT suspenderlo I-TREATMENT al I-TREATMENT tercer I-TREATMENT mes. I-TREATMENT Luego B-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION asintomática I-EVOLUTION (remisión I-EVOLUTION clínica) I-EVOLUTION y I-EVOLUTION en I-EVOLUTION control I-EVOLUTION con I-EVOLUTION calprotectina I-EVOLUTION fecal I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION rango I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dermatitis I-PAST_MEDICAL_HISTORY seborreica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuero I-PAST_MEDICAL_HISTORY cabelludo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY viaje I-PAST_MEDICAL_HISTORY reciente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Ilhabela, I-PAST_MEDICAL_HISTORY Brasil. I-PAST_MEDICAL_HISTORY Después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY permanecer I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY semana I-PAST_MEDICAL_HISTORY fuera I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY país, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY retornó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Chile. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS dermatólogo I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS regreso, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS en I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo I-PRESENT_ILLNESS parieto I-PRESENT_ILLNESS occipital, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS objetos I-PRESENT_ILLNESS extraños I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mueven I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS cabeza. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION se I-EXPLORATION identificaro I-EXPLORATION 3 I-EXPLORATION úlceras I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION aproximadamente, I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION supuraba I-EXPLORATION abundante I-EXPLORATION contenido I-EXPLORATION seropurulento, I-EXPLORATION en I-EXPLORATION cuyos I-EXPLORATION fondos I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION múltiples I-EXPLORATION larvas I-EXPLORATION vivas I-EXPLORATION y I-EXPLORATION móviles. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT extracción I-TREATMENT manual I-TREATMENT en I-TREATMENT la I-TREATMENT sala I-TREATMENT de I-TREATMENT atención, I-TREATMENT mediante I-TREATMENT pinzas, I-TREATMENT con I-TREATMENT bastante I-TREATMENT facilidad I-TREATMENT y I-TREATMENT sin I-TREATMENT molestias I-TREATMENT para I-TREATMENT la I-TREATMENT paciente I-TREATMENT durante I-TREATMENT el I-TREATMENT procedimiento, I-TREATMENT obteniéndose I-TREATMENT 25 I-TREATMENT especímenes. I-TREATMENT Se I-TREATMENT indicó I-TREATMENT ivermectina I-TREATMENT oral I-TREATMENT en I-TREATMENT dosis I-TREATMENT única I-TREATMENT de I-TREATMENT 200 I-TREATMENT ug/kg. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION presentó I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION sintomatología, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT cirugía I-TREATMENT exploratoria I-TREATMENT y I-TREATMENT aseo I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT local, I-TREATMENT se I-TREATMENT logró I-TREATMENT extraer I-TREATMENT 4 I-TREATMENT larvas I-TREATMENT más. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas, I-EXPLORATION no I-EXPLORATION evidenciándose I-EXPLORATION más I-EXPLORATION larvas, I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION compromiso I-EXPLORATION óseo. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratada I-TREATMENT con I-TREATMENT antibioterapia I-TREATMENT oral I-TREATMENT y I-TREATMENT curaciones I-TREATMENT de I-TREATMENT sitio I-TREATMENT operatorio, I-TREATMENT presentando B-EVOLUTION una I-EVOLUTION rápida I-EVOLUTION y I-EVOLUTION favorable I-EVOLUTION respuesta I-EVOLUTION clínica, I-EVOLUTION logrando I-EVOLUTION cierre I-EVOLUTION por I-EVOLUTION segunda I-EVOLUTION intención I-EVOLUTION de I-EVOLUTION las I-EVOLUTION heridas I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION recurrencias I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION fecha. I-EVOLUTION I-EVOLUTION Todas B-EXPLORATION las I-EXPLORATION larvas I-EXPLORATION obtenidas I-EXPLORATION fueron I-EXPLORATION analizadas I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION Parasitología I-EXPLORATION Básico-Clínico I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Ciencias I-EXPLORATION Biomédicas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Facultad I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Chile, I-EXPLORATION identificándose I-EXPLORATION larvas I-EXPLORATION en I-EXPLORATION estado I-EXPLORATION L2 I-EXPLORATION y I-EXPLORATION L3 I-EXPLORATION de I-EXPLORATION Cochliomyia I-EXPLORATION hominivorax. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY DM1 I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY hemoglobina I-PAST_MEDICAL_HISTORY glicosilada I-PAST_MEDICAL_HISTORY (HbA1c) I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8, I-PAST_MEDICAL_HISTORY 5%. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS estaba I-PRESENT_ILLNESS ingiriendo I-PRESENT_ILLNESS alimentos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cantidad I-PRESENT_ILLNESS adecuada, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS omitió I-PRESENT_ILLNESS la I-PRESENT_ILLNESS dosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS insulina I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mismo I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Dirigidamente, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS no I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS ayuno I-PRESENT_ILLNESS prolongado, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alcohol I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS en I-PRESENT_ILLNESS riesgo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS embarazo I-PRESENT_ILLNESS previo I-PRESENT_ILLNESS al I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION ingreso, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION vigil, I-EXPLORATION y I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION leve I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION extra I-EXPLORATION celular I-EXPLORATION (VEC). I-EXPLORATION Su I-EXPLORATION Índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION era I-EXPLORATION 29 I-EXPLORATION Kg/m2. I-EXPLORATION En I-EXPLORATION sus I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION al I-EXPLORATION ingreso, I-EXPLORATION destacaba: I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 26.000 I-EXPLORATION x I-EXPLORATION mm3, I-EXPLORATION glicemia I-EXPLORATION 200 I-EXPLORATION mg/dl, I-EXPLORATION gases I-EXPLORATION arteriales I-EXPLORATION con I-EXPLORATION acidosis I-EXPLORATION metabólica I-EXPLORATION severa I-EXPLORATION (pH I-EXPLORATION 7, I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION bicarbonato I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION meq/L), I-EXPLORATION cetonemia++++++ I-EXPLORATION (no I-EXPLORATION se I-EXPLORATION dispone I-EXPLORATION de I-EXPLORATION medición I-EXPLORATION cuantitativa), I-EXPLORATION cetonuria I-EXPLORATION +++, I-EXPLORATION glucosuria. I-EXPLORATION La I-EXPLORATION proteína I-EXPLORATION c I-EXPLORATION reactiva, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION amilasemia I-EXPLORATION y I-EXPLORATION los I-EXPLORATION electrolitos I-EXPLORATION plasmáticos I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION resultó I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Ingresó B-TREATMENT a I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Cuidados I-TREATMENT Intensivos I-TREATMENT (UCI), I-TREATMENT iniciándose I-TREATMENT hidratación I-TREATMENT parenteral I-TREATMENT e I-TREATMENT insulina I-TREATMENT cristalina I-TREATMENT endovenosa, I-TREATMENT en I-TREATMENT infusión I-TREATMENT continua. I-TREATMENT Evolucionó B-EVOLUTION favorablemente. I-EVOLUTION Dada I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION una I-EVOLUTION Cetoacidosis I-EVOLUTION diabética I-EVOLUTION (CAD) I-EVOLUTION sin I-EVOLUTION un I-EVOLUTION desencadenante I-EVOLUTION claro I-EVOLUTION y I-EVOLUTION la I-EVOLUTION glucosuria I-EVOLUTION inapropiadamente I-EVOLUTION alta I-EVOLUTION para I-EVOLUTION tal I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION hiperglicemia, I-EVOLUTION se I-EVOLUTION reinterroga I-EVOLUTION a I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION acerca I-EVOLUTION del I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION otros I-EVOLUTION medicamentos; I-EVOLUTION entonces B-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY iniciado I-PAST_MEDICAL_HISTORY canaglifozina I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY cuadro. I-PAST_MEDICAL_HISTORY Una B-TREATMENT vez I-TREATMENT estabilizada, I-TREATMENT se I-TREATMENT reajustó I-TREATMENT esquema I-TREATMENT de I-TREATMENT insulina I-TREATMENT y I-TREATMENT fue I-TREATMENT dada I-TREATMENT de I-TREATMENT alta I-TREATMENT al I-TREATMENT cuarto I-TREATMENT día I-TREATMENT de I-TREATMENT hospitalización. I-TREATMENT I-TREATMENT Se B-EVOLUTION realizó I-EVOLUTION la I-EVOLUTION notificación I-EVOLUTION al I-EVOLUTION Instituto I-EVOLUTION de I-EVOLUTION Salud I-EVOLUTION Pública I-EVOLUTION y I-EVOLUTION se I-EVOLUTION informó I-EVOLUTION al I-EVOLUTION Laboratorio I-EVOLUTION Janssen I-EVOLUTION Chile, I-EVOLUTION constituyéndose I-EVOLUTION en I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION caso I-EVOLUTION descrito I-EVOLUTION de I-EVOLUTION CAD I-EVOLUTION con I-EVOLUTION el I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION estos I-EVOLUTION medicamentos I-EVOLUTION en I-EVOLUTION nuestro I-EVOLUTION país. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY conocidos, I-PAST_MEDICAL_HISTORY consulta B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Emergencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS palidez, I-PRESENT_ILLNESS mialgias, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS escalofríos. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacan I-EXPLORATION en I-EXPLORATION paladar I-EXPLORATION numerosas I-EXPLORATION lesiones I-EXPLORATION herpetiformes, I-EXPLORATION hemograma I-EXPLORATION evidencia I-EXPLORATION pancitopenia, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION hospitalizar. I-EXPLORATION Se I-EXPLORATION efectúa I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION mielograma, I-EXPLORATION inmunofenotipo I-EXPLORATION y I-EXPLORATION cariograma, I-EXPLORATION diagnosticándose I-EXPLORATION LMA I-EXPLORATION indiferenciada I-EXPLORATION con I-EXPLORATION expresión I-EXPLORATION aberrante I-EXPLORATION CD7. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT quimioterapia I-TREATMENT de I-TREATMENT inducción I-TREATMENT con I-TREATMENT esquema I-TREATMENT 3+7 I-TREATMENT (daunorrubicina I-TREATMENT + I-TREATMENT citarabina) I-TREATMENT presentando I-TREATMENT al I-TREATMENT cuarto I-TREATMENT día I-TREATMENT del I-TREATMENT primer I-TREATMENT ciclo I-TREATMENT diarrea I-TREATMENT y I-TREATMENT fiebre, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT toman I-TREATMENT hemocultivos I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT terapia I-TREATMENT antibiótica I-TREATMENT empírica I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro. I-TREATMENT Los B-EXPLORATION hemocultivos I-EXPLORATION resultaron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Klebsiella I-EXPLORATION pneumoniae I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION cefalosporinas I-EXPLORATION de I-EXPLORATION tercera I-EXPLORATION generación, I-EXPLORATION manteniéndose I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION antibiótico I-EXPLORATION inicial. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION persiste I-EVOLUTION febril I-EVOLUTION sin I-EVOLUTION clínica I-EVOLUTION que I-EVOLUTION sugiera I-EVOLUTION el I-EVOLUTION foco I-EVOLUTION infeccioso; I-EVOLUTION cursa I-EVOLUTION con I-EVOLUTION neutropenia I-EVOLUTION grave I-EVOLUTION que I-EVOLUTION se I-EVOLUTION prolonga I-EVOLUTION por I-EVOLUTION 20 I-EVOLUTION días, I-EVOLUTION con I-EVOLUTION parámetros I-EVOLUTION inflamatorios I-EVOLUTION en I-EVOLUTION ascenso I-EVOLUTION y I-EVOLUTION alteración I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION hepáticas I-EVOLUTION con I-EVOLUTION patrón I-EVOLUTION colestásico. I-EVOLUTION Se B-TREATMENT decide I-TREATMENT agregar I-TREATMENT tratamiento I-TREATMENT antifúngico I-TREATMENT empírico I-TREATMENT con I-TREATMENT anidulafungina I-TREATMENT y B-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION tomografia I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION en I-EXPLORATION que I-EXPLORATION destaca I-EXPLORATION hepatoesplenomegalia I-EXPLORATION con I-EXPLORATION lesiones I-EXPLORATION focales I-EXPLORATION esplénicas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION inflamatorio-infeccioso. I-EXPLORATION Además I-EXPLORATION presenta I-EXPLORATION coriorretinitis I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION micosis. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION hemocultivo I-EXPLORATION de I-EXPLORATION hongos I-EXPLORATION (medio I-EXPLORATION Sabourand) I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION negativos, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION MALDI I-EXPLORATION TOF I-EXPLORATION MS I-EXPLORATION (Matrix-Assisted I-EXPLORATION Laser I-EXPLORATION Desorption/Ionization I-EXPLORATION time I-EXPLORATION of I-EXPLORATION flight I-EXPLORATION mass I-EXPLORATION espectrometry) I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION resulta I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION S. I-EXPLORATION capitata, I-EXPLORATION agregándose I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION voriconazol I-EXPLORATION (200 I-EXPLORATION mg/12 I-EXPLORATION h). I-EXPLORATION Por B-TREATMENT falta I-TREATMENT de I-TREATMENT respuesta I-TREATMENT a I-TREATMENT la I-TREATMENT terapia I-TREATMENT se I-TREATMENT reemplaza I-TREATMENT la I-TREATMENT anidulafungina I-TREATMENT por I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT liposomal I-TREATMENT (50 I-TREATMENT mg/día), I-TREATMENT se I-TREATMENT practica I-TREATMENT ecocardiografía I-TREATMENT que I-TREATMENT descarta I-TREATMENT endocarditis. I-TREATMENT Nuevo B-EXPLORATION TC I-EXPLORATION muestra I-EXPLORATION múltiples I-EXPLORATION áreas I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION esmerilado I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION pulmonares I-EXPLORATION superiores I-EXPLORATION y I-EXPLORATION lóbulo I-EXPLORATION medio, I-EXPLORATION atelectasias I-EXPLORATION bibasales I-EXPLORATION y I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION moderado I-EXPLORATION izquierdo, I-EXPLORATION adenopatías I-EXPLORATION mediastínicas I-EXPLORATION e I-EXPLORATION hiliares I-EXPLORATION bilaterales, I-EXPLORATION hepatoesplenomagalia I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION focales I-EXPLORATION hipovasculares, I-EXPLORATION en I-EXPLORATION hígado, I-EXPLORATION bazo I-EXPLORATION y I-EXPLORATION riñón. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION realizados I-EXPLORATION de I-EXPLORATION catéteres I-EXPLORATION resultados I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT toracocentesis I-TREATMENT evacuadora I-TREATMENT con I-TREATMENT estudio I-TREATMENT de I-TREATMENT líquido I-TREATMENT pleural I-TREATMENT que I-TREATMENT muestra I-TREATMENT exudado I-TREATMENT de I-TREATMENT predominio I-TREATMENT mononuclear. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION invalidante I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION y I-EVOLUTION flanco I-EVOLUTION izquierdos, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION realiza I-EVOLUTION control I-EVOLUTION radiológico I-EVOLUTION que I-EVOLUTION evidencia I-EVOLUTION regresión I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION hepáticas I-EVOLUTION y I-EVOLUTION renales, I-EVOLUTION pero I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION izquierdo I-EVOLUTION y I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION esplénicas I-EVOLUTION que I-EVOLUTION ahora I-EVOLUTION son I-EVOLUTION de I-EVOLUTION aspecto I-EVOLUTION hemorrágico. I-EVOLUTION Analizado B-TREATMENT el I-TREATMENT caso I-TREATMENT en I-TREATMENT forma I-TREATMENT multidisciplinaria I-TREATMENT se I-TREATMENT decide I-TREATMENT esplenectomía I-TREATMENT de I-TREATMENT desfocamiento I-TREATMENT y I-TREATMENT VTC, I-TREATMENT para I-TREATMENT evacuación I-TREATMENT y I-TREATMENT aseo I-TREATMENT pleural I-TREATMENT y, I-TREATMENT definir I-TREATMENT diagnóstico I-TREATMENT diferencial I-TREATMENT (neoplásico, I-TREATMENT tuberculoso I-TREATMENT y I-TREATMENT micosis I-TREATMENT invasora). I-TREATMENT Se I-TREATMENT efectúa I-TREATMENT VTC I-TREATMENT con I-TREATMENT evacuación I-TREATMENT de I-TREATMENT 2.000 I-TREATMENT ml I-TREATMENT de I-TREATMENT derrame I-TREATMENT pleural, I-TREATMENT aseo I-TREATMENT con I-TREATMENT solución I-TREATMENT salina, I-TREATMENT biopsia I-TREATMENT pleural I-TREATMENT y I-TREATMENT drenaje, I-TREATMENT observándose B-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 4 I-EXPLORATION mm I-EXPLORATION distribuidas I-EXPLORATION difusamente I-EXPLORATION en I-EXPLORATION pleura I-EXPLORATION parietal, I-EXPLORATION visceral I-EXPLORATION y I-EXPLORATION diafragmática. I-EXPLORATION Se I-EXPLORATION efectúa I-EXPLORATION laparotomía I-EXPLORATION observándose I-EXPLORATION esplenomegalia I-EXPLORATION hemorrágica I-EXPLORATION más I-EXPLORATION abscesos I-EXPLORATION esplénicos, I-EXPLORATION se B-TREATMENT practica I-TREATMENT esplenectomía I-TREATMENT para I-TREATMENT limpieza I-TREATMENT del I-TREATMENT foco. I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION tomadas I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION VTC I-EXPLORATION y I-EXPLORATION la I-EXPLORATION laparotomía I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION hifas I-EXPLORATION septadas. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION intraoperatorios I-EXPLORATION resultaron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION S. I-EXPLORATION capitata I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 72 I-EXPLORATION h. I-EXPLORATION Posterior B-EVOLUTION a I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION favorablemente I-EVOLUTION y B-TREATMENT se I-TREATMENT completan I-TREATMENT 58 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT liposomal I-TREATMENT (alcanzando I-TREATMENT una I-TREATMENT dosis I-TREATMENT acumulada I-TREATMENT de I-TREATMENT 2, I-TREATMENT 9 I-TREATMENT g I-TREATMENT sin I-TREATMENT manifestar I-TREATMENT efectos I-TREATMENT adversos) I-TREATMENT y I-TREATMENT 80 I-TREATMENT días I-TREATMENT con I-TREATMENT voriconazol I-TREATMENT (dosis I-TREATMENT acumulada I-TREATMENT de I-TREATMENT 32 I-TREATMENT g I-TREATMENT sin I-TREATMENT efectos I-TREATMENT adversos). I-TREATMENT Se B-EVOLUTION da I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones, I-EVOLUTION finalizando I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION oncológico I-EVOLUTION manteniéndose I-EVOLUTION durante I-EVOLUTION los I-EVOLUTION ciclos I-EVOLUTION de I-EVOLUTION quimioterapia I-EVOLUTION con I-EVOLUTION profilaxis I-EVOLUTION con I-EVOLUTION voriconazol. I-EVOLUTION A I-EVOLUTION más I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en B-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY personalidad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ánimo, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY intentos I-PAST_MEDICAL_HISTORY suicidas. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS febrero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2017 I-PRESENT_ILLNESS ingirió I-PRESENT_ILLNESS bupropión I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS g, I-PRESENT_ILLNESS clorpromazina I-PRESENT_ILLNESS 1, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS g I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS copas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vino. I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS familiares I-PRESENT_ILLNESS la I-PRESENT_ILLNESS encontraron I-PRESENT_ILLNESS alterada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS llevaron I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Salvador, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS comprometida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Glasgow I-PRESENT_ILLNESS 10, I-PRESENT_ILLNESS presión I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS 90/60, I-PRESENT_ILLNESS taquicárdica I-PRESENT_ILLNESS 115 I-PRESENT_ILLNESS lpm, I-PRESENT_ILLNESS electrocardiograma I-PRESENT_ILLNESS con I-PRESENT_ILLNESS segmento I-PRESENT_ILLNESS Q-t I-PRESENT_ILLNESS alargado I-PRESENT_ILLNESS (550 I-PRESENT_ILLNESS ms) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ácido I-PRESENT_ILLNESS láctico I-PRESENT_ILLNESS elevado I-PRESENT_ILLNESS (32, I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS mg/dl). I-PRESENT_ILLNESS Dentro B-EVOLUTION de I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION presentó I-EVOLUTION dos I-EVOLUTION breves I-EVOLUTION episodios I-EVOLUTION convulsivos, I-EVOLUTION de I-EVOLUTION 30 I-EVOLUTION seg I-EVOLUTION y I-EVOLUTION de I-EVOLUTION menos I-EVOLUTION de I-EVOLUTION un I-EVOLUTION minuto. I-EVOLUTION El B-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION mostró I-EXPLORATION actividad I-EXPLORATION delta-theta I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION voltaje, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION epilepsia. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION (TAC) I-EXPLORATION sin I-EXPLORATION contraste I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION tenía I-EXPLORATION escaza I-EXPLORATION reactividad I-EXPLORATION y I-EXPLORATION se I-EXPLORATION mantuvo I-EXPLORATION alterada I-EXPLORATION de I-EXPLORATION conciencia, I-EXPLORATION con I-EXPLORATION mioclonías I-EXPLORATION generalizadas I-EXPLORATION y I-EXPLORATION movimientos I-EXPLORATION involuntarios I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades; I-EXPLORATION tono I-EXPLORATION muscular I-EXPLORATION aumentado, I-EXPLORATION reflejos I-EXPLORATION osteotendíneos I-EXPLORATION (ROT) I-EXPLORATION policinéticos I-EXPLORATION y I-EXPLORATION reflejos I-EXPLORATION plantares I-EXPLORATION flexores. I-EXPLORATION En B-EVOLUTION la I-EVOLUTION mañana I-EVOLUTION del I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION sufrió I-EVOLUTION paro I-EVOLUTION cardiorrespiratorio I-EVOLUTION por I-EVOLUTION asistolia, I-EVOLUTION recibió B-TREATMENT reanimación I-TREATMENT inmediata, I-TREATMENT adrenalina, I-TREATMENT intubación, I-TREATMENT luego I-TREATMENT de I-TREATMENT 5 I-TREATMENT min I-TREATMENT logró I-TREATMENT actividad I-TREATMENT cardiaca I-TREATMENT espontánea. I-TREATMENT I-TREATMENT Al B-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION habían I-EVOLUTION desaparecido I-EVOLUTION las I-EVOLUTION mioclonías, I-EVOLUTION estaba I-EVOLUTION inconsciente I-EVOLUTION y I-EVOLUTION mantenía I-EVOLUTION una I-EVOLUTION persistente I-EVOLUTION apertura I-EVOLUTION palpebral I-EVOLUTION con I-EVOLUTION escaso I-EVOLUTION pestañeo I-EVOLUTION y I-EVOLUTION con I-EVOLUTION una I-EVOLUTION sobre-elevación I-EVOLUTION anormal I-EVOLUTION de I-EVOLUTION los I-EVOLUTION ojos, I-EVOLUTION como I-EVOLUTION mirando I-EVOLUTION hacia I-EVOLUTION atrás. I-EVOLUTION Las I-EVOLUTION pupilas I-EVOLUTION estaban I-EVOLUTION iguales I-EVOLUTION y I-EVOLUTION reactivas I-EVOLUTION a I-EVOLUTION la I-EVOLUTION luz, I-EVOLUTION con I-EVOLUTION reflejos I-EVOLUTION oculocefálicos I-EVOLUTION conservados. I-EVOLUTION Sus I-EVOLUTION extremidades I-EVOLUTION se I-EVOLUTION mostraban I-EVOLUTION hipotónicas I-EVOLUTION y I-EVOLUTION tenía I-EVOLUTION los I-EVOLUTION ROT I-EVOLUTION exaltados I-EVOLUTION con I-EVOLUTION Babinski I-EVOLUTION bilateral. I-EVOLUTION Los B-EXPLORATION estímulos I-EXPLORATION nociceptivos I-EXPLORATION desencadenaban I-EXPLORATION respuestas I-EXPLORATION extensoras I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cuatro I-EXPLORATION extremidades I-EXPLORATION y I-EXPLORATION un I-EXPLORATION simultáneo I-EXPLORATION cierre I-EXPLORATION palpebral I-EXPLORATION con I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION los I-EXPLORATION globos I-EXPLORATION oculares, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION la I-EXPLORATION reapertura I-EXPLORATION palpebral I-EXPLORATION volvían I-EXPLORATION a I-EXPLORATION elevarse I-EXPLORATION simulando I-EXPLORATION un I-EXPLORATION rebote I-EXPLORATION ocular. I-EXPLORATION El I-EXPLORATION fenómeno I-EXPLORATION se I-EXPLORATION repetía I-EXPLORATION con I-EXPLORATION cualquier I-EXPLORATION estímulo. I-EXPLORATION La I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION realizada I-EXPLORATION al I-EXPLORATION octavo I-EXPLORATION día, I-EXPLORATION mostró I-EXPLORATION en I-EXPLORATION la I-EXPLORATION difusión I-EXPLORATION imágenes I-EXPLORATION hiperintensas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sustancia I-EXPLORATION blanca I-EXPLORATION del I-EXPLORATION centro I-EXPLORATION oval I-EXPLORATION y I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION calloso I-EXPLORATION y I-EXPLORATION en I-EXPLORATION secuencia I-EXPLORATION FLAIR I-EXPLORATION áreas I-EXPLORATION menores I-EXPLORATION hiperintensas I-EXPLORATION en I-EXPLORATION ganglios I-EXPLORATION basales I-EXPLORATION y I-EXPLORATION corteza, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION una I-EXPLORATION encefalopatía I-EXPLORATION hipóxico-isquémica. I-EXPLORATION I-EXPLORATION La B-EVOLUTION supraversión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mirada I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION al I-EVOLUTION menos I-EVOLUTION diez I-EVOLUTION días, I-EVOLUTION luego I-EVOLUTION la I-EVOLUTION mirada I-EVOLUTION se I-EVOLUTION hizo I-EVOLUTION central, I-EVOLUTION mientras I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION seguía I-EVOLUTION en I-EVOLUTION coma I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION variaciones I-EVOLUTION después I-EVOLUTION de I-EVOLUTION un I-EVOLUTION mes. I-EVOLUTION Las I-EVOLUTION pupilas I-EVOLUTION se I-EVOLUTION mantenían I-EVOLUTION iguales I-EVOLUTION con I-EVOLUTION respuesta I-EVOLUTION a I-EVOLUTION la I-EVOLUTION luz I-EVOLUTION y I-EVOLUTION reflejos I-EVOLUTION oculocefálicos I-EVOLUTION conservados, I-EVOLUTION los I-EVOLUTION ROT I-EVOLUTION estaban I-EVOLUTION vivos I-EVOLUTION con I-EVOLUTION reflejos I-EVOLUTION plantares I-EVOLUTION extensores. I-EVOLUTION Los I-EVOLUTION estímulos I-EVOLUTION nociseptivos I-EVOLUTION seguían I-EVOLUTION generando I-EVOLUTION respuestas I-EVOLUTION extensoras. I-EVOLUTION El I-EVOLUTION EEG I-EVOLUTION estaba I-EVOLUTION prácticamente I-EVOLUTION plano. I-EVOLUTION La B-EXPLORATION RM I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION definida I-EXPLORATION atrofia I-EXPLORATION cerebral, I-EXPLORATION con I-EXPLORATION hiperintensidades I-EXPLORATION en I-EXPLORATION los I-EXPLORATION núcleos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION y I-EXPLORATION en I-EXPLORATION distintas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION corteza I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION cerebelosa. I-EXPLORATION Había B-EVOLUTION desaparecido I-EVOLUTION la I-EVOLUTION hiperintensidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION substancia I-EVOLUTION blanca. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 47 I-EVOLUTION días. I-EVOLUTION I-EVOLUTION Ingresa B-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Hematología I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY masculino I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY LLA I-PAST_MEDICAL_HISTORY común, I-PAST_MEDICAL_HISTORY (Philadelphia I-PAST_MEDICAL_HISTORY negativo). I-PAST_MEDICAL_HISTORY Inducción B-TREATMENT con I-TREATMENT esquema I-TREATMENT LLA I-TREATMENT 15-30 I-TREATMENT según I-TREATMENT protocolo, I-TREATMENT con I-TREATMENT rápida I-TREATMENT respuesta I-TREATMENT y I-TREATMENT remisión I-TREATMENT completa. I-TREATMENT En I-TREATMENT la I-TREATMENT etapa I-TREATMENT de I-TREATMENT consolidación I-TREATMENT se I-TREATMENT inició I-TREATMENT QI I-TREATMENT triple I-TREATMENT (Metrotrexato I-TREATMENT 15 I-TREATMENT mg, I-TREATMENT Citarabina I-TREATMENT 50 I-TREATMENT mg, I-TREATMENT Betametasona I-TREATMENT 4 I-TREATMENT mg). I-TREATMENT Durante B-EVOLUTION esta I-EVOLUTION etapa I-EVOLUTION apareció I-EVOLUTION neutropenia I-EVOLUTION y I-EVOLUTION el I-EVOLUTION mielograma I-EVOLUTION mostró I-EVOLUTION 71% I-EVOLUTION de I-EVOLUTION linfoblastos I-EVOLUTION y I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION blastos I-EVOLUTION en I-EVOLUTION LCR, I-EVOLUTION sin I-EVOLUTION síntomas I-EVOLUTION neurológicos. I-EVOLUTION Se I-EVOLUTION definió I-EVOLUTION como I-EVOLUTION una I-EVOLUTION recaída I-EVOLUTION combinada I-EVOLUTION precoz. I-EVOLUTION En B-TREATMENT la I-TREATMENT terapia I-TREATMENT de I-TREATMENT rescate, I-TREATMENT recibió I-TREATMENT seis I-TREATMENT pulsos I-TREATMENT de I-TREATMENT QI, I-TREATMENT lográndose I-TREATMENT remisión I-TREATMENT completa I-TREATMENT y I-TREATMENT desaparición I-TREATMENT de I-TREATMENT los I-TREATMENT blastos I-TREATMENT del I-TREATMENT LCR. I-TREATMENT Al I-TREATMENT octavo I-TREATMENT mes I-TREATMENT se I-TREATMENT continuó I-TREATMENT con I-TREATMENT block I-TREATMENT R2. I-TREATMENT Después B-EVOLUTION del I-EVOLUTION primer I-EVOLUTION procedimiento I-EVOLUTION intratecal I-EVOLUTION inició I-EVOLUTION inestabilidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION marcha. I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION vigil, I-EXPLORATION orientado, I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION pares I-EXPLORATION craneanos, I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION la I-EXPLORATION potencia I-EXPLORATION muscular, I-EXPLORATION ROT I-EXPLORATION preservados, I-EXPLORATION marcha I-EXPLORATION insegura, I-EXPLORATION Romberg I-EXPLORATION positivo I-EXPLORATION y I-EXPLORATION alteración I-EXPLORATION propioceptiva I-EXPLORATION en I-EXPLORATION las I-EXPLORATION EEII, I-EXPLORATION prueba I-EXPLORATION índice-nariz I-EXPLORATION y I-EXPLORATION talón-rodilla I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT quimioterapia, I-TREATMENT iniciándose I-TREATMENT Tiamina I-TREATMENT 90 I-TREATMENT mg I-TREATMENT c/12 I-TREATMENT h, I-TREATMENT Piridoxina I-TREATMENT 150 I-TREATMENT mg I-TREATMENT c/12 I-TREATMENT h, I-TREATMENT Leucovorina I-TREATMENT 50 I-TREATMENT mg I-TREATMENT c/12 I-TREATMENT h, I-TREATMENT Cianocobalamina I-TREATMENT 2 I-TREATMENT ampollas I-TREATMENT y I-TREATMENT c/24 I-TREATMENT h I-TREATMENT Meteonina I-TREATMENT S-adenosylmetionina. I-TREATMENT I-TREATMENT Dos B-EVOLUTION días I-EVOLUTION después I-EVOLUTION paciente I-EVOLUTION vigil I-EVOLUTION con I-EVOLUTION funciones I-EVOLUTION superiores I-EVOLUTION preservadas, I-EVOLUTION había I-EVOLUTION progresado I-EVOLUTION la I-EVOLUTION inestabilidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION marcha, I-EVOLUTION agregándose I-EVOLUTION hipostesia I-EVOLUTION táctil, I-EVOLUTION dificultad I-EVOLUTION para I-EVOLUTION la I-EVOLUTION bipedestación I-EVOLUTION por I-EVOLUTION debilidad I-EVOLUTION proximal I-EVOLUTION de I-EVOLUTION EEII, I-EVOLUTION hiperreflexia, I-EVOLUTION Babinski I-EVOLUTION e I-EVOLUTION incontinencia I-EVOLUTION urinaria. I-EVOLUTION RM B-EXPLORATION de I-EXPLORATION médula I-EXPLORATION mostró I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION en I-EXPLORATION cordones I-EXPLORATION posteriores I-EXPLORATION desde I-EXPLORATION cervical I-EXPLORATION a I-EXPLORATION T11. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION aumentó I-EVOLUTION la I-EVOLUTION debilidad I-EVOLUTION en I-EVOLUTION EEII I-EVOLUTION y I-EVOLUTION pared I-EVOLUTION abdominal, I-EVOLUTION ROT I-EVOLUTION apagados, I-EVOLUTION Babinski, I-EVOLUTION las I-EVOLUTION alteraciones I-EVOLUTION propioceptivas I-EVOLUTION persistían, I-EVOLUTION tenía I-EVOLUTION preservada I-EVOLUTION la I-EVOLUTION sensibilidad I-EVOLUTION dolorosa, I-EVOLUTION sin I-EVOLUTION compromiso I-EVOLUTION en I-EVOLUTION EESS. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION día I-EVOLUTION decimosegundo I-EVOLUTION tenía I-EVOLUTION paraplejia I-EVOLUTION fláccida, I-EVOLUTION ROT I-EVOLUTION abolidos, I-EVOLUTION sin I-EVOLUTION nivel I-EVOLUTION sensitivo. I-EVOLUTION Un I-EVOLUTION hemograma I-EVOLUTION con I-EVOLUTION recaída I-EVOLUTION leucémica I-EVOLUTION en I-EVOLUTION el I-EVOLUTION día I-EVOLUTION decimonono I-EVOLUTION obligó I-EVOLUTION a I-EVOLUTION continuar I-EVOLUTION con I-EVOLUTION cuidados I-EVOLUTION paliativos I-EVOLUTION en I-EVOLUTION su I-EVOLUTION domicilio. I-EVOLUTION El I-EVOLUTION compromiso I-EVOLUTION neurológico I-EVOLUTION no I-EVOLUTION progresó, I-EVOLUTION falleciendo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION LLA. I-EVOLUTION I-EVOLUTION Mujer, B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY hijos. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 17 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY diagnosticó I-PAST_MEDICAL_HISTORY DM I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY polidipsia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY poliuria, I-PAST_MEDICAL_HISTORY asociada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY glicemia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ayunas I-PAST_MEDICAL_HISTORY 130 I-PAST_MEDICAL_HISTORY mg/dl, I-PAST_MEDICAL_HISTORY confirmada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY prueba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tolerancia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY glucosa I-PAST_MEDICAL_HISTORY oral I-PAST_MEDICAL_HISTORY (PTGO) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 75 I-PAST_MEDICAL_HISTORY g: I-PAST_MEDICAL_HISTORY 116 I-PAST_MEDICAL_HISTORY mg/dl I-PAST_MEDICAL_HISTORY ayunas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 234 I-PAST_MEDICAL_HISTORY mg/dl I-PAST_MEDICAL_HISTORY post I-PAST_MEDICAL_HISTORY carga. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION descartó I-EXPLORATION DM1 I-EXPLORATION por I-EXPLORATION autoanticuerpos I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION péptido I-EXPLORATION C I-EXPLORATION normal, I-EXPLORATION HbA1c I-EXPLORATION 6, I-EXPLORATION 8% I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION y I-EXPLORATION orina I-EXPLORATION sin I-EXPLORATION glucosuria. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION RI, I-EXPLORATION talla I-EXPLORATION 1, I-EXPLORATION 56 I-EXPLORATION m I-EXPLORATION y I-EXPLORATION peso I-EXPLORATION 44, I-EXPLORATION 5 I-EXPLORATION kg, I-EXPLORATION IMC I-EXPLORATION 18 I-EXPLORATION kg/m2. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT no I-TREATMENT farmacológico I-TREATMENT y I-TREATMENT metformina I-TREATMENT 850 I-TREATMENT mg/2 I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT Evolucionó B-EVOLUTION satisfactoriamente I-EVOLUTION durante I-EVOLUTION 4 I-EVOLUTION años, I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION complicaciones, I-EVOLUTION mantuvo I-EVOLUTION HbA1c I-EVOLUTION entre I-EVOLUTION 6-7%. I-EVOLUTION En B-TREATMENT enero I-TREATMENT de I-TREATMENT 2015 I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT metformina I-TREATMENT por I-TREATMENT intolerancia I-TREATMENT gástrica I-TREATMENT y I-TREATMENT considerando I-TREATMENT la I-TREATMENT evolución I-TREATMENT y B-FAMILY_HISTORY los I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY DM, I-FAMILY_HISTORY se B-TREATMENT planteó I-TREATMENT que I-TREATMENT podría I-TREATMENT presentar I-TREATMENT MODY. I-TREATMENT I-TREATMENT Se B-FAMILY_HISTORY estudió I-FAMILY_HISTORY la I-FAMILY_HISTORY DM I-FAMILY_HISTORY en I-FAMILY_HISTORY familiares I-FAMILY_HISTORY con I-FAMILY_HISTORY PTGO, I-FAMILY_HISTORY pesquisándose I-FAMILY_HISTORY DM I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY padre. I-FAMILY_HISTORY Su I-FAMILY_HISTORY hermano I-FAMILY_HISTORY presentaba I-FAMILY_HISTORY anormalidad I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY glicemia. I-FAMILY_HISTORY La I-FAMILY_HISTORY madre I-FAMILY_HISTORY no I-FAMILY_HISTORY tenía I-FAMILY_HISTORY DM. I-FAMILY_HISTORY I-FAMILY_HISTORY *Rango I-FAMILY_HISTORY normal: I-FAMILY_HISTORY 1, I-FAMILY_HISTORY 1 I-FAMILY_HISTORY – I-FAMILY_HISTORY 4, I-FAMILY_HISTORY 4 I-FAMILY_HISTORY ng/ml. I-FAMILY_HISTORY I-FAMILY_HISTORY De I-FAMILY_HISTORY la I-FAMILY_HISTORY anamnesis I-FAMILY_HISTORY familiar I-FAMILY_HISTORY destaca I-FAMILY_HISTORY una I-FAMILY_HISTORY fuerte I-FAMILY_HISTORY presencia I-FAMILY_HISTORY de I-FAMILY_HISTORY DM I-FAMILY_HISTORY por I-FAMILY_HISTORY la I-FAMILY_HISTORY línea I-FAMILY_HISTORY paterna, I-FAMILY_HISTORY donde I-FAMILY_HISTORY 8 I-FAMILY_HISTORY de I-FAMILY_HISTORY 9 I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY del I-FAMILY_HISTORY padre I-FAMILY_HISTORY del I-FAMILY_HISTORY caso I-FAMILY_HISTORY índice, I-FAMILY_HISTORY están I-FAMILY_HISTORY diagnosticados I-FAMILY_HISTORY con I-FAMILY_HISTORY DM2, I-FAMILY_HISTORY además I-FAMILY_HISTORY de I-FAMILY_HISTORY ambos I-FAMILY_HISTORY abuelos. I-FAMILY_HISTORY Por I-FAMILY_HISTORY la I-FAMILY_HISTORY línea I-FAMILY_HISTORY materna, I-FAMILY_HISTORY solamente I-FAMILY_HISTORY la I-FAMILY_HISTORY abuela I-FAMILY_HISTORY y I-FAMILY_HISTORY una I-FAMILY_HISTORY tía I-FAMILY_HISTORY tienen I-FAMILY_HISTORY DM2. I-FAMILY_HISTORY I-FAMILY_HISTORY Se B-EXPLORATION utilizó I-EXPLORATION la I-EXPLORATION aplicación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Exeter5, I-EXPLORATION estimándose I-EXPLORATION que I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION MODY I-EXPLORATION con I-EXPLORATION una I-EXPLORATION probabilidad I-EXPLORATION de I-EXPLORATION 75, I-EXPLORATION 5%. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION familiar, I-EXPLORATION para I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION contaba I-EXPLORATION con I-EXPLORATION el I-EXPLORATION consentimiento I-EXPLORATION informado I-EXPLORATION de I-EXPLORATION los I-EXPLORATION participantes I-EXPLORATION y I-EXPLORATION la I-EXPLORATION aprobación I-EXPLORATION del I-EXPLORATION Comité I-EXPLORATION de I-EXPLORATION Ética I-EXPLORATION del I-EXPLORATION Hospital I-EXPLORATION San I-EXPLORATION Juan I-EXPLORATION de I-EXPLORATION Dios. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION análisis I-EXPLORATION genético-molecular I-EXPLORATION (Laboratorio I-EXPLORATION de I-EXPLORATION Genética I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Red I-EXPLORATION UC-Christus I-EXPLORATION Santiago, I-EXPLORATION Chile) I-EXPLORATION de I-EXPLORATION los I-EXPLORATION exones I-EXPLORATION 1 I-EXPLORATION a I-EXPLORATION 10 I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION GCK I-EXPLORATION mediante I-EXPLORATION secuenciación I-EXPLORATION directa I-EXPLORATION de I-EXPLORATION las I-EXPLORATION regiones I-EXPLORATION codificantes I-EXPLORATION y I-EXPLORATION de I-EXPLORATION las I-EXPLORATION uniones I-EXPLORATION intrón-exón. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION mutación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION posición I-EXPLORATION 1343 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION exón I-EXPLORATION 10 I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION GCK, I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION cambio I-EXPLORATION de I-EXPLORATION guanina I-EXPLORATION por I-EXPLORATION adenina I-EXPLORATION (1343 I-EXPLORATION G>A); I-EXPLORATION en I-EXPLORATION el I-EXPLORATION otro I-EXPLORATION alelo I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION dicha I-EXPLORATION mutación I-EXPLORATION (paciente I-EXPLORATION heterocigota). I-EXPLORATION I-EXPLORATION El I-EXPLORATION padre I-EXPLORATION y I-EXPLORATION el I-EXPLORATION hermano I-EXPLORATION presentan I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION mutación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION GCK I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION heterocigota. I-EXPLORATION La I-EXPLORATION madre I-EXPLORATION mostró I-EXPLORATION ambos I-EXPLORATION alelos I-EXPLORATION silvestres, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION no I-EXPLORATION es I-EXPLORATION MODY2 I-EXPLORATION ni I-EXPLORATION tiene I-EXPLORATION DM. I-EXPLORATION La I-EXPLORATION variante I-EXPLORATION encontrada I-EXPLORATION probablemente I-EXPLORATION es I-EXPLORATION patogénica, I-EXPLORATION pues I-EXPLORATION genera I-EXPLORATION un I-EXPLORATION cambio I-EXPLORATION no I-EXPLORATION sinónimo I-EXPLORATION o I-EXPLORATION missense I-EXPLORATION del I-EXPLORATION aminoácido I-EXPLORATION (aa) I-EXPLORATION glicina I-EXPLORATION por I-EXPLORATION ácido I-EXPLORATION aspártico I-EXPLORATION (Gly448Asp) I-EXPLORATION en I-EXPLORATION la I-EXPLORATION enzima I-EXPLORATION glucoquinasa I-EXPLORATION (GCK). I-EXPLORATION Estos I-EXPLORATION resultados I-EXPLORATION permiten I-EXPLORATION establecer I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION MODY2 I-EXPLORATION en I-EXPLORATION una I-EXPLORATION familia I-EXPLORATION chilena I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION una I-EXPLORATION mutación I-EXPLORATION no I-EXPLORATION descrita I-EXPLORATION previamente. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA), I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY asociada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY subclínico. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS evaluó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS control I-PRESENT_ILLNESS de I-PRESENT_ILLNESS HTA I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diabetes I-PRESENT_ILLNESS mellitus. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION facies I-EXPLORATION cushingoide I-EXPLORATION y I-EXPLORATION relleno I-EXPLORATION de I-EXPLORATION huecos I-EXPLORATION supraclaviculares. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION cortisol I-EXPLORATION libre I-EXPLORATION urinario I-EXPLORATION (CLU): I-EXPLORATION 236 I-EXPLORATION ug/24 I-EXPLORATION h I-EXPLORATION (VN I-EXPLORATION hasta I-EXPLORATION 100 I-EXPLORATION ug/24 I-EXPLORATION h), I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Nugent I-EXPLORATION o I-EXPLORATION de I-EXPLORATION supresión I-EXPLORATION nocturna I-EXPLORATION con I-EXPLORATION dexametasona I-EXPLORATION (Dx) I-EXPLORATION 1 I-EXPLORATION mg: I-EXPLORATION 11, I-EXPLORATION 1 I-EXPLORATION ug/dl I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1, I-EXPLORATION 8 I-EXPLORATION ug/dl), I-EXPLORATION ACTH I-EXPLORATION 32, I-EXPLORATION 1pg/ml I-EXPLORATION (VN I-EXPLORATION hasta I-EXPLORATION 46 I-EXPLORATION pg/ml). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION funcional: I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Dx/ I-EXPLORATION desmopresina, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION respuesta I-EXPLORATION de I-EXPLORATION cortisol I-EXPLORATION postestímulo, I-EXPLORATION sugiriendo I-EXPLORATION origen I-EXPLORATION hipofisiario. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION silla I-EXPLORATION turca I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION adenoma I-EXPLORATION posterolateral I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm, I-EXPLORATION que I-EXPLORATION determina I-EXPLORATION leve I-EXPLORATION remodelación I-EXPLORATION del I-EXPLORATION piso I-EXPLORATION selar. I-EXPLORATION Por B-TREATMENT distintas I-TREATMENT razones, I-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT se I-TREATMENT realizó I-TREATMENT cirugía. I-TREATMENT En B-EXPLORATION controles I-EXPLORATION sucesivos I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION CLU I-EXPLORATION sin I-EXPLORATION mediar I-EXPLORATION tratamiento. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 3 I-EXPLORATION años I-EXPLORATION tuvo I-EXPLORATION un I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Nugent I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION ng/dl, I-EXPLORATION ACTH: I-EXPLORATION 54, I-EXPLORATION 8 I-EXPLORATION pg/ml I-EXPLORATION y I-EXPLORATION CLU: I-EXPLORATION 50, I-EXPLORATION 1 I-EXPLORATION ug/24 I-EXPLORATION h. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION silla I-EXPLORATION turca I-EXPLORATION mostró I-EXPLORATION adenoma I-EXPLORATION de I-EXPLORATION similares I-EXPLORATION características, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION intratumoral. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 7 I-EXPLORATION años I-EXPLORATION tiene I-EXPLORATION CLU I-EXPLORATION 28, I-EXPLORATION 8 I-EXPLORATION ug/24 I-EXPLORATION h, I-EXPLORATION la I-EXPLORATION diabetes I-EXPLORATION mellitus I-EXPLORATION mantiene I-EXPLORATION un I-EXPLORATION control I-EXPLORATION adecuado I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION (HbA1c: I-EXPLORATION 7, I-EXPLORATION 6%) I-EXPLORATION y I-EXPLORATION ha I-EXPLORATION disminuido I-EXPLORATION 10 I-EXPLORATION kilos I-EXPLORATION de I-EXPLORATION peso I-EXPLORATION desde I-EXPLORATION su I-EXPLORATION evaluación I-EXPLORATION inicial. I-EXPLORATION I-EXPLORATION Ambas B-EVOLUTION pacientes I-EVOLUTION aún I-EVOLUTION sobreviven, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 82 I-EVOLUTION y I-EVOLUTION 88 I-EVOLUTION años, I-EVOLUTION respectivamente I-EVOLUTION y I-EVOLUTION no I-EVOLUTION manifiestan I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION hiperfunción I-EVOLUTION endocrina. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS zurdo, B-PAST_MEDICAL_HISTORY hipertenso, I-PAST_MEDICAL_HISTORY despertó I-PAST_MEDICAL_HISTORY desorientado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY disártrico, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY déficit I-PAST_MEDICAL_HISTORY sensitivo-motor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY extremidades I-PAST_MEDICAL_HISTORY derechas. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS vigilia, I-PRESENT_ILLNESS cumplía I-PRESENT_ILLNESS órdenes I-PRESENT_ILLNESS simples, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS embargo, I-PRESENT_ILLNESS mantenía I-PRESENT_ILLNESS cerrados I-PRESENT_ILLNESS los I-PRESENT_ILLNESS ojos, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS apertura I-PRESENT_ILLNESS mecánica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS párpados I-PRESENT_ILLNESS mostró I-PRESENT_ILLNESS pupilas I-PRESENT_ILLNESS iguales, I-PRESENT_ILLNESS oculomotilidad I-PRESENT_ILLNESS conservada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mirada I-PRESENT_ILLNESS preferencial I-PRESENT_ILLNESS a I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS hemiplejia I-PRESENT_ILLNESS faciobraquiocrural I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hemianopsia. I-PRESENT_ILLNESS La B-EXPLORATION TC I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION mostró I-EXPLORATION hematoma I-EXPLORATION fronto-parietal I-EXPLORATION izquierdo. I-EXPLORATION Al B-TREATMENT segundo I-TREATMENT día, I-TREATMENT debido I-TREATMENT al I-TREATMENT progresivo I-TREATMENT deterioro I-TREATMENT clínico, I-TREATMENT fue I-TREATMENT necesario I-TREATMENT drenar I-TREATMENT el I-TREATMENT hematoma, I-TREATMENT que B-EVOLUTION evolucionó I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION Permaneció I-EVOLUTION comprometido I-EVOLUTION de I-EVOLUTION conciencia I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION sexto I-EVOLUTION día. I-EVOLUTION Cuando I-EVOLUTION recuperó I-EVOLUTION la I-EVOLUTION vigilancia I-EVOLUTION podía I-EVOLUTION apretar I-EVOLUTION la I-EVOLUTION mano I-EVOLUTION izquierda, I-EVOLUTION pero I-EVOLUTION era I-EVOLUTION incapaz I-EVOLUTION de I-EVOLUTION abrir I-EVOLUTION voluntariamente I-EVOLUTION los I-EVOLUTION ojos, I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION comprobar I-EVOLUTION que I-EVOLUTION conservaba I-EVOLUTION la I-EVOLUTION oculomotilidad I-EVOLUTION voluntaria I-EVOLUTION y I-EVOLUTION dirigía I-EVOLUTION la I-EVOLUTION mirada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION orden. I-EVOLUTION Desde I-EVOLUTION el I-EVOLUTION octavo I-EVOLUTION día I-EVOLUTION inició I-EVOLUTION apertura I-EVOLUTION palpebral I-EVOLUTION parcial I-EVOLUTION y I-EVOLUTION transitoria I-EVOLUTION del I-EVOLUTION ojo I-EVOLUTION izquierdo. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION días I-EVOLUTION subsiguientes I-EVOLUTION lograba I-EVOLUTION la I-EVOLUTION elevación I-EVOLUTION transitoria I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION párpados, I-EVOLUTION notándose I-EVOLUTION al I-EVOLUTION decimosegundo I-EVOLUTION día I-EVOLUTION mayor I-EVOLUTION apertura I-EVOLUTION del I-EVOLUTION ojo I-EVOLUTION derecho. I-EVOLUTION Después I-EVOLUTION del I-EVOLUTION decimotercer I-EVOLUTION día I-EVOLUTION tenía I-EVOLUTION elevación I-EVOLUTION persistente I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION párpados. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EF, I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY miocardiopatía. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY inicia I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY quemante I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pies I-PAST_MEDICAL_HISTORY desencadenadas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ejercicio, I-PAST_MEDICAL_HISTORY exposición I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY sol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fiebre. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY disminución I-PAST_MEDICAL_HISTORY progresiva I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY crisis. I-PAST_MEDICAL_HISTORY Ocasionalmente I-PAST_MEDICAL_HISTORY sensación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mareo I-PAST_MEDICAL_HISTORY subjetivo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estitiquez-diarrea. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 42 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY parte I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY familiar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY medición I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY niveles I-PAST_MEDICAL_HISTORY enzimáticos. I-PAST_MEDICAL_HISTORY Inició I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY reemplazo I-PAST_MEDICAL_HISTORY enzimático I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 45 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS se I-PRESENT_ILLNESS diagnostica I-PRESENT_ILLNESS miocardiopatía I-PRESENT_ILLNESS hipertrófica I-PRESENT_ILLNESS y B-TREATMENT se I-TREATMENT instala I-TREATMENT marcapaso. I-TREATMENT Escasos B-EXPLORATION angioqueratomas. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION neurológico I-EXPLORATION mostro I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION polineuropatía I-EXPLORATION sensitiva I-EXPLORATION y I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION neurofisiológica I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION polineuropatía I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION sensitivo I-EXPLORATION axonal I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION mielínicas I-EXPLORATION gruesas I-EXPLORATION y I-EXPLORATION severo I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION mielínicas I-EXPLORATION delgadas I-EXPLORATION y I-EXPLORATION amielínicas, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION una I-EXPLORATION radiculopatía I-EXPLORATION L5-S1 I-EXPLORATION izquierda. I-EXPLORATION Ausencia I-EXPLORATION generalizada I-EXPLORATION de I-EXPLORATION RSC. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION evaluación I-EXPLORATION intervalo I-EXPLORATION R-R, I-EXPLORATION debido I-EXPLORATION al I-EXPLORATION uso I-EXPLORATION de I-EXPLORATION marcapasos. I-EXPLORATION I-EXPLORATION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS inicia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS quemante I-PRESENT_ILLNESS en I-PRESENT_ILLNESS manos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pies, I-PRESENT_ILLNESS desencadenados I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ejercicio, I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS calor I-PRESENT_ILLNESS o I-PRESENT_ILLNESS frío. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pies I-PRESENT_ILLNESS congelados, I-PRESENT_ILLNESS para I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS pone I-PRESENT_ILLNESS pies I-PRESENT_ILLNESS en I-PRESENT_ILLNESS agua I-PRESENT_ILLNESS tibia I-PRESENT_ILLNESS o I-PRESENT_ILLNESS los I-PRESENT_ILLNESS abriga. I-PRESENT_ILLNESS Ocasionalmente I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pinchazos. I-PRESENT_ILLNESS Distensión I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS ocasional. I-PRESENT_ILLNESS Escasos B-EXPLORATION angioqueratomas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION reciente I-EXPLORATION en I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION estudio I-EXPLORATION familiar, I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION enzimáticos. I-EXPLORATION Inicio B-TREATMENT reciente I-TREATMENT de I-TREATMENT terapia I-TREATMENT de I-TREATMENT remplazo I-TREATMENT enzimática. I-TREATMENT Evaluación B-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION neurofisiológica I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION neuropático I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION mielínicas I-EXPLORATION delgadas I-EXPLORATION y I-EXPLORATION amielínicas. I-EXPLORATION Ausencia I-EXPLORATION generalizada I-EXPLORATION de I-EXPLORATION RSC I-EXPLORATION y I-EXPLORATION evaluación I-EXPLORATION de I-EXPLORATION intervalo I-EXPLORATION R-R I-EXPLORATION en I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS trasladado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS UCI I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disnea, I-PRESENT_ILLNESS hipotensión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS desaturación, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39.5°C. I-PRESENT_ILLNESS Se B-EXPLORATION diagnostica I-EXPLORATION de I-EXPLORATION shock I-EXPLORATION séptico I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION colitis I-EXPLORATION infecciosa. I-EXPLORATION A B-TREATMENT su I-TREATMENT ingreso I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT drogas I-TREATMENT vasoactivas I-TREATMENT (noradrenalina I-TREATMENT a I-TREATMENT 0.1 I-TREATMENT ugr/kg/min I-TREATMENT y I-TREATMENT dopamina I-TREATMENT a I-TREATMENT 6 I-TREATMENT ugr/kg/min) I-TREATMENT y I-TREATMENT cobertura I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION llegada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION UCI, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION comienza I-EVOLUTION a I-EVOLUTION realizar I-EVOLUTION deposiciones I-EVOLUTION con I-EVOLUTION aspecto I-EVOLUTION melénico I-EVOLUTION en I-EVOLUTION cantidad I-EVOLUTION abundante. I-EVOLUTION Para B-EXPLORATION facilitar I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION exacta I-EXPLORATION del I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION las I-EXPLORATION heces, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION el I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mismas I-EXPLORATION se I-EXPLORATION coloca I-EXPLORATION un I-EXPLORATION dispositivo I-EXPLORATION de I-EXPLORATION incontinencia I-EXPLORATION fecal I-EXPLORATION Flexi-Seal I-EXPLORATION FMS. I-EXPLORATION Dicho I-EXPLORATION dispositivo I-EXPLORATION se I-EXPLORATION mantuvo I-EXPLORATION colocado I-EXPLORATION durante I-EXPLORATION 6 I-EXPLORATION días I-EXPLORATION sin I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION ninguna I-EXPLORATION complicación, I-EXPLORATION procediéndose I-EXPLORATION a I-EXPLORATION su I-EXPLORATION retirada I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION heces, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION el I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION consistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mismas. I-EXPLORATION En B-TREATMENT su I-TREATMENT 8º I-TREATMENT día I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT se I-TREATMENT inicia I-TREATMENT aporte I-TREATMENT nutricional I-TREATMENT por I-TREATMENT vía I-TREATMENT enteral, I-TREATMENT con I-TREATMENT una I-TREATMENT mala I-TREATMENT tolerancia I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT paciente, I-TREATMENT realizando I-TREATMENT varias I-TREATMENT deposiciones I-TREATMENT diarias I-TREATMENT aunque I-TREATMENT en I-TREATMENT escasa I-TREATMENT cantidad. I-TREATMENT Además, I-TREATMENT una I-TREATMENT vez I-TREATMENT solucionado I-TREATMENT el I-TREATMENT episodio I-TREATMENT de I-TREATMENT sangrado I-TREATMENT digestivo I-TREATMENT se I-TREATMENT inicio I-TREATMENT profilaxis I-TREATMENT antitrombótica I-TREATMENT con I-TREATMENT enoxaparina I-TREATMENT 40 I-TREATMENT mg/día I-TREATMENT subcutáneo. I-TREATMENT En B-EVOLUTION el I-EVOLUTION día I-EVOLUTION 25º I-EVOLUTION tras I-EVOLUTION de I-EVOLUTION la I-EVOLUTION retirada I-EVOLUTION del I-EVOLUTION dispositivo, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION comienza I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION brusca I-EVOLUTION con I-EVOLUTION dos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION rectorragia I-EVOLUTION importante, I-EVOLUTION sin I-EVOLUTION producirse I-EVOLUTION inestabilización I-EVOLUTION hemodinámica. I-EVOLUTION Se B-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION urgente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION normal I-EXPLORATION hasta I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION recto I-EXPLORATION distal, I-EXPLORATION lugar I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION ulceración I-EXPLORATION que I-EXPLORATION abarca I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION circunferencia, I-EXPLORATION existiendo I-EXPLORATION además I-EXPLORATION depósitos I-EXPLORATION de I-EXPLORATION fibrina I-EXPLORATION y I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION necrótico, I-EXPLORATION que I-EXPLORATION impresiona I-EXPLORATION de I-EXPLORATION ulceración I-EXPLORATION por I-EXPLORATION sonda. I-EXPLORATION I-EXPLORATION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY municipio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Puerto I-PAST_MEDICAL_HISTORY Guzmán, I-PAST_MEDICAL_HISTORY Putumayo, I-PAST_MEDICAL_HISTORY llevada B-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS supurante I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cuello I-PRESENT_ILLNESS presente I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS nacimiento, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cedió I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antibióticos. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION que I-EXPLORATION sugería I-EXPLORATION una I-EXPLORATION fístula, I-EXPLORATION según I-EXPLORATION lo I-EXPLORATION referido I-EXPLORATION en I-EXPLORATION la I-EXPLORATION historia I-EXPLORATION clínica. I-EXPLORATION Con B-TREATMENT este I-TREATMENT diagnóstico I-TREATMENT se I-TREATMENT programó I-TREATMENT para I-TREATMENT cirugía. I-TREATMENT En B-EXPLORATION exámenes I-EXPLORATION prequirúrgicos I-EXPLORATION se I-EXPLORATION reportó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tripomastigotes I-EXPLORATION de I-EXPLORATION T. I-EXPLORATION cruzi I-EXPLORATION en I-EXPLORATION extendido I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica. I-EXPLORATION Se B-TREATMENT prescribió I-TREATMENT tratamiento I-TREATMENT etiológico I-TREATMENT con I-TREATMENT benzonidazol I-TREATMENT por I-TREATMENT 60 I-TREATMENT días. I-TREATMENT El B-EXPLORATION diagnóstico I-EXPLORATION fue I-EXPLORATION confirmado I-EXPLORATION mediante I-EXPLORATION aislamiento, I-EXPLORATION cultivo, I-EXPLORATION isoenzimas, I-EXPLORATION inoculación I-EXPLORATION en I-EXPLORATION ratón I-EXPLORATION y I-EXPLORATION PCR. I-EXPLORATION I-EXPLORATION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY municipio I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY Peñón, I-PAST_MEDICAL_HISTORY Santander. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS consistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS eritema I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS palpebral I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS secreción I-PRESENT_ILLNESS ocular I-PRESENT_ILLNESS purulenta. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION edema I-EXPLORATION palpebral I-EXPLORATION y I-EXPLORATION conjuntiva I-EXPLORATION izquierda I-EXPLORATION hiperémica I-EXPLORATION sin I-EXPLORATION secreciones. I-EXPLORATION Se B-TREATMENT hizo I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT celulitis I-TREATMENT periorbitaria I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT manejo I-TREATMENT antibiótico I-TREATMENT ambulatorio. I-TREATMENT Un B-EVOLUTION año I-EVOLUTION después I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION consistente I-EVOLUTION en I-EVOLUTION debilidad, I-EVOLUTION fiebre I-EVOLUTION subjetiva, I-EVOLUTION disnea, I-EVOLUTION cefalea, I-EVOLUTION malestar I-EVOLUTION general I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION faríngeo. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION ficha I-EXPLORATION epide-miológica I-EXPLORATION se I-EXPLORATION consignó I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Romaña I-EXPLORATION positivo I-EXPLORATION (probablemente I-EXPLORATION en I-EXPLORATION retrospectiva). I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION pruebas I-EXPLORATION serológicas, I-EXPLORATION reportadas I-EXPLORATION como I-EXPLORATION Elisa I-EXPLORATION positivo I-EXPLORATION e I-EXPLORATION IFI I-EXPLORATION reactivo I-EXPLORATION con I-EXPLORATION título I-EXPLORATION de I-EXPLORATION 1: I-EXPLORATION 32, I-EXPLORATION por I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION Laboratorio I-EXPLORATION Departamental I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION de I-EXPLORATION Santander. I-EXPLORATION Se B-TREATMENT administró I-TREATMENT tratamiento I-TREATMENT etiológico I-TREATMENT con I-TREATMENT benzonidazol I-TREATMENT a I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT 250 I-TREATMENT mg/día I-TREATMENT durante I-TREATMENT 60 I-TREATMENT días. I-TREATMENT El B-EXPLORATION diagnóstico I-EXPLORATION fue I-EXPLORATION confirmado I-EXPLORATION mediante I-EXPLORATION serología I-EXPLORATION por I-EXPLORATION IFI I-EXPLORATION reactiva I-EXPLORATION 1: I-EXPLORATION 64 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION INS. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION para I-EXPLORATION cultivo. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY municipio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Carepa, I-PAST_MEDICAL_HISTORY quien B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS llevada I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rinorrea I-PRESENT_ILLNESS hialina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS diarreicas I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS moco I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS sangre. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS día I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS epistaxis. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION hipoactiva, I-EXPLORATION con I-EXPLORATION palidez I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION epistaxis I-EXPLORATION reciente I-EXPLORATION en I-EXPLORATION narina I-EXPLORATION derecha, I-EXPLORATION temperatura I-EXPLORATION axilar I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 5 I-EXPLORATION °C, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 96 I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION y I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION de I-EXPLORATION 32 I-EXPLORATION por I-EXPLORATION minuto. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION hepatoesplenomegalia. I-EXPLORATION Con B-TREATMENT esta I-TREATMENT historia I-TREATMENT se I-TREATMENT hizo I-TREATMENT una I-TREATMENT impresión I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT dengue I-TREATMENT con I-TREATMENT manifestaciones I-TREATMENT hemorrágicas I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT líquidos I-TREATMENT y I-TREATMENT antipiréticos. I-TREATMENT I-TREATMENT Los B-EXPLORATION exámenes I-EXPLORATION paraclínicos I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION reportaron I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION 18, I-EXPLORATION 4%, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION 8.600/ml, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION 30.000/µl, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 2, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION directa I-EXPLORATION 0, I-EXPLORATION 7 I-EXPLORATION mg/dl. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION persistió I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION gota I-EXPLORATION gruesa, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION P. I-EXPLORATION vivax. I-EXPLORATION Con B-TREATMENT este I-TREATMENT resultado I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cloroquina. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION su I-EVOLUTION cuadro I-EVOLUTION febril. I-EVOLUTION A B-TREATMENT pesar I-TREATMENT de I-TREATMENT su I-TREATMENT estado I-TREATMENT hematológico, I-TREATMENT no I-TREATMENT se I-TREATMENT realizó I-TREATMENT ninguna I-TREATMENT intervención. I-TREATMENT Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS consultas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS largo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS oído I-PRESENT_ILLNESS tapado I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipoacusia I-PRESENT_ILLNESS ligera, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS manejada I-PRESENT_ILLNESS como I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tapón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cerumen I-PRESENT_ILLNESS repetidamente I-PRESENT_ILLNESS por I-PRESENT_ILLNESS medicina I-PRESENT_ILLNESS general I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lavados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS oído. I-PRESENT_ILLNESS Sin I-PRESENT_ILLNESS embargo, I-PRESENT_ILLNESS los I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS se I-PRESENT_ILLNESS incrementaron I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS profundizó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hipoacusia I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS llegar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sordera I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conducción I-PRESENT_ILLNESS definida I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS otorrinolaringólogo. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION con I-EXPLORATION este I-EXPLORATION especialista, I-EXPLORATION también I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION tumoral I-EXPLORATION que I-EXPLORATION protruía I-EXPLORATION del I-EXPLORATION oído I-EXPLORATION medio I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION timpánica. I-EXPLORATION Fue B-TREATMENT llevada I-TREATMENT a I-TREATMENT cirugía I-TREATMENT para I-TREATMENT resección-biopsia I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT y I-TREATMENT se I-TREATMENT obtuvieron, I-TREATMENT mediante I-TREATMENT miringotomía, I-TREATMENT múltiples I-TREATMENT fragmentos I-TREATMENT de I-TREATMENT tejido I-TREATMENT de I-TREATMENT consistencia I-TREATMENT firme, I-TREATMENT de I-TREATMENT color I-TREATMENT parduzco, I-TREATMENT con I-TREATMENT escaso I-TREATMENT sangrado. I-TREATMENT No I-TREATMENT se I-TREATMENT mencionó I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT especialista I-TREATMENT el I-TREATMENT compromiso I-TREATMENT de I-TREATMENT la I-TREATMENT cadena I-TREATMENT de I-TREATMENT huesecillos I-TREATMENT ni I-TREATMENT del I-TREATMENT nervio I-TREATMENT facial. I-TREATMENT I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histológico, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION recubierto I-EXPLORATION por I-EXPLORATION epitelio I-EXPLORATION escamoso I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION epitelial I-EXPLORATION benigno I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION expansivo, I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION estructuras I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION trabécula I-EXPLORATION y I-EXPLORATION tubulares I-EXPLORATION revestidas I-EXPLORATION por I-EXPLORATION una I-EXPLORATION capa I-EXPLORATION de I-EXPLORATION células I-EXPLORATION rectangulares I-EXPLORATION sin I-EXPLORATION atipias I-EXPLORATION ni I-EXPLORATION mitosis, I-EXPLORATION con I-EXPLORATION secreción I-EXPLORATION en I-EXPLORATION la I-EXPLORATION luz, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION áreas I-EXPLORATION sólidas I-EXPLORATION compuestas I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION escaso I-EXPLORATION citoplasma I-EXPLORATION y I-EXPLORATION núcleo I-EXPLORATION pequeño I-EXPLORATION hipercromático. I-EXPLORATION El I-EXPLORATION estroma I-EXPLORATION estaba I-EXPLORATION ricamente I-EXPLORATION irrigado. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION histoquímica I-EXPLORATION con I-EXPLORATION coloraciones I-EXPLORATION de I-EXPLORATION ácido I-EXPLORATION peryódico I-EXPLORATION de I-EXPLORATION Schiff I-EXPLORATION (PAS), I-EXPLORATION Ziehl-Nielsen I-EXPLORATION (ZN) I-EXPLORATION y I-EXPLORATION azul I-EXPLORATION alciano I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Patología I-EXPLORATION Interfacultades I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Colombia, I-EXPLORATION acorde I-EXPLORATION con I-EXPLORATION la I-EXPLORATION metodología I-EXPLORATION adaptada I-EXPLORATION del I-EXPLORATION Armed I-EXPLORATION Forces I-EXPLORATION Institute I-EXPLORATION of I-EXPLORATION Pathology I-EXPLORATION (AFIP) I-EXPLORATION de I-EXPLORATION los I-EXPLORATION Estados I-EXPLORATION Unidos I-EXPLORATION (10), I-EXPLORATION y I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION secreción I-EXPLORATION de I-EXPLORATION mucoproteínas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION y I-EXPLORATION mínimo I-EXPLORATION componente I-EXPLORATION intracitoplasmático I-EXPLORATION ; I-EXPLORATION igualmente, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION pigmento I-EXPLORATION pardo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION citoplasma I-EXPLORATION celular. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION las I-EXPLORATION tinciones I-EXPLORATION de I-EXPLORATION inmunohistoquímica, I-EXPLORATION se I-EXPLORATION empleó I-EXPLORATION la I-EXPLORATION metodología I-EXPLORATION propia I-EXPLORATION del I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Patología I-EXPLORATION Interfacultades I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Colombia, I-EXPLORATION adaptada I-EXPLORATION de I-EXPLORATION los I-EXPLORATION insertos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION reactivos. I-EXPLORATION Previa I-EXPLORATION inhibición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION actividad I-EXPLORATION peroxidasa I-EXPLORATION endógena I-EXPLORATION con I-EXPLORATION H2O2 I-EXPLORATION al I-EXPLORATION 3%, I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION la I-EXPLORATION recuperación I-EXPLORATION antigénica I-EXPLORATION en I-EXPLORATION Target I-EXPLORATION 10x I-EXPLORATION (Dako®) I-EXPLORATION y I-EXPLORATION lavados I-EXPLORATION seriados I-EXPLORATION con I-EXPLORATION TBS, I-EXPLORATION se I-EXPLORATION incubó I-EXPLORATION por I-EXPLORATION 30 I-EXPLORATION minutos I-EXPLORATION con I-EXPLORATION cromogranín I-EXPLORATION A I-EXPLORATION en I-EXPLORATION dilución I-EXPLORATION 1: I-EXPLORATION 200 I-EXPLORATION (Novocastra®) I-EXPLORATION y I-EXPLORATION RTU-S100p I-EXPLORATION prediluida I-EXPLORATION (Novocastra®), I-EXPLORATION y I-EXPLORATION se I-EXPLORATION valoró I-EXPLORATION la I-EXPLORATION reactividad I-EXPLORATION con I-EXPLORATION el I-EXPLORATION sistema I-EXPLORATION de I-EXPLORATION estreptavidina-HRP I-EXPLORATION (Dako®), I-EXPLORATION para I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION usó I-EXPLORATION como I-EXPLORATION cromógeno I-EXPLORATION diaminobencidina I-EXPLORATION (DAB). I-EXPLORATION Luego I-EXPLORATION del I-EXPLORATION montaje I-EXPLORATION de I-EXPLORATION las I-EXPLORATION láminas, I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION demostrar I-EXPLORATION la I-EXPLORATION positividad, I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION cromogranina I-EXPLORATION como I-EXPLORATION de I-EXPLORATION S100 I-EXPLORATION con I-EXPLORATION intensidad I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION moderada, I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION patrones I-EXPLORATION observados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION células I-EXPLORATION mioepiteliales I-EXPLORATION con I-EXPLORATION S100. I-EXPLORATION I-EXPLORATION El B-PRESENT_ILLNESS primer I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS es I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY licor I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY fin I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY semana I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY embriaguez, I-PAST_MEDICAL_HISTORY cuatro B-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS purulenta, I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS moderados I-PRESENT_ILLNESS esfuerzos, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5°C, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS pleurítico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hemitórax I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS automedicación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS dosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dexametasona I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS mg I-PRESENT_ILLNESS intramuscular I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS admisión. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Ingresó B-EXPLORATION febril, I-EXPLORATION taquicárdico, I-EXPLORATION taquipneico, I-EXPLORATION hipo-xémico I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION y I-EXPLORATION consolidación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION derecha. I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION muestra I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 14.500 I-EXPLORATION por I-EXPLORATION mm3, I-EXPLORATION neutrofilia I-EXPLORATION de I-EXPLORATION 96%, I-EXPLORATION hiperglucemia I-EXPLORATION de I-EXPLORATION 638 I-EXPLORATION mg/dl, I-EXPLORATION hiperazoemia I-EXPLORATION (nitrógeno I-EXPLORATION ureico I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION de I-EXPLORATION 27, I-EXPLORATION 45 I-EXPLORATION mg/dl). I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION hospitalizado I-EVOLUTION con I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION neumonía I-EVOLUTION grave I-EVOLUTION extrahospitalaria I-EVOLUTION IIIA, I-EVOLUTION según I-EVOLUTION las I-EVOLUTION guías I-EVOLUTION nacionales I-EVOLUTION de I-EVOLUTION manejo I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION enfermedad I-EVOLUTION (6). I-EVOLUTION I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION progresó I-EVOLUTION rápidamente I-EVOLUTION a I-EVOLUTION falla I-EVOLUTION respiratoria I-EVOLUTION hipoxémica, I-EVOLUTION con I-EVOLUTION choque I-EVOLUTION séptico I-EVOLUTION y, I-EVOLUTION posteriormente, I-EVOLUTION disfunción I-EVOLUTION orgánica I-EVOLUTION múltiple. I-EVOLUTION Se B-DERIVED_FROM/TO trasladó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cuidados I-DERIVED_FROM/TO intensivos, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se B-TREATMENT inició I-TREATMENT manejo I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT ceftriaxona, I-TREATMENT 2 I-TREATMENT g I-TREATMENT endovenosos I-TREATMENT al I-TREATMENT día, I-TREATMENT y I-TREATMENT claritromicina, I-TREATMENT 500 I-TREATMENT mg I-TREATMENT endovenosos I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computadorizada I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION consolidación I-EXPLORATION multilobar I-EXPLORATION en I-EXPLORATION los I-EXPLORATION lóbulos I-EXPLORATION inferiores I-EXPLORATION con I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION bilateral, I-EXPLORATION no I-EXPLORATION libre I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudió I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION indicó I-EXPLORATION empiema I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION cocos I-EXPLORATION Gram I-EXPLORATION positivos. I-EXPLORATION Requirió B-TREATMENT toracostomía I-TREATMENT de I-TREATMENT drenaje I-TREATMENT cerrado I-TREATMENT y I-TREATMENT se I-TREATMENT indicó I-TREATMENT posteriormente I-TREATMENT toracotomía I-TREATMENT más I-TREATMENT decorticación. I-TREATMENT Durante B-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 72 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION postoperatorio, I-EVOLUTION persistieron I-EVOLUTION los I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION respuesta I-EVOLUTION inflamatoria I-EVOLUTION sistémica. I-EVOLUTION Ante B-TREATMENT el I-TREATMENT deterioro I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT requirió I-TREATMENT soporte I-TREATMENT dialítico I-TREATMENT y I-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT antibiótico I-TREATMENT a I-TREATMENT linezolide. I-TREATMENT Posterior B-EVOLUTION al I-EVOLUTION cambio I-EVOLUTION de I-EVOLUTION antimicrobiano I-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION adecuada, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION permitió I-EVOLUTION retirarlo I-EVOLUTION del I-EVOLUTION respirador I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION soporte I-EVOLUTION vasopresor. I-EVOLUTION Se I-EVOLUTION completaron I-EVOLUTION 21 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION respuesta I-EVOLUTION satisfactoria I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION terapia I-EVOLUTION antimicrobiana I-EVOLUTION ambulatoria I-EVOLUTION adicional. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY manejo I-PAST_MEDICAL_HISTORY farmacológico, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcoholismo, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY clínico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY súbito I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sensación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mareo; I-PAST_MEDICAL_HISTORY cuatro B-PRESENT_ILLNESS horas I-PRESENT_ILLNESS después I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS disartria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hemiparesia I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó B-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencias I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION le I-EXPLORATION encontró I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 120/70 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION y I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION por I-EXPLORATION minuto; I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION general I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Estaba I-EXPLORATION alerta, I-EXPLORATION orientado I-EXPLORATION en I-EXPLORATION persona, I-EXPLORATION tiempo I-EXPLORATION y I-EXPLORATION espacio, I-EXPLORATION con I-EXPLORATION disartria, I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION esfera I-EXPLORATION mental, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION meníngeos; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cráneo I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION vertebral; I-EXPLORATION había I-EXPLORATION isocoria I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION pupila I-EXPLORATION de I-EXPLORATION Argyll I-EXPLORATION Robertson, I-EXPLORATION parálisis I-EXPLORATION facial I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION escasa I-EXPLORATION elevación I-EXPLORATION del I-EXPLORATION velo I-EXPLORATION del I-EXPLORATION paladar I-EXPLORATION y I-EXPLORATION trastornos I-EXPLORATION dinámicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION deglución, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION los I-EXPLORATION nervios I-EXPLORATION craneales. I-EXPLORATION I-EXPLORATION Presentaba I-EXPLORATION hemiparesia I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fuerza I-EXPLORATION en I-EXPLORATION el I-EXPLORATION miembro I-EXPLORATION superior I-EXPLORATION (3/5) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION inferior I-EXPLORATION (4/5), I-EXPLORATION con I-EXPLORATION hiperreflexia I-EXPLORATION generalizada I-EXPLORATION simétrica, I-EXPLORATION con I-EXPLORATION respuesta I-EXPLORATION plantar I-EXPLORATION izquierda I-EXPLORATION neutra I-EXPLORATION y I-EXPLORATION de I-EXPLORATION flexión I-EXPLORATION contralateral; I-EXPLORATION además, I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION temblor I-EXPLORATION de I-EXPLORATION acción I-EXPLORATION y I-EXPLORATION postural I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computadorizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipodensa, I-EXPLORATION lacunar, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION interna. I-EXPLORATION Ese I-EXPLORATION mismo I-EXPLORATION día I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION póntico I-EXPLORATION extenso, I-EXPLORATION con I-EXPLORATION estenosis I-EXPLORATION crítica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION basilar I-EXPLORATION y I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION vertebral I-EXPLORATION izquierda, I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION circulación I-EXPLORATION anterior. I-EXPLORATION I-EXPLORATION Se B-TREATMENT sometió I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT endovascular I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT encontró I-TREATMENT estenosis I-TREATMENT completa I-TREATMENT del I-TREATMENT tercio I-TREATMENT inferior I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT basilar, I-TREATMENT sin I-TREATMENT flujo I-TREATMENT distal, I-TREATMENT y I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT stent I-TREATMENT sin I-TREATMENT complicaciones, I-TREATMENT quedando I-TREATMENT con I-TREATMENT una I-TREATMENT estenosis I-TREATMENT residual I-TREATMENT de I-TREATMENT 24 I-TREATMENT %. I-TREATMENT I-TREATMENT Durante B-EXPLORATION la I-EXPLORATION hospitalización I-EXPLORATION se I-EXPLORATION hicieron I-EXPLORATION estudios I-EXPLORATION para I-EXPLORATION accidente I-EXPLORATION cerebrovascular I-EXPLORATION y I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION era I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION VIH, I-EXPLORATION el I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION suero I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION (1:256) I-EXPLORATION con I-EXPLORATION FTA-ABS, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION compromiso I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION nervioso I-EXPLORATION central. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION pleocitosis I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION leucocitos I-EXPLORATION por I-EXPLORATION mm3 I-EXPLORATION con I-EXPLORATION 10 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION polimorfonucleares I-EXPLORATION y I-EXPLORATION 90 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION mononucleares, I-EXPLORATION glucosa I-EXPLORATION de I-EXPLORATION 71 I-EXPLORATION mg/dl, I-EXPLORATION proteínas I-EXPLORATION de I-EXPLORATION 33 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION VDRL I-EXPLORATION reactivo I-EXPLORATION (1:2). I-EXPLORATION I-EXPLORATION Con B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT se I-TREATMENT confirmó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT neurosífilis I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT 24 I-TREATMENT millones I-TREATMENT de I-TREATMENT unidades I-TREATMENT de I-TREATMENT penicilina I-TREATMENT cristalina I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 21 I-TREATMENT días. I-TREATMENT Durante I-TREATMENT su I-TREATMENT estadía I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT de I-TREATMENT cuidados I-TREATMENT intensivos, I-TREATMENT el I-TREATMENT paciente I-TREATMENT requirió I-TREATMENT intubación I-TREATMENT orotraqueal I-TREATMENT por I-TREATMENT riesgo I-TREATMENT de I-TREATMENT compromiso I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea I-TREATMENT debido I-TREATMENT a I-TREATMENT su I-TREATMENT infarto I-TREATMENT en I-TREATMENT el I-TREATMENT tallo I-TREATMENT cerebral. I-TREATMENT Presentó B-EVOLUTION una I-EVOLUTION neumonía I-EVOLUTION tardía I-EVOLUTION asociada I-EVOLUTION al I-EVOLUTION respirador I-EVOLUTION por I-EVOLUTION Serratia I-EVOLUTION marcescens, I-EVOLUTION para B-TREATMENT la I-TREATMENT cual I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT antibiótico, I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION hospitalización, I-EVOLUTION no I-EVOLUTION recuperó I-EVOLUTION la I-EVOLUTION funcionalidad I-EVOLUTION de I-EVOLUTION los I-EVOLUTION nervios I-EVOLUTION craneales I-EVOLUTION bulbares, I-EVOLUTION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT fue I-TREATMENT necesario I-TREATMENT practicar I-TREATMENT traqueostomía I-TREATMENT y I-TREATMENT gastrostomía. I-TREATMENT Antes B-EXPLORATION de I-EXPLORATION dar I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION al I-EXPLORATION paciente, I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION importante I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pleocitosis I-EXPLORATION y I-EXPLORATION proteinorraquia; I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION el I-EXPLORATION VDRL I-EXPLORATION fue I-EXPLORATION reactivo I-EXPLORATION (1:8), I-EXPLORATION probablemente I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION inflamatoria I-EXPLORATION posterior I-EXPLORATION al I-EXPLORATION tratamiento. I-EXPLORATION I-EXPLORATION Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION disartria, I-EVOLUTION parálisis I-EVOLUTION supranuclear I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mirada, I-EVOLUTION hemiparesia I-EVOLUTION izquierda, I-EVOLUTION traqueostomía, I-EVOLUTION gastrostomía I-EVOLUTION percutánea I-EVOLUTION y B-TREATMENT manejo I-TREATMENT ambulatorio I-TREATMENT dual I-TREATMENT con I-TREATMENT antiagregación I-TREATMENT plaquetaria. I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS proveniente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Palmira I-PAST_MEDICAL_HISTORY (población I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY suroccidente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Colombia I-PAST_MEDICAL_HISTORY cerca I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Costa I-PAST_MEDICAL_HISTORY Pacífica), I-PAST_MEDICAL_HISTORY referida B-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Clínica I-DERIVED_FROM/TO Sebastián I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Belalcázar I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cali, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO historia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 20 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO de I-DERIVED_FROM/TO fiebre I-DERIVED_FROM/TO y I-DERIVED_FROM/TO tos I-DERIVED_FROM/TO productiva, I-DERIVED_FROM/TO asociada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO pérdida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO peso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO seis I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO (4 I-DERIVED_FROM/TO kg) I-DERIVED_FROM/TO y I-DERIVED_FROM/TO una I-DERIVED_FROM/TO infección I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vías I-DERIVED_FROM/TO aéreas I-DERIVED_FROM/TO superiores I-DERIVED_FROM/TO con I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO antibiótico I-DERIVED_FROM/TO y I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO tórpida. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION hepatoesplenomegalia I-EXPLORATION y I-EXPLORATION adenopatía I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION axila I-EXPLORATION derecha; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION manifestaciones I-EXPLORATION cutáneas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION hemático I-EXPLORATION inicialmente I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION anemia I-EXPLORATION y I-EXPLORATION leucopenia, I-EXPLORATION seguidas I-EXPLORATION por I-EXPLORATION leucocitosis, I-EXPLORATION linfocitosis I-EXPLORATION (11.000/mm I-EXPLORATION 3 I-EXPLORATION ) I-EXPLORATION y I-EXPLORATION neutropenia I-EXPLORATION absoluta. I-EXPLORATION Se I-EXPLORATION encontraron I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION deshigrogenasa I-EXPLORATION láctica I-EXPLORATION de I-EXPLORATION 300 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION calcio I-EXPLORATION sérico I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 1 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION obtuvieron I-EXPLORATION biopsias I-EXPLORATION de I-EXPLORATION ganglio I-EXPLORATION linfático I-EXPLORATION y I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION con I-EXPLORATION el I-EXPLORATION fin I-EXPLORATION de I-EXPLORATION descartar I-EXPLORATION un I-EXPLORATION linfoma. I-EXPLORATION Estos I-EXPLORATION dos I-EXPLORATION tejidos I-EXPLORATION y I-EXPLORATION la I-EXPLORATION sangre I-EXPLORATION estaban I-EXPLORATION infiltrados I-EXPLORATION por I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION T I-EXPLORATION con I-EXPLORATION importante I-EXPLORATION pleomorfismo I-EXPLORATION nuclear. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION extendidos I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION "células I-EXPLORATION flor" I-EXPLORATION ( I-EXPLORATION flower I-EXPLORATION cells I-EXPLORATION ) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION identificó I-EXPLORATION un I-EXPLORATION fenotipo I-EXPLORATION CD3+, I-EXPLORATION CD2+, I-EXPLORATION CD4+, I-EXPLORATION CD5+, I-EXPLORATION CD7-, I-EXPLORATION CD8-, I-EXPLORATION CD56- I-EXPLORATION y I-EXPLORATION TdTen I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION ganglio I-EXPLORATION linfático I-EXPLORATION como I-EXPLORATION en I-EXPLORATION la I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION citometría I-EXPLORATION de I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica. I-EXPLORATION I-EXPLORATION Teniendo I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION anteriores, I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION una I-EXPLORATION leucemia/linfoma I-EXPLORATION de I-EXPLORATION célula I-EXPLORATION T I-EXPLORATION del I-EXPLORATION adulto; I-EXPLORATION por I-EXPLORATION consiguiente, I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION ELISA I-EXPLORATION y I-EXPLORATION Western I-EXPLORATION Blot I-EXPLORATION para I-EXPLORATION HTLV I-EXPLORATION 1-2, I-EXPLORATION las I-EXPLORATION cuales I-EXPLORATION resultaron I-EXPLORATION positivas, I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION diagnóstico. I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION del I-EXPLORATION Western I-EXPLORATION blot I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION HTLV-1 I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION bandas I-EXPLORATION p19, I-EXPLORATION GD21 I-EXPLORATION y I-EXPLORATION rgp46-I. I-EXPLORATION La B-EVOLUTION forma I-EVOLUTION de I-EVOLUTION leucemia I-EVOLUTION identificada I-EVOLUTION correspondió I-EVOLUTION a I-EVOLUTION leucemia I-EVOLUTION aguda. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION antes I-EVOLUTION de I-EVOLUTION iniciar I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS posterior, I-PRESENT_ILLNESS cuya I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS aumentó I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS dificultar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente, I-PRESENT_ILLNESS además, I-PRESENT_ILLNESS tuvo I-PRESENT_ILLNESS picos I-PRESENT_ILLNESS febriles I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuantificados, I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS retroocular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS entró I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estupor I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ingresar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION registró I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION sistólico I-EXPLORATION mitral I-EXPLORATION de I-EXPLORATION grado I-EXPLORATION II/IV, I-EXPLORATION rigidez I-EXPLORATION en I-EXPLORATION la I-EXPLORATION nuca I-EXPLORATION y I-EXPLORATION un I-EXPLORATION puntaje I-EXPLORATION de I-EXPLORATION 8/15 I-EXPLORATION en I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION coma I-EXPLORATION de I-EXPLORATION Glasgow. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION ordenaron I-EXPLORATION tomografías I-EXPLORATION computadorizadas I-EXPLORATION (TC), I-EXPLORATION una I-EXPLORATION cerebral I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION contrastada, I-EXPLORATION con I-EXPLORATION resultados I-EXPLORATION normales. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION meningitis I-EXPLORATION se I-EXPLORATION le I-EXPLORATION hizo I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION con I-EXPLORATION análisis I-EXPLORATION citoquímico I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION mostró I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION número I-EXPLORATION de I-EXPLORATION células, I-EXPLORATION hipoglucorraquia I-EXPLORATION e I-EXPLORATION hiperproteinorraquia, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION cocos I-EXPLORATION Gram I-EXPLORATION positivos. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT (2 I-TREATMENT g I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas), I-TREATMENT vancomicina I-TREATMENT (1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas) I-TREATMENT y I-TREATMENT dexametasona I-TREATMENT (8 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 6 I-TREATMENT horas I-TREATMENT por I-TREATMENT 4 I-TREATMENT días). I-TREATMENT En B-EXPLORATION dos I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo, I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION Streptococcus I-EXPLORATION pneumoniae, I-EXPLORATION serotipo I-EXPLORATION 18C, I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas, I-EXPLORATION con I-EXPLORATION concentración I-EXPLORATION inhibitoria I-EXPLORATION mínima I-EXPLORATION (CIM) I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 06 I-EXPLORATION µg/ml I-EXPLORATION para I-EXPLORATION penicilina I-EXPLORATION y I-EXPLORATION eritromicina, I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 03 I-EXPLORATION µg/ml I-EXPLORATION para I-EXPLORATION ceftriaxona I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 05 I-EXPLORATION µg/ml I-EXPLORATION para I-EXPLORATION trimetoprim- I-EXPLORATION sulfametoxazol I-EXPLORATION y I-EXPLORATION vancomicina, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION un I-EXPLORATION microorganismo I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION varios I-EXPLORATION antibióticos. I-EXPLORATION I-EXPLORATION Con B-TREATMENT base I-TREATMENT en I-TREATMENT estos I-TREATMENT resultados, I-TREATMENT al I-TREATMENT cuarto I-TREATMENT día I-TREATMENT de I-TREATMENT tra I-TREATMENT tamiento I-TREATMENT se I-TREATMENT decidió I-TREATMENT suspender I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT se I-TREATMENT continuó I-TREATMENT el I-TREATMENT manejo I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT dirigido I-TREATMENT específicamente I-TREATMENT al I-TREATMENT microorganismo I-TREATMENT aislado. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION siguió I-EVOLUTION siendo I-EVOLUTION irregular, I-EVOLUTION con I-EVOLUTION picos I-EVOLUTION febriles I-EVOLUTION durante I-EVOLUTION su I-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION leucocitosis, I-EVOLUTION neutrófilos I-EVOLUTION en I-EVOLUTION cayado I-EVOLUTION y I-EVOLUTION elevación I-EVOLUTION constante I-EVOLUTION de I-EVOLUTION los I-EVOLUTION reactantes I-EVOLUTION de I-EVOLUTION fase I-EVOLUTION aguda. I-EVOLUTION Los B-EXPLORATION hemocultivos I-EXPLORATION de I-EXPLORATION control I-EXPLORATION para I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION hongos I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION al I-EXPLORATION octavo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización I-EXPLORATION se I-EXPLORATION registró I-EXPLORATION hipoventilación I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION estertores I-EXPLORATION basales I-EXPLORATION en I-EXPLORATION pulmón I-EXPLORATION derecho; I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION infiltrados I-EXPLORATION alveolares I-EXPLORATION basales I-EXPLORATION en I-EXPLORATION dicho I-EXPLORATION pulmón I-EXPLORATION y I-EXPLORATION broncograma I-EXPLORATION aéreo. I-EXPLORATION Dado B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT neumonía I-TREATMENT asociada I-TREATMENT y I-TREATMENT la I-TREATMENT deficiente I-TREATMENT progresión I-TREATMENT clínica, I-TREATMENT se I-TREATMENT decidió I-TREATMENT comenzar I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT cefepime I-TREATMENT (2 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas) I-TREATMENT y I-TREATMENT linezolid I-TREATMENT (600 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas). I-TREATMENT I-TREATMENT Ante B-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION del I-EXPLORATION soplo I-EXPLORATION cardiaco I-EXPLORATION mitral, I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION transesofágico, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION evidenció I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION grave I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION ruptura I-EXPLORATION del I-EXPLORATION festón I-EXPLORATION medial I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION su I-EXPLORATION subsiguiente I-EXPLORATION prolapso, I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION cuatro I-EXPLORATION vegetaciones I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION auricular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION valva I-EXPLORATION posterior, I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION mm, I-EXPLORATION 11 I-EXPLORATION x I-EXPLORATION 3 I-EXPLORATION mm, I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION mm. I-EXPLORATION Ante B-TREATMENT el I-TREATMENT hallazgo I-TREATMENT de I-TREATMENT endocarditis I-TREATMENT sobre I-TREATMENT válvula I-TREATMENT mitral I-TREATMENT nativa, I-TREATMENT se I-TREATMENT decidió I-TREATMENT continuar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT durante I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT más I-TREATMENT y B-DERIVED_FROM/TO remitir I-DERIVED_FROM/TO al I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO a I-DERIVED_FROM/TO una I-DERIVED_FROM/TO institución I-DERIVED_FROM/TO de I-DERIVED_FROM/TO IV I-DERIVED_FROM/TO nivel I-DERIVED_FROM/TO para I-DERIVED_FROM/TO el I-DERIVED_FROM/TO reemplazo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO válvula. I-DERIVED_FROM/TO I-DERIVED_FROM/TO El B-EVOLUTION paciente I-EVOLUTION ingresó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION institución I-EVOLUTION de I-EVOLUTION nivel I-EVOLUTION IV I-EVOLUTION en I-EVOLUTION malas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION estaba I-EVOLUTION hipotenso I-EVOLUTION y B-TREATMENT hubo I-TREATMENT necesidad I-TREATMENT de I-TREATMENT administrarle I-TREATMENT vasopresores I-TREATMENT y I-TREATMENT utilizar I-TREATMENT catéter I-TREATMENT de I-TREATMENT Swan-Ganz I-TREATMENT ; I-TREATMENT presentó B-EVOLUTION tres I-EVOLUTION paros I-EVOLUTION cardiorrespiratorios I-EVOLUTION en I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION (ritmo I-EVOLUTION de I-EVOLUTION paro: I-EVOLUTION actividad I-EVOLUTION eléctrica I-EVOLUTION sin I-EVOLUTION pulso). I-EVOLUTION Presentaba, B-TREATMENT además, I-TREATMENT signos I-TREATMENT clínicos I-TREATMENT y I-TREATMENT paraclínicos I-TREATMENT de I-TREATMENT hipoperfusión, I-TREATMENT por I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT le I-TREATMENT administró I-TREATMENT inotrópico, I-TREATMENT y I-TREATMENT nuevamente I-TREATMENT se I-TREATMENT intensificó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibiótico, I-TREATMENT administrando I-TREATMENT vancomicina I-TREATMENT (1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas) I-TREATMENT y I-TREATMENT meropenem I-TREATMENT (1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas). I-TREATMENT I-TREATMENT Se B-EXPLORATION hizo, I-EXPLORATION igualmente, I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION contrastada, I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION focos I-EXPLORATION isquémicos I-EXPLORATION en I-EXPLORATION varios I-EXPLORATION terri I-EXPLORATION torios I-EXPLORATION vasculares I-EXPLORATION supratentoriales I-EXPLORATION e I-EXPLORATION infratentoriales, I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION se I-EXPLORATION consideran I-EXPLORATION indicativos I-EXPLORATION de I-EXPLORATION embolia. I-EXPLORATION I-EXPLORATION Gradualmente B-EVOLUTION se I-EVOLUTION logró I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION neurológica I-EVOLUTION parcial, I-EVOLUTION lo B-TREATMENT que I-TREATMENT posibilitó I-TREATMENT retirarle I-TREATMENT el I-TREATMENT tubo I-TREATMENT de I-TREATMENT tórax I-TREATMENT y I-TREATMENT el I-TREATMENT medicamento I-TREATMENT vasoactivo, I-TREATMENT pero I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT la I-TREATMENT administración I-TREATMENT del I-TREATMENT inotrópico I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT persis I-TREATMENT tencia I-TREATMENT de I-TREATMENT la I-TREATMENT disfunción I-TREATMENT cardiaca I-TREATMENT con I-TREATMENT compromiso I-TREATMENT grave I-TREATMENT de I-TREATMENT la I-TREATMENT válvula I-TREATMENT mitral. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Neurología I-EVOLUTION se I-EVOLUTION evaluó I-EVOLUTION al I-EVOLUTION paciente I-EVOLUTION cinco I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION y I-EVOLUTION se I-EVOLUTION encontró I-EVOLUTION que I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION de I-EVOLUTION conciencia I-EVOLUTION era I-EVOLUTION adecuado, I-EVOLUTION sin I-EVOLUTION deficiencias I-EVOLUTION neurológicas I-EVOLUTION focalizadas; I-EVOLUTION finalmente, B-TREATMENT al I-TREATMENT décimo I-TREATMENT día I-TREATMENT de I-TREATMENT hospitalización, I-TREATMENT se I-TREATMENT reemplazó I-TREATMENT la I-TREATMENT válvula I-TREATMENT mitral I-TREATMENT por I-TREATMENT una I-TREATMENT prótesis I-TREATMENT mecánica I-TREATMENT #27. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION inicial I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION fue I-EVOLUTION estable I-EVOLUTION y I-EVOLUTION no I-EVOLUTION requirió I-EVOLUTION de I-EVOLUTION medicamento I-EVOLUTION vasopresor I-EVOLUTION o I-EVOLUTION inotrópico; I-EVOLUTION la I-EVOLUTION única I-EVOLUTION complicación I-EVOLUTION que I-EVOLUTION se I-EVOLUTION presentó I-EVOLUTION fue I-EVOLUTION una I-EVOLUTION coagulopatía I-EVOLUTION secundaria I-EVOLUTION al I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION bomba I-EVOLUTION extracorpórea, I-EVOLUTION la B-TREATMENT cual I-TREATMENT se I-TREATMENT corrigió I-TREATMENT con I-TREATMENT transfusión I-TREATMENT de I-TREATMENT hemocomponentes. I-TREATMENT I-TREATMENT En B-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION mitral I-EXPLORATION nativa I-EXPLORATION se I-EXPLORATION reportó I-EXPLORATION endocarditis I-EXPLORATION aguda, I-EXPLORATION en I-EXPLORATION tanto I-EXPLORATION que I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION definitivos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION siguió I-EVOLUTION hospitalizado I-EVOLUTION para I-EVOLUTION optimizar I-EVOLUTION la I-EVOLUTION anticoagulación. I-EVOLUTION Diez I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION presentó I-EVOLUTION deterioro I-EVOLUTION clínico, I-EVOLUTION con I-EVOLUTION inestabilidad I-EVOLUTION hemodinámica I-EVOLUTION y I-EVOLUTION falla I-EVOLUTION respiratoria. I-EVOLUTION Se B-TREATMENT documentó I-TREATMENT bacteriemia I-TREATMENT por I-TREATMENT Klebsiella I-TREATMENT pneumoniae I-TREATMENT positiva I-TREATMENT para I-TREATMENT betalactamasa I-TREATMENT de I-TREATMENT espectro I-TREATMENT extendido I-TREATMENT (BLEE), I-TREATMENT ante I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT administró I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT meropenem I-TREATMENT y I-TREATMENT vancomicina. I-TREATMENT En B-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION ecocardiograma I-EXPLORATION transesofágico I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION que I-EXPLORATION la I-EXPLORATION prótesis I-EXPLORATION mecánica I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION mitral I-EXPLORATION funcio I-EXPLORATION naba I-EXPLORATION normalmente. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION hacer I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION inmunodeficiencia I-EXPLORATION humoral I-EXPLORATION en I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION al I-EXPLORATION haber I-EXPLORATION presentado I-EXPLORATION dos I-EXPLORATION bacteriemias I-EXPLORATION por I-EXPLORATION bacterias I-EXPLORATION encapsuladas, I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION Al B-TREATMENT completarse I-TREATMENT una I-TREATMENT semana I-TREATMENT de I-TREATMENT administración I-TREATMENT de I-TREATMENT meropenem I-TREATMENT se I-TREATMENT comenzó I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT ceftriaxona I-TREATMENT con I-TREATMENT la I-TREATMENT intención I-TREATMENT de I-TREATMENT completar I-TREATMENT otra I-TREATMENT semana I-TREATMENT más, I-TREATMENT suspender I-TREATMENT y I-TREATMENT continuar I-TREATMENT después I-TREATMENT solo I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT hasta I-TREATMENT completar I-TREATMENT las I-TREATMENT seis I-TREATMENT semanas I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT para I-TREATMENT endocarditis. I-TREATMENT I-TREATMENT Finalmente, B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION secuelas I-EVOLUTION neurológicas I-EVOLUTION evidentes I-EVOLUTION y I-EVOLUTION con I-EVOLUTION fracción I-EVOLUTION de I-EVOLUTION eyección I-EVOLUTION preservada I-EVOLUTION (60-65 I-EVOLUTION %), I-EVOLUTION cavidades I-EVOLUTION izquierda I-EVOLUTION y I-EVOLUTION derecha I-EVOLUTION de I-EVOLUTION tamaño I-EVOLUTION y I-EVOLUTION contractilidad I-EVOLUTION normales, I-EVOLUTION prótesis I-EVOLUTION mecánica I-EVOLUTION mitral I-EVOLUTION con I-EVOLUTION función I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION gradiente I-EVOLUTION medio I-EVOLUTION (6 I-EVOLUTION mm I-EVOLUTION Hg), I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION imágenes I-EVOLUTION sugestivas I-EVOLUTION de I-EVOLUTION vegetaciones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY ni B-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO externa I-DERIVED_FROM/TO de I-DERIVED_FROM/TO urología I-DERIVED_FROM/TO ante I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hallazgo I-DERIVED_FROM/TO en I-DERIVED_FROM/TO ecografía I-DERIVED_FROM/TO abdominal, I-DERIVED_FROM/TO realizada I-DERIVED_FROM/TO por I-DERIVED_FROM/TO síntomas I-DERIVED_FROM/TO digestivos I-DERIVED_FROM/TO inespecíficos, I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO suprarrenal I-DERIVED_FROM/TO derecha I-DERIVED_FROM/TO sólida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 6 I-DERIVED_FROM/TO cm I-DERIVED_FROM/TO de I-DERIVED_FROM/TO diámetro. I-DERIVED_FROM/TO I-DERIVED_FROM/TO La B-EXPLORATION anamnesis I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION no I-EXPLORATION revelaron I-EXPLORATION síntomas I-EXPLORATION ni I-EXPLORATION signos I-EXPLORATION que I-EXPLORATION orientaran I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION endocrinopatía, I-EXPLORATION ni I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION primario. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION procedió, I-EXPLORATION mediante I-EXPLORATION estudio I-EXPLORATION endocrinológico, I-EXPLORATION a I-EXPLORATION establecer I-EXPLORATION el I-EXPLORATION carácter I-EXPLORATION funcionante I-EXPLORATION o I-EXPLORATION no I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION suprarrenal. I-EXPLORATION Se I-EXPLORATION determinaron: I-EXPLORATION cortisol I-EXPLORATION libre I-EXPLORATION en I-EXPLORATION orina; I-EXPLORATION cortisol I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas; I-EXPLORATION supresión I-EXPLORATION con I-EXPLORATION 1 I-EXPLORATION mgr I-EXPLORATION de I-EXPLORATION dexametasona; I-EXPLORATION cortisol I-EXPLORATION basal I-EXPLORATION en I-EXPLORATION sangre; I-EXPLORATION ACTH; I-EXPLORATION aldosterona I-EXPLORATION en I-EXPLORATION sangre; I-EXPLORATION DHEA-sulfato; I-EXPLORATION catecolaminas I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION (noradrenalina, I-EXPLORATION adrenalina) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION orina, I-EXPLORATION y I-EXPLORATION sus I-EXPLORATION metabolitos I-EXPLORATION (vanilmandélico, I-EXPLORATION metanefrinas). I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION analíticos I-EXPLORATION practicados I-EXPLORATION fueron I-EXPLORATION todos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION demuestra I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION suprarrenal I-EXPLORATION derecha I-EXPLORATION sólida, I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION bien I-EXPLORATION definidos I-EXPLORATION y I-EXPLORATION densidad I-EXPLORATION heterogénea, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION hipodensas I-EXPLORATION e I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION calcio I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION que I-EXPLORATION mide I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 3 I-EXPLORATION cm. I-EXPLORATION La I-EXPLORATION Resonancia I-EXPLORATION Magnética I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION ovalada I-EXPLORATION y I-EXPLORATION bien I-EXPLORATION definida, I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION isointensa I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION bazo I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION T2, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION irregulares I-EXPLORATION hiperintensas I-EXPLORATION en I-EXPLORATION T2. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION concluyó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION suprarrenal I-EXPLORATION derecha I-EXPLORATION sólida, I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION y I-EXPLORATION no I-EXPLORATION funcionante. I-EXPLORATION Con B-TREATMENT este I-TREATMENT diagnóstico, I-TREATMENT y I-TREATMENT apoyados I-TREATMENT fundamentalmente I-TREATMENT en I-TREATMENT el I-TREATMENT tamaño I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración, I-TREATMENT así I-TREATMENT como I-TREATMENT en I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT calcificaciones I-TREATMENT irregulares I-TREATMENT en I-TREATMENT su I-TREATMENT interior, I-TREATMENT se I-TREATMENT decidió I-TREATMENT la I-TREATMENT exéresis I-TREATMENT quirúrgica I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT ante I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT que I-TREATMENT se I-TREATMENT tratara I-TREATMENT de I-TREATMENT un I-TREATMENT carcinoma I-TREATMENT suprarrenal. I-TREATMENT Se I-TREATMENT practicó I-TREATMENT suprarrenalectomía I-TREATMENT derecha I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT lumbotomía. I-TREATMENT I-TREATMENT Macroscópicamente, I-TREATMENT la I-TREATMENT pieza I-TREATMENT de I-TREATMENT suprarrenalectomía I-TREATMENT midió I-TREATMENT 8 I-TREATMENT x I-TREATMENT 6, I-TREATMENT 5 I-TREATMENT x I-TREATMENT 3 I-TREATMENT cm. I-TREATMENT La B-EXPLORATION tumoración I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION multinodular, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION homogéneo, I-EXPLORATION blanquecino-grisáceo I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fasciculado. I-EXPLORATION Microscópicamente, I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION está I-EXPLORATION constituido I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Schwann I-EXPLORATION dispuestas I-EXPLORATION en I-EXPLORATION pequeños I-EXPLORATION fascículos I-EXPLORATION entrelazados I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION estroma I-EXPLORATION mixoide I-EXPLORATION y I-EXPLORATION grupos I-EXPLORATION de I-EXPLORATION células I-EXPLORATION ganglionares I-EXPLORATION maduras. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION para I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION S-100, I-EXPLORATION observándose I-EXPLORATION intensa I-EXPLORATION y I-EXPLORATION generalizada I-EXPLORATION inmunoreacción I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION neoplásicas. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION es I-EXPLORATION de I-EXPLORATION ganglioneuroma I-EXPLORATION suprarrenal. I-EXPLORATION I-EXPLORATION Tras B-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS prostático I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS IPSS I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS PSA: I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 91. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destaca I-EXPLORATION un I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION encontrando I-EXPLORATION un I-EXPLORATION adenoma I-EXPLORATION grado I-EXPLORATION 1, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION hemiescroto I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION lisa, I-EXPLORATION dura, I-EXPLORATION no I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION profundos, I-EXPLORATION blanquecina I-EXPLORATION e I-EXPLORATION indolora I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración. I-EXPLORATION El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS demanda I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS aduciendo I-PRESENT_ILLNESS problemas I-PRESENT_ILLNESS estéticos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-TREATMENT realiza I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT local I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT Macroscópicamente B-EXPLORATION la I-EXPLORATION masa I-EXPLORATION presenta I-EXPLORATION coloración I-EXPLORATION blanquecina I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION cm, I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION sólida, I-EXPLORATION amarillenta I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION arremolinado. I-EXPLORATION I-EXPLORATION Microscópicamente I-EXPLORATION se I-EXPLORATION describe I-EXPLORATION una I-EXPLORATION neoformación I-EXPLORATION mesenquimal I-EXPLORATION relativamente I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION no I-EXPLORATION encapsulada, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION haces I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION estirpe I-EXPLORATION muscular I-EXPLORATION lisa I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION marcada I-EXPLORATION positividad I-EXPLORATION citoplasmática I-EXPLORATION con I-EXPLORATION actina, I-EXPLORATION desmina I-EXPLORATION y I-EXPLORATION focal I-EXPLORATION con I-EXPLORATION CD I-EXPLORATION 68. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION atipia I-EXPLORATION citológica. I-EXPLORATION La I-EXPLORATION actividad I-EXPLORATION mitótica I-EXPLORATION es I-EXPLORATION muy I-EXPLORATION baja I-EXPLORATION (0, I-EXPLORATION 5 I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 50 I-EXPLORATION HPF), I-EXPLORATION no I-EXPLORATION observándose I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION ni I-EXPLORATION necrosis. I-EXPLORATION I-EXPLORATION El B-EVOLUTION diagnóstico I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION leiomioma I-EVOLUTION escrotal. I-EVOLUTION Tras I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION no I-EVOLUTION hay I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION local. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 69 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que, B-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales, I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY bien I-PAST_MEDICAL_HISTORY diferenciado I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY análogos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY LHRH I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mielolipoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY glándula I-PAST_MEDICAL_HISTORY suprarrenal I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY casualmente I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY TAC I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS anorexia, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 0º I-PRESENT_ILLNESS C, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS coincidiendo, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuadro, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS accidental I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cama. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION aunque I-EXPLORATION hemodinámica I-EXPLORATION estable. I-EXPLORATION El I-EXPLORATION abdomen I-EXPLORATION era I-EXPLORATION globuloso I-EXPLORATION y I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION ligeramente I-EXPLORATION distendido. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Murphy I-EXPLORATION positivo. I-EXPLORATION La I-EXPLORATION auscultación I-EXPLORATION cardio I-EXPLORATION respiratoria I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION mostraba I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 13.800 I-EXPLORATION *10e9/L I-EXPLORATION y I-EXPLORATION neutrofilia I-EXPLORATION (83%), I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 110 I-EXPLORATION g/l I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION indirecta I-EXPLORATION (0, I-EXPLORATION 9 I-EXPLORATION mg/dl). I-EXPLORATION I-EXPLORATION Fue I-EXPLORATION realizada I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION heterogénea I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION dependiente I-EXPLORATION de I-EXPLORATION glándula I-EXPLORATION suprarrenal I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION compresión I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION cava, I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION discernir I-EXPLORATION si I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION hematoma I-EXPLORATION o I-EXPLORATION absceso. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION confirmó I-EXPLORATION tal I-EXPLORATION hallazgo, I-EXPLORATION informándolo I-EXPLORATION como I-EXPLORATION hematoma I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION activo, I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION que I-EXPLORATION comprimía I-EXPLORATION y I-EXPLORATION desplazaba I-EXPLORATION vena I-EXPLORATION cava. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT laparotomía I-TREATMENT urgente I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT suprarrenalectomía I-TREATMENT derecha I-TREATMENT y I-TREATMENT exéresis I-TREATMENT del I-TREATMENT hematoma. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION transcurrió I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY excepción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY palpitaciones I-PAST_MEDICAL_HISTORY ocasionales. I-PAST_MEDICAL_HISTORY Presentó B-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS súbita I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS disnea, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS neumonía I-PRESENT_ILLNESS e I-PRESENT_ILLNESS ingresada I-PRESENT_ILLNESS para I-PRESENT_ILLNESS iniciar I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS antibiótico. I-PRESENT_ILLNESS A B-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION se I-EVOLUTION agravó I-EVOLUTION el I-EVOLUTION cuadro I-EVOLUTION con I-EVOLUTION fiebre, I-EVOLUTION hipoxemia I-EVOLUTION progresiva I-EVOLUTION y I-EVOLUTION oliguria, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION trasladada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos I-EVOLUTION (UCI). I-EVOLUTION I-EVOLUTION Al B-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION UCI I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 40, I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION del I-EXPLORATION 85% I-EXPLORATION con I-EXPLORATION reservorio, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 140 I-EXPLORATION ppm, I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION 120/40 I-EXPLORATION mmHg, I-EXPLORATION temp-35º I-EXPLORATION C. I-EXPLORATION La I-EXPLORATION auscultación I-EXPLORATION cardiopulmonar I-EXPLORATION mostraba I-EXPLORATION crepitantes I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION hemitorax I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulsos I-EXPLORATION distales I-EXPLORATION aunque I-EXPLORATION sin I-EXPLORATION edemas I-EXPLORATION en I-EXPLORATION extremidades. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION realizada I-EXPLORATION destacaba I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 36400, I-EXPLORATION Glucosa: I-EXPLORATION 266 I-EXPLORATION mg/dL, I-EXPLORATION Creatinina: I-EXPLORATION 3, I-EXPLORATION 3 I-EXPLORATION mg/dL, I-EXPLORATION AST: I-EXPLORATION 3127 I-EXPLORATION U/L, I-EXPLORATION ALT: I-EXPLORATION 3139 I-EXPLORATION U/L, I-EXPLORATION Gamma I-EXPLORATION GT: I-EXPLORATION 86 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION tiempos I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION ligeramente I-EXPLORATION elevados. I-EXPLORATION Gasometría: I-EXPLORATION PH: I-EXPLORATION 7, I-EXPLORATION 11. I-EXPLORATION PCO2: I-EXPLORATION 41. I-EXPLORATION PO2: I-EXPLORATION 44. I-EXPLORATION Saturación I-EXPLORATION O2: I-EXPLORATION 63. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION infiltrado I-EXPLORATION alveolo-intersticial I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION derecho. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT intubación I-TREATMENT inmediata I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT de I-TREATMENT mayor I-TREATMENT espectro. I-TREATMENT La B-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION fracaso I-EXPLORATION multiorgánico I-EXPLORATION y I-EXPLORATION en I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION analítica I-EXPLORATION llamó I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION la I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION creatinin-fosfoquinasa I-EXPLORATION y I-EXPLORATION troponina, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecocardiograma I-EXPLORATION transesofágico, I-EXPLORATION objetivándose I-EXPLORATION masa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION cava I-EXPLORATION superior I-EXPLORATION que I-EXPLORATION llegaba I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION bilateral I-EXPLORATION sin I-EXPLORATION tromboembolismo I-EXPLORATION pulmonar, I-EXPLORATION dilatación I-EXPLORATION y I-EXPLORATION ocupación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior I-EXPLORATION intrahépatica I-EXPLORATION que I-EXPLORATION proximalmente I-EXPLORATION llega I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION distalmente I-EXPLORATION hasta I-EXPLORATION las I-EXPLORATION venas I-EXPLORATION renales. I-EXPLORATION Hipodensidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION suprahepática I-EXPLORATION derecha I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION trombosis I-EXPLORATION secundaria I-EXPLORATION y I-EXPLORATION masa I-EXPLORATION suprarrenal I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION hipercaptante, I-EXPLORATION en I-EXPLORATION íntimo I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior. I-EXPLORATION I-EXPLORATION Habiendo B-DERIVED_FROM/TO estabilizado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO UCI I-DERIVED_FROM/TO de I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO a I-DERIVED_FROM/TO los I-DERIVED_FROM/TO 4 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO su I-DERIVED_FROM/TO ingreso, I-DERIVED_FROM/TO intubada I-DERIVED_FROM/TO y I-DERIVED_FROM/TO con I-DERIVED_FROM/TO disfunción I-DERIVED_FROM/TO multiorgánica, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO fin I-DERIVED_FROM/TO de I-DERIVED_FROM/TO planificar I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO quirúrgico. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-EXPLORATION repite I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION destaca I-EXPLORATION leucocitosis, I-EXPLORATION AST: I-EXPLORATION 165 I-EXPLORATION UI/L, I-EXPLORATION ALT: I-EXPLORATION 1050 I-EXPLORATION UI/L I-EXPLORATION con I-EXPLORATION ionograma I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION normales. I-EXPLORATION Tras B-TREATMENT valorar I-TREATMENT las I-TREATMENT pruebas I-TREATMENT aportadas, I-TREATMENT dada I-TREATMENT la I-TREATMENT gravedad I-TREATMENT del I-TREATMENT cuadro, I-TREATMENT y I-TREATMENT puesto I-TREATMENT que I-TREATMENT las I-TREATMENT pruebas I-TREATMENT de I-TREATMENT imagen I-TREATMENT realizadas I-TREATMENT no I-TREATMENT presentan I-TREATMENT metástasis I-TREATMENT a I-TREATMENT distancia, I-TREATMENT se I-TREATMENT planteó I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT urgente. I-TREATMENT I-TREATMENT Se I-TREATMENT realiza I-TREATMENT una I-TREATMENT laparatomía I-TREATMENT subcostal I-TREATMENT bilateral I-TREATMENT al I-TREATMENT mismo I-TREATMENT tiempo I-TREATMENT que I-TREATMENT una I-TREATMENT esternotomía I-TREATMENT longitudinal. I-TREATMENT Se I-TREATMENT aprecia I-TREATMENT derrame I-TREATMENT pleural I-TREATMENT bilateral, I-TREATMENT ligero I-TREATMENT derrame I-TREATMENT pericárdico I-TREATMENT y I-TREATMENT corazón I-TREATMENT con I-TREATMENT contracción I-TREATMENT normal I-TREATMENT en I-TREATMENT la I-TREATMENT cavidad I-TREATMENT torácica, I-TREATMENT mientras I-TREATMENT que I-TREATMENT la I-TREATMENT laparotomía I-TREATMENT muestra I-TREATMENT isquemia I-TREATMENT de I-TREATMENT los I-TREATMENT segmentos I-TREATMENT 6 I-TREATMENT y I-TREATMENT 7 I-TREATMENT del I-TREATMENT hígado I-TREATMENT y I-TREATMENT masa I-TREATMENT suprarrenal I-TREATMENT derecha. I-TREATMENT I-TREATMENT El I-TREATMENT equipo I-TREATMENT de I-TREATMENT Cirugía I-TREATMENT General I-TREATMENT realiza I-TREATMENT hepatectomía I-TREATMENT anterior I-TREATMENT con I-TREATMENT maniobra I-TREATMENT de I-TREATMENT Pringle I-TREATMENT intermitente, I-TREATMENT sin I-TREATMENT voltear I-TREATMENT el I-TREATMENT hígado, I-TREATMENT seccionando I-TREATMENT el I-TREATMENT hígado I-TREATMENT hasta I-TREATMENT llegar I-TREATMENT a I-TREATMENT cara I-TREATMENT anterior I-TREATMENT de I-TREATMENT la I-TREATMENT Cava I-TREATMENT retrohepática. I-TREATMENT Posteriormente, I-TREATMENT el I-TREATMENT equipo I-TREATMENT de I-TREATMENT Urología I-TREATMENT tras I-TREATMENT descolgar I-TREATMENT el I-TREATMENT colon I-TREATMENT derecho I-TREATMENT realiza I-TREATMENT disección I-TREATMENT de I-TREATMENT vena I-TREATMENT cava I-TREATMENT hasta I-TREATMENT iliacas I-TREATMENT primitivas, I-TREATMENT ligadura I-TREATMENT de I-TREATMENT vena I-TREATMENT genital I-TREATMENT derecha, I-TREATMENT liberación I-TREATMENT de I-TREATMENT vena I-TREATMENT renal I-TREATMENT y I-TREATMENT cara I-TREATMENT anterior I-TREATMENT de I-TREATMENT riñón I-TREATMENT derecho. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT liberación I-TREATMENT de I-TREATMENT la I-TREATMENT glándula I-TREATMENT suprarrenal I-TREATMENT derecha, I-TREATMENT a I-TREATMENT excepción I-TREATMENT de I-TREATMENT su I-TREATMENT borde I-TREATMENT superior I-TREATMENT y I-TREATMENT medial I-TREATMENT que I-TREATMENT está I-TREATMENT íntimamente I-TREATMENT unido I-TREATMENT a I-TREATMENT la I-TREATMENT pared I-TREATMENT derecha I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT cava. I-TREATMENT Queda I-TREATMENT así I-TREATMENT expuesto I-TREATMENT el I-TREATMENT campo I-TREATMENT para I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT suprarrenal I-TREATMENT e I-TREATMENT hígado I-TREATMENT derecho I-TREATMENT a I-TREATMENT falta I-TREATMENT de I-TREATMENT cavotomía.. I-TREATMENT I-TREATMENT Una I-TREATMENT vez I-TREATMENT realizado I-TREATMENT esto, I-TREATMENT el I-TREATMENT equipo I-TREATMENT de I-TREATMENT Cirugía I-TREATMENT Cardiaca I-TREATMENT comienza I-TREATMENT la I-TREATMENT circulación I-TREATMENT extracorpórea I-TREATMENT bajando I-TREATMENT progresivamente I-TREATMENT la I-TREATMENT temperatura I-TREATMENT hasta I-TREATMENT alcanzar I-TREATMENT 14ºC I-TREATMENT a I-TREATMENT nivel I-TREATMENT esofágico I-TREATMENT y I-TREATMENT 19ºC I-TREATMENT a I-TREATMENT nivel I-TREATMENT rectal, I-TREATMENT tras I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT exanguinar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT y I-TREATMENT parar I-TREATMENT la I-TREATMENT circulación I-TREATMENT extracorpórea I-TREATMENT manteniendo I-TREATMENT la I-TREATMENT sangre I-TREATMENT en I-TREATMENT un I-TREATMENT oxigenador. I-TREATMENT Es I-TREATMENT entonces I-TREATMENT cuando I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT realizar I-TREATMENT una I-TREATMENT cavotomía I-TREATMENT inferior I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT suprarrenal I-TREATMENT hasta I-TREATMENT 2 I-TREATMENT cm I-TREATMENT de I-TREATMENT diafragma, I-TREATMENT aurículotomía I-TREATMENT derecha I-TREATMENT y I-TREATMENT retirada I-TREATMENT del I-TREATMENT trombo I-TREATMENT tumoral I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT incisión I-TREATMENT realizada I-TREATMENT en I-TREATMENT la I-TREATMENT cava I-TREATMENT inferior. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT sección I-TREATMENT de I-TREATMENT pared I-TREATMENT lateral I-TREATMENT derecha I-TREATMENT de I-TREATMENT vena I-TREATMENT cava I-TREATMENT (desde I-TREATMENT la I-TREATMENT vena I-TREATMENT suprarrenal I-TREATMENT hasta I-TREATMENT la I-TREATMENT vena I-TREATMENT suprahepática I-TREATMENT derecha), I-TREATMENT extrayendo I-TREATMENT en I-TREATMENT bloque I-TREATMENT hígado I-TREATMENT derecho I-TREATMENT con I-TREATMENT venas I-TREATMENT suprahepática I-TREATMENT y I-TREATMENT suprarrenal I-TREATMENT derechas I-TREATMENT incluidas I-TREATMENT en I-TREATMENT dicho I-TREATMENT parche, I-TREATMENT suprarrenal I-TREATMENT derecha I-TREATMENT y I-TREATMENT trombo. I-TREATMENT Se I-TREATMENT produce I-TREATMENT rotura I-TREATMENT del I-TREATMENT trombo I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT vena I-TREATMENT renal, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT en I-TREATMENT un I-TREATMENT segundo I-TREATMENT tiempo I-TREATMENT se I-TREATMENT extrae I-TREATMENT por I-TREATMENT tracción I-TREATMENT el I-TREATMENT trombo I-TREATMENT desde I-TREATMENT vena I-TREATMENT renal I-TREATMENT hasta I-TREATMENT iliacas I-TREATMENT primitivas. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT irrigación I-TREATMENT de I-TREATMENT cava I-TREATMENT y I-TREATMENT aurícula I-TREATMENT derecha I-TREATMENT y, I-TREATMENT al I-TREATMENT no I-TREATMENT observarse I-TREATMENT restos I-TREATMENT de I-TREATMENT trombo I-TREATMENT ni I-TREATMENT infiltración I-TREATMENT de I-TREATMENT las I-TREATMENT paredes I-TREATMENT de I-TREATMENT cava I-TREATMENT o I-TREATMENT aurícula, I-TREATMENT se I-TREATMENT procede I-TREATMENT al I-TREATMENT cierre I-TREATMENT de I-TREATMENT vena I-TREATMENT cava I-TREATMENT y I-TREATMENT orejuela I-TREATMENT derecha I-TREATMENT por I-TREATMENT separado I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT vez I-TREATMENT mediante I-TREATMENT sutura I-TREATMENT continua I-TREATMENT con I-TREATMENT monofilamento. I-TREATMENT Una I-TREATMENT vez I-TREATMENT realizado I-TREATMENT dicho I-TREATMENT cierre I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT reperfundir I-TREATMENT progresivamente I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT volviendo I-TREATMENT a I-TREATMENT entrar I-TREATMENT en I-TREATMENT circulación I-TREATMENT extracorpórea, I-TREATMENT recalentándola I-TREATMENT y I-TREATMENT procediendo I-TREATMENT a I-TREATMENT desclampar I-TREATMENT la I-TREATMENT aorta I-TREATMENT y I-TREATMENT perfundir I-TREATMENT el I-TREATMENT corazón I-TREATMENT al I-TREATMENT alcanzar I-TREATMENT una I-TREATMENT temperatura I-TREATMENT esofágica I-TREATMENT de I-TREATMENT 34ºC. I-TREATMENT El I-TREATMENT inicio I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT cardiaca I-TREATMENT permite I-TREATMENT la I-TREATMENT salida I-TREATMENT de I-TREATMENT circulación I-TREATMENT extracorpórea. I-TREATMENT I-TREATMENT Se I-TREATMENT colocan I-TREATMENT drenajes I-TREATMENT retroesternal, I-TREATMENT mediastínico, I-TREATMENT subhepático I-TREATMENT y I-TREATMENT retroperitoneal I-TREATMENT en I-TREATMENT fosa I-TREATMENT renal I-TREATMENT derecha. I-TREATMENT Durante I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT transfundieron I-TREATMENT 14 I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes, I-TREATMENT 1200 I-TREATMENT ml I-TREATMENT de I-TREATMENT plasma I-TREATMENT y I-TREATMENT 2 I-TREATMENT unidades I-TREATMENT de I-TREATMENT plaquetas. I-TREATMENT Durante B-EVOLUTION la I-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION se I-EVOLUTION realiza I-EVOLUTION ecografía I-EVOLUTION abdominal I-EVOLUTION que I-EVOLUTION muestras I-EVOLUTION buena I-EVOLUTION permeabilidad I-EVOLUTION del I-EVOLUTION sistema I-EVOLUTION venoso I-EVOLUTION hepático I-EVOLUTION izquierdo I-EVOLUTION y I-EVOLUTION de I-EVOLUTION vena I-EVOLUTION cava. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION trasladada I-EVOLUTION a I-EVOLUTION planta, I-EVOLUTION encontrándose I-EVOLUTION consciente, I-EVOLUTION orientada I-EVOLUTION y I-EVOLUTION colaboradora, I-EVOLUTION aunque I-EVOLUTION presentando I-EVOLUTION debilidad I-EVOLUTION en I-EVOLUTION las I-EVOLUTION cuatro I-EVOLUTION extremidades. I-EVOLUTION La B-TREATMENT paciente I-TREATMENT permanece I-TREATMENT ingresada I-TREATMENT en I-TREATMENT planta I-TREATMENT durante I-TREATMENT 20 I-TREATMENT días I-TREATMENT recibiendo I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT cinesiterapia I-TREATMENT generalizada I-TREATMENT pasiva I-TREATMENT y I-TREATMENT asistida. I-TREATMENT Tras I-TREATMENT buena I-TREATMENT evolución I-TREATMENT en I-TREATMENT la I-TREATMENT movilidad I-TREATMENT es I-TREATMENT dada I-TREATMENT de I-TREATMENT alta, I-TREATMENT no I-TREATMENT precisando I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT excepción I-TREATMENT de I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular. I-TREATMENT I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION feocromocitoma I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION suprarrenal I-EXPLORATION derecha I-EXPLORATION cuyo I-EXPLORATION diámetro I-EXPLORATION mayor I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm. I-EXPLORATION El I-EXPLORATION tumor I-EXPLORATION no I-EXPLORATION está I-EXPLORATION encapsulado I-EXPLORATION y I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION fuera I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION suprarrenal, I-EXPLORATION sin I-EXPLORATION afectar I-EXPLORATION a I-EXPLORATION los I-EXPLORATION órganos I-EXPLORATION adyacentes. I-EXPLORATION Existe I-EXPLORATION necrosis I-EXPLORATION tumoral I-EXPLORATION extensa. I-EXPLORATION La I-EXPLORATION glándula I-EXPLORATION suprarrenal I-EXPLORATION no I-EXPLORATION neoplásica I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION anomalías. I-EXPLORATION Los I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION estudiados I-EXPLORATION no I-EXPLORATION presentan I-EXPLORATION tumor. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION hepático I-EXPLORATION hay I-EXPLORATION extensas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION centrolobulillar, I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION hepatocitos I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION en I-EXPLORATION los I-EXPLORATION fragmentos I-EXPLORATION estudiados I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION hepático. I-EXPLORATION Trombo I-EXPLORATION infrarrenal I-EXPLORATION hemático, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION tumorales. I-EXPLORATION I-EXPLORATION En B-EVOLUTION la I-EVOLUTION revisión I-EVOLUTION realizada I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION asintomática, I-EVOLUTION realizando I-EVOLUTION vida I-EVOLUTION activa I-EVOLUTION y I-EVOLUTION la I-EVOLUTION TC I-EVOLUTION no I-EVOLUTION mostró I-EVOLUTION lesiones I-EVOLUTION sugestivas I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION tumoral. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY quirúrgicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sala I-PRESENT_ILLNESS de I-PRESENT_ILLNESS traumatología I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS diagnostico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lumbalgia I-PRESENT_ILLNESS rebelde I-PRESENT_ILLNESS al I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS domiciliario. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION abdominopélvico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION retroperitoneal I-EXPLORATION (paraaórtica) I-EXPLORATION que I-EXPLORATION se I-EXPLORATION continua I-EXPLORATION con I-EXPLORATION la I-EXPLORATION cadena I-EXPLORATION iliaca I-EXPLORATION primitiva I-EXPLORATION y I-EXPLORATION las I-EXPLORATION cadenas I-EXPLORATION iliacas, I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION la I-EXPLORATION externa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION abdominopelviana I-EXPLORATION (9¥28 I-EXPLORATION cm). I-EXPLORATION La I-EXPLORATION tumoración I-EXPLORATION es I-EXPLORATION sólida I-EXPLORATION con I-EXPLORATION pequeñas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION cervicotorácico I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION punción I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION células I-EXPLORATION germinales I-EXPLORATION tipo I-EXPLORATION seminoma. I-EXPLORATION I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION testicular I-EXPLORATION bilateral I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION testicular I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION ecogénicas I-EXPLORATION puntiformes I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION testículos I-EXPLORATION (mas I-EXPLORATION llamativas I-EXPLORATION y I-EXPLORATION extensas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION teste I-EXPLORATION izquierdo), I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION masa I-EXPLORATION clara. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION ecográficos, I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION biopsia I-EXPLORATION testicular I-EXPLORATION bilateral. I-EXPLORATION En I-EXPLORATION ambos I-EXPLORATION testes I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION atrofia I-EXPLORATION testicular I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION "solo I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Sertoli", I-EXPLORATION hialinización I-EXPLORATION tubular I-EXPLORATION y I-EXPLORATION microlitiasis. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION practicada I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION llamaba I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION una I-EXPLORATION LDH I-EXPLORATION de I-EXPLORATION 1903 I-EXPLORATION y I-EXPLORATION b-HCG I-EXPLORATION de I-EXPLORATION 23, I-EXPLORATION 8, I-EXPLORATION con I-EXPLORATION α-fetoproteína I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT CTEP I-TREATMENT (Cisplatino I-TREATMENT y I-TREATMENT Etopósido). I-TREATMENT Después B-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION ciclos I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION observándose I-EXPLORATION la I-EXPLORATION total I-EXPLORATION desaparición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION retroperitoneal, I-EXPLORATION quedando I-EXPLORATION tan I-EXPLORATION solo I-EXPLORATION dos I-EXPLORATION adenopatías I-EXPLORATION paraaórticas I-EXPLORATION izquierdas I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION iliaca I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION cada I-EXPLORATION una, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT dos I-TREATMENT ciclos I-TREATMENT mas I-TREATMENT de I-TREATMENT CTEP, I-TREATMENT sin B-EVOLUTION conseguirse I-EVOLUTION reducción I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION dichas I-EVOLUTION adenopatías. I-EVOLUTION I-EVOLUTION Con B-TREATMENT la I-TREATMENT intención I-TREATMENT de I-TREATMENT extirpar I-TREATMENT la I-TREATMENT masa I-TREATMENT tumoral I-TREATMENT restante I-TREATMENT tras I-TREATMENT la I-TREATMENT quimioterapia, I-TREATMENT se I-TREATMENT practicó I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT con I-TREATMENT resección I-TREATMENT de I-TREATMENT las I-TREATMENT adenopatías I-TREATMENT y I-TREATMENT orquiectomía I-TREATMENT bilateral. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION adenopatías I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION fibroso I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION linfoide I-EXPLORATION disperso I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION tumor. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION los I-EXPLORATION testículos I-EXPLORATION informo I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION solo I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Sertoli, I-EXPLORATION con I-EXPLORATION importante I-EXPLORATION atrofia I-EXPLORATION tubular, I-EXPLORATION hialinosis, I-EXPLORATION calcificaciones I-EXPLORATION y I-EXPLORATION microlitiasis I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION tumor. I-EXPLORATION I-EXPLORATION Tras B-EVOLUTION doce I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION clínicamente I-EVOLUTION asintomático I-EVOLUTION con B-TREATMENT tratamiento I-TREATMENT hormonal I-TREATMENT sustitutivo I-TREATMENT y B-EVOLUTION sin I-EVOLUTION recidiva I-EVOLUTION radiológica I-EVOLUTION ni I-EVOLUTION analítica. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipo I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS dispepsia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS plenitud I-PRESENT_ILLNESS postprandrial. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY laparotomía I-PAST_MEDICAL_HISTORY exploradora I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 14 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY abdominal, I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY desconocemos I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY haberse I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY centro. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION ocupación I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION hemiabdomen I-EXPLORATION derecho I-EXPLORATION por I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica, I-EXPLORATION a I-EXPLORATION tensión, I-EXPLORATION indolora I-EXPLORATION y I-EXPLORATION mate I-EXPLORATION a I-EXPLORATION la I-EXPLORATION percusión I-EXPLORATION que I-EXPLORATION sobrepasaba I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION de I-EXPLORATION rutina I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 13 I-EXPLORATION x I-EXPLORATION 106 I-EXPLORATION hematíes, I-EXPLORATION 20.5 I-EXPLORATION g/dl I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION y I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 65.9%, I-EXPLORATION con I-EXPLORATION cifras I-EXPLORATION similares I-EXPLORATION en I-EXPLORATION el I-EXPLORATION preoperatorio I-EXPLORATION inmediato. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hidronefrosis I-EXPLORATION masiva I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION ectasia I-EXPLORATION pielocalicial I-EXPLORATION masiva I-EXPLORATION con I-EXPLORATION prácticamente I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION cortical, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION hemiabdomen I-EXPLORATION derecho, I-EXPLORATION sobrepasando I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION hasta I-EXPLORATION contactar I-EXPLORATION con I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION en I-EXPLORATION herradura I-EXPLORATION I-EXPLORATION Se B-TREATMENT practicó, I-TREATMENT por I-TREATMENT lumbotomía, I-TREATMENT nefrectomía I-TREATMENT derecha I-TREATMENT de I-TREATMENT un I-TREATMENT gran I-TREATMENT riñón I-TREATMENT hidronefrótico I-TREATMENT secundario I-TREATMENT a I-TREATMENT estenosis I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT pieloureteral, I-TREATMENT cursando I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION hidronefrótico I-EXPLORATION con I-EXPLORATION atrofia I-EXPLORATION cortical I-EXPLORATION marcada. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION Hemoglobina I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION g/dl, I-EXPLORATION 4, I-EXPLORATION 6 I-EXPLORATION millones I-EXPLORATION de I-EXPLORATION eritrocitos I-EXPLORATION y I-EXPLORATION 43, I-EXPLORATION 7% I-EXPLORATION de I-EXPLORATION hematocrito. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION otro I-EXPLORATION hemograma I-EXPLORATION 10 I-EXPLORATION meses I-EXPLORATION después I-EXPLORATION evidenciándose I-EXPLORATION una I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION recuento I-EXPLORATION eritrocitario. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Pielonefritis I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY nefríticos I-PAST_MEDICAL_HISTORY izquierdos I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY estudiados I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY juventud. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION puñopercusión I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION un I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION con I-EXPLORATION hipertrofia I-EXPLORATION prostática I-EXPLORATION volumen I-EXPLORATION III/IV, I-EXPLORATION fibroadenomatosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION nódulos. I-EXPLORATION Analítica I-EXPLORATION sanguínea I-EXPLORATION con I-EXPLORATION bioquímica I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION PSA I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 4 I-EXPLORATION ng/ml I-EXPLORATION y I-EXPLORATION formula I-EXPLORATION sanguínea I-EXPLORATION con I-EXPLORATION leucocitosis I-EXPLORATION y I-EXPLORATION desviación I-EXPLORATION izquierda. I-EXPLORATION Analítica I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION con I-EXPLORATION nitritos I-EXPLORATION positivos I-EXPLORATION y I-EXPLORATION leucocituria. I-EXPLORATION Urocultivos I-EXPLORATION y I-EXPLORATION Hemocultivos I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION E. I-EXPLORATION Coli. I-EXPLORATION Rx I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION aparato I-EXPLORATION urinario I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION significativos. I-EXPLORATION Ecografía I-EXPLORATION con I-EXPLORATION ectasia I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION grado I-EXPLORATION II-III. I-EXPLORATION La I-EXPLORATION UIV I-EXPLORATION realizada I-EXPLORATION muestra I-EXPLORATION vía I-EXPLORATION urinaria I-EXPLORATION alta I-EXPLORATION derecha I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION y I-EXPLORATION retraso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION y I-EXPLORATION eliminación I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION persiste I-EXPLORATION a I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION horas. I-EXPLORATION Se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION nefrostomía I-EXPLORATION derivativa I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION pielografía I-EXPLORATION anterógrada, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION demuestra I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION en I-EXPLORATION uréter I-EXPLORATION iliaco I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION tumoración I-EXPLORATION ureteral I-EXPLORATION de I-EXPLORATION 3-4 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION uréter I-EXPLORATION en I-EXPLORATION anzuelo. I-EXPLORATION Citología I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION nefrostomía I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION objetivaba I-EXPLORATION dicha I-EXPLORATION lesión I-EXPLORATION como I-EXPLORATION confinada I-EXPLORATION al I-EXPLORATION órgano I-EXPLORATION origen. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT Nefroureterectomía I-TREATMENT izquierda I-TREATMENT previa I-TREATMENT desinserción I-TREATMENT endoscópica, I-TREATMENT siendo I-TREATMENT el I-TREATMENT resultado I-TREATMENT anatomopatológico I-TREATMENT de I-TREATMENT Papiloma I-TREATMENT invertido I-TREATMENT de I-TREATMENT uréter I-TREATMENT y I-TREATMENT riñón I-TREATMENT izquierdo I-TREATMENT con I-TREATMENT pielonefritis I-TREATMENT crónica. I-TREATMENT A B-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sufre I-EVOLUTION una I-EVOLUTION RAO I-EVOLUTION que I-EVOLUTION aconseja I-EVOLUTION la I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION Adenomectomía I-EVOLUTION Retropúbica I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION presenta I-EVOLUTION sendas I-EVOLUTION recidivas I-EVOLUTION vesicales I-EVOLUTION de I-EVOLUTION Carcinoma I-EVOLUTION transicional I-EVOLUTION de I-EVOLUTION vejiga I-EVOLUTION T1GII. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION vivo I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION urotelial I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION años I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION PI. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urología I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS nódulo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS paratesticular I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Tres B-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY hospital I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY ACVA I-PAST_MEDICAL_HISTORY parietal I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY presentando I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fuerza I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY hemicuerpo I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dificultad I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY habla. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY tomografía I-PAST_MEDICAL_HISTORY axial I-PAST_MEDICAL_HISTORY computerizada I-PAST_MEDICAL_HISTORY (TAC) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cráneo I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY apreció I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY hipodensa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY brazo I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cápsula I-PAST_MEDICAL_HISTORY blanca I-PAST_MEDICAL_HISTORY interna I-PAST_MEDICAL_HISTORY izquierda, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY sutiles I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY fronto-parietal I-PAST_MEDICAL_HISTORY izquierda. I-PAST_MEDICAL_HISTORY Tras I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY administración I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY contraste I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY apreciaron I-PAST_MEDICAL_HISTORY imágenes I-PAST_MEDICAL_HISTORY compatibles I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY aneurisma, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY observó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY tortuosidad I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY arteria I-PAST_MEDICAL_HISTORY cerebral I-PAST_MEDICAL_HISTORY media I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY podría I-PAST_MEDICAL_HISTORY corresponder I-PAST_MEDICAL_HISTORY bien I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trombo I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY efecto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY volumen I-PAST_MEDICAL_HISTORY parcial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY contexto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY vaso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY morfología I-PAST_MEDICAL_HISTORY tortuosa. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY angio-resonancia I-PAST_MEDICAL_HISTORY magnética I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY observó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY arterias I-PAST_MEDICAL_HISTORY cerebrales I-PAST_MEDICAL_HISTORY medias I-PAST_MEDICAL_HISTORY eran I-PAST_MEDICAL_HISTORY asimétricas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cuanto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY señal, I-PAST_MEDICAL_HISTORY presentando I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY disminución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY señal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY todo I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY trayecto, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY estenosis. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY electrocardiograma I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY alteraciones. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY carotídea, I-PAST_MEDICAL_HISTORY arteriografía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY troncos I-PAST_MEDICAL_HISTORY cerebrales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY supraórticos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ecocardiograma I-PAST_MEDICAL_HISTORY transesofágico I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY determinaciones I-PAST_MEDICAL_HISTORY analíticas I-PAST_MEDICAL_HISTORY sanguíneas, I-PAST_MEDICAL_HISTORY todos I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY parámetros I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY normales, I-PAST_MEDICAL_HISTORY incluidos I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY estudios I-PAST_MEDICAL_HISTORY realizados I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY llegar I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY etiológico I-PAST_MEDICAL_HISTORY como: I-PAST_MEDICAL_HISTORY anticoagulante I-PAST_MEDICAL_HISTORY lúpico, I-PAST_MEDICAL_HISTORY homocisteína, I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anticardiolipina, I-PAST_MEDICAL_HISTORY (α2 I-PAST_MEDICAL_HISTORY antiplasmina, I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anti-proteinasa-3, I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anti-mieloperoxidasa, I-PAST_MEDICAL_HISTORY proteína I-PAST_MEDICAL_HISTORY S, I-PAST_MEDICAL_HISTORY actividad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY proteína I-PAST_MEDICAL_HISTORY C, I-PAST_MEDICAL_HISTORY RPR, I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY antinucleares, I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anticitoplasma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY neutrófilos I-PAST_MEDICAL_HISTORY (ANCA), I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anti I-PAST_MEDICAL_HISTORY SSA I-PAST_MEDICAL_HISTORY Ro I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anti I-PAST_MEDICAL_HISTORY SSB I-PAST_MEDICAL_HISTORY LA. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY definitiva, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY trata I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY joven I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ACVA I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY territorio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cerebral I-PAST_MEDICAL_HISTORY media I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY etiología I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY filiada. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS pétrea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS paratesticular I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION testicular I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION del I-EXPLORATION cordón I-EXPLORATION espermático I-EXPLORATION izquierdo. I-EXPLORATION Los I-EXPLORATION testículos I-EXPLORATION son I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION morfología I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Resonacia I-EXPLORATION Magnética I-EXPLORATION objetivándose I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cordón I-EXPLORATION espermático I-EXPLORATION izquierdo I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION comporta I-EXPLORATION con I-EXPLORATION alta I-EXPLORATION señal I-EXPLORATION en I-EXPLORATION secuencias I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION T2. I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION se I-EXPLORATION produce I-EXPLORATION un I-EXPLORATION realce I-EXPLORATION periférico I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION con I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION hipointensa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION centro I-EXPLORATION que I-EXPLORATION representa I-EXPLORATION a I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION avascular I-EXPLORATION de I-EXPLORATION necrosis. I-EXPLORATION Las I-EXPLORATION posibilidades I-EXPLORATION diagnósticas I-EXPLORATION fueron I-EXPLORATION dos: I-EXPLORATION liposarcoma I-EXPLORATION del I-EXPLORATION cordón I-EXPLORATION espermático I-EXPLORATION o I-EXPLORATION vasculitis. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT biopsia I-TREATMENT de I-TREATMENT cordón I-TREATMENT espermático I-TREATMENT y I-TREATMENT testículo. I-TREATMENT Macroscópicamente B-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION nodular, I-EXPLORATION sólida I-EXPLORATION y I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION blanquecina, I-EXPLORATION con I-EXPLORATION zona I-EXPLORATION irregulares I-EXPLORATION amarillentas I-EXPLORATION que I-EXPLORATION medía I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm. I-EXPLORATION Histológicamente I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION vasculitis I-EXPLORATION granulomatosa I-EXPLORATION necrotizante I-EXPLORATION que I-EXPLORATION afectaba I-EXPLORATION fundamentalmente I-EXPLORATION a I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION mediano I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION centra I-EXPLORATION irregular I-EXPLORATION con I-EXPLORATION necrosis. I-EXPLORATION El I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION es I-EXPLORATION transmural I-EXPLORATION y I-EXPLORATION ocasiona I-EXPLORATION una I-EXPLORATION obliteración I-EXPLORATION prácticamente I-EXPLORATION total I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION vascular. I-EXPLORATION Periféricamente I-EXPLORATION en I-EXPLORATION las I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION adyacentes I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION marcada I-EXPLORATION fibrosis, I-EXPLORATION necrosis I-EXPLORATION grasa I-EXPLORATION e I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION agudo I-EXPLORATION y I-EXPLORATION crónico. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Ziehl-Neelsen I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION bacilos I-EXPLORATION alcohol I-EXPLORATION resistentes. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION anatomo I-EXPLORATION patológico I-EXPLORATION es I-EXPLORATION de I-EXPLORATION vasculitis I-EXPLORATION granulomatosa I-EXPLORATION necrotizante I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION paratesticular. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION testículo I-EXPLORATION no I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION complicaciones I-EVOLUTION postoperatorias I-EVOLUTION y B-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT Deflazacort I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 30 I-TREATMENT mg/día. I-TREATMENT En B-EVOLUTION el I-EVOLUTION momento I-EVOLUTION actual I-EVOLUTION después I-EVOLUTION de I-EVOLUTION 16 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION ninguna I-EVOLUTION sintomatología I-EVOLUTION y I-EVOLUTION sigue I-EVOLUTION con I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION mantenimiento I-EVOLUTION (6 I-EVOLUTION mg/día). I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY cesáreas, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION intravenosa I-EXPLORATION una I-EXPLORATION acodadura I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION derecho I-EXPLORATION en I-EXPLORATION su I-EXPLORATION tercio I-EXPLORATION superior I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION Asintomática, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION A B-EXPLORATION los I-EXPLORATION dos I-EXPLORATION meses, I-EXPLORATION nuevo I-EXPLORATION ingreso I-EXPLORATION por I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION nueva I-EXPLORATION batería I-EXPLORATION de I-EXPLORATION pruebas: I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION comprueba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION uréter I-EXPLORATION distal I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION pequeñas I-EXPLORATION calcificaciones I-EXPLORATION en I-EXPLORATION riñón I-EXPLORATION derecho; I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION confirma I-EXPLORATION lo I-EXPLORATION hallado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION y I-EXPLORATION además I-EXPLORATION descarta I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION uropatía I-EXPLORATION obstructiva. I-EXPLORATION En I-EXPLORATION todo I-EXPLORATION momento I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION Se B-TREATMENT trata I-TREATMENT la I-TREATMENT litiasis I-TREATMENT ureteral I-TREATMENT mediante I-TREATMENT ureteroscopia I-TREATMENT y I-TREATMENT lasertricia I-TREATMENT persistiendo I-TREATMENT la I-TREATMENT clínica I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT la I-TREATMENT eficacia I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT lo I-TREATMENT que I-TREATMENT motiva I-TREATMENT nuevo I-TREATMENT ingreso I-TREATMENT unos I-TREATMENT meses I-TREATMENT más I-TREATMENT tarde. I-TREATMENT Se B-EXPLORATION realiza I-EXPLORATION UIV I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION ectasia I-EXPLORATION ureteropielocalicial I-EXPLORATION derecha I-EXPLORATION hasta I-EXPLORATION cresta I-EXPLORATION iliaca. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION los I-EXPLORATION riñones I-EXPLORATION son I-EXPLORATION normales I-EXPLORATION pero I-EXPLORATION el I-EXPLORATION uréter I-EXPLORATION derecho I-EXPLORATION está I-EXPLORATION discretamente I-EXPLORATION dilatado I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION identifica I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION ovárico I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION pudiera I-EXPLORATION estar I-EXPLORATION comprimiendo I-EXPLORATION parcialmente I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION (vista I-EXPLORATION por I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION ginecología I-EXPLORATION no I-EXPLORATION precisa I-EXPLORATION tratamiento I-EXPLORATION alguno, I-EXPLORATION solamente I-EXPLORATION revisiones I-EXPLORATION periódicas). I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION pielografía I-EXPLORATION ascendente I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION se I-EXPLORATION ve I-EXPLORATION la I-EXPLORATION ectasia I-EXPLORATION ureteropielocalicial I-EXPLORATION sin I-EXPLORATION observar I-EXPLORATION claramente I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION ureteral; I-EXPLORATION se B-TREATMENT coloca I-TREATMENT un I-TREATMENT catéter I-TREATMENT doble I-TREATMENT J I-TREATMENT que I-TREATMENT es I-TREATMENT retirado I-TREATMENT a I-TREATMENT las I-TREATMENT 8 I-TREATMENT semanas I-TREATMENT sin I-TREATMENT apreciar I-TREATMENT la I-TREATMENT paciente I-TREATMENT mejoría I-TREATMENT clínica. I-TREATMENT Se B-EXPLORATION decide I-EXPLORATION hacer I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION que I-EXPLORATION nos I-EXPLORATION pueda I-EXPLORATION aportar I-EXPLORATION algún I-EXPLORATION dato I-EXPLORATION nuevo I-EXPLORATION que I-EXPLORATION justifique I-EXPLORATION los I-EXPLORATION síntomas; I-EXPLORATION dicha I-EXPLORATION RMN I-EXPLORATION nos I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION una I-EXPLORATION ectasia I-EXPLORATION ureteral I-EXPLORATION derecha I-EXPLORATION por I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION ovárica. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programa I-TREATMENT para I-TREATMENT intervención I-TREATMENT quirúrgica: I-TREATMENT ligadura I-TREATMENT de I-TREATMENT vena I-TREATMENT ovárica I-TREATMENT más I-TREATMENT ureterolisis I-TREATMENT derecha I-TREATMENT por I-TREATMENT vía I-TREATMENT laparoscópica I-TREATMENT transabdominal. I-TREATMENT La I-TREATMENT paciente I-TREATMENT es I-TREATMENT colocada I-TREATMENT en I-TREATMENT ligero I-TREATMENT decúbito I-TREATMENT lateral I-TREATMENT izquierdo. I-TREATMENT Insuflación I-TREATMENT abdominal I-TREATMENT con I-TREATMENT CO2 I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT aguja I-TREATMENT de I-TREATMENT Veress I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT cuatro I-TREATMENT trócares, I-TREATMENT 2 I-TREATMENT de I-TREATMENT 5 I-TREATMENT mm I-TREATMENT - I-TREATMENT (uno I-TREATMENT subesternal I-TREATMENT y I-TREATMENT otro I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT lumbar I-TREATMENT entre I-TREATMENT la I-TREATMENT cresta I-TREATMENT iliaca I-TREATMENT y I-TREATMENT la I-TREATMENT 12ª I-TREATMENT costilla) I-TREATMENT - I-TREATMENT y I-TREATMENT 2 I-TREATMENT de I-TREATMENT 10 I-TREATMENT mm I-TREATMENT - I-TREATMENT (uno I-TREATMENT en I-TREATMENT el I-TREATMENT ombligo, I-TREATMENT donde I-TREATMENT se I-TREATMENT coloca I-TREATMENT la I-TREATMENT óptica, I-TREATMENT y I-TREATMENT el I-TREATMENT otro I-TREATMENT suprapúbico) I-TREATMENT -. I-TREATMENT Tras I-TREATMENT la I-TREATMENT incisión I-TREATMENT de I-TREATMENT la I-TREATMENT línea I-TREATMENT de I-TREATMENT Toldt I-TREATMENT y I-TREATMENT decolación I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT identificación I-TREATMENT del I-TREATMENT uréter I-TREATMENT lumbar I-TREATMENT y I-TREATMENT seguimiento I-TREATMENT del I-TREATMENT mismo I-TREATMENT hasta I-TREATMENT observar I-TREATMENT su I-TREATMENT paso I-TREATMENT entre I-TREATMENT la I-TREATMENT arteria I-TREATMENT iliaca I-TREATMENT y I-TREATMENT la I-TREATMENT vena I-TREATMENT ovárica, I-TREATMENT ésta I-TREATMENT última I-TREATMENT cruza I-TREATMENT por I-TREATMENT encima I-TREATMENT del I-TREATMENT uréter I-TREATMENT y I-TREATMENT se I-TREATMENT bifurca I-TREATMENT en I-TREATMENT 2 I-TREATMENT ramas I-TREATMENT que I-TREATMENT actúan I-TREATMENT a I-TREATMENT modo I-TREATMENT de I-TREATMENT pinza I-TREATMENT comprimiendo I-TREATMENT el I-TREATMENT uréter. I-TREATMENT Se I-TREATMENT libera I-TREATMENT la I-TREATMENT vena I-TREATMENT ovárica I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT ligadura I-TREATMENT y I-TREATMENT sección I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT Para I-TREATMENT finalizar, I-TREATMENT colocamos I-TREATMENT un I-TREATMENT drenaje I-TREATMENT tipo I-TREATMENT Redon I-TREATMENT sin I-TREATMENT aspiración I-TREATMENT a I-TREATMENT través I-TREATMENT del I-TREATMENT trócar I-TREATMENT lateral, I-TREATMENT se I-TREATMENT confirma I-TREATMENT la I-TREATMENT hemostasia, I-TREATMENT se I-TREATMENT evacúa I-TREATMENT el I-TREATMENT CO2 I-TREATMENT y I-TREATMENT se I-TREATMENT suturan I-TREATMENT los I-TREATMENT puertos I-TREATMENT de I-TREATMENT entrada. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION cursa I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION En I-EVOLUTION revisiones I-EVOLUTION posteriores, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION totalmente I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION UIV I-EVOLUTION de I-EVOLUTION control I-EVOLUTION ha I-EVOLUTION desaparecido I-EVOLUTION la I-EVOLUTION ectasia I-EVOLUTION y I-EVOLUTION acodadura I-EVOLUTION del I-EVOLUTION uréter I-EVOLUTION derecho. I-EVOLUTION I-EVOLUTION Hermanos B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS casados B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hijos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infertilidad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sinusitis I-PAST_MEDICAL_HISTORY frecuentes I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY infecciones I-PAST_MEDICAL_HISTORY respiratorias I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY muchos I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY niegan I-PAST_MEDICAL_HISTORY haberlas I-PAST_MEDICAL_HISTORY padecido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY Madre B-FAMILY_HISTORY y I-FAMILY_HISTORY hermana I-FAMILY_HISTORY presentan I-FAMILY_HISTORY broncopatía I-FAMILY_HISTORY crónica I-FAMILY_HISTORY no I-FAMILY_HISTORY filiada. I-FAMILY_HISTORY Padre I-FAMILY_HISTORY sano I-FAMILY_HISTORY sin I-FAMILY_HISTORY afectación I-FAMILY_HISTORY pulmonar I-FAMILY_HISTORY o I-FAMILY_HISTORY sinusal. I-FAMILY_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION hermanos, I-EXPLORATION hermana, I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION madre, I-EXPLORATION sólo I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION roncus I-EXPLORATION en I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION pulmonar. I-EXPLORATION No B-FAMILY_HISTORY se I-FAMILY_HISTORY pudieron I-FAMILY_HISTORY obtener I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY clínicos I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY ascendencia I-FAMILY_HISTORY tanto I-FAMILY_HISTORY paterna I-FAMILY_HISTORY como I-FAMILY_HISTORY materna. I-FAMILY_HISTORY Bioquímica B-EXPLORATION ordinaria I-EXPLORATION normal, I-EXPLORATION incluyendo I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION renal. I-EXPLORATION Alfa-1-anti-tripsina I-EXPLORATION normal. I-EXPLORATION Proteinograma I-EXPLORATION e I-EXPLORATION inmunoglobulinas I-EXPLORATION normales. I-EXPLORATION Hormonas I-EXPLORATION tiroideas I-EXPLORATION normales. I-EXPLORATION Marcadores I-EXPLORATION del I-EXPLORATION virus I-EXPLORATION B I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION y I-EXPLORATION del I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION negativos. I-EXPLORATION Anticuerpos I-EXPLORATION antinucleares, I-EXPLORATION pruebas I-EXPLORATION reumáticas, I-EXPLORATION fracción I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION C4 I-EXPLORATION negativos. I-EXPLORATION Gasometría I-EXPLORATION arterial I-EXPLORATION basal I-EXPLORATION y I-EXPLORATION bicarbonato I-EXPLORATION normal. I-EXPLORATION Espirometría I-EXPLORATION normal. I-EXPLORATION Saturación I-EXPLORATION Hb I-EXPLORATION normal. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION normal. I-EXPLORATION Tanto I-EXPLORATION los I-EXPLORATION hermanos I-EXPLORATION como I-EXPLORATION la I-EXPLORATION hermana I-EXPLORATION y I-EXPLORATION la I-EXPLORATION madre I-EXPLORATION rehusaron I-EXPLORATION hacer I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION respiratoria I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION ultraestructural I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cilios. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION semen I-EXPLORATION indica I-EXPLORATION astenozoospermia I-EXPLORATION total I-EXPLORATION en I-EXPLORATION 3 I-EXPLORATION seminogramas I-EXPLORATION diferentes I-EXPLORATION realizados I-EXPLORATION a I-EXPLORATION ambos I-EXPLORATION hermanos, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION concentración I-EXPLORATION espermática I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 23 I-EXPLORATION millones/ml, I-EXPLORATION un I-EXPLORATION porcentaje I-EXPLORATION de I-EXPLORATION formas I-EXPLORATION normales I-EXPLORATION por I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION Kruger I-EXPLORATION del I-EXPLORATION 6% I-EXPLORATION y I-EXPLORATION una I-EXPLORATION viabilidad I-EXPLORATION del I-EXPLORATION 95%. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION ultraestructural I-EXPLORATION del I-EXPLORATION flagelo I-EXPLORATION espermático I-EXPLORATION por I-EXPLORATION microscopía I-EXPLORATION electrónica I-EXPLORATION indica I-EXPLORATION que I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION hermanos I-EXPLORATION tienen I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION anomalía. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION mayoría I-EXPLORATION de I-EXPLORATION las I-EXPLORATION secciones I-EXPLORATION transversales I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION brazos I-EXPLORATION de I-EXPLORATION dineína. I-EXPLORATION El I-EXPLORATION filamento I-EXPLORATION de I-EXPLORATION nexina I-EXPLORATION está I-EXPLORATION presente, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION las I-EXPLORATION fibras I-EXPLORATION radiales I-EXPLORATION y I-EXPLORATION el I-EXPLORATION par I-EXPLORATION central. I-EXPLORATION En I-EXPLORATION espermatozoides I-EXPLORATION aislados, I-EXPLORATION coincidiendo I-EXPLORATION con I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION los I-EXPLORATION brazos I-EXPLORATION de I-EXPLORATION dineína, I-EXPLORATION hay I-EXPLORATION también I-EXPLORATION pérdida I-EXPLORATION del I-EXPLORATION par I-EXPLORATION central. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION anomalía I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vaina I-EXPLORATION fibrosa, I-EXPLORATION ni I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION densas. I-EXPLORATION La I-EXPLORATION pieza I-EXPLORATION intermedia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION aproximadamente I-EXPLORATION de I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION tenía I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION número I-EXPLORATION de I-EXPLORATION mitocondrias I-EXPLORATION y I-EXPLORATION mitocondrias I-EXPLORATION extras I-EXPLORATION no I-EXPLORATION alineadas. I-EXPLORATION Otros I-EXPLORATION datos I-EXPLORATION añadidos I-EXPLORATION fueron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION microtúbulos I-EXPLORATION extra I-EXPLORATION periféricos I-EXPLORATION al I-EXPLORATION axonema. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vejiga I-PAST_MEDICAL_HISTORY hiperrefléxica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY sección I-PAST_MEDICAL_HISTORY medular I-PAST_MEDICAL_HISTORY traumática I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS disparos I-PRESENT_ILLNESS miccionales I-PRESENT_ILLNESS con I-PRESENT_ILLNESS incontinencia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuadros I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pielonefritis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS repetición. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION cistografía I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION vejiga I-EXPLORATION de I-EXPLORATION escasa I-EXPLORATION capacidad, I-EXPLORATION sin I-EXPLORATION reflujo I-EXPLORATION vesicoureteral. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION urodinámico I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION disparo I-EXPLORATION miccional I-EXPLORATION desde I-EXPLORATION los I-EXPLORATION 60cc I-EXPLORATION de I-EXPLORATION llenado I-EXPLORATION con I-EXPLORATION altas I-EXPLORATION presiones I-EXPLORATION vesicales I-EXPLORATION que I-EXPLORATION había I-EXPLORATION resultado I-EXPLORATION refractario I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION conservador. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT enterocistoplastia I-TREATMENT de I-TREATMENT ampliación I-TREATMENT laparoscópica I-TREATMENT con I-TREATMENT un I-TREATMENT segmento I-TREATMENT ileal I-TREATMENT de I-TREATMENT 25 I-TREATMENT cm I-TREATMENT plegado I-TREATMENT en I-TREATMENT U. I-TREATMENT La I-TREATMENT duración I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía I-TREATMENT fue I-TREATMENT de I-TREATMENT 4, I-TREATMENT 5 I-TREATMENT horas I-TREATMENT con I-TREATMENT un I-TREATMENT sangrado I-TREATMENT mínimo. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION constipación, I-EVOLUTION que I-EVOLUTION ya I-EVOLUTION presentaba I-EVOLUTION ocasionalmente I-EVOLUTION antes I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION Se I-EVOLUTION procedió I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION al I-EVOLUTION duodécimo I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION El I-EVOLUTION seguimiento I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION meses. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION programa I-EVOLUTION de I-EVOLUTION autocateterismos, I-EVOLUTION continente I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION infección I-EVOLUTION urinaria. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS destacando B-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY insulina, I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY miopía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cataratas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS craurosis I-PRESENT_ILLNESS prepucial I-PRESENT_ILLNESS que I-PRESENT_ILLNESS impide I-PRESENT_ILLNESS retracción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prepucio. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION debajo I-EXPLORATION de I-EXPLORATION prepucio I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION glande I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION tres I-EXPLORATION centímetros I-EXPLORATION no I-EXPLORATION doloroso I-EXPLORATION y I-EXPLORATION muy I-EXPLORATION consistente. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION pene, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION con I-EXPLORATION anestesia I-EXPLORATION local I-EXPLORATION incisión I-EXPLORATION prepucial I-EXPLORATION encontrándonos I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION cuatro I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION rojo I-EXPLORATION amarillento, I-EXPLORATION algo I-EXPLORATION rugoso, I-EXPLORATION consistente I-EXPLORATION al I-EXPLORATION tacto I-EXPLORATION y I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION glande. I-EXPLORATION Se I-EXPLORATION tomó I-EXPLORATION una I-EXPLORATION cuña I-EXPLORATION profunda I-EXPLORATION del I-EXPLORATION nódulo I-EXPLORATION y I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION anatomopatológico. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT no I-TREATMENT realizar I-TREATMENT circuncisión I-TREATMENT ni I-TREATMENT exéresis I-TREATMENT del I-TREATMENT nódulo I-TREATMENT a I-TREATMENT la I-TREATMENT espera I-TREATMENT del I-TREATMENT resultado. I-TREATMENT Aunque I-TREATMENT con I-TREATMENT la I-TREATMENT incisión I-TREATMENT prepucial I-TREATMENT el I-TREATMENT glande I-TREATMENT pudo I-TREATMENT ser I-TREATMENT exteriorizado I-TREATMENT y I-TREATMENT realizar I-TREATMENT una I-TREATMENT higiene I-TREATMENT adecuada. I-TREATMENT I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION histológico I-EXPLORATION es I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION amiloidosis I-EXPLORATION nodular. I-EXPLORATION Es B-EVOLUTION curioso I-EVOLUTION señalar I-EVOLUTION que I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tiempo I-EVOLUTION transcurrido I-EVOLUTION a I-EVOLUTION la I-EVOLUTION espera I-EVOLUTION del I-EVOLUTION resultado I-EVOLUTION histológico, I-EVOLUTION al I-EVOLUTION poder I-EVOLUTION realizar I-EVOLUTION una I-EVOLUTION higiene I-EVOLUTION adecuada, I-EVOLUTION el I-EVOLUTION aspecto I-EVOLUTION del I-EVOLUTION nódulo I-EVOLUTION mejoró. I-EVOLUTION I-EVOLUTION De B-TREATMENT forma I-TREATMENT reglada I-TREATMENT realizamos I-TREATMENT circuncisión I-TREATMENT y I-TREATMENT exéresis I-TREATMENT completa I-TREATMENT del I-TREATMENT nódulo, I-TREATMENT confirmando B-EXPLORATION este I-EXPLORATION segundo I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION nódulo I-EXPLORATION amiloidótico. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION permanganato I-EXPLORATION potásico I-EXPLORATION que I-EXPLORATION permitió I-EXPLORATION diferenciar I-EXPLORATION el I-EXPLORATION amiloide I-EXPLORATION tipo I-EXPLORATION AA I-EXPLORATION del I-EXPLORATION AL, I-EXPLORATION éste I-EXPLORATION último I-EXPLORATION característico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION forma I-EXPLORATION primaria I-EXPLORATION y I-EXPLORATION no I-EXPLORATION sensible I-EXPLORATION al I-EXPLORATION permanganato. I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION tisular I-EXPLORATION se I-EXPLORATION tiñó I-EXPLORATION con I-EXPLORATION Rojo I-EXPLORATION Congo I-EXPLORATION y I-EXPLORATION se I-EXPLORATION examinó I-EXPLORATION con I-EXPLORATION luz I-EXPLORATION polarizada I-EXPLORATION observándose I-EXPLORATION la I-EXPLORATION típica I-EXPLORATION birrefrigencia I-EXPLORATION verde. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION haber I-EXPLORATION identificado I-EXPLORATION el I-EXPLORATION amiloide, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION e I-EXPLORATION inmunohistoquímica. I-EXPLORATION El I-EXPLORATION componente I-EXPLORATION amiloide I-EXPLORATION lo I-EXPLORATION constituía I-EXPLORATION el I-EXPLORATION tipo I-EXPLORATION AL, I-EXPLORATION característico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION amiloidosis I-EXPLORATION primaria I-EXPLORATION y I-EXPLORATION amiloidosis I-EXPLORATION local. I-EXPLORATION Este I-EXPLORATION componente I-EXPLORATION fibrilar I-EXPLORATION se I-EXPLORATION caracteriza I-EXPLORATION por I-EXPLORATION tener I-EXPLORATION un I-EXPLORATION depósito I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION Kappa I-EXPLORATION o I-EXPLORATION lambda. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION complementario I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION amiloidosis I-EXPLORATION generalizada I-EXPLORATION consistente I-EXPLORATION en I-EXPLORATION hemograma, I-EXPLORATION bioquímica, I-EXPLORATION proteinograma, I-EXPLORATION PSA, I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION rectal. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION síndrome I-EXPLORATION nefrótico I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION creímos I-EXPLORATION oportuno I-EXPLORATION realizar I-EXPLORATION biopsia I-EXPLORATION renal. I-EXPLORATION Tampoco I-EXPLORATION presentaba I-EXPLORATION artritis, I-EXPLORATION insuficiencia I-EXPLORATION cardíaca, I-EXPLORATION hipotensión I-EXPLORATION ni I-EXPLORATION neuropatía. I-EXPLORATION Todas I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION presentaron I-EXPLORATION unos I-EXPLORATION resultados I-EXPLORATION normales I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION amiloidosis I-EXPLORATION generalizada. I-EXPLORATION I-EXPLORATION Dos B-EVOLUTION años I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION recidivado I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION desarrollado I-EVOLUTION amiloidosis I-EVOLUTION generalizada. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS edemas I-PRESENT_ILLNESS progresivos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores, I-PRESENT_ILLNESS región I-PRESENT_ILLNESS genital I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inguinal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS ninguna I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS acompañante. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY constaban I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY nefríticos I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY complicados. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION llamaba I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION dura I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION púbica, I-EXPLORATION incluyendo I-EXPLORATION pene, I-EXPLORATION escroto I-EXPLORATION y I-EXPLORATION región I-EXPLORATION inguinal, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION por I-EXPLORATION ambas I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION siendo I-EXPLORATION más I-EXPLORATION evidente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION izquierda, I-EXPLORATION sin I-EXPLORATION fovea. I-EXPLORATION No I-EXPLORATION existían I-EXPLORATION lesiones I-EXPLORATION cutáneas, I-EXPLORATION ni I-EXPLORATION adenopatías I-EXPLORATION laterocervicales I-EXPLORATION o I-EXPLORATION axilares. I-EXPLORATION Palpación I-EXPLORATION de I-EXPLORATION probables I-EXPLORATION adenopatías I-EXPLORATION inguinales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION próstata I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION dura I-EXPLORATION y I-EXPLORATION no I-EXPLORATION dolorosa. I-EXPLORATION I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION incluyendo I-EXPLORATION bioquímica, I-EXPLORATION hemograma, I-EXPLORATION proteinograma, I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION con I-EXPLORATION proteinuria I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION estrictamente I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION destacando I-EXPLORATION un I-EXPLORATION PSA I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION microgramos/l. I-EXPLORATION I-EXPLORATION Tanto I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION como I-EXPLORATION el I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION objetivaron I-EXPLORATION múltiples I-EXPLORATION adenopatías I-EXPLORATION retroperitoneales I-EXPLORATION paraaórticas I-EXPLORATION y I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION cadenas I-EXPLORATION ilíacas I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION próstata I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño. I-EXPLORATION Se I-EXPLORATION consultó I-EXPLORATION con I-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Urología I-EXPLORATION y I-EXPLORATION se I-EXPLORATION llevó I-EXPLORATION a I-EXPLORATION cabo I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION prostática I-EXPLORATION concluyente I-EXPLORATION para I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION próstata I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION adenopatía I-EXPLORATION inguinal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION invasión I-EXPLORATION por I-EXPLORATION adenocarcinoma I-EXPLORATION prostático. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION intensa I-EXPLORATION positividad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION población I-EXPLORATION neoplásica I-EXPLORATION para I-EXPLORATION la I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION prostática, I-EXPLORATION el I-EXPLORATION antígeno I-EXPLORATION prostático I-EXPLORATION específico I-EXPLORATION (PSA) I-EXPLORATION y I-EXPLORATION para I-EXPLORATION los I-EXPLORATION receptores I-EXPLORATION de I-EXPLORATION andrógenos. I-EXPLORATION La I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION mostró I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION captación I-EXPLORATION retroauricular I-EXPLORATION y I-EXPLORATION en I-EXPLORATION apófisis I-EXPLORATION espinosa I-EXPLORATION y I-EXPLORATION carilla I-EXPLORATION auricular I-EXPLORATION de I-EXPLORATION C3. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT hormonal I-TREATMENT con I-TREATMENT antiandrógenos I-TREATMENT y I-TREATMENT análogos I-TREATMENT de I-TREATMENT LHRH. I-TREATMENT Ante I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT metástasis I-TREATMENT óseas, I-TREATMENT se I-TREATMENT añadió I-TREATMENT ácido I-TREATMENT zoledrónico. I-TREATMENT A B-EVOLUTION los I-EVOLUTION nueve I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION tratamiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION hallaba I-EVOLUTION estable I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION cambios I-EVOLUTION en I-EVOLUTION la I-EVOLUTION exploración I-EVOLUTION física. I-EVOLUTION El I-EVOLUTION PSA I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 4, I-EVOLUTION 6 I-EVOLUTION microgramos/l. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS es B-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO para I-DERIVED_FROM/TO completar I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO acudir I-DERIVED_FROM/TO al I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO especialidades I-DERIVED_FROM/TO por I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO indolora I-DERIVED_FROM/TO en I-DERIVED_FROM/TO su I-DERIVED_FROM/TO testículo I-DERIVED_FROM/TO izquierdo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO un I-DERIVED_FROM/TO mes I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO otra I-DERIVED_FROM/TO sintomatología. I-DERIVED_FROM/TO Se B-EXPLORATION le I-EXPLORATION detecta I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION en I-EXPLORATION el I-EXPLORATION centro I-EXPLORATION de I-EXPLORATION especialidades I-EXPLORATION un I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION hipogénico I-EXPLORATION y I-EXPLORATION disminuido I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION que I-EXPLORATION dificulta I-EXPLORATION su I-EXPLORATION valoración, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION testículo I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION parénquima I-EXPLORATION heterogéneo I-EXPLORATION sospechoso I-EXPLORATION de I-EXPLORATION neoplasia. I-EXPLORATION I-EXPLORATION No B-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tampoco I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION un I-EXPLORATION teste I-EXPLORATION izquierdo I-EXPLORATION hipotrófico. I-EXPLORATION El I-EXPLORATION teste I-EXPLORATION derecho I-EXPLORATION se I-EXPLORATION presenta I-EXPLORATION algo I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION tamaño. I-EXPLORATION Ambos I-EXPLORATION no I-EXPLORATION dolorosos, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION regulares. I-EXPLORATION Epidídimos I-EXPLORATION y I-EXPLORATION cordones I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION solicitan I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION que I-EXPLORATION resultan I-EXPLORATION en I-EXPLORATION una I-EXPLORATION alfa-feto I-EXPLORATION proteína I-EXPLORATION de I-EXPLORATION 2.7 I-EXPLORATION ng/ml I-EXPLORATION con I-EXPLORATION una I-EXPLORATION beta-hCG I-EXPLORATION de I-EXPLORATION 4.2 I-EXPLORATION mUI/ml. I-EXPLORATION I-EXPLORATION Durante I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION nuevas I-EXPLORATION exploraciones I-EXPLORATION complementarias, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION con I-EXPLORATION flujo I-EXPLORATION Doppler I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION teste I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 49mm I-EXPLORATION x I-EXPLORATION 36mm I-EXPLORATION x I-EXPLORATION 26mm I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION hipoecoica, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION lobulados, I-EXPLORATION heterogénea, I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION prácticamente I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION testículo, I-EXPLORATION y I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION flujo I-EXPLORATION Doppler. I-EXPLORATION Y I-EXPLORATION un I-EXPLORATION teste I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 32 I-EXPLORATION mm I-EXPLORATION x I-EXPLORATION 22 I-EXPLORATION mm I-EXPLORATION x I-EXPLORATION 20 I-EXPLORATION mm I-EXPLORATION hetrogéneo I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION focal I-EXPLORATION ligeramente I-EXPLORATION hipoecoica I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 9 I-EXPLORATION mm I-EXPLORATION con I-EXPLORATION sutil I-EXPLORATION flujo I-EXPLORATION Doppler. I-EXPLORATION Además, I-EXPLORATION microlitiasis I-EXPLORATION testiculares I-EXPLORATION bilaterales. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION TAC I-EXPLORATION toraco-abdomino-pélvico I-EXPLORATION con I-EXPLORATION contraste, I-EXPLORATION donde I-EXPLORATION no I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION metástasis I-EXPLORATION en I-EXPLORATION ninguno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION territorios I-EXPLORATION visualizados. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT tumor I-TREATMENT testicular I-TREATMENT bilateral, I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT orquiectomía I-TREATMENT bilateral I-TREATMENT vía I-TREATMENT inguinal. I-TREATMENT Al I-TREATMENT mismo I-TREATMENT tiempo I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT hormonal I-TREATMENT sustitutivo. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION Anatomía I-EXPLORATION patológica I-EXPLORATION informan I-EXPLORATION de I-EXPLORATION testículo I-EXPLORATION izquierdo I-EXPLORATION atrófico I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION focos I-EXPLORATION microscópicos I-EXPLORATION de I-EXPLORATION Seminoma I-EXPLORATION clásico I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION amplias I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION Neoplasia I-EXPLORATION Intratubular I-EXPLORATION de I-EXPLORATION Células I-EXPLORATION Germinales I-EXPLORATION (NICG) I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION tumoral I-EXPLORATION en I-EXPLORATION albugínea, I-EXPLORATION rete I-EXPLORATION testis, I-EXPLORATION epidídimo I-EXPLORATION o I-EXPLORATION infiltración I-EXPLORATION vascular. I-EXPLORATION El I-EXPLORATION testículo I-EXPLORATION derecho I-EXPLORATION presenta I-EXPLORATION tumoración I-EXPLORATION con I-EXPLORATION características I-EXPLORATION de I-EXPLORATION Seminoma I-EXPLORATION clásico I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION prácticamente I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION parénquima, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION Neoplasia I-EXPLORATION Intratubular I-EXPLORATION de I-EXPLORATION Células I-EXPLORATION Germinales I-EXPLORATION (NICG) I-EXPLORATION y I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION atrofia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION testículo I-EXPLORATION restante. I-EXPLORATION Túnica I-EXPLORATION albugínea, I-EXPLORATION rete I-EXPLORATION testis, I-EXPLORATION epidídimo I-EXPLORATION y I-EXPLORATION borde I-EXPLORATION quirúrgico I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION tumor. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT se I-TREATMENT completó I-TREATMENT con I-TREATMENT dos I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT carboplatino. I-TREATMENT I-TREATMENT Actualmente B-EVOLUTION lleva I-EVOLUTION aproximadamente I-EVOLUTION 3 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumadora B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cigarrillos/día, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY poliquistosis I-PAST_MEDICAL_HISTORY hepatorrenal I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY (con I-PAST_MEDICAL_HISTORY aclaramiento I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY ml/min I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY proteinuria). I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY patológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS que I-PRESENT_ILLNESS requiere I-PRESENT_ILLNESS ingreso. I-PRESENT_ILLNESS Inicialmente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS orienta I-PRESENT_ILLNESS como I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS quística. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION ecografía I-EXPLORATION reno-vesical I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION poliquistosis I-EXPLORATION hepatorrenal, I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION desestructuración I-EXPLORATION parenquimatosa I-EXPLORATION renal I-EXPLORATION por I-EXPLORATION quistes, I-EXPLORATION preferentemente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION contralateral, I-EXPLORATION Existe I-EXPLORATION una I-EXPLORATION ecogenicidad I-EXPLORATION heterogénea I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION preservado I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION turgencia I-EXPLORATION parenquimatosa I-EXPLORATION y I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION desdibujamiento I-EXPLORATION sinusal I-EXPLORATION izquierdo I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION ecogénico I-EXPLORATION que I-EXPLORATION ejerce I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION y I-EXPLORATION se I-EXPLORATION proyecta I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION pelvis I-EXPLORATION renal. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION poca I-EXPLORATION especificidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION ecográficos I-EXPLORATION se I-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION mediante I-EXPLORATION TC I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION nuevamente I-EXPLORATION desestructuración I-EXPLORATION renal I-EXPLORATION bilateral I-EXPLORATION por I-EXPLORATION poliquistosis, I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION quistes I-EXPLORATION hiperdensos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION basal I-EXPLORATION realizado I-EXPLORATION sin I-EXPLORATION contraste I-EXPLORATION endovenoso. I-EXPLORATION La I-EXPLORATION afectación I-EXPLORATION es I-EXPLORATION asimétrica, I-EXPLORATION más I-EXPLORATION intensa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo, I-EXPLORATION siendo I-EXPLORATION dicho I-EXPLORATION riñón I-EXPLORATION de I-EXPLORATION mayor I-EXPLORATION tamaño. I-EXPLORATION La I-EXPLORATION región I-EXPLORATION piélica I-EXPLORATION izquierda I-EXPLORATION está I-EXPLORATION ocupada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION realce I-EXPLORATION moderado I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION endovenosa I-EXPLORATION de I-EXPLORATION contraste, I-EXPLORATION sin I-EXPLORATION definición I-EXPLORATION clara I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION límites. I-EXPLORATION Funcionalmente I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION evidente I-EXPLORATION retraso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION eliminación I-EXPLORATION del I-EXPLORATION contraste I-EXPLORATION endovenoso I-EXPLORATION en I-EXPLORATION las I-EXPLORATION secciones I-EXPLORATION realizadas I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION retardada. I-EXPLORATION El I-EXPLORATION conjunto I-EXPLORATION de I-EXPLORATION hallazgos I-EXPLORATION sugiere I-EXPLORATION ocupación I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION poliquistosis I-EXPLORATION con I-EXPLORATION alteración I-EXPLORATION funcional I-EXPLORATION secundaria. I-EXPLORATION Se I-EXPLORATION observan I-EXPLORATION ganglios I-EXPLORATION retroperitoneales I-EXPLORATION no I-EXPLORATION aumentados I-EXPLORATION significativamente I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION situación I-EXPLORATION interaortocava I-EXPLORATION y I-EXPLORATION retroaórtica. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT clínico I-TREATMENT de I-TREATMENT masa I-TREATMENT renal I-TREATMENT compatible I-TREATMENT con I-TREATMENT proceso I-TREATMENT neoformativo, I-TREATMENT se I-TREATMENT realiza I-TREATMENT nefrectomía I-TREATMENT radical I-TREATMENT izquierda, I-TREATMENT con I-TREATMENT suprarrenalectomía I-TREATMENT izquierda I-TREATMENT más I-TREATMENT linfadenectomía I-TREATMENT aortocava, I-TREATMENT sin I-TREATMENT incidencias I-TREATMENT ni I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION no I-EVOLUTION surgen I-EVOLUTION complicaciones, I-EVOLUTION con I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION estable. I-EVOLUTION Un I-EVOLUTION mes I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION nefrectomía, I-EVOLUTION el I-EVOLUTION aclaramiento I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 52 I-EVOLUTION ml/min I-EVOLUTION y I-EVOLUTION aparece I-EVOLUTION proteinuria I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 16 I-EVOLUTION g/24 I-EVOLUTION h. I-EVOLUTION I-EVOLUTION En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION anátomo-patológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza, I-EXPLORATION macroscópicamente I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION renal I-EXPLORATION blanquecina, I-EXPLORATION firme, I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 8, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION cm., I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos, I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION área I-EXPLORATION central I-EXPLORATION de I-EXPLORATION necrosis. I-EXPLORATION Está I-EXPLORATION situada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION central I-EXPLORATION renal, I-EXPLORATION afectando I-EXPLORATION la I-EXPLORATION práctica I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION parénquima, I-EXPLORATION alcanzando I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION perirrenal I-EXPLORATION y I-EXPLORATION rodeando I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION suprarrenal. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hilio I-EXPLORATION renal I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION cuatro I-EXPLORATION ganglios I-EXPLORATION linfáticos. I-EXPLORATION El I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION no I-EXPLORATION tumoral I-EXPLORATION está I-EXPLORATION totalmente I-EXPLORATION desestructurado I-EXPLORATION y I-EXPLORATION sustituido I-EXPLORATION por I-EXPLORATION múltiples I-EXPLORATION quistes I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION y I-EXPLORATION que I-EXPLORATION afectan I-EXPLORATION tanto I-EXPLORATION corteza I-EXPLORATION como I-EXPLORATION médula I-EXPLORATION renal. I-EXPLORATION Histológicamente, I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION está I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION citoplasma I-EXPLORATION amplio I-EXPLORATION y I-EXPLORATION eosinófilo, I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION redondeados I-EXPLORATION con I-EXPLORATION marcada I-EXPLORATION atipia, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION organizan I-EXPLORATION en I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION sólido I-EXPLORATION cohesivo, I-EXPLORATION característico I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION escamoso I-EXPLORATION pobremente I-EXPLORATION diferenciado. I-EXPLORATION Son I-EXPLORATION extensas I-EXPLORATION las I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION tumoral. I-EXPLORATION El I-EXPLORATION tumor I-EXPLORATION afecta I-EXPLORATION uréter I-EXPLORATION proximal, I-EXPLORATION pelvis I-EXPLORATION renal, I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION tanto I-EXPLORATION perirrenal I-EXPLORATION como I-EXPLORATION perihiliar. I-EXPLORATION Se I-EXPLORATION objetiva I-EXPLORATION infiltración I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION extensa I-EXPLORATION infiltración I-EXPLORATION tumoral I-EXPLORATION perineural I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION ganglios I-EXPLORATION simpáticos I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION renal. I-EXPLORATION La I-EXPLORATION masa I-EXPLORATION tumoral I-EXPLORATION está I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION carcinoma I-EXPLORATION escamoso, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cual, I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION urotelial I-EXPLORATION papilar I-EXPLORATION intraureteral. I-EXPLORATION Se I-EXPLORATION identifica I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION carcinoma I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuatro I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION hiliares I-EXPLORATION identificados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pieza. I-EXPLORATION Los I-EXPLORATION márgenes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION quirúrgica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza, I-EXPLORATION son I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION linfadenectomía I-EXPLORATION paraórtica I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION 6 I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION neoplásica. I-EXPLORATION En I-EXPLORATION resumen, I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION anátomo-patológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION es I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION escamoso I-EXPLORATION pobremente I-EXPLORATION diferenciado I-EXPLORATION originado I-EXPLORATION en I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION uréter, I-EXPLORATION categoría I-EXPLORATION pT4pN2, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION renal I-EXPLORATION poliquística I-EXPLORATION autosómico-dominante I-EXPLORATION (riñón I-EXPLORATION poliquístico I-EXPLORATION del I-EXPLORATION adulto). I-EXPLORATION B-TREATMENT En I-TREATMENT la I-TREATMENT actualidad, I-TREATMENT la I-TREATMENT paciente I-TREATMENT sigue I-TREATMENT tratamiento I-TREATMENT oncológico. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY reseñables, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS macrohematuria I-PRESENT_ILLNESS asintomática I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION la I-EXPLORATION citología I-EXPLORATION urinaria I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cistoscopia I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION intravenosa I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION un I-EXPLORATION efecto I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION desplazamiento I-EXPLORATION craneal I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION colector. I-EXPLORATION I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION heterogénea I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm, I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION inferior, I-EXPLORATION con I-EXPLORATION realce I-EXPLORATION periférico, I-EXPLORATION áreas I-EXPLORATION hipodensas I-EXPLORATION centrales I-EXPLORATION y I-EXPLORATION calcificaciones. I-EXPLORATION Se I-EXPLORATION observaban I-EXPLORATION asimismo I-EXPLORATION adenopatías I-EXPLORATION látero-cava, I-EXPLORATION retrocava I-EXPLORATION e I-EXPLORATION interaorto-cava, I-EXPLORATION siendo I-EXPLORATION la I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm. I-EXPLORATION I-EXPLORATION Se B-TREATMENT practicó I-TREATMENT nefrectomía I-TREATMENT radical I-TREATMENT derecha I-TREATMENT y I-TREATMENT linfadenectomía I-TREATMENT retroperitoneal, I-TREATMENT mediante I-TREATMENT abordaje I-TREATMENT abdominal I-TREATMENT anterior. I-TREATMENT El I-TREATMENT estudio I-TREATMENT anatomopatológico I-TREATMENT reveló I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT un I-TREATMENT adenocarcinoma I-TREATMENT renal I-TREATMENT de I-TREATMENT células I-TREATMENT claras I-TREATMENT de I-TREATMENT 10, I-TREATMENT 5 I-TREATMENT x I-TREATMENT 9 I-TREATMENT cm I-TREATMENT y I-TREATMENT afectación I-TREATMENT metastásica I-TREATMENT de I-TREATMENT 9 I-TREATMENT de I-TREATMENT los I-TREATMENT 12 I-TREATMENT ganglios I-TREATMENT linfáticos I-TREATMENT aislados, I-TREATMENT cuyo I-TREATMENT tamaño I-TREATMENT oscilaba I-TREATMENT entre I-TREATMENT 0, I-TREATMENT 3 I-TREATMENT y I-TREATMENT 6 I-TREATMENT cm. I-TREATMENT I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION transcurrió I-EVOLUTION con I-EVOLUTION normalidad I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION 4º I-EVOLUTION día, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION que I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION la I-EVOLUTION salida I-EVOLUTION de I-EVOLUTION un I-EVOLUTION líquido I-EVOLUTION lechoso I-EVOLUTION y I-EVOLUTION denso I-EVOLUTION por I-EVOLUTION el I-EVOLUTION catéter I-EVOLUTION de I-EVOLUTION drenaje. I-EVOLUTION El B-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION era I-EXPLORATION estéril I-EXPLORATION y I-EXPLORATION su I-EXPLORATION análisis I-EXPLORATION bioquímico I-EXPLORATION y I-EXPLORATION citológico I-EXPLORATION era I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION quilo: I-EXPLORATION pH: I-EXPLORATION 7, I-EXPLORATION 581, I-EXPLORATION 7600 I-EXPLORATION células I-EXPLORATION nucleadas/mm3 I-EXPLORATION (82% I-EXPLORATION mononucleares, I-EXPLORATION 18% I-EXPLORATION polinucleares), I-EXPLORATION colesterol: I-EXPLORATION 352 I-EXPLORATION mg/dl, I-EXPLORATION triglicéridos: I-EXPLORATION 3920 I-EXPLORATION mg/dl. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION Sudan I-EXPLORATION III I-EXPLORATION se I-EXPLORATION visualizaban I-EXPLORATION abundantes I-EXPLORATION gotas I-EXPLORATION de I-EXPLORATION grasa I-EXPLORATION neutra. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION abdominal, I-EXPLORATION observando I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION porción I-EXPLORATION izquierda I-EXPLORATION del I-EXPLORATION mesenterio, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION linfocele. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT ascitis I-TREATMENT quilosa I-TREATMENT se I-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT consistente I-TREATMENT en I-TREATMENT suspensión I-TREATMENT de I-TREATMENT dieta I-TREATMENT oral I-TREATMENT y I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT total. I-TREATMENT Ante I-TREATMENT el I-TREATMENT incremento I-TREATMENT del I-TREATMENT débito I-TREATMENT de I-TREATMENT la I-TREATMENT fístula I-TREATMENT quilosa I-TREATMENT en I-TREATMENT las I-TREATMENT 48 I-TREATMENT horas I-TREATMENT siguientes I-TREATMENT al I-TREATMENT inicio I-TREATMENT del I-TREATMENT tratamiento, I-TREATMENT se I-TREATMENT añadió I-TREATMENT octreótide I-TREATMENT (0, I-TREATMENT 1 I-TREATMENT mg/8h, I-TREATMENT subcutáneo), I-TREATMENT observándose I-TREATMENT un I-TREATMENT descenso I-TREATMENT manifiesto I-TREATMENT del I-TREATMENT drenaje I-TREATMENT quiloso. I-TREATMENT I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION linfografía I-EXPLORATION isotópica I-EXPLORATION (99mTc) I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 12 I-EXPLORATION y I-EXPLORATION 24 I-EXPLORATION días I-EXPLORATION del I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fístula, I-EXPLORATION observando I-EXPLORATION un I-EXPLORATION acúmulo I-EXPLORATION de I-EXPLORATION trazador I-EXPLORATION medial I-EXPLORATION a I-EXPLORATION cadena I-EXPLORATION ilíaca I-EXPLORATION derecha, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION linfonodo, I-EXPLORATION sin I-EXPLORATION objetivarse I-EXPLORATION fuga I-EXPLORATION linfática I-EXPLORATION alguna. I-EXPLORATION I-EXPLORATION En I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION tras I-EXPLORATION 9 I-EXPLORATION días I-EXPLORATION sin I-EXPLORATION débito I-EXPLORATION fistuloso, I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION del I-EXPLORATION quilocele I-EXPLORATION retroperitoneal, I-EXPLORATION procediendo B-TREATMENT a I-TREATMENT realizar I-TREATMENT drenaje I-TREATMENT TAC-dirigido I-TREATMENT del I-TREATMENT mismo. I-TREATMENT El I-TREATMENT drenaje I-TREATMENT de I-TREATMENT la I-TREATMENT colección I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT hasta I-TREATMENT los I-TREATMENT 7 I-TREATMENT días, I-TREATMENT tras I-TREATMENT 4 I-TREATMENT días I-TREATMENT sin I-TREATMENT débito. I-TREATMENT I-TREATMENT El I-TREATMENT paciente I-TREATMENT permaneció I-TREATMENT en I-TREATMENT dieta I-TREATMENT absoluta I-TREATMENT y I-TREATMENT con I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT total I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT octreótide I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT 22 I-TREATMENT días. I-TREATMENT I-TREATMENT Cinco B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION radiológicamente I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION fuga I-EVOLUTION quilosa. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS presentando B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY atraso I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY desarrollo I-PAST_MEDICAL_HISTORY psico-motor, I-PAST_MEDICAL_HISTORY trombocitopenia I-PAST_MEDICAL_HISTORY auto-inmune, I-PAST_MEDICAL_HISTORY neumonía I-PAST_MEDICAL_HISTORY linfocítica I-PAST_MEDICAL_HISTORY granulomatosa I-PAST_MEDICAL_HISTORY difusa, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY anti-fosfolipídeo, I-PAST_MEDICAL_HISTORY esplenomegalia, I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY central, I-PAST_MEDICAL_HISTORY soriasis I-PAST_MEDICAL_HISTORY inversa I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY psicosis. I-PAST_MEDICAL_HISTORY Medicado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY alendronato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sodio, I-PAST_MEDICAL_HISTORY haloperidol, I-PAST_MEDICAL_HISTORY lorazepam, I-PAST_MEDICAL_HISTORY trihexifenidilo, I-PAST_MEDICAL_HISTORY omeprazol, I-PAST_MEDICAL_HISTORY carbonato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hierro I-PAST_MEDICAL_HISTORY oral. I-PAST_MEDICAL_HISTORY Enviado B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urología I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS genitales I-PRESENT_ILLNESS externos. I-PRESENT_ILLNESS Refería I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS generalizada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS difusa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS escrotal, I-PRESENT_ILLNESS condicionando I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS miccional, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha I-PRESENT_ILLNESS e I-PRESENT_ILLNESS higiene I-PRESENT_ILLNESS deficiente. I-PRESENT_ILLNESS Negaba B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY quirúrgicos I-PAST_MEDICAL_HISTORY genitales, I-PAST_MEDICAL_HISTORY inguinales I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY pélvicos. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY radioterapia I-PAST_MEDICAL_HISTORY inguinal I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY pélvica. I-PAST_MEDICAL_HISTORY Negaba I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY países I-PAST_MEDICAL_HISTORY asociados I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY filariosis I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY cuadros I-PAST_MEDICAL_HISTORY compatibles I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY erisipela I-PAST_MEDICAL_HISTORY inguinal/genital. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION objetivo I-EXPLORATION presentaba I-EXPLORATION marcado I-EXPLORATION espesamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION túnicas I-EXPLORATION de I-EXPLORATION los I-EXPLORATION genitales I-EXPLORATION externos, I-EXPLORATION endurecido, I-EXPLORATION indoloro, I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION mal I-EXPLORATION definidos, I-EXPLORATION envolviendo I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION circunferencia I-EXPLORATION y I-EXPLORATION hasta I-EXPLORATION peniana, I-EXPLORATION mimetizando I-EXPLORATION edema I-EXPLORATION penoescrotal I-EXPLORATION masivo. I-EXPLORATION Aparentemente I-EXPLORATION las I-EXPLORATION porciones I-EXPLORATION dorsales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION escrotal I-EXPLORATION no I-EXPLORATION estaban I-EXPLORATION envueltas I-EXPLORATION por I-EXPLORATION el I-EXPLORATION proceso. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION las I-EXPLORATION túnicas I-EXPLORATION eran I-EXPLORATION perfectamente I-EXPLORATION móviles I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION a I-EXPLORATION los I-EXPLORATION planos I-EXPLORATION profundos, I-EXPLORATION tales I-EXPLORATION como I-EXPLORATION los I-EXPLORATION cuerpos I-EXPLORATION cavernosos I-EXPLORATION y I-EXPLORATION glande, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION alteraciones. I-EXPLORATION Adicionalmente I-EXPLORATION presentaba I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION psoriásico I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION los I-EXPLORATION muslos I-EXPLORATION y I-EXPLORATION peri-umbilical, I-EXPLORATION con I-EXPLORATION aspectos I-EXPLORATION de I-EXPLORATION maceración I-EXPLORATION y I-EXPLORATION exudado I-EXPLORATION importantes. I-EXPLORATION La I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION regiones I-EXPLORATION inguinales I-EXPLORATION no I-EXPLORATION ponía I-EXPLORATION en I-EXPLORATION evidencia I-EXPLORATION adenopatías I-EXPLORATION sospechosas. I-EXPLORATION Miembros I-EXPLORATION inferiores I-EXPLORATION sin I-EXPLORATION edemas. I-EXPLORATION Tacto I-EXPLORATION rectal I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION anormales. I-EXPLORATION Sin I-EXPLORATION adenopatías I-EXPLORATION periféricas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION términos I-EXPLORATION analíticos I-EXPLORATION únicamente I-EXPLORATION era I-EXPLORATION notoria I-EXPLORATION una I-EXPLORATION trombocitopenia I-EXPLORATION discreta I-EXPLORATION (123.000/mL), I-EXPLORATION no I-EXPLORATION registrándose I-EXPLORATION cualquier I-EXPLORATION otra I-EXPLORATION alteración I-EXPLORATION como I-EXPLORATION leucocitosis I-EXPLORATION o I-EXPLORATION eosinofília. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION descartar I-EXPLORATION neoformaciones/adenopatías I-EXPLORATION pélvicas I-EXPLORATION o I-EXPLORATION inguinales, I-EXPLORATION fue I-EXPLORATION pedido I-EXPLORATION TAC I-EXPLORATION pélvico I-EXPLORATION que I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION cualquier I-EXPLORATION anomalía, I-EXPLORATION excepto I-EXPLORATION un I-EXPLORATION marcadísimo I-EXPLORATION espesamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION túnicas I-EXPLORATION genitales. I-EXPLORATION I-EXPLORATION Sin I-EXPLORATION antecedentes I-EXPLORATION que I-EXPLORATION permitieran I-EXPLORATION orientar I-EXPLORATION para I-EXPLORATION otro I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION diagnóstico, I-EXPLORATION fue I-EXPLORATION adelantado I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION linfedema I-EXPLORATION idiopático I-EXPLORATION genital, I-EXPLORATION en I-EXPLORATION este I-EXPLORATION caso I-EXPLORATION linfedema I-EXPLORATION praecox, I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION de I-EXPLORATION presentación. I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT intención I-TREATMENT de I-TREATMENT mejorar I-TREATMENT el I-TREATMENT trofismo I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT circundante I-TREATMENT y I-TREATMENT la I-TREATMENT sintomatología I-TREATMENT urinaria, I-TREATMENT fue I-TREATMENT colocada I-TREATMENT cistostomía I-TREATMENT percutánea I-TREATMENT y I-TREATMENT sometido I-TREATMENT a I-TREATMENT terapéutica I-TREATMENT antibiótica I-TREATMENT y I-TREATMENT anti-fúngica I-TREATMENT durante I-TREATMENT dos I-TREATMENT semanas. I-TREATMENT Se B-EVOLUTION verificó I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION acentuada I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION cutáneas I-EVOLUTION exudativas, I-EVOLUTION sin I-EVOLUTION modificación I-EVOLUTION de I-EVOLUTION las I-EVOLUTION áreas I-EVOLUTION propiamente I-EVOLUTION afectadas I-EVOLUTION por I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION En B-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT procedió I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT la I-TREATMENT situación. I-TREATMENT Este I-TREATMENT consistió I-TREATMENT en I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT toda I-TREATMENT la I-TREATMENT piel I-TREATMENT macroscópicamente I-TREATMENT afectada, I-TREATMENT colocación I-TREATMENT de I-TREATMENT injertos I-TREATMENT cutáneos I-TREATMENT para I-TREATMENT cobertura I-TREATMENT de I-TREATMENT la I-TREATMENT hasta I-TREATMENT peniana I-TREATMENT y I-TREATMENT confección I-TREATMENT de I-TREATMENT neo-escroto I-TREATMENT con I-TREATMENT colgajos I-TREATMENT cutáneos I-TREATMENT de I-TREATMENT piel I-TREATMENT vecina. I-TREATMENT En I-TREATMENT primer I-TREATMENT lugar I-TREATMENT fue I-TREATMENT realizada I-TREATMENT una I-TREATMENT circuncisión, I-TREATMENT seguida I-TREATMENT de I-TREATMENT incisión I-TREATMENT peniana I-TREATMENT dorsal I-TREATMENT longitudinal I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT y I-TREATMENT túnicas I-TREATMENT hasta I-TREATMENT la I-TREATMENT profundidad I-TREATMENT de I-TREATMENT la I-TREATMENT fáscia I-TREATMENT de I-TREATMENT Buck, I-TREATMENT con I-TREATMENT disección I-TREATMENT circunferencial I-TREATMENT de I-TREATMENT la I-TREATMENT totalidad I-TREATMENT del I-TREATMENT hasta I-TREATMENT peniana I-TREATMENT llegando I-TREATMENT a I-TREATMENT la I-TREATMENT base I-TREATMENT del I-TREATMENT pene. I-TREATMENT A I-TREATMENT continuación I-TREATMENT fue I-TREATMENT realizada I-TREATMENT una I-TREATMENT incisión I-TREATMENT arciforme I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT ambas I-TREATMENT regiones I-TREATMENT inguinales, I-TREATMENT teniendo I-TREATMENT como I-TREATMENT centro I-TREATMENT la I-TREATMENT base I-TREATMENT del I-TREATMENT pene. I-TREATMENT A I-TREATMENT partir I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT fueron I-TREATMENT aislados I-TREATMENT los I-TREATMENT cordones I-TREATMENT inguinales, I-TREATMENT exteriorizados I-TREATMENT los I-TREATMENT testículos I-TREATMENT y I-TREATMENT realizada I-TREATMENT inversión I-TREATMENT de I-TREATMENT la I-TREATMENT túnica I-TREATMENT vaginal. I-TREATMENT Bajo I-TREATMENT control I-TREATMENT de I-TREATMENT todas I-TREATMENT las I-TREATMENT estructuras I-TREATMENT importantes, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT afectada. I-TREATMENT Una I-TREATMENT vez I-TREATMENT que I-TREATMENT la I-TREATMENT porción I-TREATMENT dorsal I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT escrotal I-TREATMENT no I-TREATMENT se I-TREATMENT encontraba I-TREATMENT aparentemente I-TREATMENT afectada I-TREATMENT (como I-TREATMENT de I-TREATMENT resto I-TREATMENT es I-TREATMENT típico I-TREATMENT en I-TREATMENT las I-TREATMENT situaciones I-TREATMENT de I-TREATMENT linfedema), I-TREATMENT esta I-TREATMENT no I-TREATMENT fue I-TREATMENT retirada, I-TREATMENT permitiendo I-TREATMENT tener I-TREATMENT así I-TREATMENT piel I-TREATMENT suficiente I-TREATMENT para I-TREATMENT confeccionar I-TREATMENT un I-TREATMENT neo-escroto I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT rotación I-TREATMENT anterior I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT Las I-TREATMENT incisiones I-TREATMENT inguinales I-TREATMENT y I-TREATMENT el I-TREATMENT escroto I-TREATMENT fueron I-TREATMENT cerrados I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT drenos I-TREATMENT aspirativos. I-TREATMENT Para I-TREATMENT cobertura I-TREATMENT del I-TREATMENT hasta I-TREATMENT peniana I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT recogida I-TREATMENT de I-TREATMENT injertos I-TREATMENT cutáneos I-TREATMENT de I-TREATMENT piel I-TREATMENT parcial I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT muslo I-TREATMENT que I-TREATMENT fueron I-TREATMENT colocados I-TREATMENT directamente I-TREATMENT sobre I-TREATMENT la I-TREATMENT fascia I-TREATMENT de I-TREATMENT Buck, I-TREATMENT en I-TREATMENT disposición I-TREATMENT helicoidal. I-TREATMENT Los I-TREATMENT drenos I-TREATMENT fueron I-TREATMENT retirados I-TREATMENT el I-TREATMENT segundo I-TREATMENT día I-TREATMENT postoperatorio I-TREATMENT y I-TREATMENT el I-TREATMENT apósito I-TREATMENT compresivo I-TREATMENT el I-TREATMENT quinto I-TREATMENT día I-TREATMENT verificándose I-TREATMENT viabilidad I-TREATMENT total I-TREATMENT del I-TREATMENT material I-TREATMENT injertado. I-TREATMENT I-TREATMENT Durante I-TREATMENT el I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT era I-TREATMENT notoria I-TREATMENT la I-TREATMENT consistencia I-TREATMENT gelatinosa I-TREATMENT acentuada I-TREATMENT de I-TREATMENT las I-TREATMENT túnicas, I-TREATMENT con I-TREATMENT aparente I-TREATMENT aspecto I-TREATMENT translúcido I-TREATMENT y I-TREATMENT exudación I-TREATMENT acentuada. I-TREATMENT La I-TREATMENT pieza I-TREATMENT quirúrgica I-TREATMENT comprendiendo I-TREATMENT piel I-TREATMENT peniana I-TREATMENT y I-TREATMENT escrotal I-TREATMENT afectada I-TREATMENT totalizaba I-TREATMENT 1, I-TREATMENT 05 I-TREATMENT Kg. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomo-patológico I-EXPLORATION puso I-EXPLORATION en I-EXPLORATION evidencia I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION mixoide I-EXPLORATION hipocelular I-EXPLORATION con I-EXPLORATION abundante I-EXPLORATION estroma I-EXPLORATION y I-EXPLORATION células I-EXPLORATION fusiformes, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION atipia I-EXPLORATION celular I-EXPLORATION y I-EXPLORATION de I-EXPLORATION mitosis, I-EXPLORATION infiltrante I-EXPLORATION y I-EXPLORATION con I-EXPLORATION componente I-EXPLORATION prominente I-EXPLORATION de I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION calibre I-EXPLORATION variado I-EXPLORATION y I-EXPLORATION ectasiados. I-EXPLORATION Inmunohistoquímica: I-EXPLORATION vimentina I-EXPLORATION +; I-EXPLORATION CD I-EXPLORATION 34 I-EXPLORATION +; I-EXPLORATION desmina I-EXPLORATION e I-EXPLORATION actina I-EXPLORATION negativos. I-EXPLORATION Conclusión: I-EXPLORATION aspectos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION angiomixoma I-EXPLORATION agresivo. I-EXPLORATION I-EXPLORATION Después B-EVOLUTION de I-EVOLUTION 13 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION bien, I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION y I-EVOLUTION satisfecho I-EVOLUTION del I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION estético. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS suprapúbico, I-PRESENT_ILLNESS polaquiuria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS nicturia. I-PRESENT_ILLNESS Sin B-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION laboratorio. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cistoscopía I-EXPLORATION se I-EXPLORATION evidencian I-EXPLORATION glomerulaciones I-EXPLORATION a I-EXPLORATION la I-EXPLORATION distención I-EXPLORATION vesical. I-EXPLORATION Una I-EXPLORATION biopsia I-EXPLORATION vesical I-EXPLORATION randomizadas I-EXPLORATION revela I-EXPLORATION mucosa I-EXPLORATION vesical I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION perivascular I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION eosinófilos. I-EXPLORATION Se I-EXPLORATION diagnóstica I-EXPLORATION cistitis I-EXPLORATION eosinofílica. I-EXPLORATION Inicialmente B-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT instilaciones I-TREATMENT vesicales I-TREATMENT de I-TREATMENT heparina I-TREATMENT y I-TREATMENT corticoides, I-TREATMENT sin I-TREATMENT embargo I-TREATMENT persistió I-TREATMENT con I-TREATMENT frecuencia I-TREATMENT miccional I-TREATMENT de I-TREATMENT 20/6. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT uso I-TREATMENT amitriptilina, I-TREATMENT oxibutinina I-TREATMENT y I-TREATMENT teltoridona I-TREATMENT sin I-TREATMENT respuesta. I-TREATMENT Estudio B-EXPLORATION urodinamico I-EXPLORATION revela I-EXPLORATION vejiga I-EXPLORATION inestable I-EXPLORATION sensitiva I-EXPLORATION durante I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION continencia. I-EXPLORATION Se I-EXPLORATION repite I-EXPLORATION cistoscopía I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION biopsia I-EXPLORATION revela I-EXPLORATION inflamación I-EXPLORATION inespecífica. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Hidroxicina I-TREATMENT 20 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT más I-TREATMENT Diclofenaco I-TREATMENT sódico I-TREATMENT 50 I-TREATMENT mg. I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h, I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT El B-EVOLUTION dolor I-EVOLUTION cedió I-EVOLUTION y I-EVOLUTION la I-EVOLUTION frecuencia I-EVOLUTION miccional I-EVOLUTION disminuyó I-EVOLUTION a I-EVOLUTION 6/0, I-EVOLUTION con I-EVOLUTION mayor I-EVOLUTION volumen I-EVOLUTION miccional. I-EVOLUTION Por B-TREATMENT somnolencia I-TREATMENT se I-TREATMENT cambió I-TREATMENT antihistamínico I-TREATMENT a I-TREATMENT Cetirizina, I-TREATMENT con I-TREATMENT igual I-TREATMENT respuesta. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS 8-10 I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematuria I-PRESENT_ILLNESS macroscópica, I-PRESENT_ILLNESS indolora I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS coágulos. I-PRESENT_ILLNESS Asimismo I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS frecuencia I-PRESENT_ILLNESS miccional, I-PRESENT_ILLNESS escozor I-PRESENT_ILLNESS miccional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tenesmo I-PRESENT_ILLNESS vesical, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS seguido I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ciprofloxacino I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Diclofenaco I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS evidenciar I-PRESENT_ILLNESS mejoría. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION no I-EXPLORATION evidencia I-EXPLORATION ningún I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION interés I-EXPLORATION (trayectos I-EXPLORATION uretero-renales I-EXPLORATION no I-EXPLORATION dolorosos, I-EXPLORATION puño I-EXPLORATION percusión I-EXPLORATION bilateral I-EXPLORATION negativa). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION ecografía I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION intravesical I-EXPLORATION de I-EXPLORATION 35, I-EXPLORATION 7 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo, I-EXPLORATION con I-EXPLORATION unos I-EXPLORATION riñones I-EXPLORATION ecográficamente I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION cistoscopia I-EXPLORATION flexible, I-EXPLORATION que I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION bilobulada I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION infiltrante I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION parcialmente I-EXPLORATION necróticas I-EXPLORATION en I-EXPLORATION su I-EXPLORATION superficie. I-EXPLORATION I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION Tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION tóraco-abdominal, I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION y I-EXPLORATION Resección I-EXPLORATION trans-uretral I-EXPLORATION (RTU) I-EXPLORATION biopsia I-EXPLORATION para I-EXPLORATION establecer I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION y I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION vesical I-EXPLORATION de I-EXPLORATION 8, I-EXPLORATION 5 I-EXPLORATION cm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo, I-EXPLORATION bien I-EXPLORATION definida I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION perivesical, I-EXPLORATION ni I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION adenopatías I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION significativo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION se I-EXPLORATION completó I-EXPLORATION con I-EXPLORATION una I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION RTU I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION mesenquimal, I-EXPLORATION fusocelular, I-EXPLORATION con I-EXPLORATION haces I-EXPLORATION largos I-EXPLORATION de I-EXPLORATION células I-EXPLORATION fusiformes I-EXPLORATION y I-EXPLORATION frecuentes I-EXPLORATION mitosis. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION intensa I-EXPLORATION inmunorreactividad I-EXPLORATION con I-EXPLORATION vimentina I-EXPLORATION y I-EXPLORATION actina I-EXPLORATION muscular I-EXPLORATION específica. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT leiomiosarcoma I-TREATMENT vesical I-TREATMENT clínicamente I-TREATMENT localizado I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT exenteración I-TREATMENT pélvica I-TREATMENT anterior I-TREATMENT (cistectomía I-TREATMENT radical, I-TREATMENT histerectomía I-TREATMENT más I-TREATMENT doble I-TREATMENT anexectomía I-TREATMENT y I-TREATMENT derivación I-TREATMENT urinaria I-TREATMENT ileal). I-TREATMENT I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vejiga I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION exofítico I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION de I-EXPLORATION 8, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 4 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION pedículo I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION I-EXPLORATION Era I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION mesenquimal I-EXPLORATION maligno I-EXPLORATION de I-EXPLORATION células I-EXPLORATION alargadas, I-EXPLORATION de I-EXPLORATION nucleolos I-EXPLORATION longilíneos I-EXPLORATION bordes I-EXPLORATION romos I-EXPLORATION y I-EXPLORATION citoplasmas I-EXPLORATION fibrilares. I-EXPLORATION En I-EXPLORATION algunas I-EXPLORATION zonas I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION figuras I-EXPLORATION de I-EXPLORATION mitosis I-EXPLORATION (20 I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 10 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION aumento). I-EXPLORATION El I-EXPLORATION tumor I-EXPLORATION se I-EXPLORATION alojaba I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION vesical, I-EXPLORATION sin I-EXPLORATION infiltrar I-EXPLORATION el I-EXPLORATION urotelio I-EXPLORATION de I-EXPLORATION superficie, I-EXPLORATION ni I-EXPLORATION la I-EXPLORATION capa I-EXPLORATION muscular I-EXPLORATION propia I-EXPLORATION vesical, I-EXPLORATION presentando I-EXPLORATION su I-EXPLORATION origen I-EXPLORATION en I-EXPLORATION la I-EXPLORATION capa I-EXPLORATION muscular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION submucosa I-EXPLORATION (Muscularis I-EXPLORATION Mucosae). I-EXPLORATION I-EXPLORATION Tanto I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION los I-EXPLORATION ganglios I-EXPLORATION iliacos I-EXPLORATION e I-EXPLORATION ilio-obturatrices, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION perivesical I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION estudiadas, I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION ninguna I-EXPLORATION alteración. I-EXPLORATION I-EXPLORATION Tras B-EVOLUTION un I-EVOLUTION postoperatorio I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION relevantes, I-EVOLUTION se B-TREATMENT decidió I-TREATMENT completar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT adyuvante I-TREATMENT que I-TREATMENT la I-TREATMENT paciente, I-TREATMENT con I-TREATMENT Adriamicina I-TREATMENT e I-TREATMENT Ifosfamida I-TREATMENT realizó I-TREATMENT en I-TREATMENT su I-TREATMENT Centro I-TREATMENT de I-TREATMENT referencia, I-TREATMENT recibiendo I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT (1 I-TREATMENT mensual) I-TREATMENT con I-TREATMENT buena I-TREATMENT tolerancia. I-TREATMENT Se I-TREATMENT retrasó I-TREATMENT el I-TREATMENT inicio I-TREATMENT del I-TREATMENT ciclo I-TREATMENT en I-TREATMENT una I-TREATMENT ocasión I-TREATMENT por I-TREATMENT fiebre. I-TREATMENT I-TREATMENT Al B-EVOLUTION año I-EVOLUTION de I-EVOLUTION finalizar I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION complementario I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION recidiva I-EVOLUTION locorregional I-EVOLUTION en I-EVOLUTION una I-EVOLUTION T.C. I-EVOLUTION realizada I-EVOLUTION durante I-EVOLUTION una I-EVOLUTION revisión. I-EVOLUTION Por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT extirpación I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT con I-TREATMENT informe I-TREATMENT anatomopatológico I-TREATMENT de I-TREATMENT leiomiosarcoma I-TREATMENT de I-TREATMENT 6, I-TREATMENT 5 I-TREATMENT cms. I-TREATMENT de I-TREATMENT diámetro I-TREATMENT con I-TREATMENT un I-TREATMENT borde I-TREATMENT afecto. I-TREATMENT Se I-TREATMENT decidió I-TREATMENT completar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quicio-radioterapia I-TREATMENT adyuvante, I-TREATMENT con I-TREATMENT régimen I-TREATMENT quimioterápico I-TREATMENT basado I-TREATMENT en I-TREATMENT Ifosfamida I-TREATMENT a I-TREATMENT altas I-TREATMENT dosis I-TREATMENT (3.520 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 24 I-TREATMENT horas I-TREATMENT por I-TREATMENT 5 I-TREATMENT días), I-TREATMENT de I-TREATMENT los I-TREATMENT cuales I-TREATMENT se I-TREATMENT ha I-TREATMENT administrado I-TREATMENT 6 I-TREATMENT ciclos, I-TREATMENT uno I-TREATMENT mensual. I-TREATMENT Una I-TREATMENT vez I-TREATMENT completados I-TREATMENT los I-TREATMENT 2 I-TREATMENT primeros I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia, I-TREATMENT recibió I-TREATMENT radioterapia I-TREATMENT externa, I-TREATMENT a I-TREATMENT razón I-TREATMENT de I-TREATMENT 1, I-TREATMENT 8 I-TREATMENT Gy/día, I-TREATMENT hasta I-TREATMENT completar I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT de I-TREATMENT 45 I-TREATMENT Gy I-TREATMENT sobre I-TREATMENT lecho I-TREATMENT tumoral I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT una I-TREATMENT sobreimpresión I-TREATMENT pélvica I-TREATMENT con I-TREATMENT 16 I-TREATMENT Gy I-TREATMENT hasta I-TREATMENT completar I-TREATMENT una I-TREATMENT dosis I-TREATMENT pélvica I-TREATMENT de I-TREATMENT 61 I-TREATMENT Gy. I-TREATMENT Posteriormente B-EVOLUTION pasó I-EVOLUTION a I-EVOLUTION revisiones I-EVOLUTION periódicas. I-EVOLUTION I-EVOLUTION A I-EVOLUTION los I-EVOLUTION ocho I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION finalizado I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION tratamiento I-EVOLUTION adyuvante, I-EVOLUTION 32 I-EVOLUTION meses I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION diagnóstico, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION una I-EVOLUTION recidiva I-EVOLUTION pélvica I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION x I-EVOLUTION 5, I-EVOLUTION 8 I-EVOLUTION cm., I-EVOLUTION con I-EVOLUTION probable I-EVOLUTION infiltración I-EVOLUTION de I-EVOLUTION recto-sigma I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION vejiga I-EVOLUTION ileal. I-EVOLUTION Se B-TREATMENT realiza I-TREATMENT rectosigmoidoscopia I-TREATMENT con I-TREATMENT punción I-TREATMENT aspiración I-TREATMENT con I-TREATMENT aguja I-TREATMENT fina, I-TREATMENT con I-TREATMENT resultado I-TREATMENT anatomopatológico I-TREATMENT de I-TREATMENT citología I-TREATMENT maligna, I-TREATMENT sarcoma I-TREATMENT fusocelular I-TREATMENT compatible I-TREATMENT con I-TREATMENT leiomiosarcoma. I-TREATMENT Se B-EXPLORATION ha I-EXPLORATION realizado I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION con I-EXPLORATION anticuerpos I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION Caldesmón I-EXPLORATION y I-EXPLORATION Miosina I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION liso, I-EXPLORATION observándose I-EXPLORATION inmunorreactividad I-EXPLORATION intensa I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION ambos I-EXPLORATION anticuerpos. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT segunda I-TREATMENT recidiva I-TREATMENT se I-TREATMENT recomendó I-TREATMENT realizar I-TREATMENT resección I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT consolidación I-TREATMENT con I-TREATMENT braquiterapia. I-TREATMENT La I-TREATMENT paciente I-TREATMENT desestimó I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT cirugía I-TREATMENT con I-TREATMENT braquiterapia I-TREATMENT por I-TREATMENT miedo I-TREATMENT a I-TREATMENT las I-TREATMENT complicaciones I-TREATMENT de I-TREATMENT la I-TREATMENT braquiterapia, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT fue I-TREATMENT intervenida I-TREATMENT en I-TREATMENT otro I-TREATMENT centro, I-TREATMENT realizando I-TREATMENT exenteración I-TREATMENT pélvica I-TREATMENT posterior. I-TREATMENT En B-EVOLUTION el I-EVOLUTION primer I-EVOLUTION control I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION recidiva, I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION incisión, I-EVOLUTION realizándose B-TREATMENT resección I-TREATMENT del I-TREATMENT mismo. I-TREATMENT I-TREATMENT En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION y I-EVOLUTION 41 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION inicial, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática, I-EVOLUTION en I-EVOLUTION controles I-EVOLUTION periódicos I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION (IMC) I-EXPLORATION de I-EXPLORATION 31, I-EXPLORATION 2, I-EXPLORATION que B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cáncer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS próstata I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estadio I-PRESENT_ILLNESS T2a I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS examen I-PRESENT_ILLNESS (antígeno I-PRESENT_ILLNESS prostático I-PRESENT_ILLNESS específico I-PRESENT_ILLNESS [PSA], I-PRESENT_ILLNESS 3, I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS ng/ml). I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión, I-PAST_MEDICAL_HISTORY diabetes, I-PAST_MEDICAL_HISTORY hiperlipemia, I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cirrosis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Antes B-TREATMENT de I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT el I-TREATMENT paciente I-TREATMENT tenía I-TREATMENT vendaje I-TREATMENT espiral I-TREATMENT y I-TREATMENT dispositivos I-TREATMENT de I-TREATMENT compresión I-TREATMENT intermitente I-TREATMENT en I-TREATMENT ambas I-TREATMENT extremidades I-TREATMENT inferiores I-TREATMENT para I-TREATMENT prevenir I-TREATMENT trombosis I-TREATMENT venosa I-TREATMENT profunda I-TREATMENT (TVP). I-TREATMENT Tras I-TREATMENT administrar I-TREATMENT anestesia I-TREATMENT combinada I-TREATMENT general-espinal, I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT colocado I-TREATMENT en I-TREATMENT posición I-TREATMENT de I-TREATMENT Trendelenburg I-TREATMENT y I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT PRL I-TREATMENT extraperitoneal, I-TREATMENT con I-TREATMENT preservación I-TREATMENT nerviosa I-TREATMENT bilateral. I-TREATMENT Su I-TREATMENT presión I-TREATMENT sanguínea I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT de I-TREATMENT administrar I-TREATMENT la I-TREATMENT anestesia I-TREATMENT era I-TREATMENT de I-TREATMENT 150/80 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT permaneció I-TREATMENT por I-TREATMENT debajo I-TREATMENT de I-TREATMENT este I-TREATMENT nivel I-TREATMENT durante I-TREATMENT todo I-TREATMENT el I-TREATMENT procedimiento. I-TREATMENT La I-TREATMENT operación I-TREATMENT duró I-TREATMENT 360 I-TREATMENT min I-TREATMENT y I-TREATMENT la I-TREATMENT pérdida I-TREATMENT de I-TREATMENT sangre I-TREATMENT fue I-TREATMENT de I-TREATMENT 1.000 I-TREATMENT ml. I-TREATMENT El I-TREATMENT sangrado I-TREATMENT ocurrió I-TREATMENT durante I-TREATMENT el I-TREATMENT control I-TREATMENT de I-TREATMENT pedículos I-TREATMENT vasculares I-TREATMENT y I-TREATMENT la I-TREATMENT disección I-TREATMENT del I-TREATMENT paquete I-TREATMENT neurovascular. I-TREATMENT La B-EXPLORATION patología I-EXPLORATION quirúrgica I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION próstata I-EXPLORATION de I-EXPLORATION 55 I-EXPLORATION g, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION en I-EXPLORATION estadio I-EXPLORATION T2a I-EXPLORATION y I-EXPLORATION una I-EXPLORATION puntuación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION Gleason I-EXPLORATION 6 I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION En B-EVOLUTION el I-EVOLUTION primer I-EVOLUTION día I-EVOLUTION posquirúrgico, I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION quejarse I-EVOLUTION de I-EVOLUTION entumecimiento I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION derecha, I-EVOLUTION que I-EVOLUTION estaba I-EVOLUTION inflamada I-EVOLUTION y I-EVOLUTION blanda I-EVOLUTION al I-EVOLUTION tacto. I-EVOLUTION Los B-EXPLORATION pulsos I-EXPLORATION pedios I-EXPLORATION estaban I-EXPLORATION presentes I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION bilateral. I-EXPLORATION Sospechamos I-EXPLORATION una I-EXPLORATION TVP I-EXPLORATION y I-EXPLORATION pedimos I-EXPLORATION una I-EXPLORATION prueba I-EXPLORATION Doppler, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION permeabilidad I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION venoso I-EXPLORATION profundo. I-EXPLORATION Su I-EXPLORATION creatinina I-EXPLORATION sérica I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION la I-EXPLORATION creatina I-EXPLORATION fosfocinasa I-EXPLORATION llegó I-EXPLORATION hasta I-EXPLORATION 23.000 I-EXPLORATION U/l. I-EXPLORATION Aunque B-TREATMENT el I-TREATMENT Doppler I-TREATMENT fue I-TREATMENT normal, I-TREATMENT se I-TREATMENT diagnosticó I-TREATMENT una I-TREATMENT TVP I-TREATMENT con I-TREATMENT rabdomiólisis I-TREATMENT secundaria I-TREATMENT y I-TREATMENT fallo I-TREATMENT renal I-TREATMENT sobre I-TREATMENT la I-TREATMENT base I-TREATMENT de I-TREATMENT los I-TREATMENT resultados I-TREATMENT clínicos, I-TREATMENT y I-TREATMENT se I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT heparina. I-TREATMENT I-TREATMENT En B-EVOLUTION los I-EVOLUTION días I-EVOLUTION posquirúrgicos I-EVOLUTION siguientes, I-EVOLUTION aunque I-EVOLUTION los I-EVOLUTION pulsos I-EVOLUTION pedios I-EVOLUTION seguían I-EVOLUTION siendo I-EVOLUTION palpables I-EVOLUTION y I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION sérica I-EVOLUTION y I-EVOLUTION creatina I-EVOLUTION fosfocinasa I-EVOLUTION mejoraban, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentaba I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION intermitente. I-EVOLUTION Se B-EXPLORATION repitieron I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION Doppler, I-EXPLORATION que I-EXPLORATION excluyeron I-EXPLORATION TVP I-EXPLORATION y I-EXPLORATION mostraron I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION tibiales I-EXPLORATION derechas. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT fasciotomía I-TREATMENT de I-TREATMENT cuatro I-TREATMENT compartimentos I-TREATMENT por I-TREATMENT el I-TREATMENT SC I-TREATMENT de I-TREATMENT la I-TREATMENT pierna. I-TREATMENT Los I-TREATMENT músculos I-TREATMENT sobresalían I-TREATMENT fácilmente I-TREATMENT a I-TREATMENT medida I-TREATMENT que I-TREATMENT se I-TREATMENT seccionaba I-TREATMENT la I-TREATMENT fascia I-TREATMENT suprayacente. I-TREATMENT Había I-TREATMENT áreas I-TREATMENT de I-TREATMENT necrosis I-TREATMENT focal I-TREATMENT que I-TREATMENT fueron I-TREATMENT eliminadas. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio, I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION fue I-EVOLUTION remitiendo I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION capaz I-EVOLUTION de I-EVOLUTION caminar I-EVOLUTION con I-EVOLUTION ayuda. I-EVOLUTION Las I-EVOLUTION heridas I-EVOLUTION se I-EVOLUTION cerraron I-EVOLUTION en I-EVOLUTION los I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION a I-EVOLUTION la I-EVOLUTION fasciotomía. I-EVOLUTION I-EVOLUTION Seis I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION PRL, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION recuperó I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION capaz I-EVOLUTION de I-EVOLUTION caminar I-EVOLUTION sin I-EVOLUTION ayuda, I-EVOLUTION pero I-EVOLUTION aún I-EVOLUTION presenta I-EVOLUTION dolor I-EVOLUTION neuropático I-EVOLUTION en I-EVOLUTION el I-EVOLUTION empeine I-EVOLUTION del I-EVOLUTION pie I-EVOLUTION derecho. I-EVOLUTION Su I-EVOLUTION PSA I-EVOLUTION estaba I-EVOLUTION por I-EVOLUTION debajo I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 04 I-EVOLUTION ng/ml, I-EVOLUTION usaba I-EVOLUTION pañal I-EVOLUTION diario I-EVOLUTION por I-EVOLUTION una I-EVOLUTION leve I-EVOLUTION incontinencia I-EVOLUTION por I-EVOLUTION esfuerzo I-EVOLUTION y I-EVOLUTION aún I-EVOLUTION no I-EVOLUTION había I-EVOLUTION recuperado I-EVOLUTION la I-EVOLUTION función I-EVOLUTION sexual. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS derivado B-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO plástica I-DERIVED_FROM/TO para I-DERIVED_FROM/TO reconstrucción I-DERIVED_FROM/TO escrotal I-DERIVED_FROM/TO después I-DERIVED_FROM/TO de I-DERIVED_FROM/TO un I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO inicial I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO urología I-DERIVED_FROM/TO con I-DERIVED_FROM/TO desbridamiento I-DERIVED_FROM/TO quirúrgico I-DERIVED_FROM/TO y I-DERIVED_FROM/TO soporte I-DERIVED_FROM/TO médico I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO semanas. I-DERIVED_FROM/TO El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes: I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY mal I-PAST_MEDICAL_HISTORY controlada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY necesidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY veces I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY semana. I-PAST_MEDICAL_HISTORY Había B-PRESENT_ILLNESS sido I-PRESENT_ILLNESS sometido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS amputación I-PRESENT_ILLNESS del I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS por I-PRESENT_ILLNESS isquemia. I-PRESENT_ILLNESS El B-TREATMENT colgajo I-TREATMENT pediculado I-TREATMENT fasciocutáneo I-TREATMENT del I-TREATMENT muslo I-TREATMENT fue I-TREATMENT usado I-TREATMENT con I-TREATMENT buenos I-TREATMENT resultados I-TREATMENT para I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT del I-TREATMENT escroto. I-TREATMENT En I-TREATMENT el I-TREATMENT posoperatorio I-TREATMENT (al I-TREATMENT 4.o I-TREATMENT día), I-TREATMENT el I-TREATMENT paciente I-TREATMENT desarrolló I-TREATMENT un I-TREATMENT edema I-TREATMENT agudo I-TREATMENT de I-TREATMENT pulmón, I-TREATMENT que I-TREATMENT se I-TREATMENT resolvió I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT médico. I-TREATMENT No B-EVOLUTION hubo I-EVOLUTION necrosis I-EVOLUTION del I-EVOLUTION colgajo I-EVOLUTION ni I-EVOLUTION se I-EVOLUTION produjeron I-EVOLUTION infecciones. I-EVOLUTION Fue B-TREATMENT necesario I-TREATMENT proceder I-TREATMENT a I-TREATMENT la I-TREATMENT remodelación I-TREATMENT de I-TREATMENT la I-TREATMENT porción I-TREATMENT inferomedial I-TREATMENT del I-TREATMENT colgajo I-TREATMENT por I-TREATMENT dehiscencia I-TREATMENT parcial I-TREATMENT de I-TREATMENT la I-TREATMENT sutura. I-TREATMENT Se B-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION paciente I-EVOLUTION del I-EVOLUTION servicio I-EVOLUTION después I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION internamiento. I-EVOLUTION I-EVOLUTION Masculino B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sentado I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS cinturón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seguridad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS parte I-PRESENT_ILLNESS trasera I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS automóvil, I-PRESENT_ILLNESS participó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS automovilístico. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS mantuvo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS asiento I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS al I-PRESENT_ILLNESS evento I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS conocimiento I-PRESENT_ILLNESS al I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS arribo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS paramédicos. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS ocurrió I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS área I-PRESENT_ILLNESS rural I-PRESENT_ILLNESS y I-PRESENT_ILLNESS el I-PRESENT_ILLNESS traslado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS DUP I-PRESENT_ILLNESS duró I-PRESENT_ILLNESS aprox. I-PRESENT_ILLNESS 90min. I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS transportado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS collarín I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inmovilizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS decúbito I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tabla I-PRESENT_ILLNESS de I-PRESENT_ILLNESS protección. I-PRESENT_ILLNESS Los B-EXPLORATION signos I-EXPLORATION vitales I-EXPLORATION a I-EXPLORATION su I-EXPLORATION llegada: I-EXPLORATION temperatura, I-EXPLORATION 36, I-EXPLORATION 5oC; I-EXPLORATION pulso, I-EXPLORATION 84/min; I-EXPLORATION PA, I-EXPLORATION 110/63mm I-EXPLORATION Hg I-EXPLORATION y I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION 14. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION (EF) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION DUP I-EXPLORATION presentó I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION leve, I-EXPLORATION escoriaciones I-EXPLORATION en I-EXPLORATION diferentes I-EXPLORATION partes I-EXPLORATION del I-EXPLORATION cuerpo, I-EXPLORATION sin I-EXPLORATION embargo I-EXPLORATION el I-EXPLORATION ultrasonido I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION los I-EXPLORATION rayos I-EXPLORATION X I-EXPLORATION solo I-EXPLORATION evidenciaron I-EXPLORATION rectificación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION cervical. I-EXPLORATION Estudios I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION normales; I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina: I-EXPLORATION microhematuria. I-EXPLORATION Después B-EVOLUTION de I-EVOLUTION algunas I-EVOLUTION horas, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION hemotórax I-EVOLUTION y I-EVOLUTION continúo I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION abdominal. I-EVOLUTION Se B-TREATMENT le I-TREATMENT colocó I-TREATMENT sonda I-TREATMENT en I-TREATMENT tórax I-TREATMENT en I-TREATMENT el I-TREATMENT hemitórax I-TREATMENT izquierdo I-TREATMENT y B-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION contrastada. I-EXPLORATION Al I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION TAC, I-EXPLORATION el I-EXPLORATION caso I-EXPLORATION fue I-EXPLORATION comentado I-EXPLORATION con I-EXPLORATION nuestro I-EXPLORATION departamento. I-EXPLORATION En I-EXPLORATION este I-EXPLORATION momento I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION contaba I-EXPLORATION con I-EXPLORATION 8hrs I-EXPLORATION en I-EXPLORATION observación. I-EXPLORATION En I-EXPLORATION nuestra I-EXPLORATION evaluación, I-EXPLORATION observamos I-EXPLORATION equimosis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION flanco I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION drenaje I-EXPLORATION escaso I-EXPLORATION por I-EXPLORATION la I-EXPLORATION sonda I-EXPLORATION en I-EXPLORATION tórax. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION sin I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION y I-EXPLORATION un I-EXPLORATION pequeño I-EXPLORATION hematoma I-EXPLORATION esplénico. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT manejar I-TREATMENT conservadoramente. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION egresado I-EVOLUTION 6 I-EVOLUTION días I-EVOLUTION después. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY controlado. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY patológico I-PAST_MEDICAL_HISTORY relevante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY habia I-PAST_MEDICAL_HISTORY advertido I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY masa I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY palpable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pulsátil I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY mes. I-PAST_MEDICAL_HISTORY Diez B-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intenso. I-PRESENT_ILLNESS La B-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION abdominal I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION infrarrenal, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION que I-EXPLORATION involucra I-EXPLORATION y I-EXPLORATION lo I-EXPLORATION adhiere I-EXPLORATION a I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION porción I-EXPLORATION del I-EXPLORATION duodeno. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT solicitó I-TREATMENT el I-TREATMENT alta I-TREATMENT voluntaria I-TREATMENT ante I-TREATMENT la I-TREATMENT propuesta I-TREATMENT quirúrgica. I-TREATMENT Cinco B-EVOLUTION días I-EVOLUTION después I-EVOLUTION reingresó I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Terapia I-EVOLUTION Intensiva I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION alta I-EVOLUTION manifestada I-EVOLUTION por I-EVOLUTION hematemesis I-EVOLUTION y I-EVOLUTION melena I-EVOLUTION de I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION shock I-EVOLUTION hipovolémico, I-EVOLUTION tensión I-EVOLUTION arterial I-EVOLUTION media I-EVOLUTION (TAM) I-EVOLUTION 30 I-EVOLUTION mmHg, I-EVOLUTION frecuencia I-EVOLUTION cardíaca I-EVOLUTION (FC): I-EVOLUTION 140 I-EVOLUTION lpm I-EVOLUTION y I-EVOLUTION hematocrito I-EVOLUTION del I-EVOLUTION 18%. I-EVOLUTION Una B-EXPLORATION vez I-EXPLORATION compensado I-EXPLORATION el I-EXPLORATION trastorno I-EXPLORATION hemodinámico, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION fibroendoscopia I-EXPLORATION digestiva I-EXPLORATION alta, I-EXPLORATION constatándose I-EXPLORATION sangrado I-EXPLORATION activo I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION porción I-EXPLORATION duodenal. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT entonces I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT por I-TREATMENT resangrado I-TREATMENT masivo, I-TREATMENT con I-TREATMENT el I-TREATMENT hallazgo I-TREATMENT intraoperatorio I-TREATMENT de I-TREATMENT aneurisma I-TREATMENT de I-TREATMENT aorta I-TREATMENT abdominal I-TREATMENT infrarrenal I-TREATMENT sacular I-TREATMENT adherido I-TREATMENT a I-TREATMENT la I-TREATMENT cara I-TREATMENT posterior I-TREATMENT de I-TREATMENT la I-TREATMENT tercera I-TREATMENT porción I-TREATMENT duodenal I-TREATMENT con I-TREATMENT comunicación I-TREATMENT a I-TREATMENT la I-TREATMENT luz I-TREATMENT de I-TREATMENT dicho I-TREATMENT órgano I-TREATMENT por I-TREATMENT un I-TREATMENT orificio I-TREATMENT de I-TREATMENT unos I-TREATMENT 4 I-TREATMENT cm I-TREATMENT de I-TREATMENT diámetro. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT un I-TREATMENT by-pass I-TREATMENT aorto-bifemoral. I-TREATMENT Debido B-EVOLUTION al I-EVOLUTION grave I-EVOLUTION compromiso I-EVOLUTION hemodinámico I-EVOLUTION presentó I-EVOLUTION paro I-EVOLUTION cardiorrespiratorio I-EVOLUTION en I-EVOLUTION quirófano, I-EVOLUTION falleciendo I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Terapia I-EVOLUTION Intensiva. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY disección I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aorta I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY clasificación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Stanford, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY colocación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY prótesis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY teflón, I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY consulta. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Una B-PRESENT_ILLNESS semana I-PRESENT_ILLNESS previa I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Terapia I-PRESENT_ILLNESS Intensiva I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS melena I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lipotimia. I-PRESENT_ILLNESS Ingresó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS hematemesis I-PRESENT_ILLNESS abundante I-PRESENT_ILLNESS y I-PRESENT_ILLNESS melena I-PRESENT_ILLNESS y I-PRESENT_ILLNESS shock I-PRESENT_ILLNESS hipovolémico, I-PRESENT_ILLNESS siendo B-TREATMENT estabilizado I-TREATMENT con I-TREATMENT fluidos. I-TREATMENT Un B-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION hematemesis I-EVOLUTION masiva I-EVOLUTION lo I-EVOLUTION lleva I-EVOLUTION al I-EVOLUTION paro I-EVOLUTION cardiorrespiratorio I-EVOLUTION y B-TREATMENT tras I-TREATMENT una I-TREATMENT adecuada I-TREATMENT resucitación I-TREATMENT se I-TREATMENT decidió I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica, I-TREATMENT con I-TREATMENT el I-TREATMENT hallazgo I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT FAE I-TREATMENT al I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT tercera I-TREATMENT porción I-TREATMENT duodenal, I-TREATMENT y I-TREATMENT un I-TREATMENT orificio I-TREATMENT de I-TREATMENT 2 I-TREATMENT x I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT cm I-TREATMENT de I-TREATMENT diámetro. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT cierre I-TREATMENT simple, I-TREATMENT gastroyeyuno I-TREATMENT anastomosis I-TREATMENT y I-TREATMENT anastomosis I-TREATMENT coledocoduodenal. I-TREATMENT Falleció B-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS sugerente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS viriasis, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS edemas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS superiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS oligoanuria I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presenta I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION obnubilación, I-EXPLORATION hipotensión, I-EXPLORATION taquicardia I-EXPLORATION y I-EXPLORATION taquipnea, I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION lesiones I-EXPLORATION petequiales I-EXPLORATION en I-EXPLORATION hombros, I-EXPLORATION espalda I-EXPLORATION y I-EXPLORATION miembros I-EXPLORATION superiores. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacan: I-EXPLORATION plaquetopenia I-EXPLORATION (13.000/mm3); I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 28 I-EXPLORATION mg/dl; I-EXPLORATION coagulopatía I-EXPLORATION con I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION tromboplastina I-EXPLORATION parcial I-EXPLORATION activado: I-EXPLORATION 47 I-EXPLORATION seg I-EXPLORATION (control: I-EXPLORATION 30 I-EXPLORATION seg), I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina: I-EXPLORATION 20 I-EXPLORATION seg I-EXPLORATION (control: I-EXPLORATION 11 I-EXPLORATION seg), I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION Quick: I-EXPLORATION 60%, I-EXPLORATION fibrinógeno: I-EXPLORATION 332 I-EXPLORATION mg/dl; I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION antitrombina-III: I-EXPLORATION 38%, I-EXPLORATION Na+: I-EXPLORATION 117mEq/l, I-EXPLORATION K+: I-EXPLORATION 6, I-EXPLORATION 7 I-EXPLORATION mEq/l, I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 7 I-EXPLORATION mg/dl; I-EXPLORATION urea I-EXPLORATION 69 I-EXPLORATION mg/dl, I-EXPLORATION y I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION con I-EXPLORATION 30 I-EXPLORATION leucocitos/mm3 I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION de I-EXPLORATION 95 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT se I-TREATMENT realiza I-TREATMENT con I-TREATMENT expansión, I-TREATMENT perfusión I-TREATMENT de I-TREATMENT noradrenalina I-TREATMENT a I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT µg/kg/min, I-TREATMENT y I-TREATMENT cefotaxima. I-TREATMENT Se I-TREATMENT inicia I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT y I-TREATMENT diálisis I-TREATMENT peritoneal I-TREATMENT por I-TREATMENT insuficiencia I-TREATMENT renal I-TREATMENT y I-TREATMENT alteraciones I-TREATMENT iónicas. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION 5 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION presenta I-EVOLUTION parada I-EVOLUTION cardiorrespiratoria I-EVOLUTION por I-EVOLUTION fibrilación I-EVOLUTION ventricular I-EVOLUTION refractaria I-EVOLUTION a I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION de I-EVOLUTION reanimación. I-EVOLUTION I-EVOLUTION Los B-EXPLORATION cultivos I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION salvo I-EXPLORATION el I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION de I-EXPLORATION petequia I-EXPLORATION cutánea I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION S. I-EXPLORATION pyogenes I-EXPLORATION serotipo I-EXPLORATION M1T1. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial I-PAST_MEDICAL_HISTORY extrínseco I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY eco-transtorácico I-PAST_MEDICAL_HISTORY (ETT) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY hipertrófica I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY obstructiva, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY mitral I-PAST_MEDICAL_HISTORY leve-moderada. I-PAST_MEDICAL_HISTORY Realizaba I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY activa I-PAST_MEDICAL_HISTORY encontrándose I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY I. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS precordial I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS esfuerzo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS de I-PRESENT_ILLNESS palpitaciones. I-PRESENT_ILLNESS En B-EXPLORATION un I-EXPLORATION primer I-EXPLORATION electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION taquicardia I-EXPLORATION regular I-EXPLORATION con I-EXPLORATION QRS I-EXPLORATION ancho I-EXPLORATION a I-EXPLORATION 210 I-EXPLORATION lpm, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION respondió I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION adenosina I-EXPLORATION ni I-EXPLORATION a I-EXPLORATION maniobras I-EXPLORATION vagales. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT realizar I-TREATMENT una I-TREATMENT cardioversión I-TREATMENT eléctrica I-TREATMENT con I-TREATMENT 100 I-TREATMENT J I-TREATMENT que I-TREATMENT derivó I-TREATMENT en I-TREATMENT fibrilación I-TREATMENT ventricular I-TREATMENT (FV) I-TREATMENT revertida I-TREATMENT con I-TREATMENT dos I-TREATMENT choques I-TREATMENT de I-TREATMENT 360 I-TREATMENT J. I-TREATMENT Se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona I-TREATMENT intravenosa, I-TREATMENT pero I-TREATMENT fue I-TREATMENT preciso I-TREATMENT suspenderla I-TREATMENT poco I-TREATMENT después I-TREATMENT por I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT disfunción I-TREATMENT sinusal, I-TREATMENT con I-TREATMENT ritmo I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT a I-TREATMENT 40 I-TREATMENT latidos/ I-TREATMENT minuto. I-TREATMENT Se I-TREATMENT le I-TREATMENT administró I-TREATMENT de I-TREATMENT forma I-TREATMENT empírica I-TREATMENT sulfato I-TREATMENT de I-TREATMENT magnesio I-TREATMENT y I-TREATMENT el I-TREATMENT paciente I-TREATMENT ingresó I-TREATMENT en I-TREATMENT la I-TREATMENT Unidad I-TREATMENT Coronaria. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION sistémica I-EXPLORATION de I-EXPLORATION 130/70 I-EXPLORATION mmHg. I-EXPLORATION Se I-EXPLORATION auscultaba I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION sistólico, I-EXPLORATION en I-EXPLORATION ápex I-EXPLORATION y I-EXPLORATION borde I-EXPLORATION esternal I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION congestión I-EXPLORATION pulmonar. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION ECG I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION disfunción I-EXPLORATION sinusal, I-EXPLORATION QRS I-EXPLORATION ancho I-EXPLORATION con I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION completo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION izquierda I-EXPLORATION e I-EXPLORATION intervalo I-EXPLORATION QT I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 30 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION de I-EXPLORATION los I-EXPLORATION síntomas I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION CPK I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 2.657 I-EXPLORATION U/l I-EXPLORATION y I-EXPLORATION una I-EXPLORATION troponina I-EXPLORATION I I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 21 I-EXPLORATION ng/ml. I-EXPLORATION Los I-EXPLORATION iones I-EXPLORATION séricos I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION realizado I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION con I-EXPLORATION un I-EXPLORATION equipo I-EXPLORATION portátil I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION (VI) I-EXPLORATION muy I-EXPLORATION dilatado I-EXPLORATION y I-EXPLORATION globalmente I-EXPLORATION hipoquinético, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION miocardio I-EXPLORATION muy I-EXPLORATION hipertrófico, I-EXPLORATION con I-EXPLORATION trabeculaciones. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION taquicardias I-EXPLORATION ventriculares I-EXPLORATION (TV), I-EXPLORATION con I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION miocardiopatía I-EXPLORATION dilatada, I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION hemodinámico. I-EXPLORATION La I-EXPLORATION ventriculografía I-EXPLORATION izquierda I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION ventrículo I-EXPLORATION con I-EXPLORATION fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION (FE) I-EXPLORATION del I-EXPLORATION 20%, I-EXPLORATION con I-EXPLORATION defectos I-EXPLORATION generalizados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION contractilidad I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION importante I-EXPLORATION trabeculación I-EXPLORATION que I-EXPLORATION sugirió I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION miocardiopatía I-EXPLORATION no I-EXPLORATION compactada I-EXPLORATION (MNC) I-EXPLORATION o I-EXPLORATION miocardiopatía I-EXPLORATION espongiforme I-EXPLORATION (ME). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION angiográficamente I-EXPLORATION significativa. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION cateterismo I-EXPLORATION derecho I-EXPLORATION las I-EXPLORATION presiones I-EXPLORATION fueron: I-EXPLORATION aurícula I-EXPLORATION derecha I-EXPLORATION (AD) I-EXPLORATION 10 I-EXPLORATION mmHg, I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION (VD) I-EXPLORATION 70/4 I-EXPLORATION mmHg, I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION (AP) I-EXPLORATION 70/15 I-EXPLORATION mmHg, I-EXPLORATION enclavamiento I-EXPLORATION capilar I-EXPLORATION pulmonar I-EXPLORATION (PECP) I-EXPLORATION 15 I-EXPLORATION mmHg. I-EXPLORATION Índice I-EXPLORATION cardíaco I-EXPLORATION 2 I-EXPLORATION litros/minuto/m2; I-EXPLORATION presión I-EXPLORATION telediastólica I-EXPLORATION VI I-EXPLORATION (PTDVI) I-EXPLORATION 30 I-EXPLORATION mmHg; I-EXPLORATION gradiente I-EXPLORATION mitral I-EXPLORATION invertido I-EXPLORATION (PTDVI I-EXPLORATION > I-EXPLORATION PECP). I-EXPLORATION La I-EXPLORATION coronariografía I-EXPLORATION mostró I-EXPLORATION unas I-EXPLORATION arterias I-EXPLORATION epicárdicas I-EXPLORATION angiográficamente I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION MNC I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION ecocardiografía I-EXPLORATION por I-EXPLORATION personal I-EXPLORATION especializado. I-EXPLORATION La I-EXPLORATION ecocardiografía-2D I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION marcada I-EXPLORATION trabeculación I-EXPLORATION del I-EXPLORATION VI, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION ápex I-EXPLORATION y I-EXPLORATION segmentos I-EXPLORATION medios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION e I-EXPLORATION inferior, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION relación I-EXPLORATION telesistólica I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION gruesa I-EXPLORATION capa I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION miocardio I-EXPLORATION no I-EXPLORATION compactado I-EXPLORATION (NC) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION fina I-EXPLORATION capa I-EXPLORATION externa I-EXPLORATION de I-EXPLORATION miocardio I-EXPLORATION compactado I-EXPLORATION (NC/C I-EXPLORATION > I-EXPLORATION 2). I-EXPLORATION Con I-EXPLORATION doppler I-EXPLORATION color I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION el I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION en I-EXPLORATION comunicación I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION profundos I-EXPLORATION recesos I-EXPLORATION intertrabeculares I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION ventricular. I-EXPLORATION El I-EXPLORATION flujo I-EXPLORATION diastólico I-EXPLORATION mitral I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION restrictivo. I-EXPLORATION El I-EXPLORATION VI I-EXPLORATION tenía I-EXPLORATION morfología I-EXPLORATION esferoidal I-EXPLORATION y I-EXPLORATION medía I-EXPLORATION en I-EXPLORATION telediástole I-EXPLORATION 70 I-EXPLORATION mm, I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION izquierda I-EXPLORATION 47 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION el I-EXPLORATION VD I-EXPLORATION 30 I-EXPLORATION mm. I-EXPLORATION Un I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION regurgitación I-EXPLORATION mitral I-EXPLORATION fue I-EXPLORATION valorado I-EXPLORATION como I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION moderada, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION tricuspídea I-EXPLORATION permitió I-EXPLORATION calcular I-EXPLORATION un I-EXPLORATION gradiente I-EXPLORATION AD-VD I-EXPLORATION de I-EXPLORATION 55 I-EXPLORATION mmHg, I-EXPLORATION estimándose I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION AP I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION mmHg. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectaron I-EXPLORATION anomalías I-EXPLORATION valvulares I-EXPLORATION estructurales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION consideró I-EXPLORATION necesario I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION buena I-EXPLORATION calidad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bidimensional1. I-EXPLORATION I-EXPLORATION Con B-EVOLUTION estos I-EVOLUTION hallazgos I-EVOLUTION ecocardiográficos I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION MNC I-EVOLUTION según I-EVOLUTION los I-EVOLUTION criterios I-EVOLUTION de I-EVOLUTION Jenni, I-EVOLUTION por I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION compactación I-EVOLUTION del I-EVOLUTION miocardio I-EVOLUTION ventricular I-EVOLUTION izquierdo I-EVOLUTION sin I-EVOLUTION otras I-EVOLUTION anomalías I-EVOLUTION cardíacas I-EVOLUTION asociadas2, I-EVOLUTION 3. I-EVOLUTION Aunque I-EVOLUTION hubiera I-EVOLUTION sido I-EVOLUTION interesante I-EVOLUTION una I-EVOLUTION cardiorresonancia, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION realizar I-EVOLUTION por I-EVOLUTION no I-EVOLUTION disponer I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION técnica I-EVOLUTION en I-EVOLUTION nuestro I-EVOLUTION hospital4, I-EVOLUTION 5. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS un I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS coche. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION inicial I-EXPLORATION estaba I-EXPLORATION estable I-EXPLORATION hemodinámicamente. I-EXPLORATION La I-EXPLORATION TACHT I-EXPLORATION corporal I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION mostraba: I-EXPLORATION seudoaneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION torácica I-EXPLORATION distal I-EXPLORATION a I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION subclavia I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION sangrado I-EXPLORATION periaórtico. I-EXPLORATION Ingresó B-TREATMENT en I-TREATMENT la I-TREATMENT UCI, I-TREATMENT donde I-TREATMENT se I-TREATMENT inició I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT médico. I-TREATMENT A I-TREATMENT las I-TREATMENT 36 I-TREATMENT horas I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT reparación I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT endoprótesis I-TREATMENT en I-TREATMENT la I-TREATMENT aorta I-TREATMENT torácica I-TREATMENT descendente I-TREATMENT por I-TREATMENT la I-TREATMENT vía I-TREATMENT femoral I-TREATMENT izquierda. I-TREATMENT Hubo I-TREATMENT una I-TREATMENT oclusión I-TREATMENT asintomática I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT subclavia I-TREATMENT izquierda. I-TREATMENT I-TREATMENT La B-EXPLORATION TACHT I-EXPLORATION de I-EXPLORATION control I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 6 I-EXPLORATION días I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION correcta I-EXPLORATION localización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION endoprótesis. I-EXPLORATION Al B-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION pericarditis I-EVOLUTION aguda I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION decimosexto I-EVOLUTION día, I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 76 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Crohn I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY prednisona I-PAST_MEDICAL_HISTORY (30mg I-PAST_MEDICAL_HISTORY diarios) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mesazalina, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS artralgias I-PRESENT_ILLNESS generalizadas. I-PRESENT_ILLNESS Ante B-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT hipotensión I-TREATMENT con I-TREATMENT una I-TREATMENT presión I-TREATMENT arterial I-TREATMENT media I-TREATMENT (PAM) I-TREATMENT <55mmHg I-TREATMENT e I-TREATMENT hiponatremia I-TREATMENT (129mEq/l) I-TREATMENT se I-TREATMENT sospecha I-TREATMENT insuficiencia I-TREATMENT suprarrenal I-TREATMENT por I-TREATMENT deprivación I-TREATMENT (abandono I-TREATMENT de I-TREATMENT la I-TREATMENT prednisona I-TREATMENT 48h I-TREATMENT antes) I-TREATMENT y I-TREATMENT se I-TREATMENT administran I-TREATMENT 60mg I-TREATMENT de I-TREATMENT metilprednisolona, I-TREATMENT con I-TREATMENT mejoría I-TREATMENT hemodinámica. I-TREATMENT Las B-EXPLORATION artralgias I-EXPLORATION se I-EXPLORATION atribuyen I-EXPLORATION también I-EXPLORATION a I-EXPLORATION un I-EXPLORATION brote I-EXPLORATION de I-EXPLORATION su I-EXPLORATION enfermedad I-EXPLORATION inflamatoria I-EXPLORATION intestinal I-EXPLORATION por I-EXPLORATION el I-EXPLORATION cese I-EXPLORATION brusco I-EXPLORATION de I-EXPLORATION la I-EXPLORATION medicación. I-EXPLORATION I-EXPLORATION En B-EVOLUTION las I-EVOLUTION siguientes I-EVOLUTION 24h I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION disnea I-EVOLUTION con I-EVOLUTION desaturación I-EVOLUTION progresiva I-EVOLUTION (hasta I-EVOLUTION el I-EVOLUTION 76%) I-EVOLUTION sin I-EVOLUTION oxigenoterapia. I-EVOLUTION Se B-EXPLORATION realiza I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION torácica, I-EXPLORATION que I-EXPLORATION observa I-EXPLORATION patrón I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION deslustrado I-EXPLORATION inespecífico I-EXPLORATION bilateral. I-EXPLORATION La B-TREATMENT sospecha I-TREATMENT diagnóstica I-TREATMENT en I-TREATMENT ese I-TREATMENT momento I-TREATMENT corresponde I-TREATMENT a I-TREATMENT enfermedad I-TREATMENT pulmonar I-TREATMENT intersticial I-TREATMENT versus I-TREATMENT neumonía I-TREATMENT adquirida I-TREATMENT en I-TREATMENT la I-TREATMENT comunidad, I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT oxigenoterapia, I-TREATMENT levofloxacino I-TREATMENT y I-TREATMENT metilprednisolona. I-TREATMENT I-TREATMENT El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO se I-DERIVED_FROM/TO trasladó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO principal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO insuficiencia I-DERIVED_FROM/TO respiratoria I-DERIVED_FROM/TO hipoxémica I-DERIVED_FROM/TO aguda. I-DERIVED_FROM/TO Al B-TREATMENT presentar I-TREATMENT 4 I-TREATMENT signos I-TREATMENT de I-TREATMENT gravedad I-TREATMENT de I-TREATMENT la I-TREATMENT British I-TREATMENT Thoracic I-TREATMENT Society4 I-TREATMENT para I-TREATMENT neumonía I-TREATMENT adquirida I-TREATMENT en I-TREATMENT la I-TREATMENT comunidad I-TREATMENT ingresó I-TREATMENT en I-TREATMENT nuestra I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Cuidados I-TREATMENT Críticos: I-TREATMENT taquipnea I-TREATMENT >30 I-TREATMENT respiraciones I-TREATMENT por I-TREATMENT minuto, I-TREATMENT urea I-TREATMENT >42mg/dl, I-TREATMENT enfermedad I-TREATMENT preexistente, I-TREATMENT edad I-TREATMENT superior I-TREATMENT a I-TREATMENT 50 I-TREATMENT años I-TREATMENT y I-TREATMENT afectación I-TREATMENT pulmonar I-TREATMENT bilateral I-TREATMENT en I-TREATMENT la I-TREATMENT radiografía I-TREATMENT de I-TREATMENT tórax. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION presentó I-EXPLORATION cuadro I-EXPLORATION indicativo I-EXPLORATION de I-EXPLORATION neumonía I-EXPLORATION intersticial I-EXPLORATION bilateral I-EXPLORATION difusa, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION acompañó I-EXPLORATION de I-EXPLORATION extensas I-EXPLORATION manifestaciones I-EXPLORATION de I-EXPLORATION alveolitis I-EXPLORATION exudativa I-EXPLORATION con I-EXPLORATION ensanchamiento I-EXPLORATION mediastínico I-EXPLORATION superior, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION adenopatías I-EXPLORATION en I-EXPLORATION las I-EXPLORATION cadenas I-EXPLORATION paratraqueales I-EXPLORATION derecha I-EXPLORATION e I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION no I-EXPLORATION había I-EXPLORATION eosinofilia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fórmula I-EXPLORATION leucocitaria I-EXPLORATION ni I-EXPLORATION leucocitosis, I-EXPLORATION esperable I-EXPLORATION en I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION parasitaria; I-EXPLORATION además, I-EXPLORATION el I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION tampoco I-EXPLORATION fue I-EXPLORATION llamativo. I-EXPLORATION Se I-EXPLORATION observó I-EXPLORATION antígeno I-EXPLORATION para I-EXPLORATION neumococo I-EXPLORATION positivo I-EXPLORATION en I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION y B-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT linezolid, I-TREATMENT cefotaxima I-TREATMENT y I-TREATMENT fluconazol, I-TREATMENT ventilación I-TREATMENT no I-TREATMENT invasiva I-TREATMENT con I-TREATMENT ventilación I-TREATMENT con I-TREATMENT presión I-TREATMENT positiva I-TREATMENT continua I-TREATMENT de I-TREATMENT +7 I-TREATMENT cmH2O I-TREATMENT y I-TREATMENT asistencia I-TREATMENT inspiratoria I-TREATMENT de I-TREATMENT +15cm I-TREATMENT H2O I-TREATMENT y I-TREATMENT FiO2 I-TREATMENT al I-TREATMENT 60%, I-TREATMENT que I-TREATMENT se I-TREATMENT alternó I-TREATMENT con I-TREATMENT períodos I-TREATMENT de I-TREATMENT oxigenoterapia I-TREATMENT con I-TREATMENT Ventimask. I-TREATMENT Progresivamente, B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION deterioro I-EVOLUTION general I-EVOLUTION con I-EVOLUTION sepsis I-EVOLUTION grave I-EVOLUTION y I-EVOLUTION disfunción I-EVOLUTION multiorgánica, I-EVOLUTION con I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION shock, I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION inotropos I-EVOLUTION y I-EVOLUTION vasopresores I-EVOLUTION para I-EVOLUTION conseguir I-EVOLUTION una I-EVOLUTION PAM I-EVOLUTION >60mmHg, I-EVOLUTION insuficiencia I-EVOLUTION renal I-EVOLUTION aguda I-EVOLUTION que B-TREATMENT requirió I-TREATMENT hemodiafiltración I-TREATMENT venovenosa I-TREATMENT continua I-TREATMENT e I-TREATMENT insuficiencia I-TREATMENT respiratoria I-TREATMENT con I-TREATMENT necesidad I-TREATMENT de I-TREATMENT intubación I-TREATMENT orotraqueal I-TREATMENT y I-TREATMENT ventilación I-TREATMENT mecánica. I-TREATMENT Ante I-TREATMENT este I-TREATMENT deterioro, I-TREATMENT se I-TREATMENT sospechó I-TREATMENT de I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT una I-TREATMENT sobreinfección I-TREATMENT bacteriana I-TREATMENT o I-TREATMENT por I-TREATMENT hongos I-TREATMENT concomitantes, I-TREATMENT lo I-TREATMENT que I-TREATMENT llevó I-TREATMENT al I-TREATMENT cambio I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT (imipenem, I-TREATMENT linezolid I-TREATMENT y I-TREATMENT anidulofungina) I-TREATMENT y I-TREATMENT extracción I-TREATMENT de I-TREATMENT nuevas I-TREATMENT muestras I-TREATMENT microbiológicas: I-TREATMENT broncoaspirado I-TREATMENT (BAS), I-TREATMENT hemocultivo I-TREATMENT y I-TREATMENT urinocultivo. I-TREATMENT Fue I-TREATMENT en I-TREATMENT este I-TREATMENT último I-TREATMENT BAS I-TREATMENT donde I-TREATMENT se I-TREATMENT observaron I-TREATMENT larvas I-TREATMENT de I-TREATMENT Ss, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT añadió I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT ivermectina I-TREATMENT (16,5mg/24h) I-TREATMENT por I-TREATMENT sonda I-TREATMENT nasogástrica I-TREATMENT (SNG). I-TREATMENT Tras I-TREATMENT repetir I-TREATMENT a I-TREATMENT las I-TREATMENT 48h I-TREATMENT los I-TREATMENT cultivos I-TREATMENT biológicos I-TREATMENT y I-TREATMENT mostrar I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT larvas I-TREATMENT de I-TREATMENT Ss I-TREATMENT aún I-TREATMENT activas I-TREATMENT en I-TREATMENT BAS, I-TREATMENT jugo I-TREATMENT gástrico I-TREATMENT y I-TREATMENT heces, I-TREATMENT se I-TREATMENT asoció I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT albendazol I-TREATMENT (400mg/24h) I-TREATMENT por I-TREATMENT SNG. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION posterior I-EXPLORATION control I-EXPLORATION microbiológico I-EXPLORATION tras I-EXPLORATION 48h I-EXPLORATION del I-EXPLORATION tratamiento I-EXPLORATION combinado, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION en I-EXPLORATION BAS I-EXPLORATION Ss I-EXPLORATION inactivos. I-EXPLORATION Sin B-EVOLUTION embargo, I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION distrés I-EVOLUTION respiratorio I-EVOLUTION agudo I-EVOLUTION (SDRA) I-EVOLUTION con I-EVOLUTION hipoxemia I-EVOLUTION grave I-EVOLUTION y I-EVOLUTION shock I-EVOLUTION séptico I-EVOLUTION refractario I-EVOLUTION al I-EVOLUTION soporte I-EVOLUTION vasoconstrictor I-EVOLUTION e I-EVOLUTION inotropo. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 17 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION en I-EVOLUTION nuestra I-EVOLUTION unidad. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS describe I-PRESENT_ILLNESS un I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Valme I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ideación I-PRESENT_ILLNESS autolítica I-PRESENT_ILLNESS persistente I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alucinaciones I-PRESENT_ILLNESS auditivas. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY psiquiátricos, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Unidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Agudos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Salud I-PAST_MEDICAL_HISTORY Mental I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY diversas I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2007, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY orientación I-PAST_MEDICAL_HISTORY diagnóstica, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY depresivo I-PAST_MEDICAL_HISTORY moderado I-PAST_MEDICAL_HISTORY (F32.1 I-PAST_MEDICAL_HISTORY CIE-10). I-PAST_MEDICAL_HISTORY Estaba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY risperidona I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY mg/24h, I-PAST_MEDICAL_HISTORY ac. I-PAST_MEDICAL_HISTORY valproico I-PAST_MEDICAL_HISTORY 1500 I-PAST_MEDICAL_HISTORY mg/24h, I-PAST_MEDICAL_HISTORY citalopram I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg/24h I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY flunitrazepam I-PAST_MEDICAL_HISTORY 1mg/24h. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS contexto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duelo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS fallecimiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hija, I-PRESENT_ILLNESS relataba I-PRESENT_ILLNESS incremento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ansiedad, I-PRESENT_ILLNESS tristeza, I-PRESENT_ILLNESS anhedonia, I-PRESENT_ILLNESS apatía, I-PRESENT_ILLNESS abandono I-PRESENT_ILLNESS de I-PRESENT_ILLNESS actividades, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alucinaciones I-PRESENT_ILLNESS auditivas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS espacio I-PRESENT_ILLNESS externo. I-PRESENT_ILLNESS Eran I-PRESENT_ILLNESS voces I-PRESENT_ILLNESS imperativas I-PRESENT_ILLNESS e I-PRESENT_ILLNESS insultantes I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tenían I-PRESENT_ILLNESS en I-PRESENT_ILLNESS él I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS repercusión I-PRESENT_ILLNESS conductual I-PRESENT_ILLNESS y I-PRESENT_ILLNESS afectiva: I-PRESENT_ILLNESS "Empezó I-PRESENT_ILLNESS como I-PRESENT_ILLNESS un I-PRESENT_ILLNESS rumor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ahora I-PRESENT_ILLNESS son I-PRESENT_ILLNESS claras, I-PRESENT_ILLNESS como I-PRESENT_ILLNESS si I-PRESENT_ILLNESS alguien I-PRESENT_ILLNESS me I-PRESENT_ILLNESS hablara. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS hacen I-PRESENT_ILLNESS más I-PRESENT_ILLNESS fuertes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS no I-PRESENT_ILLNESS puedo I-PRESENT_ILLNESS controlarlas, I-PRESENT_ILLNESS me I-PRESENT_ILLNESS dicen I-PRESENT_ILLNESS que I-PRESENT_ILLNESS me I-PRESENT_ILLNESS haga I-PRESENT_ILLNESS daño, I-PRESENT_ILLNESS también I-PRESENT_ILLNESS me I-PRESENT_ILLNESS insultan.". I-PRESENT_ILLNESS Estaba B-EXPLORATION consciente, I-EXPLORATION orientado I-EXPLORATION auto I-EXPLORATION y I-EXPLORATION alopsíquicamente, I-EXPLORATION euproséxico. I-EXPLORATION Su I-EXPLORATION actitud I-EXPLORATION era I-EXPLORATION de I-EXPLORATION colaboración I-EXPLORATION y I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION alteraciones I-EXPLORATION groseras I-EXPLORATION en I-EXPLORATION funciones I-EXPLORATION superiores. I-EXPLORATION El I-EXPLORATION lenguaje I-EXPLORATION era I-EXPLORATION fluido, I-EXPLORATION espontáneo I-EXPLORATION y I-EXPLORATION coherente. I-EXPLORATION Refería I-EXPLORATION sentimientos I-EXPLORATION de I-EXPLORATION culpa I-EXPLORATION por I-EXPLORATION la I-EXPLORATION reciente I-EXPLORATION muerte I-EXPLORATION de I-EXPLORATION su I-EXPLORATION hija, I-EXPLORATION desconfianza I-EXPLORATION de I-EXPLORATION todos I-EXPLORATION aquellos I-EXPLORATION que I-EXPLORATION le I-EXPLORATION rodeaban, I-EXPLORATION y I-EXPLORATION desamparo I-EXPLORATION y I-EXPLORATION soledad I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION a I-EXPLORATION su I-EXPLORATION situación I-EXPLORATION vital. I-EXPLORATION Tenía I-EXPLORATION ideas I-EXPLORATION de I-EXPLORATION muerte I-EXPLORATION y I-EXPLORATION autolisis. I-EXPLORATION Se I-EXPLORATION quejaba I-EXPLORATION de I-EXPLORATION insomnio I-EXPLORATION con I-EXPLORATION despertares I-EXPLORATION intermitentes I-EXPLORATION y I-EXPLORATION frecuentes I-EXPLORATION pesadillas. I-EXPLORATION Disponía I-EXPLORATION de I-EXPLORATION nulo I-EXPLORATION soporte I-EXPLORATION familiar I-EXPLORATION y I-EXPLORATION social I-EXPLORATION y I-EXPLORATION había I-EXPLORATION abandonado I-EXPLORATION progresivamente I-EXPLORATION su I-EXPLORATION trabajo. I-EXPLORATION I-EXPLORATION Datos B-PAST_MEDICAL_HISTORY biográficos I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Niñez I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY adolescencia I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Siendo I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY pequeño I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY padres I-PAST_MEDICAL_HISTORY emigraron I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY él, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY hermanos, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY quedó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY España, I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY cuidado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY abuelos I-PAST_MEDICAL_HISTORY paternos. I-PAST_MEDICAL_HISTORY Recuerda I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY feliz, I-PAST_MEDICAL_HISTORY protegido I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY arropado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ellos, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY llegó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY considerar I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY padres. I-PAST_MEDICAL_HISTORY Definía I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY abuelo I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY persona, I-PAST_MEDICAL_HISTORY responsable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY trabajador. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY abuela, I-PAST_MEDICAL_HISTORY "Una I-PAST_MEDICAL_HISTORY santa, I-PAST_MEDICAL_HISTORY volcada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY mi I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY todos.". I-PAST_MEDICAL_HISTORY Con I-PAST_MEDICAL_HISTORY ellos I-PAST_MEDICAL_HISTORY vivía I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY tía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ésta, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY compartió I-PAST_MEDICAL_HISTORY juegos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY afecto. I-PAST_MEDICAL_HISTORY Paso I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY adolescencia I-PAST_MEDICAL_HISTORY separado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY padres. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY pesar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY estos I-PAST_MEDICAL_HISTORY regresaron I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY país I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY emigraron, I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY consiguió I-PAST_MEDICAL_HISTORY integrarse I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY nuclear. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY entender I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY qué, I-PAST_MEDICAL_HISTORY comentaba I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sentido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY culpa I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ello. I-PAST_MEDICAL_HISTORY Describía I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY distante I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY egoísta; I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY padre I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY afectuoso, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY ambos, I-PAST_MEDICAL_HISTORY "Incapaces I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hacer I-PAST_MEDICAL_HISTORY nada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY mí". I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY crió I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY económico I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY hermanos, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY despertó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY éstos I-PAST_MEDICAL_HISTORY recelos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY críticas I-PAST_MEDICAL_HISTORY constantes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY él, I-PAST_MEDICAL_HISTORY clara I-PAST_MEDICAL_HISTORY desconfianza I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY relación. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY colegio I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY instituto I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY ejemplar, I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY buenas I-PAST_MEDICAL_HISTORY notas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY compañeros I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY profesores. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY aquella I-PAST_MEDICAL_HISTORY época, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY describía I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY sí I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY "Trabajador, I-PAST_MEDICAL_HISTORY guasón, I-PAST_MEDICAL_HISTORY amable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY entregado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY todos...". I-PAST_MEDICAL_HISTORY Cursó I-PAST_MEDICAL_HISTORY estudios I-PAST_MEDICAL_HISTORY superiores, I-PAST_MEDICAL_HISTORY ejerciendo I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY profesión I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY éxito I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Vida I-PAST_MEDICAL_HISTORY adulta I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY noviazgo I-PAST_MEDICAL_HISTORY normalizado I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY casó I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY hijos: I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY niña I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY niño, I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY menor. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY matrimonio I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY bien, I-PAST_MEDICAL_HISTORY sentía I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY esposa I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY aliada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY escasas I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY podía I-PAST_MEDICAL_HISTORY imponer I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY criterio. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY hija, I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY él, I-PAST_MEDICAL_HISTORY "La I-PAST_MEDICAL_HISTORY única I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mundo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY me I-PAST_MEDICAL_HISTORY defendía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY apoyaba I-PAST_MEDICAL_HISTORY ante I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY críticas". I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY conflicto I-PAST_MEDICAL_HISTORY relevante I-PAST_MEDICAL_HISTORY surgió I-PAST_MEDICAL_HISTORY quince I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY morir I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY abuelos. I-PAST_MEDICAL_HISTORY Por I-PAST_MEDICAL_HISTORY cuestiones I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY herencia, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY sintió I-PAST_MEDICAL_HISTORY duramente I-PAST_MEDICAL_HISTORY criticado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY padres I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hermanos, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY llamaron I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY "Niño I-PAST_MEDICAL_HISTORY rico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aprovechado.". I-PAST_MEDICAL_HISTORY Dos I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY comentado, I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY importantes I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY laboral; I-PAST_MEDICAL_HISTORY tema I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY generó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY él I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY profundo I-PAST_MEDICAL_HISTORY malestar; I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY sentirse I-PAST_MEDICAL_HISTORY intensamente I-PAST_MEDICAL_HISTORY inseguro I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY desconfiado, I-PAST_MEDICAL_HISTORY reduciendo I-PAST_MEDICAL_HISTORY progresivamente I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY labor I-PAST_MEDICAL_HISTORY profesional. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY hizo I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY patente I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY conflictiva I-PAST_MEDICAL_HISTORY conyugal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY separación I-PAST_MEDICAL_HISTORY matrimonial, I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY hija I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY enfermó I-PAST_MEDICAL_HISTORY gravemente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY falleció I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY después. I-PAST_MEDICAL_HISTORY Ahora I-PAST_MEDICAL_HISTORY vivía I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mantenía I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY vecinos I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY barrio I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY residía. I-PAST_MEDICAL_HISTORY Disfrutaba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pequeñas I-PAST_MEDICAL_HISTORY tertulias I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY bares I-PAST_MEDICAL_HISTORY cercanos I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY abandonando I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY irritabilidad I-PAST_MEDICAL_HISTORY creciente, I-PAST_MEDICAL_HISTORY facilitada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY abusivo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Psicoterapia B-TREATMENT breve I-TREATMENT I-TREATMENT Se I-TREATMENT propuso I-TREATMENT al I-TREATMENT paciente I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT psicoterapia I-TREATMENT dinámica I-TREATMENT breve I-TREATMENT durante I-TREATMENT su I-TREATMENT ingreso I-TREATMENT en I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Agudos. I-TREATMENT El I-TREATMENT número I-TREATMENT de I-TREATMENT sesiones I-TREATMENT no I-TREATMENT se I-TREATMENT concretó I-TREATMENT al I-TREATMENT inicio, I-TREATMENT quedando I-TREATMENT esto I-TREATMENT a I-TREATMENT expensas I-TREATMENT de I-TREATMENT la I-TREATMENT evolución I-TREATMENT y I-TREATMENT tiempo I-TREATMENT del I-TREATMENT ingreso. I-TREATMENT Se I-TREATMENT realizaron I-TREATMENT doce I-TREATMENT sesiones I-TREATMENT de I-TREATMENT cuarenta I-TREATMENT minutos I-TREATMENT de I-TREATMENT duración. I-TREATMENT Como I-TREATMENT criterios I-TREATMENT de I-TREATMENT inclusión I-TREATMENT se I-TREATMENT tuvieron I-TREATMENT en I-TREATMENT cuenta: I-TREATMENT la I-TREATMENT capacidad I-TREATMENT que I-TREATMENT presentaba I-TREATMENT el I-TREATMENT paciente I-TREATMENT para I-TREATMENT pensar I-TREATMENT sobre I-TREATMENT sus I-TREATMENT sentimientos, I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT varias I-TREATMENT relaciones I-TREATMENT significativas I-TREATMENT en I-TREATMENT el I-TREATMENT pasado I-TREATMENT y I-TREATMENT la I-TREATMENT buena I-TREATMENT capacidad I-TREATMENT de I-TREATMENT vinculación I-TREATMENT con I-TREATMENT el I-TREATMENT terapeuta. I-TREATMENT I-TREATMENT Hipótesis B-EXPLORATION Psicodinámica I-EXPLORATION Inicial I-EXPLORATION I-EXPLORATION Los I-EXPLORATION mecanismos I-EXPLORATION adaptativos I-EXPLORATION del I-EXPLORATION yo I-EXPLORATION desplegados I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION infancia I-EXPLORATION como I-EXPLORATION la I-EXPLORATION constancia, I-EXPLORATION capacidad I-EXPLORATION de I-EXPLORATION trabajo, I-EXPLORATION responsabilidad, I-EXPLORATION entrega I-EXPLORATION a I-EXPLORATION los I-EXPLORATION demás I-EXPLORATION y I-EXPLORATION calidez I-EXPLORATION afectiva I-EXPLORATION proporcionaron I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION una I-EXPLORATION adecuada I-EXPLORATION imagen I-EXPLORATION del I-EXPLORATION sí I-EXPLORATION durante I-EXPLORATION años. I-EXPLORATION Ninguna I-EXPLORATION de I-EXPLORATION estas I-EXPLORATION cualidades I-EXPLORATION habían I-EXPLORATION logrado I-EXPLORATION mantenerse I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION duro I-EXPLORATION golpe I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muerte I-EXPLORATION de I-EXPLORATION su I-EXPLORATION hija I-EXPLORATION (factor I-EXPLORATION desencadenante). I-EXPLORATION Debilitado I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION emocional I-EXPLORATION por I-EXPLORATION el I-EXPLORATION fracaso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION relación I-EXPLORATION conyugal, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION profesional I-EXPLORATION por I-EXPLORATION el I-EXPLORATION conflicto I-EXPLORATION laboral I-EXPLORATION y I-EXPLORATION aislado I-EXPLORATION socialmente I-EXPLORATION por I-EXPLORATION las I-EXPLORATION consecuencias I-EXPLORATION del I-EXPLORATION consumo I-EXPLORATION excesivo I-EXPLORATION de I-EXPLORATION alcohol, I-EXPLORATION fue I-EXPLORATION invadido I-EXPLORATION por I-EXPLORATION sentimientos I-EXPLORATION reactivados I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION pasado, I-EXPLORATION surgidos I-EXPLORATION en I-EXPLORATION etapas I-EXPLORATION no I-EXPLORATION resueltas I-EXPLORATION del I-EXPLORATION desarrollo I-EXPLORATION infantil, I-EXPLORATION cuando I-EXPLORATION fue I-EXPLORATION excluido I-EXPLORATION de I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION nuclear I-EXPLORATION (conflicto I-EXPLORATION nuclear). I-EXPLORATION Sentimientos I-EXPLORATION de I-EXPLORATION culpa, I-EXPLORATION desconfianza, I-EXPLORATION desamparo I-EXPLORATION y I-EXPLORATION soledad, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION presente I-EXPLORATION provocaron I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION quiebra I-EXPLORATION de I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION sí, I-EXPLORATION de I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION del I-EXPLORATION yo I-EXPLORATION y I-EXPLORATION del I-EXPLORATION sentido I-EXPLORATION de I-EXPLORATION la I-EXPLORATION realidad. I-EXPLORATION Vencido I-EXPLORATION por I-EXPLORATION la I-EXPLORATION puesta I-EXPLORATION en I-EXPLORATION marcha I-EXPLORATION de I-EXPLORATION mecanismos I-EXPLORATION defensivos I-EXPLORATION como I-EXPLORATION la I-EXPLORATION introyección, I-EXPLORATION interiorizando I-EXPLORATION el I-EXPLORATION objeto I-EXPLORATION persecutorio, I-EXPLORATION las I-EXPLORATION voces I-EXPLORATION y I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION objeto I-EXPLORATION idealizado, I-EXPLORATION las I-EXPLORATION figuras I-EXPLORATION de I-EXPLORATION la I-EXPLORATION abuela I-EXPLORATION e I-EXPLORATION hija, I-EXPLORATION deseando I-EXPLORATION morir I-EXPLORATION como I-EXPLORATION ellas, I-EXPLORATION se I-EXPLORATION mostraba I-EXPLORATION incapaz I-EXPLORATION de I-EXPLORATION enfrentar I-EXPLORATION su I-EXPLORATION propio I-EXPLORATION sustento I-EXPLORATION y I-EXPLORATION destino. I-EXPLORATION I-EXPLORATION Trabajo B-TREATMENT en I-TREATMENT el I-TREATMENT Foco I-TREATMENT I-TREATMENT Teniendo I-TREATMENT en I-TREATMENT cuenta I-TREATMENT la I-TREATMENT hipótesis I-TREATMENT psicodinámica I-TREATMENT inicial, I-TREATMENT se I-TREATMENT seleccionaron I-TREATMENT los I-TREATMENT sentimientos I-TREATMENT de I-TREATMENT culpa, I-TREATMENT desconfianza, I-TREATMENT desamparo I-TREATMENT y I-TREATMENT soledad I-TREATMENT como I-TREATMENT foco I-TREATMENT terapéutico. I-TREATMENT Estos I-TREATMENT sentimientos I-TREATMENT se I-TREATMENT abordaron I-TREATMENT desde I-TREATMENT una I-TREATMENT perspectiva I-TREATMENT cognitiva, I-TREATMENT emocional I-TREATMENT y I-TREATMENT conductual, I-TREATMENT intentando I-TREATMENT facilitar I-TREATMENT al I-TREATMENT paciente I-TREATMENT su I-TREATMENT identificación, I-TREATMENT expresión, I-TREATMENT regulación I-TREATMENT y I-TREATMENT transformación: I-TREATMENT I-TREATMENT Sentimiento I-TREATMENT de I-TREATMENT culpa: I-TREATMENT se I-TREATMENT sentía I-TREATMENT terriblemente I-TREATMENT culpable I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT y I-TREATMENT posterior I-TREATMENT fallecimiento I-TREATMENT de I-TREATMENT su I-TREATMENT hija. I-TREATMENT Se I-TREATMENT facilitó I-TREATMENT la I-TREATMENT expresión I-TREATMENT de I-TREATMENT este I-TREATMENT sentimiento, I-TREATMENT aumentando I-TREATMENT la I-TREATMENT conciencia I-TREATMENT de I-TREATMENT su I-TREATMENT presencia I-TREATMENT en I-TREATMENT el I-TREATMENT pasado. I-TREATMENT Se I-TREATMENT abordaron I-TREATMENT las I-TREATMENT fantasías I-TREATMENT de I-TREATMENT omnipotencia I-TREATMENT y I-TREATMENT creencias I-TREATMENT mágicas, I-TREATMENT la I-TREATMENT aceptación I-TREATMENT de I-TREATMENT los I-TREATMENT límites I-TREATMENT propios I-TREATMENT y I-TREATMENT el I-TREATMENT reconocimiento I-TREATMENT de I-TREATMENT los I-TREATMENT límites I-TREATMENT de I-TREATMENT la I-TREATMENT naturaleza I-TREATMENT humana. I-TREATMENT Para I-TREATMENT favorecer I-TREATMENT la I-TREATMENT reparación I-TREATMENT del I-TREATMENT daño I-TREATMENT y I-TREATMENT la I-TREATMENT transformación I-TREATMENT del I-TREATMENT sentimiento, I-TREATMENT se I-TREATMENT le I-TREATMENT animó I-TREATMENT a I-TREATMENT la I-TREATMENT conducta I-TREATMENT de I-TREATMENT ayuda I-TREATMENT y I-TREATMENT entrega I-TREATMENT a I-TREATMENT los I-TREATMENT demás I-TREATMENT pacientes, I-TREATMENT personas I-TREATMENT necesitadas I-TREATMENT como I-TREATMENT él. I-TREATMENT I-TREATMENT Sentimiento I-TREATMENT de I-TREATMENT desconfianza: I-TREATMENT sentimiento I-TREATMENT que I-TREATMENT emergió I-TREATMENT tras I-TREATMENT la I-TREATMENT conflictiva I-TREATMENT familiar I-TREATMENT y I-TREATMENT laboral. I-TREATMENT Con I-TREATMENT la I-TREATMENT intención I-TREATMENT de I-TREATMENT trabajar I-TREATMENT la I-TREATMENT confianza I-TREATMENT en I-TREATMENT sí I-TREATMENT mismo, I-TREATMENT base I-TREATMENT de I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT confiar I-TREATMENT en I-TREATMENT los I-TREATMENT demás, I-TREATMENT se I-TREATMENT hizo I-TREATMENT un I-TREATMENT intento I-TREATMENT de I-TREATMENT reestructurar I-TREATMENT la I-TREATMENT imagen I-TREATMENT de I-TREATMENT sí I-TREATMENT y I-TREATMENT la I-TREATMENT autoestima I-TREATMENT perdida, I-TREATMENT ofreciéndole I-TREATMENT una I-TREATMENT experiencia I-TREATMENT emocional I-TREATMENT correctiva, I-TREATMENT en I-TREATMENT el I-TREATMENT contexto I-TREATMENT de I-TREATMENT la I-TREATMENT relación I-TREATMENT terapéutica, I-TREATMENT al I-TREATMENT valorarle I-TREATMENT y I-TREATMENT reforzar I-TREATMENT con I-TREATMENT frecuencia I-TREATMENT sus I-TREATMENT cualidades, I-TREATMENT entre I-TREATMENT ellas, I-TREATMENT su I-TREATMENT generosidad, I-TREATMENT entrega I-TREATMENT y I-TREATMENT capacidad I-TREATMENT de I-TREATMENT apego. I-TREATMENT Además I-TREATMENT se I-TREATMENT le I-TREATMENT instó I-TREATMENT a I-TREATMENT contactar I-TREATMENT con I-TREATMENT su I-TREATMENT tía I-TREATMENT y I-TREATMENT primo I-TREATMENT que I-TREATMENT residían I-TREATMENT ahora I-TREATMENT en I-TREATMENT otra I-TREATMENT ciudad, I-TREATMENT con I-TREATMENT los I-TREATMENT que I-TREATMENT había I-TREATMENT mantenido I-TREATMENT una I-TREATMENT relación I-TREATMENT de I-TREATMENT confianza I-TREATMENT y I-TREATMENT apego. I-TREATMENT I-TREATMENT Sentimiento I-TREATMENT de I-TREATMENT desamparo I-TREATMENT y I-TREATMENT soledad: I-TREATMENT La I-TREATMENT muerte I-TREATMENT de I-TREATMENT sus I-TREATMENT abuelos I-TREATMENT y I-TREATMENT su I-TREATMENT hija, I-TREATMENT el I-TREATMENT divorcio I-TREATMENT y I-TREATMENT el I-TREATMENT aislamiento I-TREATMENT social I-TREATMENT favorecieron I-TREATMENT ambos I-TREATMENT sentimientos. I-TREATMENT Se I-TREATMENT trabajó I-TREATMENT la I-TREATMENT resolución I-TREATMENT del I-TREATMENT duelo, I-TREATMENT facilitando I-TREATMENT la I-TREATMENT identificación I-TREATMENT y I-TREATMENT expresión I-TREATMENT de I-TREATMENT la I-TREATMENT rabia I-TREATMENT por I-TREATMENT la I-TREATMENT muerte I-TREATMENT de I-TREATMENT sus I-TREATMENT seres I-TREATMENT más I-TREATMENT queridos I-TREATMENT y I-TREATMENT señalando I-TREATMENT la I-TREATMENT permanencia I-TREATMENT de I-TREATMENT las I-TREATMENT relaciones I-TREATMENT de I-TREATMENT objeto I-TREATMENT en I-TREATMENT el I-TREATMENT interior. I-TREATMENT Además, I-TREATMENT se I-TREATMENT destacó I-TREATMENT la I-TREATMENT importancia I-TREATMENT de I-TREATMENT la I-TREATMENT ayuda I-TREATMENT recibida I-TREATMENT desde I-TREATMENT el I-TREATMENT exterior, I-TREATMENT de I-TREATMENT la I-TREATMENT institución I-TREATMENT sanitaria. I-TREATMENT Tomó I-TREATMENT en I-TREATMENT aquel I-TREATMENT momento I-TREATMENT conciencia I-TREATMENT del I-TREATMENT miedo I-TREATMENT a I-TREATMENT enfrentar I-TREATMENT su I-TREATMENT situación, I-TREATMENT a I-TREATMENT vivir I-TREATMENT en I-TREATMENT soledad I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT propuso I-TREATMENT entonces I-TREATMENT reiniciar I-TREATMENT el I-TREATMENT contacto I-TREATMENT telefónico I-TREATMENT con I-TREATMENT amigos I-TREATMENT y I-TREATMENT compañeros. I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO urgencias I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO psiquiatra I-DERIVED_FROM/TO habitual I-DERIVED_FROM/TO debido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO alteraciones I-DERIVED_FROM/TO conductuales I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO entorno I-DERIVED_FROM/TO familiar. I-DERIVED_FROM/TO Ha B-PRESENT_ILLNESS venido I-PRESENT_ILLNESS desarrollando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS hábitos I-PRESENT_ILLNESS alimentarios I-PRESENT_ILLNESS que I-PRESENT_ILLNESS han I-PRESENT_ILLNESS puesto I-PRESENT_ILLNESS en I-PRESENT_ILLNESS peligro I-PRESENT_ILLNESS su I-PRESENT_ILLNESS salud, I-PRESENT_ILLNESS rechazando I-PRESENT_ILLNESS algunos I-PRESENT_ILLNESS alimentos I-PRESENT_ILLNESS por I-PRESENT_ILLNESS considerar I-PRESENT_ILLNESS que I-PRESENT_ILLNESS estaban I-PRESENT_ILLNESS "contaminados". I-PRESENT_ILLNESS Cuando I-PRESENT_ILLNESS se I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS tratado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS modificar I-PRESENT_ILLNESS estas I-PRESENT_ILLNESS conductas, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS mostrado I-PRESENT_ILLNESS irritado I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS agresividad I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS su I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hermano I-PRESENT_ILLNESS menor. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS entrevista I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mostró I-PRESENT_ILLNESS colaborador, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aspecto I-PRESENT_ILLNESS descuidado I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS falta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS higiene. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS contacto I-PRESENT_ILLNESS era I-PRESENT_ILLNESS peculiar, I-PRESENT_ILLNESS mostrando I-PRESENT_ILLNESS sonrisas I-PRESENT_ILLNESS inapropiadas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS una I-PRESENT_ILLNESS alta I-PRESENT_ILLNESS latencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS discurso. I-PRESENT_ILLNESS Negaba I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sensopercepción I-PRESENT_ILLNESS y I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pensamiento. I-PRESENT_ILLNESS Refirió B-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY epilépticas I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY acudió I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY psiquiatría I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conducta; I-PAST_MEDICAL_HISTORY allí I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Asperger. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY pesar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY sintomatología I-PAST_MEDICAL_HISTORY psicótica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY aquella I-PAST_MEDICAL_HISTORY ocasión, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY pautó I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY neuroléptico I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY abandonó I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY reacción I-PAST_MEDICAL_HISTORY adversa. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY valoración I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY bajo I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY psiquiátrico. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS ingreso, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mostraba I-PRESENT_ILLNESS tranquilo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS colaborador. I-PRESENT_ILLNESS En B-EVOLUTION la I-EVOLUTION primera I-EVOLUTION consulta, I-EVOLUTION solicitó I-EVOLUTION un I-EVOLUTION tiempo I-EVOLUTION previo I-EVOLUTION a I-EVOLUTION la I-EVOLUTION entrevista I-EVOLUTION para I-EVOLUTION poder I-EVOLUTION realizar I-EVOLUTION un I-EVOLUTION paseo I-EVOLUTION por I-EVOLUTION los I-EVOLUTION pasillos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION planta, I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION esto I-EVOLUTION le I-EVOLUTION ayudaba I-EVOLUTION a I-EVOLUTION calmarse. I-EVOLUTION Cuando I-EVOLUTION se I-EVOLUTION exploró I-EVOLUTION el I-EVOLUTION motivo I-EVOLUTION del I-EVOLUTION ingreso, I-EVOLUTION mostró I-EVOLUTION escasa I-EVOLUTION conciencia I-EVOLUTION de I-EVOLUTION enfermedad, I-EVOLUTION refiriendo I-EVOLUTION encontrarse I-EVOLUTION en I-EVOLUTION desacuerdo I-EVOLUTION con I-EVOLUTION la I-EVOLUTION necesidad I-EVOLUTION del I-EVOLUTION mismo. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION no I-EVOLUTION mostraba I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION desconfianza, I-EVOLUTION presentando I-EVOLUTION buena I-EVOLUTION disposición I-EVOLUTION a I-EVOLUTION recibir I-EVOLUTION tratamiento. I-EVOLUTION Su B-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY primera I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY notado I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY algo I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY diferente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente, I-PAST_MEDICAL_HISTORY si I-PAST_MEDICAL_HISTORY bien I-PAST_MEDICAL_HISTORY reconocía I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY información I-PAST_MEDICAL_HISTORY sobre I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Asperger I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY comentaba I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY compañeros I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colegio I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY reían I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY él I-PAST_MEDICAL_HISTORY porque I-PAST_MEDICAL_HISTORY utilizaba I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY vocabulario I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY formal. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY rendimiento I-PAST_MEDICAL_HISTORY académico I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY excelente I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY bachillerato, I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY suspender I-PAST_MEDICAL_HISTORY asignaturas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY pesar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY contar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY capacidad I-PAST_MEDICAL_HISTORY intelectual I-PAST_MEDICAL_HISTORY superior I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY media. I-PAST_MEDICAL_HISTORY Hasta I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY pasaba I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY parte I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY casa, I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY convivía I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY hermano I-PAST_MEDICAL_HISTORY menor. I-PAST_MEDICAL_HISTORY Comentaba I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY menudo I-PAST_MEDICAL_HISTORY solía I-PAST_MEDICAL_HISTORY dar I-PAST_MEDICAL_HISTORY largos I-PAST_MEDICAL_HISTORY paseos I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY desplazaba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY autobús, I-PAST_MEDICAL_HISTORY actividades I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY realizaba I-PAST_MEDICAL_HISTORY siempre I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY solitario. I-PAST_MEDICAL_HISTORY Refería I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY fuerte I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY ciencias I-PAST_MEDICAL_HISTORY naturales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EVOLUTION avanzar I-EVOLUTION el I-EVOLUTION ingreso, I-EVOLUTION se I-EVOLUTION le I-EVOLUTION observaba I-EVOLUTION más I-EVOLUTION distendido, I-EVOLUTION con I-EVOLUTION menor I-EVOLUTION rigidez I-EVOLUTION postural I-EVOLUTION y I-EVOLUTION menor I-EVOLUTION latencia I-EVOLUTION de I-EVOLUTION respuesta I-EVOLUTION en I-EVOLUTION el I-EVOLUTION discurso. I-EVOLUTION También I-EVOLUTION se I-EVOLUTION redujeron I-EVOLUTION las I-EVOLUTION sonrisas I-EVOLUTION inmotivadas, I-EVOLUTION las I-EVOLUTION cuales I-EVOLUTION reaparecían I-EVOLUTION en I-EVOLUTION el I-EVOLUTION contexto I-EVOLUTION de I-EVOLUTION la I-EVOLUTION interacción I-EVOLUTION con I-EVOLUTION personas I-EVOLUTION desconocidas. I-EVOLUTION El B-TREATMENT tratamiento I-TREATMENT antipsicótico I-TREATMENT se I-TREATMENT mostró I-TREATMENT eficaz I-TREATMENT en I-TREATMENT la I-TREATMENT reducción I-TREATMENT de I-TREATMENT la I-TREATMENT irritabilidad I-TREATMENT del I-TREATMENT paciente. I-TREATMENT La B-EVOLUTION rigidez I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION las I-EVOLUTION ideas I-EVOLUTION sobre I-EVOLUTION la I-EVOLUTION alimentación I-EVOLUTION y I-EVOLUTION los I-EVOLUTION hábitos I-EVOLUTION de I-EVOLUTION higiene I-EVOLUTION y I-EVOLUTION sueño I-EVOLUTION continuaron I-EVOLUTION al I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que B-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO urgencias I-DERIVED_FROM/TO de I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO por I-DERIVED_FROM/TO alteraciones I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO conducta I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO vía I-DERIVED_FROM/TO pública. I-DERIVED_FROM/TO Sus B-PRESENT_ILLNESS padres I-PRESENT_ILLNESS referían I-PRESENT_ILLNESS que I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS había I-PRESENT_ILLNESS ido I-PRESENT_ILLNESS disminuyendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS las I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sueño, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS verbalizado I-PRESENT_ILLNESS ideas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carácter I-PRESENT_ILLNESS mesiánico. I-PRESENT_ILLNESS Parecía I-PRESENT_ILLNESS llevar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS desorganizada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS descuido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS tareas I-PRESENT_ILLNESS básicas, I-PRESENT_ILLNESS dedicación I-PRESENT_ILLNESS excesiva I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS videojuegos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deficiente I-PRESENT_ILLNESS alimentación. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION entrevista I-EXPLORATION se I-EXPLORATION mostró I-EXPLORATION hostil, I-EXPLORATION suspicaz, I-EXPLORATION e I-EXPLORATION interpretativo I-EXPLORATION con I-EXPLORATION el I-EXPLORATION entorno, I-EXPLORATION especialmente I-EXPLORATION con I-EXPLORATION los I-EXPLORATION colores, I-EXPLORATION llegando I-EXPLORATION a I-EXPLORATION referir I-EXPLORATION que I-EXPLORATION se I-EXPLORATION "sentía" I-EXPLORATION azul. I-EXPLORATION Negó I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION esfera I-EXPLORATION sensoperceptiva. I-EXPLORATION Desde B-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY psiquiatría I-PAST_MEDICAL_HISTORY debido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY psicóticos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY afectivos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY respuesta I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY psicofarmacológico, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY abandonado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ya B-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mostró I-EVOLUTION tranquilo, I-EVOLUTION pero I-EVOLUTION muy I-EVOLUTION desconfiado. I-EVOLUTION Explicó I-EVOLUTION lo I-EVOLUTION sucedido I-EVOLUTION como I-EVOLUTION resultado I-EVOLUTION de I-EVOLUTION la I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION "pistas I-EVOLUTION falsas" I-EVOLUTION que I-EVOLUTION le I-EVOLUTION llevaron I-EVOLUTION a I-EVOLUTION alertar I-EVOLUTION a I-EVOLUTION determinadas I-EVOLUTION personas I-EVOLUTION de I-EVOLUTION que I-EVOLUTION estaban I-EVOLUTION en I-EVOLUTION peligro. I-EVOLUTION Su B-FAMILY_HISTORY madre I-FAMILY_HISTORY refirió I-FAMILY_HISTORY llevar I-FAMILY_HISTORY varios I-FAMILY_HISTORY años I-FAMILY_HISTORY en I-FAMILY_HISTORY tratamiento I-FAMILY_HISTORY psiquiátrico I-FAMILY_HISTORY por I-FAMILY_HISTORY distimia, I-FAMILY_HISTORY mientras I-FAMILY_HISTORY que I-FAMILY_HISTORY el I-FAMILY_HISTORY padre I-FAMILY_HISTORY había I-FAMILY_HISTORY recibido I-FAMILY_HISTORY un I-FAMILY_HISTORY diagnóstico I-FAMILY_HISTORY de I-FAMILY_HISTORY trastorno I-FAMILY_HISTORY obsesivo I-FAMILY_HISTORY compulsivo I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY pasado. I-FAMILY_HISTORY Los B-EXPLORATION familiares I-EXPLORATION no I-EXPLORATION refirieron I-EXPLORATION ninguna I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION el I-EXPLORATION desarrollo I-EXPLORATION del I-EXPLORATION paciente, I-EXPLORATION si I-EXPLORATION bien I-EXPLORATION él I-EXPLORATION mismo I-EXPLORATION reconoció I-EXPLORATION que I-EXPLORATION siempre I-EXPLORATION se I-EXPLORATION había I-EXPLORATION sentido I-EXPLORATION un I-EXPLORATION "bicho I-EXPLORATION raro". I-EXPLORATION Recordaba I-EXPLORATION la I-EXPLORATION etapa I-EXPLORATION escolar I-EXPLORATION como I-EXPLORATION un I-EXPLORATION "infierno", I-EXPLORATION presentando I-EXPLORATION un I-EXPLORATION mal I-EXPLORATION manejo I-EXPLORATION de I-EXPLORATION las I-EXPLORATION relaciones I-EXPLORATION interpersonales, I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION reconocer I-EXPLORATION que I-EXPLORATION le I-EXPLORATION daba I-EXPLORATION "fobia" I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION de I-EXPLORATION las I-EXPLORATION personas. I-EXPLORATION Es I-EXPLORATION por I-EXPLORATION esta I-EXPLORATION razón I-EXPLORATION por I-EXPLORATION la I-EXPLORATION que I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION adolescencia I-EXPLORATION mantenía I-EXPLORATION contacto I-EXPLORATION interpersonal I-EXPLORATION casi I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION exclusiva I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION juegos I-EXPLORATION de I-EXPLORATION ordenador I-EXPLORATION en I-EXPLORATION línea. I-EXPLORATION I-EXPLORATION A B-EVOLUTION medida I-EVOLUTION que I-EVOLUTION avanzó I-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION se I-EVOLUTION le I-EVOLUTION observaba I-EVOLUTION más I-EVOLUTION distendido, I-EVOLUTION si I-EVOLUTION bien I-EVOLUTION refería I-EVOLUTION sentirse I-EVOLUTION incómodo I-EVOLUTION rodeado I-EVOLUTION de I-EVOLUTION gente. I-EVOLUTION También I-EVOLUTION comentó I-EVOLUTION que I-EVOLUTION le I-EVOLUTION molestaba I-EVOLUTION el I-EVOLUTION sonido I-EVOLUTION del I-EVOLUTION tubo I-EVOLUTION del I-EVOLUTION televisor I-EVOLUTION situado I-EVOLUTION en I-EVOLUTION una I-EVOLUTION de I-EVOLUTION las I-EVOLUTION salas I-EVOLUTION comunes I-EVOLUTION de I-EVOLUTION la I-EVOLUTION unidad, I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION percibía I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION nítida. I-EVOLUTION Como I-EVOLUTION estrategia I-EVOLUTION de I-EVOLUTION afrontamiento I-EVOLUTION en I-EVOLUTION los I-EVOLUTION momentos I-EVOLUTION de I-EVOLUTION estrés, I-EVOLUTION deambulaba I-EVOLUTION por I-EVOLUTION el I-EVOLUTION pasillo I-EVOLUTION siguiendo I-EVOLUTION una I-EVOLUTION secuencia I-EVOLUTION rutinaria I-EVOLUTION que I-EVOLUTION podía I-EVOLUTION durar I-EVOLUTION varias I-EVOLUTION horas I-EVOLUTION y I-EVOLUTION que, I-EVOLUTION según I-EVOLUTION decía, I-EVOLUTION le I-EVOLUTION ayudaba I-EVOLUTION a I-EVOLUTION relajarse. I-EVOLUTION Mencionó B-EXPLORATION tener I-EXPLORATION habitualmente I-EXPLORATION "paranoias" I-EXPLORATION que I-EXPLORATION asociaba I-EXPLORATION con I-EXPLORATION su I-EXPLORATION comportamiento I-EXPLORATION anterior I-EXPLORATION al I-EXPLORATION ingreso. I-EXPLORATION Relacionó I-EXPLORATION el I-EXPLORATION episodio I-EXPLORATION conductual I-EXPLORATION con I-EXPLORATION un I-EXPLORATION sentimiento I-EXPLORATION profundo I-EXPLORATION de I-EXPLORATION soledad I-EXPLORATION y I-EXPLORATION frustración I-EXPLORATION por I-EXPLORATION su I-EXPLORATION incapacidad I-EXPLORATION para I-EXPLORATION mantener I-EXPLORATION relaciones I-EXPLORATION interpersonales I-EXPLORATION estables. I-EXPLORATION Al I-EXPLORATION ser I-EXPLORATION preguntado I-EXPLORATION por I-EXPLORATION la I-EXPLORATION relación I-EXPLORATION entre I-EXPLORATION percepción I-EXPLORATION y I-EXPLORATION color I-EXPLORATION manifestada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencias, I-EXPLORATION respondió I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION la I-EXPLORATION letra I-EXPLORATION traducida I-EXPLORATION de I-EXPLORATION una I-EXPLORATION canción I-EXPLORATION (en I-EXPLORATION inglés I-EXPLORATION la I-EXPLORATION palabra I-EXPLORATION "blue" I-EXPLORATION presenta I-EXPLORATION dos I-EXPLORATION significados: I-EXPLORATION azul I-EXPLORATION y I-EXPLORATION triste. I-EXPLORATION Al I-EXPLORATION decir I-EXPLORATION sentirse I-EXPLORATION azul I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION realmente I-EXPLORATION expresaba I-EXPLORATION un I-EXPLORATION sentimiento I-EXPLORATION de I-EXPLORATION tristeza). I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT presentó I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT antipsicótico, I-TREATMENT si B-EVOLUTION bien I-EVOLUTION tanto I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION afectivos I-EVOLUTION como I-EVOLUTION la I-EVOLUTION rigidez I-EVOLUTION en I-EVOLUTION el I-EVOLUTION pensamiento I-EVOLUTION nunca I-EVOLUTION desaparecieron. I-EVOLUTION I-EVOLUTION La B-EXPLORATION tabla I-EXPLORATION 1 I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION comparación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Escala I-EXPLORATION de I-EXPLORATION Inteligencia I-EXPLORATION Wechsler I-EXPLORATION para I-EXPLORATION Adultos I-EXPLORATION (WAIS) I-EXPLORATION (30), I-EXPLORATION la I-EXPLORATION Escala I-EXPLORATION de I-EXPLORATION Síndromes I-EXPLORATION Positivos I-EXPLORATION y I-EXPLORATION Negativos I-EXPLORATION (PANSS) I-EXPLORATION (32) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION Cociente I-EXPLORATION de I-EXPLORATION Espectro I-EXPLORATION Autista I-EXPLORATION (AQ) I-EXPLORATION (31) I-EXPLORATION en I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION pacientes. I-EXPLORATION La I-EXPLORATION tabla I-EXPLORATION 2 I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION comparación I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION esquizofrenia I-EXPLORATION y I-EXPLORATION autismo I-EXPLORATION compartidos I-EXPLORATION en I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION casos I-EXPLORATION descritos. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA) I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY difícil I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mala I-PAST_MEDICAL_HISTORY cumplimiento I-PAST_MEDICAL_HISTORY terapéutico. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2008 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY probable I-PAST_MEDICAL_HISTORY nefroangiosclerosis. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY implanta I-PAST_MEDICAL_HISTORY catéter I-PAST_MEDICAL_HISTORY peritoneal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY diciembre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2009, I-PAST_MEDICAL_HISTORY iniciando I-PAST_MEDICAL_HISTORY DP I-PAST_MEDICAL_HISTORY continua I-PAST_MEDICAL_HISTORY ambulatoria I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY tarde I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY incidencias I-PAST_MEDICAL_HISTORY destacables. I-PAST_MEDICAL_HISTORY Un B-PRESENT_ILLNESS mes I-PRESENT_ILLNESS después I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disfunción I-PRESENT_ILLNESS del I-PRESENT_ILLNESS catéter I-PRESENT_ILLNESS peritoneal, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS el I-PRESENT_ILLNESS drenaje. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION hipoventilación I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION campo I-EXPLORATION medio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pulmón I-EXPLORATION derecho. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION refiere I-EXPLORATION disnea, I-EXPLORATION aunque I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION oxígeno, I-EXPLORATION con I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION importante I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION hidrotórax I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION DP I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION toracocentesis I-EXPLORATION diagnóstica, I-EXPLORATION obteniendo I-EXPLORATION un I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION con I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION datos: I-EXPLORATION leucocitos I-EXPLORATION 200. I-EXPLORATION Glucosa I-EXPLORATION 418. I-EXPLORATION Proteínas I-EXPLORATION <1, I-EXPLORATION LDH I-EXPLORATION 42. I-EXPLORATION I-EXPLORATION Dado B-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT negaba I-TREATMENT a I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT hemodiálisis, I-TREATMENT tras I-TREATMENT unos I-TREATMENT días I-TREATMENT de I-TREATMENT reposo I-TREATMENT peritoneal I-TREATMENT con I-TREATMENT los I-TREATMENT que I-TREATMENT se I-TREATMENT consiguió I-TREATMENT la I-TREATMENT normalización I-TREATMENT de I-TREATMENT la I-TREATMENT radiografía I-TREATMENT de I-TREATMENT tórax, I-TREATMENT se I-TREATMENT intenta I-TREATMENT realizar I-TREATMENT DP I-TREATMENT automática I-TREATMENT con I-TREATMENT bajo I-TREATMENT volumen I-TREATMENT y I-TREATMENT cabecera I-TREATMENT a I-TREATMENT 45o, I-TREATMENT sin I-TREATMENT conseguir I-TREATMENT un I-TREATMENT buen I-TREATMENT funcionamiento I-TREATMENT del I-TREATMENT catéter I-TREATMENT por I-TREATMENT importante I-TREATMENT dificultad I-TREATMENT para I-TREATMENT el I-TREATMENT drenaje I-TREATMENT y I-TREATMENT con I-TREATMENT nueva I-TREATMENT aparición I-TREATMENT de I-TREATMENT hidrotórax. I-TREATMENT Finalmente, I-TREATMENT el I-TREATMENT paciente I-TREATMENT aceptó I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT HD I-TREATMENT que I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT actual I-TREATMENT se I-TREATMENT realiza I-TREATMENT sin I-TREATMENT incidencias I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT FAV I-TREATMENT radiocefálica I-TREATMENT izquierda. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Nefrología I-DERIVED_FROM/TO por B-PRESENT_ILLNESS creatinina I-PRESENT_ILLNESS plasmática I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2, I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS mg/dl. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY diversas I-PAST_MEDICAL_HISTORY intervenciones I-PAST_MEDICAL_HISTORY quirúrgicas I-PAST_MEDICAL_HISTORY (menisco I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1985; I-PAST_MEDICAL_HISTORY timoma I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anatomía I-PAST_MEDICAL_HISTORY patológica I-PAST_MEDICAL_HISTORY benigna I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1999; I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY nasosinusales I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2008; I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2006; I-PAST_MEDICAL_HISTORY cistocele I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2008; I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cadera I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY julio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2010); I-PAST_MEDICAL_HISTORY colangitis I-PAST_MEDICAL_HISTORY esclerosante I-PAST_MEDICAL_HISTORY primaria I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2003, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY ursodesoxicólico. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY cateterismo I-PAST_MEDICAL_HISTORY biliar I-PAST_MEDICAL_HISTORY retrógado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY esfinterectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dilatación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY zonas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estenosis. I-PAST_MEDICAL_HISTORY También I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY inflamatoria I-PAST_MEDICAL_HISTORY intestinal I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY misma I-PAST_MEDICAL_HISTORY época; I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY practicaron I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY colonoscopias I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY unas I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY eran I-PAST_MEDICAL_HISTORY normales I-PAST_MEDICAL_HISTORY y, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otras, I-PAST_MEDICAL_HISTORY mostraban I-PAST_MEDICAL_HISTORY mínimas I-PAST_MEDICAL_HISTORY ulceraciones I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY iliocecal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY colon. I-PAST_MEDICAL_HISTORY Pericarditis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY etiología I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY filiada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY enero I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2010. I-PAST_MEDICAL_HISTORY Gonartrosis I-PAST_MEDICAL_HISTORY bilateral. I-PAST_MEDICAL_HISTORY Intolerancia I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY hierro I-PAST_MEDICAL_HISTORY oral. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY vista I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY externa I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY zolpidem, I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg/día; I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY ursodesoxicólico, I-PAST_MEDICAL_HISTORY 1250 I-PAST_MEDICAL_HISTORY mg/día; I-PAST_MEDICAL_HISTORY pantoprazol, I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY mg/día; I-PAST_MEDICAL_HISTORY mirtazapina, I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY mg/día; I-PAST_MEDICAL_HISTORY dextropropoxífeno, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY paracetamol I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY ocasional. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS interrogatorio I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS cansancio, I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS medianos I-PRESENT_ILLNESS esfuerzos; I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS del I-PRESENT_ILLNESS apetito; I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS ocasionales I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tos; I-PRESENT_ILLNESS estreñimiento I-PRESENT_ILLNESS habitual I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unas I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS que I-PRESENT_ILLNESS alternaba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día, I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS patológicos; I-PRESENT_ILLNESS nicturia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS meses; I-PRESENT_ILLNESS micciones I-PRESENT_ILLNESS diurnas I-PRESENT_ILLNESS cada I-PRESENT_ILLNESS 3-4 I-PRESENT_ILLNESS horas; I-PRESENT_ILLNESS no I-PRESENT_ILLNESS relataba I-PRESENT_ILLNESS antecedentes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS renoureterales I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS tenido I-PRESENT_ILLNESS hematuria. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-FAMILY_HISTORY cuanto I-FAMILY_HISTORY a I-FAMILY_HISTORY sus I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares, I-FAMILY_HISTORY padres I-FAMILY_HISTORY fallecidos I-FAMILY_HISTORY en I-FAMILY_HISTORY edad I-FAMILY_HISTORY avanzada I-FAMILY_HISTORY y I-FAMILY_HISTORY tres I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY fallecidos I-FAMILY_HISTORY por I-FAMILY_HISTORY tumores. I-FAMILY_HISTORY I-FAMILY_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física: I-EXPLORATION talla: I-EXPLORATION 159 I-EXPLORATION cm; I-EXPLORATION peso: I-EXPLORATION 53 I-EXPLORATION kg. I-EXPLORATION Presión I-EXPLORATION arterial: I-EXPLORATION 137/72 I-EXPLORATION mmHg; I-EXPLORATION frecuencia I-EXPLORATION cardíaca: I-EXPLORATION 95 I-EXPLORATION lpm. I-EXPLORATION Sin I-EXPLORATION ingurgitación I-EXPLORATION yugular; I-EXPLORATION carótidas I-EXPLORATION rítmicas I-EXPLORATION y I-EXPLORATION simétricas; I-EXPLORATION auscultación I-EXPLORATION cardiopulmonar I-EXPLORATION normal; I-EXPLORATION en I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION hepatomegalia I-EXPLORATION de I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION traveses I-EXPLORATION de I-EXPLORATION dedo I-EXPLORATION más I-EXPLORATION evidente I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION derecho, I-EXPLORATION no I-EXPLORATION dolorosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION soplos I-EXPLORATION abdominales. I-EXPLORATION Extremidades: I-EXPLORATION sin I-EXPLORATION edemas I-EXPLORATION y I-EXPLORATION pulsos I-EXPLORATION distales I-EXPLORATION presentes. I-EXPLORATION I-EXPLORATION Revisada I-EXPLORATION la I-EXPLORATION historia I-EXPLORATION analítica, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION en I-EXPLORATION noviembre I-EXPLORATION de I-EXPLORATION 2010 I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION plasmática I-EXPLORATION osciló I-EXPLORATION entre I-EXPLORATION 2, I-EXPLORATION 4-2, I-EXPLORATION 5 I-EXPLORATION mg/dl; I-EXPLORATION en I-EXPLORATION diciembre I-EXPLORATION de I-EXPLORATION 2010 I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION plasmática I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 9 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION en I-EXPLORATION enero I-EXPLORATION de I-EXPLORATION 2011, I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 7 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION en I-EXPLORATION enero I-EXPLORATION y I-EXPLORATION febrero I-EXPLORATION de I-EXPLORATION 2011, I-EXPLORATION cabe I-EXPLORATION destacar: I-EXPLORATION colesterol: I-EXPLORATION 204 I-EXPLORATION mg/dl; I-EXPLORATION GOT I-EXPLORATION (glutamato-oxalacetato-transaminasa): I-EXPLORATION 37 I-EXPLORATION U/l; I-EXPLORATION GPT I-EXPLORATION (glutamato-piruvato-transaminasa): I-EXPLORATION 23 I-EXPLORATION U/l; I-EXPLORATION GGT I-EXPLORATION (gammaglutamil I-EXPLORATION transferasa): I-EXPLORATION 431 I-EXPLORATION U/l; I-EXPLORATION fosfatasa I-EXPLORATION alcalina: I-EXPLORATION 483 I-EXPLORATION U/l; I-EXPLORATION LDH I-EXPLORATION (lactatodeshidrogenasa): I-EXPLORATION 646 I-EXPLORATION U/l; I-EXPLORATION ferritina: I-EXPLORATION 399 I-EXPLORATION ng/ml; I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION transferrina, I-EXPLORATION 11%. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION ordinaria I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemograma: I-EXPLORATION hematocrito: I-EXPLORATION 35, I-EXPLORATION 1%; I-EXPLORATION hemoglobina: I-EXPLORATION 11, I-EXPLORATION 3 I-EXPLORATION g/dl; I-EXPLORATION resto I-EXPLORATION normal. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION coagulación: I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION tromboplastina I-EXPLORATION parcial I-EXPLORATION activado: I-EXPLORATION 45 I-EXPLORATION segundos. I-EXPLORATION Anticardiolipina I-EXPLORATION IgM I-EXPLORATION positiva: I-EXPLORATION 21, I-EXPLORATION 80 I-EXPLORATION U I-EXPLORATION MPL/ml I-EXPLORATION (normal: I-EXPLORATION 0, I-EXPLORATION 5-11). I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION recogida I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas: I-EXPLORATION proteinuria: I-EXPLORATION 0, I-EXPLORATION 53 I-EXPLORATION g/24 I-EXPLORATION horas; I-EXPLORATION aclaramiento I-EXPLORATION de I-EXPLORATION creatinina: I-EXPLORATION 17 I-EXPLORATION ml/min. I-EXPLORATION El I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunológico I-EXPLORATION mostró I-EXPLORATION positividad I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION anticitoplasma I-EXPLORATION de I-EXPLORATION neutrófilos I-EXPLORATION (ANCA) I-EXPLORATION (anti-MPO I-EXPLORATION y I-EXPLORATION Anti-PR3 I-EXPLORATION negativos); I-EXPLORATION los I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (ANA), I-EXPLORATION anti-DNA, I-EXPLORATION anticuerpos I-EXPLORATION antimúsculo I-EXPLORATION liso, I-EXPLORATION anticuerpos I-EXPLORATION antimitocondriales I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION inmunoglobulinas: I-EXPLORATION IgG: I-EXPLORATION 253 I-EXPLORATION mg/dl I-EXPLORATION (normal: I-EXPLORATION 751-1560); I-EXPLORATION IgM: I-EXPLORATION 10 I-EXPLORATION mg/dl I-EXPLORATION (normal: I-EXPLORATION 46-304); I-EXPLORATION IgA I-EXPLORATION 81 I-EXPLORATION mg/dl I-EXPLORATION (normal: I-EXPLORATION 82-453). I-EXPLORATION El I-EXPLORATION complemento, I-EXPLORATION factor I-EXPLORATION reumatoide, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION y I-EXPLORATION ceruloplasmina I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION inmunodeficiencia I-EXPLORATION humana, I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION hormonas I-EXPLORATION tiroideas I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antitiroideos I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION paratohormona I-EXPLORATION intacta I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 149 I-EXPLORATION pg/ml. I-EXPLORATION I-EXPLORATION La I-EXPLORATION electroforesis I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION inmunoglobulinas, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION orina, I-EXPLORATION proteinuria I-EXPLORATION no I-EXPLORATION selectiva. I-EXPLORATION La I-EXPLORATION proteinuria I-EXPLORATION de I-EXPLORATION Bence-Jones I-EXPLORATION resultó I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION (ecografía I-EXPLORATION renal): I-EXPLORATION riñones I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION morfología I-EXPLORATION y I-EXPLORATION ecogenicidad I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION litiasis I-EXPLORATION ni I-EXPLORATION dilatación. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION deterioro I-EXPLORATION de I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION de I-EXPLORATION causa I-EXPLORATION no I-EXPLORATION clara I-EXPLORATION (se I-EXPLORATION desconocían I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION previa), I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION percutánea I-EXPLORATION con I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION hallazgos: I-EXPLORATION 4 I-EXPLORATION glomérulos, I-EXPLORATION 2 I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION completamente I-EXPLORATION esclerosados I-EXPLORATION y I-EXPLORATION los I-EXPLORATION otros I-EXPLORATION 2 I-EXPLORATION en I-EXPLORATION vías I-EXPLORATION de I-EXPLORATION esclerosis. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION inmunofluorescencia I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION IgG, I-EXPLORATION IgA, I-EXPLORATION IgM I-EXPLORATION y I-EXPLORATION C3. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION intersticio I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION un I-EXPLORATION denso I-EXPLORATION infiltrado I-EXPLORATION linfocitario I-EXPLORATION que I-EXPLORATION expandía I-EXPLORATION y I-EXPLORATION ocupaba I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION tejido, I-EXPLORATION destruyendo I-EXPLORATION la I-EXPLORATION arquitectura I-EXPLORATION habitual I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION renal. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION valoraba I-EXPLORATION bien I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION debido I-EXPLORATION al I-EXPLORATION infiltrado I-EXPLORATION existente. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION figura I-EXPLORATION 2 I-EXPLORATION A I-EXPLORATION se I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION inmunohistoquímica I-EXPLORATION con I-EXPLORATION CD3 I-EXPLORATION (anticuerpo I-EXPLORATION monoclonal I-EXPLORATION que I-EXPLORATION marca I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION en I-EXPLORATION general) I-EXPLORATION y I-EXPLORATION demuestra I-EXPLORATION que I-EXPLORATION la I-EXPLORATION mayoría I-EXPLORATION del I-EXPLORATION infiltrado I-EXPLORATION es I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION T, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION figura I-EXPLORATION 2 I-EXPLORATION B, I-EXPLORATION la I-EXPLORATION inmunohistoquímica I-EXPLORATION con I-EXPLORATION CD4. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION final I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION nefropatía I-EXPLORATION tubulointersticial I-EXPLORATION severa I-EXPLORATION (infiltrado I-EXPLORATION intersticial I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION linfocitario I-EXPLORATION T I-EXPLORATION CD4 I-EXPLORATION positivos). I-EXPLORATION I-EXPLORATION Con B-TREATMENT los I-TREATMENT hallazgos I-TREATMENT de I-TREATMENT la I-TREATMENT biopsia I-TREATMENT se I-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona, I-TREATMENT 50 I-TREATMENT mg/día, I-TREATMENT en I-TREATMENT pauta I-TREATMENT descendente. I-TREATMENT I-TREATMENT Ocho B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION mantiene I-EVOLUTION una I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION estabilizada I-EVOLUTION (creatinina I-EVOLUTION plasmática I-EVOLUTION de I-EVOLUTION 2, I-EVOLUTION 2 I-EVOLUTION mg/dl, I-EVOLUTION aclaramiento I-EVOLUTION de I-EVOLUTION 20 I-EVOLUTION ml/min I-EVOLUTION y I-EVOLUTION proteinuria I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 49 I-EVOLUTION g/24 I-EVOLUTION h). I-EVOLUTION Respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION función I-EVOLUTION hepática: I-EVOLUTION GOT: I-EVOLUTION 24 I-EVOLUTION U/l; I-EVOLUTION GPT: I-EVOLUTION 18 I-EVOLUTION U/l; I-EVOLUTION GGT: I-EVOLUTION 172 I-EVOLUTION U/l; I-EVOLUTION fosfatasa I-EVOLUTION alcalina: I-EVOLUTION 342 I-EVOLUTION U/l. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS ingresado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fosas I-PRESENT_ILLNESS lumbares, I-PRESENT_ILLNESS fatiga I-PRESENT_ILLNESS y I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diuresis I-PRESENT_ILLNESS conservada. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cocaína I-PAST_MEDICAL_HISTORY intranasal I-PAST_MEDICAL_HISTORY (1 I-PAST_MEDICAL_HISTORY g) I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY admisión. I-PAST_MEDICAL_HISTORY Negó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS todo I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS antiinflamatorios I-PRESENT_ILLNESS no I-PRESENT_ILLNESS esteroideos I-PRESENT_ILLNESS u I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS medicamentos. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION ligeramente I-EXPLORATION elevada I-EXPLORATION de I-EXPLORATION 147/97 I-EXPLORATION mmHg, I-EXPLORATION sin I-EXPLORATION fiebre, I-EXPLORATION erupción I-EXPLORATION cutánea I-EXPLORATION o I-EXPLORATION artralgias. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION exploraciones I-EXPLORATION cardiovascular I-EXPLORATION y I-EXPLORATION respiratoria I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION abdomen I-EXPLORATION era I-EXPLORATION blando, I-EXPLORATION depresible I-EXPLORATION e I-EXPLORATION indoloro, I-EXPLORATION el I-EXPLORATION hígado I-EXPLORATION era I-EXPLORATION palpable I-EXPLORATION a I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION por I-EXPLORATION debajo I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION costal I-EXPLORATION y I-EXPLORATION presentaba I-EXPLORATION discreto I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION lumbar I-EXPLORATION bilateral. I-EXPLORATION I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION inicial I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION anodino I-EXPLORATION (sin I-EXPLORATION eosinofilia), I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION albúmina I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION rango I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad; I-EXPLORATION creatinina I-EXPLORATION sérica: I-EXPLORATION 160 I-EXPLORATION μmol/l; I-EXPLORATION urea: I-EXPLORATION 7, I-EXPLORATION 5 I-EXPLORATION mmol/l; I-EXPLORATION potasio: I-EXPLORATION 3, I-EXPLORATION 9 I-EXPLORATION mmol/l; I-EXPLORATION sodio: I-EXPLORATION 139 I-EXPLORATION mmol/l; I-EXPLORATION cloruro: I-EXPLORATION 101 I-EXPLORATION mmol/l. I-EXPLORATION La I-EXPLORATION creatina I-EXPLORATION cinasa I-EXPLORATION total I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION (3, I-EXPLORATION 3 I-EXPLORATION μkat/l), I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fracción I-EXPLORATION MB I-EXPLORATION normal. I-EXPLORATION El I-EXPLORATION sedimento I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION mostró I-EXPLORATION 2 I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION hematíes I-EXPLORATION por I-EXPLORATION campo I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION hematíes I-EXPLORATION dismórficos I-EXPLORATION ni I-EXPLORATION eosinófilos. I-EXPLORATION Bioquímica I-EXPLORATION orina: I-EXPLORATION sodio: I-EXPLORATION 46 I-EXPLORATION mmol/l, I-EXPLORATION potasio: I-EXPLORATION 33 I-EXPLORATION mmol/l I-EXPLORATION y I-EXPLORATION cloruro: I-EXPLORATION 63 I-EXPLORATION mmol/l, I-EXPLORATION cociente I-EXPLORATION proteína: I-EXPLORATION creatinina I-EXPLORATION en I-EXPLORATION 5 I-EXPLORATION g/mol; I-EXPLORATION urocultivo I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Proteinograma I-EXPLORATION electroforético, I-EXPLORATION inmunoglobulinas, I-EXPLORATION complemento, I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION enzima I-EXPLORATION convertidora I-EXPLORATION de I-EXPLORATION angiotensina I-EXPLORATION y I-EXPLORATION títulos I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein-Barr, I-EXPLORATION citomegalovirus, I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION B, I-EXPLORATION y I-EXPLORATION C I-EXPLORATION y I-EXPLORATION micoplasma I-EXPLORATION no I-EXPLORATION detectó I-EXPLORATION infección I-EXPLORATION activa. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION demostró I-EXPLORATION unos I-EXPLORATION riñones I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION normal, I-EXPLORATION difusamente I-EXPLORATION ecogénicos I-EXPLORATION con I-EXPLORATION flujo I-EXPLORATION arterial I-EXPLORATION y I-EXPLORATION venoso I-EXPLORATION apropiado. I-EXPLORATION I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION cardiotorácico I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION y I-EXPLORATION unos I-EXPLORATION campos I-EXPLORATION pulmonares I-EXPLORATION sin I-EXPLORATION infiltrados. I-EXPLORATION I-EXPLORATION Después B-EVOLUTION de I-EVOLUTION su I-EVOLUTION admisión, I-EVOLUTION el I-EVOLUTION débito I-EVOLUTION urinario I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION en I-EVOLUTION 50 I-EVOLUTION a I-EVOLUTION 75 I-EVOLUTION ml/h I-EVOLUTION y I-EVOLUTION la I-EVOLUTION creatinina I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION sin I-EVOLUTION cambios. I-EVOLUTION El B-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION sometió I-EXPLORATION a I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION renal. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION histológicos I-EXPLORATION son I-EXPLORATION los I-EXPLORATION siguientes: I-EXPLORATION la I-EXPLORATION microscopía I-EXPLORATION óptica I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 13 I-EXPLORATION glomérulos, I-EXPLORATION todos I-EXPLORATION ellos I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION esclerosis, I-EXPLORATION proliferación I-EXPLORATION o I-EXPLORATION lesiones I-EXPLORATION necróticas. I-EXPLORATION Las I-EXPLORATION membranas I-EXPLORATION basales I-EXPLORATION y I-EXPLORATION el I-EXPLORATION mesangio I-EXPLORATION glomerular I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION intersticio I-EXPLORATION mostraba I-EXPLORATION moderado I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION mononuclear I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION eosinófilos, I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tubulitis I-EXPLORATION focal I-EXPLORATION y I-EXPLORATION atrofia. I-EXPLORATION Las I-EXPLORATION arteriolas I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION lesiones I-EXPLORATION destacables I-EXPLORATION y I-EXPLORATION no I-EXPLORATION existían I-EXPLORATION depósitos I-EXPLORATION inmunes I-EXPLORATION a I-EXPLORATION la I-EXPLORATION inmunofluorescencia. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION patológico I-EXPLORATION de I-EXPLORATION nefritis I-EXPLORATION tubulointersticial I-EXPLORATION aguda I-EXPLORATION (NIA). I-EXPLORATION I-EXPLORATION Este I-EXPLORATION hecho, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION las I-EXPLORATION características I-EXPLORATION clínicas I-EXPLORATION y I-EXPLORATION el I-EXPLORATION consumo I-EXPLORATION reciente I-EXPLORATION de I-EXPLORATION cocaína, I-EXPLORATION nos I-EXPLORATION llevó I-EXPLORATION a I-EXPLORATION definir I-EXPLORATION este I-EXPLORATION caso I-EXPLORATION como I-EXPLORATION NIA I-EXPLORATION inducida I-EXPLORATION por I-EXPLORATION cocaína. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT obviamente I-TREATMENT interrumpió I-TREATMENT el I-TREATMENT consumo I-TREATMENT de I-TREATMENT la I-TREATMENT droga I-TREATMENT y I-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT prednisona I-TREATMENT oral I-TREATMENT (1 I-TREATMENT mg/kg/día I-TREATMENT dosis I-TREATMENT inicial), I-TREATMENT que I-TREATMENT se I-TREATMENT disminuyó I-TREATMENT progresivamente I-TREATMENT y I-TREATMENT se I-TREATMENT interrumpió I-TREATMENT después I-TREATMENT de I-TREATMENT 12 I-TREATMENT semanas. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION posterior I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION recuperación I-EVOLUTION completa I-EVOLUTION ya I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida I-PAST_MEDICAL_HISTORY (IMC I-PAST_MEDICAL_HISTORY 47 I-PAST_MEDICAL_HISTORY kg/m2), I-PAST_MEDICAL_HISTORY HTA, I-PAST_MEDICAL_HISTORY DM I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY apnea I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY sueño I-PAST_MEDICAL_HISTORY (SAOS), I-PAST_MEDICAL_HISTORY hipercolesterolemia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY infarto I-PAST_MEDICAL_HISTORY agudo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY miocardio I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY stent I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY angioplastia I-PAST_MEDICAL_HISTORY coronaria I-PAST_MEDICAL_HISTORY transluminal I-PAST_MEDICAL_HISTORY percutánea-stent. I-PAST_MEDICAL_HISTORY Se B-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO para I-DERIVED_FROM/TO la I-DERIVED_FROM/TO realización I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO bariátrica, I-DERIVED_FROM/TO técnica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO gastrectomía I-DERIVED_FROM/TO tubular I-DERIVED_FROM/TO laparoscópica. I-DERIVED_FROM/TO Al B-TREATMENT alta, I-TREATMENT su I-TREATMENT tratamiento I-TREATMENT incluyó I-TREATMENT ramipril I-TREATMENT 10 I-TREATMENT mg/24 I-TREATMENT horas, I-TREATMENT bisoprolol/hidroclorotiazida I-TREATMENT 10/25 I-TREATMENT mg/24 I-TREATMENT horas, I-TREATMENT atorvastatina I-TREATMENT 10 I-TREATMENT mg/24 I-TREATMENT horas, I-TREATMENT barnidipino I-TREATMENT 20 I-TREATMENT mg/24 I-TREATMENT horas I-TREATMENT y I-TREATMENT metformina I-TREATMENT 1/8 I-TREATMENT horas. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refirió I-EVOLUTION escasa I-EVOLUTION ingesta I-EVOLUTION hidroalimentaria, I-EVOLUTION episodios I-EVOLUTION ocasionales I-EVOLUTION de I-EVOLUTION mareo I-EVOLUTION y I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION 20 I-EVOLUTION kg I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION en I-EVOLUTION un I-EVOLUTION mes. I-EVOLUTION Ante I-EVOLUTION el I-EVOLUTION empeoramiento I-EVOLUTION clínico I-EVOLUTION progresivo I-EVOLUTION y I-EVOLUTION la I-EVOLUTION asociación I-EVOLUTION de I-EVOLUTION síndrome I-EVOLUTION diarreico, I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION Urgencias, I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION mal I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION bradipsiquia, I-EVOLUTION sequedad I-EVOLUTION de I-EVOLUTION piel I-EVOLUTION y I-EVOLUTION mucosas, I-EVOLUTION y I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION (PA) I-EVOLUTION 92/65 I-EVOLUTION mmHg. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION analítica: I-EXPLORATION glucosa I-EXPLORATION 214 I-EXPLORATION mg/dl, I-EXPLORATION urea I-EXPLORATION 403 I-EXPLORATION mg/dl, I-EXPLORATION creatinina I-EXPLORATION (Cr) I-EXPLORATION 9, I-EXPLORATION 2 I-EXPLORATION mg/dl, I-EXPLORATION Na I-EXPLORATION 151 I-EXPLORATION mmol/l, I-EXPLORATION Cl I-EXPLORATION 113 I-EXPLORATION mmol/l, I-EXPLORATION K I-EXPLORATION 4 I-EXPLORATION mmol/l; I-EXPLORATION hemograma: I-EXPLORATION hemoglobina I-EXPLORATION (Hb) I-EXPLORATION 15, I-EXPLORATION 4 I-EXPLORATION g/dl, I-EXPLORATION VH I-EXPLORATION 44, I-EXPLORATION 5%; I-EXPLORATION leucocitos I-EXPLORATION 18800/uL; I-EXPLORATION plaquetas I-EXPLORATION 287000/uL; I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION orina: I-EXPLORATION urea I-EXPLORATION 239 I-EXPLORATION mg/dl, I-EXPLORATION Cr I-EXPLORATION 339 I-EXPLORATION mg/dl, I-EXPLORATION Na I-EXPLORATION 52 I-EXPLORATION mmol/l, I-EXPLORATION K I-EXPLORATION 9, I-EXPLORATION 1 I-EXPLORATION mmol/l, I-EXPLORATION excreción I-EXPLORATION fraccional I-EXPLORATION de I-EXPLORATION sodio I-EXPLORATION (EF I-EXPLORATION Na) I-EXPLORATION 0, I-EXPLORATION 9%; I-EXPLORATION gasometría I-EXPLORATION venosa: I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 33, I-EXPLORATION bicarbonato I-EXPLORATION 11, I-EXPLORATION 1 I-EXPLORATION mmol/l, I-EXPLORATION pCO2 I-EXPLORATION 21 I-EXPLORATION mmHg. I-EXPLORATION Se B-TREATMENT ingresó I-TREATMENT en I-TREATMENT Nefrología I-TREATMENT con I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT IRA I-TREATMENT prerrenal, I-TREATMENT hipernatremia I-TREATMENT e I-TREATMENT infección I-TREATMENT urinaria, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT y I-TREATMENT reposición I-TREATMENT hidroelectrolítica I-TREATMENT controlada I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta, I-TREATMENT siendo I-TREATMENT la I-TREATMENT creatinina I-TREATMENT al I-TREATMENT alta I-TREATMENT de I-TREATMENT 0, I-TREATMENT 86 I-TREATMENT mg/dl. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS IRC B-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nefropatía I-PAST_MEDICAL_HISTORY diabética I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY sustitutivo I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hemodiálisis, I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY dilatada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY isquémico, I-PAST_MEDICAL_HISTORY retinopatía I-PAST_MEDICAL_HISTORY diabética, I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY vascular I-PAST_MEDICAL_HISTORY cerebral I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY años; I-PAST_MEDICAL_HISTORY ingresa B-PRESENT_ILLNESS en I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS medicina I-PRESENT_ILLNESS interna I-PRESENT_ILLNESS por I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cetoacidosis I-PRESENT_ILLNESS diabética. I-PRESENT_ILLNESS Durante B-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION detectan I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION maculopapulosas, I-EXPLORATION eritematosas, I-EXPLORATION con I-EXPLORATION zona I-EXPLORATION descamativa I-EXPLORATION hiperqueratósica I-EXPLORATION central, I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION universal. I-EXPLORATION Se B-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO con I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO dermatología, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realiza I-DERIVED_FROM/TO biopsia I-DERIVED_FROM/TO cutánea I-DERIVED_FROM/TO de I-DERIVED_FROM/TO las I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO y I-DERIVED_FROM/TO se I-DERIVED_FROM/TO diagnostica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO enfermedad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Kyrle. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en B-PAST_MEDICAL_HISTORY DP I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY octubre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2012 I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nefropatía I-PAST_MEDICAL_HISTORY diabética. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS líquido I-PRESENT_ILLNESS peritoneal I-PRESENT_ILLNESS turbio, I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS descenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ultrafiltración. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY neoformación I-PAST_MEDICAL_HISTORY nasal. I-PAST_MEDICAL_HISTORY Los B-EXPLORATION resultados I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION eran: I-EXPLORATION aspecto I-EXPLORATION turbio, I-EXPLORATION 700 I-EXPLORATION leucocitos/μl I-EXPLORATION (mononucleares I-EXPLORATION 80% I-EXPLORATION y I-EXPLORATION polimorfonucleares I-EXPLORATION 20%), I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION del I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION mononucleares I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION terapia I-EXPLORATION antibiótica I-EXPLORATION empírica I-EXPLORATION con I-EXPLORATION vancomicina I-EXPLORATION y I-EXPLORATION ceftazidima I-EXPLORATION intraperitoneal. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION ni I-EXPLORATION masas; I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION salida I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION túnel I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION analíticos I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION destacaban: I-EXPLORATION leucocitos I-EXPLORATION 37000/mm3, I-EXPLORATION plaquetas I-EXPLORATION 640000/mm3, I-EXPLORATION hemoglobina I-EXPLORATION 10, I-EXPLORATION 3g/dl, I-EXPLORATION creatinina I-EXPLORATION 5, I-EXPLORATION 4mg/dl, I-EXPLORATION urea I-EXPLORATION 180mg/dl, I-EXPLORATION Na I-EXPLORATION 138mEq/l, I-EXPLORATION K I-EXPLORATION 4mEq/l, I-EXPLORATION calcio I-EXPLORATION 9, I-EXPLORATION 5mg/dl, I-EXPLORATION fósforo I-EXPLORATION 4, I-EXPLORATION 8mg/dl, I-EXPLORATION albúmina I-EXPLORATION 3, I-EXPLORATION 9mg/dl. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION días I-EXPLORATION después I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION para I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION nasal I-EXPLORATION en I-EXPLORATION los I-EXPLORATION días I-EXPLORATION siguientes, I-EXPLORATION siendo I-EXPLORATION informado I-EXPLORATION de I-EXPLORATION adenopatías I-EXPLORATION mediastínicas I-EXPLORATION y I-EXPLORATION retroperitoneales I-EXPLORATION diseminadas. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION nasal I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION linfoma I-EXPLORATION no-Hodgkin I-EXPLORATION de I-EXPLORATION células I-EXPLORATION B I-EXPLORATION grandes I-EXPLORATION y I-EXPLORATION la I-EXPLORATION citología I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION demostró I-EXPLORATION linfocitos I-EXPLORATION atípicos. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT inició I-TREATMENT su I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT y I-TREATMENT permaneció I-TREATMENT en I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT DP I-TREATMENT sin I-TREATMENT más I-TREATMENT incidencias I-TREATMENT dialíticas. I-TREATMENT I-TREATMENT La B-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION turbio I-EXPLORATION en I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION DP I-EXPLORATION generalmente I-EXPLORATION se I-EXPLORATION asocia I-EXPLORATION a I-EXPLORATION una I-EXPLORATION peritonitis. I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION bacteriana I-EXPLORATION se I-EXPLORATION requieren I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION dos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION condiciones: I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION solo I-EXPLORATION o I-EXPLORATION acompañado I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION síntomas I-EXPLORATION abdominales, I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION con I-EXPLORATION más I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION leucocitos/μl, I-EXPLORATION siendo I-EXPLORATION más I-EXPLORATION del I-EXPLORATION 50% I-EXPLORATION polimorfonucleares, I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION o I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION que I-EXPLORATION demuestre I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION microorganismos1. I-EXPLORATION I-EXPLORATION Es I-EXPLORATION difícil I-EXPLORATION diferenciar I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION peritoneal I-EXPLORATION con I-EXPLORATION cultivo I-EXPLORATION negativo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION inflamación I-EXPLORATION peritoneal I-EXPLORATION no I-EXPLORATION infecciosa I-EXPLORATION (peritonitis I-EXPLORATION estéril). I-EXPLORATION Un I-EXPLORATION cultivo I-EXPLORATION peritoneal I-EXPLORATION negativo I-EXPLORATION generalmente I-EXPLORATION se I-EXPLORATION debe I-EXPLORATION a I-EXPLORATION fallos I-EXPLORATION técnicos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION procesamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION manejo I-EXPLORATION resulta I-EXPLORATION complicado, I-EXPLORATION dado I-EXPLORATION que I-EXPLORATION existen I-EXPLORATION peritonitis I-EXPLORATION infecciosas I-EXPLORATION sin I-EXPLORATION crecimiento I-EXPLORATION bacteriano I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo. I-EXPLORATION Se I-EXPLORATION aconseja I-EXPLORATION revisar I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION cultivo I-EXPLORATION cuando I-EXPLORATION estos I-EXPLORATION sean I-EXPLORATION negativos I-EXPLORATION en I-EXPLORATION más I-EXPLORATION del I-EXPLORATION 20% I-EXPLORATION de I-EXPLORATION las I-EXPLORATION ocasiones I-EXPLORATION e I-EXPLORATION interrogar I-EXPLORATION por I-EXPLORATION el I-EXPLORATION uso I-EXPLORATION de I-EXPLORATION antibióticos I-EXPLORATION previos I-EXPLORATION al I-EXPLORATION paciente2. I-EXPLORATION Para I-EXPLORATION lograr I-EXPLORATION una I-EXPLORATION rapidez I-EXPLORATION diagnóstica I-EXPLORATION en I-EXPLORATION casos I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION estéril, I-EXPLORATION las I-EXPLORATION guías I-EXPLORATION de I-EXPLORATION DP I-EXPLORATION españolas I-EXPLORATION esquematizan I-EXPLORATION teniendo I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION o I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION en I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION células. I-EXPLORATION Un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION polimorfornucleares I-EXPLORATION puede I-EXPLORATION ser I-EXPLORATION por I-EXPLORATION inflamación I-EXPLORATION de I-EXPLORATION víscera I-EXPLORATION intraperitoneal I-EXPLORATION o I-EXPLORATION yuxtaperitoneal, I-EXPLORATION medicamentos I-EXPLORATION o I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION contaminado I-EXPLORATION por I-EXPLORATION endotoxinas. I-EXPLORATION Si I-EXPLORATION están I-EXPLORATION aumentados I-EXPLORATION los I-EXPLORATION eosinófilos, I-EXPLORATION se I-EXPLORATION sospechará I-EXPLORATION reacción I-EXPLORATION alérgica I-EXPLORATION al I-EXPLORATION material I-EXPLORATION de I-EXPLORATION diálisis, I-EXPLORATION medicamentos, I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION por I-EXPLORATION sangre I-EXPLORATION retrógrada I-EXPLORATION o I-EXPLORATION tras I-EXPLORATION peritonitis I-EXPLORATION por I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION parásitos. I-EXPLORATION El I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION mononucleares I-EXPLORATION puede I-EXPLORATION asociarse I-EXPLORATION a I-EXPLORATION icodextrina, I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION micobacterias, I-EXPLORATION hongos. I-EXPLORATION Si I-EXPLORATION además I-EXPLORATION hay I-EXPLORATION hematíes, I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION de I-EXPLORATION considerar: I-EXPLORATION ovulación, I-EXPLORATION menstruación I-EXPLORATION retrógrada, I-EXPLORATION rotura I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION ovárico, I-EXPLORATION líquido I-EXPLORATION hipertónico, I-EXPLORATION adherencias I-EXPLORATION peritoneales, I-EXPLORATION ejercicio I-EXPLORATION físico I-EXPLORATION y I-EXPLORATION trauma I-EXPLORATION por I-EXPLORATION catéter. I-EXPLORATION Con I-EXPLORATION elevados I-EXPLORATION mononucleares I-EXPLORATION y I-EXPLORATION células I-EXPLORATION malignas, I-EXPLORATION hay I-EXPLORATION que I-EXPLORATION pensar I-EXPLORATION en I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION o I-EXPLORATION metástasis I-EXPLORATION peritoneales. I-EXPLORATION Por I-EXPLORATION otra I-EXPLORATION parte, I-EXPLORATION en I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION puede I-EXPLORATION ser I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION de I-EXPLORATION fibrina I-EXPLORATION o I-EXPLORATION de I-EXPLORATION triglicéridos3, I-EXPLORATION 4. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION literatura I-EXPLORATION se I-EXPLORATION describen I-EXPLORATION algunos I-EXPLORATION casos I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION en I-EXPLORATION DP I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION procesos I-EXPLORATION tumorales, I-EXPLORATION entre I-EXPLORATION ellos, I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION renales I-EXPLORATION recurrente I-EXPLORATION diagnosticado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION citología I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION peritoneal5. I-EXPLORATION Otro I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION peritonitis I-EXPLORATION estéril I-EXPLORATION con I-EXPLORATION un I-EXPLORATION antecedente I-EXPLORATION de I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION diagnosticado I-EXPLORATION diez I-EXPLORATION años I-EXPLORATION antes. I-EXPLORATION La I-EXPLORATION citología I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION permitió I-EXPLORATION observar I-EXPLORATION los I-EXPLORATION linfocitos I-EXPLORATION atípicos I-EXPLORATION y, I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION caso, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION invasión I-EXPLORATION peritoneal, I-EXPLORATION continuó I-EXPLORATION con I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION DP6. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION conclusión I-EXPLORATION del I-EXPLORATION caso, I-EXPLORATION debemos I-EXPLORATION señalar I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION de I-EXPLORATION las I-EXPLORATION peritonitis I-EXPLORATION estériles I-EXPLORATION no I-EXPLORATION debemos I-EXPLORATION olvidar I-EXPLORATION la I-EXPLORATION posible I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION neoplásico. I-EXPLORATION I-EXPLORATION Paciente B-DERIVED_FROM/TO de I-DERIVED_FROM/TO 48 I-DERIVED_FROM/TO años I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO detectarse I-DERIVED_FROM/TO ambulatoriamente I-DERIVED_FROM/TO una I-DERIVED_FROM/TO creatinina I-DERIVED_FROM/TO sérica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 7, I-DERIVED_FROM/TO 56mg/dl. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaba: I-EXPLORATION tensión I-EXPLORATION arterial: I-EXPLORATION 163/111mmHg, I-EXPLORATION peso: I-EXPLORATION 105kg, I-EXPLORATION talla: I-EXPLORATION 190cm, I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal: I-EXPLORATION 29kg/m2. I-EXPLORATION Leve I-EXPLORATION déficit I-EXPLORATION cognitivo. I-EXPLORATION Fenotipo I-EXPLORATION corporal I-EXPLORATION corpulento. I-EXPLORATION Facies I-EXPLORATION con I-EXPLORATION prognatismo I-EXPLORATION y I-EXPLORATION macroglosia. I-EXPLORATION Labios I-EXPLORATION gruesos, I-EXPLORATION arcos I-EXPLORATION superciliares I-EXPLORATION prominentes, I-EXPLORATION voz I-EXPLORATION grave. I-EXPLORATION Auscultación I-EXPLORATION normal. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normal. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refería I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION su I-EXPLORATION morfología I-EXPLORATION corporal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION mostraba I-EXPLORATION riñones I-EXPLORATION de I-EXPLORATION dimensiones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION límite I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION con I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION bilateral I-EXPLORATION marcadamente I-EXPLORATION adelgazado, I-EXPLORATION prácticamente I-EXPLORATION inexistente. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION presentaba I-EXPLORATION parámetros I-EXPLORATION bioquímicos I-EXPLORATION propios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION uremia I-EXPLORATION con I-EXPLORATION serologías I-EXPLORATION víricas I-EXPLORATION negativas I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION inmunológicas I-EXPLORATION normales. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION practicaron I-EXPLORATION determinaciones I-EXPLORATION hormonales: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Cortisol: I-EXPLORATION 23mcg/dl I-EXPLORATION (6-28), I-EXPLORATION TSH: I-EXPLORATION 1, I-EXPLORATION 01mcUI/ml I-EXPLORATION (0,27-4,2). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Renina: I-EXPLORATION 29, I-EXPLORATION 7microUI/ml I-EXPLORATION (2,8-39,9). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Aldosterona: I-EXPLORATION 152, I-EXPLORATION 8pg/ml I-EXPLORATION (10-160). I-EXPLORATION I-EXPLORATION - I-EXPLORATION FSH: I-EXPLORATION 12, I-EXPLORATION 4mUI/ml I-EXPLORATION (1,5-12,4), I-EXPLORATION LH: I-EXPLORATION 8, I-EXPLORATION 4mUI/ml I-EXPLORATION (1,7-8,6). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Prolactina: I-EXPLORATION 553mUI/l I-EXPLORATION (86-324), I-EXPLORATION testosterona I-EXPLORATION total: I-EXPLORATION 1, I-EXPLORATION 99ng/ml I-EXPLORATION (2,5-8,4). I-EXPLORATION I-EXPLORATION - I-EXPLORATION GH: I-EXPLORATION 4, I-EXPLORATION 24ng/ml I-EXPLORATION (0-1). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Somatomedina I-EXPLORATION C I-EXPLORATION (IGF1): I-EXPLORATION 670ng/ml I-EXPLORATION (100-358). I-EXPLORATION I-EXPLORATION - I-EXPLORATION IGF1-BP3: I-EXPLORATION 7, I-EXPLORATION 59micro/ml I-EXPLORATION (3,3-6,7). I-EXPLORATION I-EXPLORATION - I-EXPLORATION ACTH: I-EXPLORATION 39pg/ml I-EXPLORATION (8-46). I-EXPLORATION I-EXPLORATION La B-TREATMENT hipertensión I-TREATMENT se I-TREATMENT controló I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT médico. I-TREATMENT Ante I-TREATMENT el I-TREATMENT deterioro I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT cuya I-TREATMENT etiología I-TREATMENT no I-TREATMENT se I-TREATMENT pudo I-TREATMENT filiar, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT mediante I-TREATMENT hemodiálisis I-TREATMENT crónica. I-TREATMENT I-TREATMENT Se B-EXPLORATION practicó I-EXPLORATION un I-EXPLORATION primer I-EXPLORATION test I-EXPLORATION de I-EXPLORATION sobrecarga I-EXPLORATION oral I-EXPLORATION a I-EXPLORATION glucosa I-EXPLORATION (TSOG). I-EXPLORATION I-EXPLORATION Llegados I-EXPLORATION a I-EXPLORATION este I-EXPLORATION punto, I-EXPLORATION los I-EXPLORATION clínicos I-EXPLORATION sospechábamos, I-EXPLORATION en I-EXPLORATION función I-EXPLORATION del I-EXPLORATION fenotipo I-EXPLORATION y I-EXPLORATION del I-EXPLORATION perfil I-EXPLORATION hormonal I-EXPLORATION (aumento I-EXPLORATION de I-EXPLORATION GH, I-EXPLORATION IGF-1 I-EXPLORATION y I-EXPLORATION IGF1-BP3; I-EXPLORATION TSOG I-EXPLORATION sin I-EXPLORATION supresión I-EXPLORATION clara I-EXPLORATION de I-EXPLORATION la I-EXPLORATION GH), I-EXPLORATION una I-EXPLORATION acromegalia. I-EXPLORATION No B-TREATMENT pudo I-TREATMENT practicarse I-TREATMENT una I-TREATMENT resonancia I-TREATMENT magnética I-TREATMENT nuclear I-TREATMENT (RMN) I-TREATMENT hipofisaria I-TREATMENT ante I-TREATMENT la I-TREATMENT negativa I-TREATMENT del I-TREATMENT paciente I-TREATMENT y I-TREATMENT su I-TREATMENT familia. I-TREATMENT I-TREATMENT Cuatro I-TREATMENT meses I-TREATMENT después I-TREATMENT se I-TREATMENT realizó I-TREATMENT finalmente I-TREATMENT la I-TREATMENT RMN I-TREATMENT sin I-TREATMENT contraste I-TREATMENT paramagnético. I-TREATMENT La B-EXPLORATION hipófisis I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tallo I-EXPLORATION hipofisario I-EXPLORATION centrado. I-EXPLORATION Se B-TREATMENT practicó I-TREATMENT un I-TREATMENT nuevo I-TREATMENT TSOG, I-TREATMENT mostrando I-TREATMENT una I-TREATMENT GH I-TREATMENT basal I-TREATMENT normal, I-TREATMENT con I-TREATMENT aumento I-TREATMENT paradójico I-TREATMENT a I-TREATMENT los I-TREATMENT 30 I-TREATMENT minutos, I-TREATMENT pero I-TREATMENT con I-TREATMENT adecuada I-TREATMENT supresión I-TREATMENT a I-TREATMENT las I-TREATMENT dos I-TREATMENT horas. I-TREATMENT I-TREATMENT En B-EXPLORATION esa I-EXPLORATION fecha I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION IGF-1 I-EXPLORATION (340 I-EXPLORATION ng/ml) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION IGF1-BP3 I-EXPLORATION (6, I-EXPLORATION 3 I-EXPLORATION µg/ml) I-EXPLORATION se I-EXPLORATION habían I-EXPLORATION normalizado I-EXPLORATION también. I-EXPLORATION La I-EXPLORATION prolactina I-EXPLORATION continuaba I-EXPLORATION elevada I-EXPLORATION y I-EXPLORATION la I-EXPLORATION testosterona I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Actualmente B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION controles I-EVOLUTION periódicos I-EVOLUTION en I-EVOLUTION endocrinología I-EVOLUTION y I-EVOLUTION continúa I-EVOLUTION en I-EVOLUTION hemodiálisis. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS con I-PRESENT_ILLNESS hialinosis I-PRESENT_ILLNESS segmentaria I-PRESENT_ILLNESS focal I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS esteroides, I-PRESENT_ILLNESS ciclofosfamida I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vincristina. I-PRESENT_ILLNESS Comenzó I-PRESENT_ILLNESS DP I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 1990. I-PRESENT_ILLNESS Durante B-TREATMENT los I-TREATMENT siguientes I-TREATMENT 11 I-TREATMENT años I-TREATMENT recibió I-TREATMENT 3 I-TREATMENT trasplantes I-TREATMENT renales, I-TREATMENT con I-TREATMENT un I-TREATMENT tiempo I-TREATMENT total I-TREATMENT fuera I-TREATMENT de I-TREATMENT diálisis I-TREATMENT de I-TREATMENT 5 I-TREATMENT años. I-TREATMENT Fue I-TREATMENT paratiroidectomizado I-TREATMENT por I-TREATMENT hiperparatiroidismo I-TREATMENT grave. I-TREATMENT I-TREATMENT El B-EVOLUTION transporte I-EVOLUTION peritoneal I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION como I-EVOLUTION medio-alto I-EVOLUTION con I-EVOLUTION tendencia I-EVOLUTION al I-EVOLUTION alza. I-EVOLUTION Con B-TREATMENT el I-TREATMENT tiempo I-TREATMENT se I-TREATMENT redujo I-TREATMENT la I-TREATMENT ultrafiltración I-TREATMENT y I-TREATMENT aumentaron I-TREATMENT las I-TREATMENT necesidades I-TREATMENT osmóticas I-TREATMENT de I-TREATMENT las I-TREATMENT soluciones. I-TREATMENT Medimos B-EXPLORATION CA-125 I-EXPLORATION en I-EXPLORATION efluente I-EXPLORATION en I-EXPLORATION diferentes I-EXPLORATION momentos, I-EXPLORATION encontrándose I-EXPLORATION un I-EXPLORATION progresivo I-EXPLORATION descenso. I-EXPLORATION Sufrió B-EVOLUTION 12 I-EVOLUTION peritonitis, I-EVOLUTION todas I-EVOLUTION por I-EVOLUTION gérmenes I-EVOLUTION Gram I-EVOLUTION positivos. I-EVOLUTION Se I-EVOLUTION insistió I-EVOLUTION al I-EVOLUTION paciente I-EVOLUTION de I-EVOLUTION la I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION ser I-EVOLUTION transferido I-EVOLUTION a I-EVOLUTION HD, I-EVOLUTION circunstancia I-EVOLUTION que I-EVOLUTION trataba I-EVOLUTION de I-EVOLUTION evitar; I-EVOLUTION finalmente I-EVOLUTION inició I-EVOLUTION HD I-EVOLUTION en I-EVOLUTION 2011. I-EVOLUTION I-EVOLUTION Seis I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION ingresó I-EVOLUTION por I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION distensión I-EVOLUTION abdominal. I-EVOLUTION Una B-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION evidenció I-EXPLORATION dilatación I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION duodenal I-EXPLORATION con I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION loculado, I-EXPLORATION y I-EXPLORATION asas I-EXPLORATION edematosas. I-EXPLORATION Se I-EXPLORATION obtuvo I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION del I-EXPLORATION peritoneo: I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION pequeños I-EXPLORATION vasos, I-EXPLORATION celularidad I-EXPLORATION inflamatoria I-EXPLORATION y I-EXPLORATION fibrosis. I-EXPLORATION Se B-TREATMENT diagnosticó I-TREATMENT de I-TREATMENT EPE, I-TREATMENT comenzando I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona I-TREATMENT y I-TREATMENT tamoxifeno. I-TREATMENT Tras B-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION la I-EVOLUTION colección I-EVOLUTION había I-EVOLUTION disminuido I-EVOLUTION de I-EVOLUTION tamaño, I-EVOLUTION no I-EVOLUTION observándose I-EVOLUTION dilatación I-EVOLUTION de I-EVOLUTION asas. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION sufrió I-EVOLUTION más I-EVOLUTION complicaciones. I-EVOLUTION Se B-TREATMENT encuentra I-TREATMENT en I-TREATMENT HD I-TREATMENT y I-TREATMENT continúa I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tamoxifeno. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY ansioso-depresivo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia, I-PAST_MEDICAL_HISTORY remitida B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO por I-DERIVED_FROM/TO aumento I-DERIVED_FROM/TO del I-DERIVED_FROM/TO tamaño I-DERIVED_FROM/TO tiroideo I-DERIVED_FROM/TO y I-DERIVED_FROM/TO adenopatías I-DERIVED_FROM/TO laterocervicales. I-DERIVED_FROM/TO La B-EXPLORATION punción- I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION de I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION fue I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION papilar I-EXPLORATION de I-EXPLORATION tiroides I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION remitida I-EXPLORATION al I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Cirugía I-EXPLORATION para I-EXPLORATION su I-EXPLORATION tratamiento. I-EXPLORATION Fue B-TREATMENT intervenida I-TREATMENT realizándose I-TREATMENT tiroidectomía I-TREATMENT total I-TREATMENT con I-TREATMENT vaciamiento I-TREATMENT cervical I-TREATMENT funcional I-TREATMENT bilateral I-TREATMENT (niveles I-TREATMENT II, I-TREATMENT III, I-TREATMENT IV I-TREATMENT y I-TREATMENT V) I-TREATMENT y I-TREATMENT del I-TREATMENT compartimento I-TREATMENT central I-TREATMENT del I-TREATMENT cuello. I-TREATMENT Se I-TREATMENT conservaron I-TREATMENT ambos I-TREATMENT nervios I-TREATMENT recurrentes, I-TREATMENT se I-TREATMENT reimplantaron I-TREATMENT las I-TREATMENT dos I-TREATMENT paratiroides I-TREATMENT inferiores I-TREATMENT y I-TREATMENT se I-TREATMENT ligo I-TREATMENT el I-TREATMENT conducto I-TREATMENT torácico. I-TREATMENT Como B-EVOLUTION complicación I-EVOLUTION postquirúrgica I-EVOLUTION inmediata I-EVOLUTION presentó I-EVOLUTION hipocalcemia I-EVOLUTION transitoria. I-EVOLUTION Fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION B-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION papilar I-EXPLORATION multifocal I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION regiones I-EXPLORATION cervicales I-EXPLORATION y I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION recurrencial. I-EXPLORATION I-EXPLORATION A B-EVOLUTION los I-EVOLUTION diez I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó, I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION brusca, I-EVOLUTION tumefacción I-EVOLUTION en I-EVOLUTION región I-EVOLUTION cervical I-EVOLUTION izquierda I-EVOLUTION con I-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION región I-EVOLUTION anterior I-EVOLUTION y I-EVOLUTION cervical I-EVOLUTION derecha. I-EVOLUTION No I-EVOLUTION presentaba I-EVOLUTION signos I-EVOLUTION inflamatorios. I-EVOLUTION Fue B-TREATMENT valorada I-TREATMENT por I-TREATMENT el I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Cirugía I-TREATMENT decidiéndose I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT drenaje I-TREATMENT aspirativo I-TREATMENT de I-TREATMENT baja I-TREATMENT presión I-TREATMENT ante I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT fístula I-TREATMENT de I-TREATMENT conducto I-TREATMENT torácico. I-TREATMENT La B-EXPLORATION salida I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION lechoso I-EXPLORATION con I-EXPLORATION una I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION triglicéridos I-EXPLORATION de I-EXPLORATION 1410 I-EXPLORATION mg/dl I-EXPLORATION confirmo I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION siendo I-EXPLORATION remitido I-EXPLORATION a I-EXPLORATION nuestras I-EXPLORATION consultas I-EXPLORATION para I-EXPLORATION tratamiento I-EXPLORATION dietético. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION valoración I-EXPLORATION antropométrica I-EXPLORATION básica I-EXPLORATION y I-EXPLORATION analítica, I-EXPLORATION objetivándose I-EXPLORATION que I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION normonutrida I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION complicaciones I-EXPLORATION metabólicas I-EXPLORATION derivadas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fístula. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT prescripción I-TREATMENT yeducación I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT de I-TREATMENT una I-TREATMENT dieta I-TREATMENT baja I-TREATMENT en I-TREATMENT LCT. I-TREATMENT Se I-TREATMENT le I-TREATMENT dieron I-TREATMENT instrucciones I-TREATMENT dietéticas I-TREATMENT escritas I-TREATMENT (tabla I-TREATMENT I) I-TREATMENT y I-TREATMENT se I-TREATMENT suplementó I-TREATMENT con I-TREATMENT aceite I-TREATMENT MCT I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 40 I-TREATMENT cc/día. I-TREATMENT I-TREATMENT Entre B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION y I-EXPLORATION antropometría I-EXPLORATION pretratamiento I-EXPLORATION dietético I-EXPLORATION y I-EXPLORATION las I-EXPLORATION realizadas I-EXPLORATION dos I-EXPLORATION semanas I-EXPLORATION después I-EXPLORATION no I-EXPLORATION hubo I-EXPLORATION diferencias I-EXPLORATION significativas I-EXPLORATION sin I-EXPLORATION objetivarse I-EXPLORATION complicaciones I-EXPLORATION metabólicas I-EXPLORATION características I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION patolología. I-EXPLORATION I-EXPLORATION Antes I-EXPLORATION de I-EXPLORATION iniciar I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION dietético I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION drenaje I-EXPLORATION diario I-EXPLORATION máximo I-EXPLORATION de I-EXPLORATION 400 I-EXPLORATION cc I-EXPLORATION de I-EXPLORATION linfa. I-EXPLORATION Al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION obtenido I-EXPLORATION por I-EXPLORATION el I-EXPLORATION drenaje I-EXPLORATION disminuyó I-EXPLORATION a I-EXPLORATION 100-200 I-EXPLORATION cc I-EXPLORATION diario I-EXPLORATION y I-EXPLORATION fue I-EXPLORATION variando I-EXPLORATION sus I-EXPLORATION características I-EXPLORATION macroscópicas I-EXPLORATION haciéndose I-EXPLORATION más I-EXPLORATION claro, I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION más I-EXPLORATION serohemático I-EXPLORATION y I-EXPLORATION menos I-EXPLORATION quiloso. I-EXPLORATION Se B-TREATMENT mantuvo I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT dietético I-TREATMENT y I-TREATMENT el I-TREATMENT drenaje I-TREATMENT percutáneo I-TREATMENT hasta I-TREATMENT el I-TREATMENT día I-TREATMENT 14 I-TREATMENT tras I-TREATMENT lo I-TREATMENT cual, I-TREATMENT al I-TREATMENT observarse I-TREATMENT mínima I-TREATMENT salida I-TREATMENT de I-TREATMENT fluido I-TREATMENT y I-TREATMENT ausencia I-TREATMENT de I-TREATMENT características I-TREATMENT quilosas I-TREATMENT se I-TREATMENT retiró I-TREATMENT el I-TREATMENT acceso I-TREATMENT percutáneo. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT dietético I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT 4 I-TREATMENT días I-TREATMENT más I-TREATMENT para I-TREATMENT observar I-TREATMENT la I-TREATMENT evolución I-TREATMENT tras I-TREATMENT la I-TREATMENT retirada I-TREATMENT del I-TREATMENT drenaje I-TREATMENT y B-EVOLUTION ante I-EVOLUTION la I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION signos I-EVOLUTION que I-EVOLUTION sugirieran I-EVOLUTION recidiva I-EVOLUTION se I-EVOLUTION liberalizó I-EVOLUTION la I-EVOLUTION dieta, I-EVOLUTION encontrándose I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION con I-EVOLUTION dieta I-EVOLUTION libre. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS sangrado I-PRESENT_ILLNESS postmenopáusico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS legrado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS adenocarcinoma I-PRESENT_ILLNESS velloglandular I-PRESENT_ILLNESS bien I-PRESENT_ILLNESS diferenciado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS extensa I-PRESENT_ILLNESS diferenciación I-PRESENT_ILLNESS escamosa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS epidermoide. I-PRESENT_ILLNESS Se B-TREATMENT intervino I-TREATMENT quirúrgicamente I-TREATMENT realizando I-TREATMENT histerectomía I-TREATMENT y I-TREATMENT doble I-TREATMENT anexectomía, I-TREATMENT linfadenectomía I-TREATMENT pélvica I-TREATMENT y I-TREATMENT lavado I-TREATMENT peritoneal. I-TREATMENT En B-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION miometrial, I-EXPLORATION la I-EXPLORATION serosa I-EXPLORATION uterina, I-EXPLORATION el I-EXPLORATION epitelio I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estroma I-EXPLORATION cervical, I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Trompa I-EXPLORATION de I-EXPLORATION Falopio I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION linfáticos I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION uterino I-EXPLORATION (estadio I-EXPLORATION IIIa I-EXPLORATION GIII). I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT tratar I-TREATMENT con I-TREATMENT radioquimioterapia I-TREATMENT concurrente. I-TREATMENT Se I-TREATMENT administraron I-TREATMENT 46 I-TREATMENT Gy I-TREATMENT con I-TREATMENT fraccionamiento I-TREATMENT clásico I-TREATMENT (5 I-TREATMENT x I-TREATMENT 200 I-TREATMENT cGy) I-TREATMENT junto I-TREATMENT con I-TREATMENT cinco I-TREATMENT ciclos I-TREATMENT de I-TREATMENT Cisplatino I-TREATMENT (40 I-TREATMENT mg/semanales). I-TREATMENT Tras I-TREATMENT finalizar I-TREATMENT ambos I-TREATMENT tratamiento I-TREATMENT la I-TREATMENT enferma I-TREATMENT recibió I-TREATMENT radioterapia I-TREATMENT endocavitaria I-TREATMENT mediante I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT molde I-TREATMENT de I-TREATMENT Chassagne I-TREATMENT con I-TREATMENT tres I-TREATMENT fuentes I-TREATMENT radioactivas I-TREATMENT de I-TREATMENT Cesio-137 I-TREATMENT de I-TREATMENT baja I-TREATMENT tasa I-TREATMENT de I-TREATMENT dosis. I-TREATMENT Recibió I-TREATMENT además I-TREATMENT tratamiento I-TREATMENT oral I-TREATMENT con I-TREATMENT Tegafur. I-TREATMENT I-TREATMENT Tres B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION terminado I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION ingresó I-EVOLUTION por I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION suboclusión I-EVOLUTION intestinal I-EVOLUTION que I-EVOLUTION se I-EVOLUTION manejó I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION conservadora. I-EVOLUTION Presentó I-EVOLUTION varios I-EVOLUTION episodios I-EVOLUTION similares I-EVOLUTION con I-EVOLUTION posterioridad I-EVOLUTION y I-EVOLUTION una I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION aproximadamente I-EVOLUTION 30 I-EVOLUTION kg I-EVOLUTION de I-EVOLUTION peso. I-EVOLUTION Fue B-TREATMENT valorada I-TREATMENT por I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Nutrición I-TREATMENT Clínica I-TREATMENT que I-TREATMENT recomendó I-TREATMENT una I-TREATMENT dieta I-TREATMENT pobre I-TREATMENT en I-TREATMENT grasas I-TREATMENT y I-TREATMENT residuos I-TREATMENT y I-TREATMENT suplementos I-TREATMENT hipercalóricos I-TREATMENT por I-TREATMENT vía I-TREATMENT oral, I-TREATMENT sin I-TREATMENT respuesta. I-TREATMENT Ingresó B-EVOLUTION para I-EVOLUTION rehabilitación I-EVOLUTION intestinal I-EVOLUTION con I-EVOLUTION un I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 26 I-EVOLUTION kg I-EVOLUTION y I-EVOLUTION una I-EVOLUTION talla I-EVOLUTION de I-EVOLUTION 148 I-EVOLUTION cm. I-EVOLUTION IMC: I-EVOLUTION 11, I-EVOLUTION 9 I-EVOLUTION kg/m2. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION realizado I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION permitió I-EXPLORATION descartar I-EXPLORATION recidiva I-EXPLORATION tumoral I-EXPLORATION encontrando I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tránsito I-EXPLORATION digestivo I-EXPLORATION superior I-EXPLORATION una I-EXPLORATION marcada I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION duodeno I-EXPLORATION y I-EXPLORATION porción I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION yeyuno I-EXPLORATION que I-EXPLORATION llega I-EXPLORATION a I-EXPLORATION medir I-EXPLORATION como I-EXPLORATION diámetro I-EXPLORATION máximo I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION yeyuno I-EXPLORATION proximal. I-EXPLORATION Tránsito I-EXPLORATION intestinal I-EXPLORATION muy I-EXPLORATION prolongado I-EXPLORATION que I-EXPLORATION llega I-EXPLORATION a I-EXPLORATION demorarse I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 48 I-EXPLORATION horas I-EXPLORATION desde I-EXPLORATION que I-EXPLORATION se I-EXPLORATION administró I-EXPLORATION el I-EXPLORATION contraste I-EXPLORATION hasta I-EXPLORATION que I-EXPLORATION alcanzó I-EXPLORATION ciego I-EXPLORATION y I-EXPLORATION colon I-EXPLORATION ascendente. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION dilatación I-EXPLORATION masiva I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION que I-EXPLORATION ocupan I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION abdomen. I-EXPLORATION Discreto I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION las I-EXPLORATION asas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION test I-EXPLORATION de I-EXPLORATION hidrógeno I-EXPLORATION espirado I-EXPLORATION con I-EXPLORATION lactosa I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION malabsorción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION Una I-EXPLORATION colonoscopia I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION ese I-EXPLORATION momento I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION colitis I-EXPLORATION distal I-EXPLORATION que I-EXPLORATION histológicamente I-EXPLORATION correspondían I-EXPLORATION a I-EXPLORATION colitis I-EXPLORATION crónica I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION postradioterapia. I-EXPLORATION Se B-TREATMENT colocó I-TREATMENT una I-TREATMENT sonda I-TREATMENT nasogástrica I-TREATMENT para I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT continua I-TREATMENT con I-TREATMENT incapacidad I-TREATMENT para I-TREATMENT progresar I-TREATMENT por I-TREATMENT encima I-TREATMENT de I-TREATMENT 30 I-TREATMENT ml/hora I-TREATMENT de I-TREATMENT una I-TREATMENT fórmula I-TREATMENT polimérica I-TREATMENT normocalórica, I-TREATMENT y I-TREATMENT sin I-TREATMENT respuesta I-TREATMENT a I-TREATMENT la I-TREATMENT adición I-TREATMENT de I-TREATMENT procinéticos. I-TREATMENT Por I-TREATMENT este I-TREATMENT motivo I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT catéter I-TREATMENT venoso I-TREATMENT central I-TREATMENT tunelizado I-TREATMENT y I-TREATMENT se I-TREATMENT incluyó I-TREATMENT en I-TREATMENT el I-TREATMENT programa I-TREATMENT de I-TREATMENT NPD I-TREATMENT de I-TREATMENT nuestro I-TREATMENT centro. I-TREATMENT Su I-TREATMENT NP I-TREATMENT inicial I-TREATMENT consistía I-TREATMENT en I-TREATMENT 1.250 I-TREATMENT ml I-TREATMENT de I-TREATMENT volumen I-TREATMENT y I-TREATMENT 1.440 I-TREATMENT kcal, I-TREATMENT infundida I-TREATMENT a I-TREATMENT lo I-TREATMENT largo I-TREATMENT de I-TREATMENT 10 I-TREATMENT horas, I-TREATMENT 7 I-TREATMENT días I-TREATMENT a I-TREATMENT la I-TREATMENT semana. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION inicial I-EVOLUTION fue I-EVOLUTION buena I-EVOLUTION con I-EVOLUTION progresiva I-EVOLUTION recuperación I-EVOLUTION del I-EVOLUTION peso I-EVOLUTION y I-EVOLUTION buena I-EVOLUTION tolerancia I-EVOLUTION a I-EVOLUTION la I-EVOLUTION NPD. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION primer I-EVOLUTION ingreso I-EVOLUTION por I-EVOLUTION una I-EVOLUTION bacteriemia I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION catéter. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION 14 I-EVOLUTION meses I-EVOLUTION fue I-EVOLUTION ingresada I-EVOLUTION en I-EVOLUTION 2 I-EVOLUTION ocasiones I-EVOLUTION por I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION deshidratación I-EVOLUTION con I-EVOLUTION afectación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION (insuficiencia I-EVOLUTION renal I-EVOLUTION prerrenal) I-EVOLUTION secundarias I-EVOLUTION a I-EVOLUTION pérdidas I-EVOLUTION aumentadas I-EVOLUTION por I-EVOLUTION vómitos I-EVOLUTION y I-EVOLUTION en I-EVOLUTION 9 I-EVOLUTION por I-EVOLUTION infecciones I-EVOLUTION por I-EVOLUTION diversos I-EVOLUTION gérmenes I-EVOLUTION Gram I-EVOLUTION positivos, I-EVOLUTION Gram I-EVOLUTION negativos I-EVOLUTION y I-EVOLUTION hongos I-EVOLUTION que I-EVOLUTION obligaron I-EVOLUTION a I-EVOLUTION recambiar I-EVOLUTION el I-EVOLUTION catéter I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION ocasiones. I-EVOLUTION En I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION ingresos I-EVOLUTION se I-EVOLUTION hizo I-EVOLUTION revisión I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pautas I-EVOLUTION de I-EVOLUTION manejo I-EVOLUTION del I-EVOLUTION catéter I-EVOLUTION venoso I-EVOLUTION central I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION NPD I-EVOLUTION sin I-EVOLUTION poder I-EVOLUTION constatar I-EVOLUTION que I-EVOLUTION hubiera I-EVOLUTION quebrantamiento I-EVOLUTION del I-EVOLUTION protocolo. I-EVOLUTION A B-TREATMENT la I-TREATMENT vista I-TREATMENT de I-TREATMENT la I-TREATMENT mala I-TREATMENT evolución I-TREATMENT clínica I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT remisión I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT tumoral I-TREATMENT se I-TREATMENT decidió I-TREATMENT plantear I-TREATMENT una I-TREATMENT solución I-TREATMENT quirúrgica I-TREATMENT alternativa. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION tránsito I-EXPLORATION digestivo I-EXPLORATION con I-EXPLORATION hallazgos I-EXPLORATION similares I-EXPLORATION al I-EXPLORATION realizado I-EXPLORATION dos I-EXPLORATION años I-EXPLORATION antes I-EXPLORATION y I-EXPLORATION un I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION calibre I-EXPLORATION en I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION más I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION sigma, I-EXPLORATION aunque I-EXPLORATION permite I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION papilla I-EXPLORATION sin I-EXPLORATION ninguna I-EXPLORATION dificultad: I-EXPLORATION no I-EXPLORATION hay I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION estenosis. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION laparotomía I-EXPLORATION media I-EXPLORATION supra I-EXPLORATION e I-EXPLORATION infraumbilical I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION duodeno I-EXPLORATION y I-EXPLORATION de I-EXPLORATION delgado I-EXPLORATION hasta I-EXPLORATION llegar I-EXPLORATION a I-EXPLORATION un I-EXPLORATION grupo I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION yeyunoileales I-EXPLORATION adheridas I-EXPLORATION entre I-EXPLORATION sí I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION pelvis I-EXPLORATION con I-EXPLORATION un I-EXPLORATION colon I-EXPLORATION de I-EXPLORATION calibre I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT liberar I-TREATMENT las I-TREATMENT asas I-TREATMENT afectadas I-TREATMENT y I-TREATMENT resecar I-TREATMENT 20 I-TREATMENT cm I-TREATMENT de I-TREATMENT yeyunoíleon I-TREATMENT incluyendo I-TREATMENT el I-TREATMENT segmento I-TREATMENT patológico, I-TREATMENT con I-TREATMENT una I-TREATMENT anastomosis I-TREATMENT laterolateral. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza: I-EXPLORATION "intestino I-EXPLORATION con I-EXPLORATION atrofia I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION vellosidades I-EXPLORATION y I-EXPLORATION fibrosis I-EXPLORATION subserosa I-EXPLORATION con I-EXPLORATION adherencias, I-EXPLORATION propio I-EXPLORATION de I-EXPLORATION cambios I-EXPLORATION postradioterapia". I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION excelente I-EVOLUTION recuperación, I-EVOLUTION con I-EVOLUTION tolerancia I-EVOLUTION alimentaria I-EVOLUTION y I-EVOLUTION tránsito I-EVOLUTION intestinal I-EVOLUTION normal. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION lleva I-EVOLUTION una I-EVOLUTION vida I-EVOLUTION normal, I-EVOLUTION es I-EVOLUTION capaz I-EVOLUTION de I-EVOLUTION tolerar I-EVOLUTION una I-EVOLUTION dieta I-EVOLUTION variada I-EVOLUTION con I-EVOLUTION restricción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lactosa I-EVOLUTION y I-EVOLUTION había I-EVOLUTION recuperado I-EVOLUTION el I-EVOLUTION peso I-EVOLUTION anterior I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION radioterapia. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 42 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS primer B-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY padres I-PAST_MEDICAL_HISTORY sanos I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consanguíneos, I-PAST_MEDICAL_HISTORY diagnosticado B-PRESENT_ILLNESS en I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS prenatal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ureterohidronefrosis I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dilatación I-PRESENT_ILLNESS gástrica. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION período I-EXPLORATION neonatal I-EXPLORATION precoz I-EXPLORATION únicamente I-EXPLORATION llamó I-EXPLORATION la I-EXPLORATION atención, I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION globuloso I-EXPLORATION y I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION deposición I-EXPLORATION meconial I-EXPLORATION al I-EXPLORATION 4º I-EXPLORATION día I-EXPLORATION de I-EXPLORATION vida, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION absoluta I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION deposiciones. I-EXPLORATION Un I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION evidenció I-EXPLORATION microcolon I-EXPLORATION y I-EXPLORATION malrotación I-EXPLORATION intestinal, I-EXPLORATION corrigiéndose I-EXPLORATION éstaúltima I-EXPLORATION quirúrgicamente. I-EXPLORATION Una I-EXPLORATION biopsia I-EXPLORATION rectal I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION enolasa I-EXPLORATION neuronal I-EXPLORATION y I-EXPLORATION descartó I-EXPLORATION aganglionismo. I-EXPLORATION Se B-TREATMENT mantuvo I-TREATMENT en I-TREATMENT todo I-TREATMENT momento I-TREATMENT con I-TREATMENT nutrición I-TREATMENT parenteral, I-TREATMENT con I-TREATMENT intentos I-TREATMENT de I-TREATMENT ingesta I-TREATMENT oral I-TREATMENT que I-TREATMENT toleró I-TREATMENT finalmente I-TREATMENT a I-TREATMENT los I-TREATMENT 2 I-TREATMENT meses I-TREATMENT de I-TREATMENT vida I-TREATMENT con I-TREATMENT un I-TREATMENT volumen I-TREATMENT máximo I-TREATMENT de I-TREATMENT 7 I-TREATMENT ml/h. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION siempre I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION diuresis I-EVOLUTION adecuada, I-EVOLUTION aunque I-EVOLUTION mantenía I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION en I-EVOLUTION límites I-EVOLUTION altos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad. I-EVOLUTION Posteriormente B-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT pieloureterostomía I-TREATMENT bilateral I-TREATMENT mejorando I-TREATMENT su I-TREATMENT función I-TREATMENT renal. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION sepsis I-EVOLUTION nosocomial I-EVOLUTION relacionada I-EVOLUTION con I-EVOLUTION el I-EVOLUTION catéter I-EVOLUTION por I-EVOLUTION Staphylococcus I-EVOLUTION epidermidis, I-EVOLUTION tratada B-TREATMENT con I-TREATMENT teicoplanina I-TREATMENT y I-TREATMENT cefotaxima I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta9. I-EVOLUTION Estos I-EVOLUTION datos I-EVOLUTION amplían I-EVOLUTION lo I-EVOLUTION ya I-EVOLUTION publicado I-EVOLUTION en I-EVOLUTION el I-EVOLUTION año I-EVOLUTION 2004 I-EVOLUTION por I-EVOLUTION parte I-EVOLUTION del I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Neonatología I-EVOLUTION y I-EVOLUTION del I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Cirugía I-EVOLUTION Pediátrica I-EVOLUTION del I-EVOLUTION Hospital I-EVOLUTION Universitario I-EVOLUTION Central I-EVOLUTION de I-EVOLUTION Asturias10. I-EVOLUTION I-EVOLUTION Actualmente I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION ureterostomía I-EVOLUTION cutánea I-EVOLUTION bilateral, I-EVOLUTION peristaltismo I-EVOLUTION y I-EVOLUTION hábito I-EVOLUTION intestinal I-EVOLUTION conservados, I-EVOLUTION relativamente I-EVOLUTION bien I-EVOLUTION nutrido I-EVOLUTION y I-EVOLUTION con I-EVOLUTION un I-EVOLUTION aceptable I-EVOLUTION y I-EVOLUTION progresivo I-EVOLUTION desarrollo I-EVOLUTION ponderal: I-EVOLUTION percentil I-EVOLUTION 10 I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION y I-EVOLUTION talla, I-EVOLUTION índice I-EVOLUTION de I-EVOLUTION Waterlow I-EVOLUTION del I-EVOLUTION 96%. I-EVOLUTION Recibe B-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT (NP) I-TREATMENT desde I-TREATMENT el I-TREATMENT tercer I-TREATMENT día I-TREATMENT de I-TREATMENT vida I-TREATMENT y I-TREATMENT actualmente I-TREATMENT en I-TREATMENT régimen I-TREATMENT ambulatorio, I-TREATMENT suplementada I-TREATMENT con I-TREATMENT aportes I-TREATMENT orales I-TREATMENT a I-TREATMENT débito I-TREATMENT continuo, I-TREATMENT desde I-TREATMENT que I-TREATMENT inició I-TREATMENT tolerancia I-TREATMENT a I-TREATMENT los I-TREATMENT mismos. I-TREATMENT La I-TREATMENT composición I-TREATMENT de I-TREATMENT la I-TREATMENT NP I-TREATMENT por I-TREATMENT kg I-TREATMENT de I-TREATMENT peso I-TREATMENT y I-TREATMENT día I-TREATMENT es I-TREATMENT de I-TREATMENT 1, I-TREATMENT 8 I-TREATMENT g I-TREATMENT de I-TREATMENT aminoácidos, I-TREATMENT 8, I-TREATMENT 6 I-TREATMENT g I-TREATMENT de I-TREATMENT glucosa, I-TREATMENT 1, I-TREATMENT 4 I-TREATMENT g I-TREATMENT lípidos, I-TREATMENT Na I-TREATMENT 3, I-TREATMENT 7 I-TREATMENT mEq, I-TREATMENT k I-TREATMENT 1, I-TREATMENT 4 I-TREATMENT mEq, I-TREATMENT Ca I-TREATMENT 0, I-TREATMENT 7 I-TREATMENT mEq, I-TREATMENT Cl I-TREATMENT 4, I-TREATMENT 4 I-TREATMENT mEq, I-TREATMENT P I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT mEq, I-TREATMENT Mg I-TREATMENT 0, I-TREATMENT 3 I-TREATMENT mEq, I-TREATMENT contiene I-TREATMENT 55, I-TREATMENT 7 I-TREATMENT kcal I-TREATMENT totales I-TREATMENT y I-TREATMENT un I-TREATMENT volumen I-TREATMENT total I-TREATMENT de I-TREATMENT 1.295 I-TREATMENT ml. I-TREATMENT La I-TREATMENT NP I-TREATMENT es I-TREATMENT perfundida I-TREATMENT durante I-TREATMENT 17 I-TREATMENT horas, I-TREATMENT en I-TREATMENT pases I-TREATMENT de I-TREATMENT 40 I-TREATMENT ml/hora, I-TREATMENT con I-TREATMENT ascenso I-TREATMENT y I-TREATMENT descenso I-TREATMENT en I-TREATMENT una I-TREATMENT hora, I-TREATMENT siendo I-TREATMENT el I-TREATMENT tiempo I-TREATMENT de I-TREATMENT reposo I-TREATMENT sin I-TREATMENT NPD I-TREATMENT de I-TREATMENT 7 I-TREATMENT horas. I-TREATMENT Recibe I-TREATMENT tratamiento I-TREATMENT profiláctico I-TREATMENT frente I-TREATMENT al I-TREATMENT sobrecrecimiento I-TREATMENT bacteriano I-TREATMENT intestinal I-TREATMENT con I-TREATMENT metronidazol, I-TREATMENT además I-TREATMENT de I-TREATMENT trimetropim, I-TREATMENT fenobarbital, I-TREATMENT hierro, I-TREATMENT ácido I-TREATMENT ursodesoxicólico, I-TREATMENT ranitidina, I-TREATMENT eritromicina, I-TREATMENT vitamina I-TREATMENT E, I-TREATMENT vitamina I-TREATMENT D3 I-TREATMENT y I-TREATMENT darbepoetina. I-TREATMENT Mensualmente, B-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION control I-EXPLORATION clínico, I-EXPLORATION analítico I-EXPLORATION (bioquímica I-EXPLORATION completa, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda) I-EXPLORATION y I-EXPLORATION control I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION ostomías I-EXPLORATION y I-EXPLORATION de I-EXPLORATION catéter I-EXPLORATION Hickman. I-EXPLORATION Ha B-EVOLUTION presentado I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION obstrucción I-EVOLUTION abdominal, I-EVOLUTION uno B-TREATMENT de I-TREATMENT los I-TREATMENT cuales, I-TREATMENT secundario I-TREATMENT a I-TREATMENT bridas I-TREATMENT intestinales, I-TREATMENT requirió I-TREATMENT intervención I-TREATMENT quirúrgica. I-TREATMENT Las B-EVOLUTION complicaciones I-EVOLUTION relacionadas I-EVOLUTION con I-EVOLUTION la I-EVOLUTION NP I-EVOLUTION han I-EVOLUTION sido I-EVOLUTION dos: I-EVOLUTION citolisis I-EVOLUTION hepática I-EVOLUTION transitoria, I-EVOLUTION que B-TREATMENT remitió I-TREATMENT tras I-TREATMENT normalizar I-TREATMENT la I-TREATMENT relación I-TREATMENT de I-TREATMENT calorías I-TREATMENT procedentes I-TREATMENT de I-TREATMENT hidratos I-TREATMENT de I-TREATMENT carbono I-TREATMENT frente I-TREATMENT a I-TREATMENT grasas I-TREATMENT (60/40) I-TREATMENT (durante I-TREATMENT este I-TREATMENT período I-TREATMENT tenía I-TREATMENT niveles I-TREATMENT elevados I-TREATMENT de I-TREATMENT GOT, I-TREATMENT GPT, I-TREATMENT fosfatasa I-TREATMENT alcalina I-TREATMENT y I-TREATMENT bilirrubina, I-TREATMENT que I-TREATMENT se I-TREATMENT normalizaron) I-TREATMENT y B-EVOLUTION una I-EVOLUTION sepsis I-EVOLUTION nosocomial I-EVOLUTION relacionada I-EVOLUTION con I-EVOLUTION el I-EVOLUTION catéter I-EVOLUTION por I-EVOLUTION Staphylococcus I-EVOLUTION epidermidis, I-EVOLUTION que B-TREATMENT respondió I-TREATMENT adecuadamente I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT antibiótico. I-TREATMENT I-TREATMENT Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 86 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS enero I-PRESENT_ILLNESS 2008 I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hipoglucemia I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS antidiabéticos I-PRESENT_ILLNESS orales, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS demencia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS ingesta, I-PRESENT_ILLNESS se B-TREATMENT decide I-TREATMENT colocación I-TREATMENT de I-TREATMENT sonda I-TREATMENT nasogástrica I-TREATMENT (SNG) I-TREATMENT para I-TREATMENT alimentación I-TREATMENT por I-TREATMENT vía I-TREATMENT enteral, I-TREATMENT tras I-TREATMENT presentar I-TREATMENT varios I-TREATMENT episodios I-TREATMENT de I-TREATMENT arrancamiento I-TREATMENT de I-TREATMENT sonda, I-TREATMENT se I-TREATMENT practicó I-TREATMENT gastrostomía I-TREATMENT radiológica I-TREATMENT percutánea I-TREATMENT (GRP). I-TREATMENT A B-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION arrancamiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sonda I-EVOLUTION de I-EVOLUTION gastrostomía, I-EVOLUTION ante B-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT sondas I-TREATMENT de I-TREATMENT recambio, I-TREATMENT se I-TREATMENT decide I-TREATMENT colocación I-TREATMENT de I-TREATMENT sonda I-TREATMENT Foley I-TREATMENT de I-TREATMENT 14 I-TREATMENT french, I-TREATMENT desde B-EVOLUTION entonces I-EVOLUTION son I-EVOLUTION múltiples I-EVOLUTION las I-EVOLUTION visitas I-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION urgencias I-EVOLUTION con I-EVOLUTION problemas I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION con I-EVOLUTION la I-EVOLUTION sonda. I-EVOLUTION Es I-EVOLUTION ingresado I-EVOLUTION por I-EVOLUTION vómitos I-EVOLUTION e I-EVOLUTION intolerancia I-EVOLUTION a I-EVOLUTION la I-EVOLUTION nutrición I-EVOLUTION enteral. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION abundante I-EVOLUTION residuo I-EVOLUTION bilioso I-EVOLUTION por I-EVOLUTION la I-EVOLUTION sonda I-EVOLUTION Foley. I-EVOLUTION Se B-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION radiológico I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sonda, I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION mala I-EXPLORATION tolerancia I-EXPLORATION enteral I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION alteraciones I-EXPLORATION radiológicas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION intestinal, I-EXPLORATION observándose I-EXPLORATION como I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION ver I-EXPLORATION en I-EXPLORATION la I-EXPLORATION figura I-EXPLORATION 1 I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION directo I-EXPLORATION del I-EXPLORATION contraste I-EXPLORATION directamente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION intestinal. I-EXPLORATION Se B-TREATMENT extrajo I-TREATMENT la I-TREATMENT sonda I-TREATMENT Foley I-TREATMENT por I-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT cirugía I-TREATMENT sin I-TREATMENT presentar I-TREATMENT complicaciones I-TREATMENT y I-TREATMENT se I-TREATMENT colocó I-TREATMENT sonda I-TREATMENT de I-TREATMENT gastrostomía I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT servicio I-TREATMENT de I-TREATMENT radiología I-TREATMENT intervencionista, I-TREATMENT siendo B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT en I-TREATMENT bolos. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Nutrición I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO Medicina I-DERIVED_FROM/TO Interna I-DERIVED_FROM/TO para I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hipoproteinemia. I-DERIVED_FROM/TO Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacan I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY arritmia I-PAST_MEDICAL_HISTORY cardíaca I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY respuesta I-PAST_MEDICAL_HISTORY ventricular I-PAST_MEDICAL_HISTORY adecuada. I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION moderada, I-EXPLORATION insuficiencia I-EXPLORATION aórtica I-EXPLORATION moderada I-EXPLORATION por I-EXPLORATION anuloectasia I-EXPLORATION valvular I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION auricular I-EXPLORATION sin I-EXPLORATION hipertensión I-EXPLORATION pulmonar. I-EXPLORATION También B-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Paget I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY hueso, I-PAST_MEDICAL_HISTORY actualmente I-PAST_MEDICAL_HISTORY inactiva. I-PAST_MEDICAL_HISTORY Monorreno I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hipoplasia I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY riñón I-PAST_MEDICAL_HISTORY contralateral. I-PAST_MEDICAL_HISTORY Intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ulcus I-PAST_MEDICAL_HISTORY gástrico I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY realizándose I-PAST_MEDICAL_HISTORY gastrectomía I-PAST_MEDICAL_HISTORY subtotal I-PAST_MEDICAL_HISTORY Billroth I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY I I-PAST_MEDICAL_HISTORY (última I-PAST_MEDICAL_HISTORY endoscopia I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY objetiva I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY gastritis I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY atrófica I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY muñón I-PAST_MEDICAL_HISTORY gástrico). I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY revisión I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Nefrología I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY patología I-PAST_MEDICAL_HISTORY renal, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY proteinuria I-PAST_MEDICAL_HISTORY significativa. I-PAST_MEDICAL_HISTORY Perfil I-PAST_MEDICAL_HISTORY hepático I-PAST_MEDICAL_HISTORY correcto. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS buen I-PRESENT_ILLNESS apetito I-PRESENT_ILLNESS y I-PRESENT_ILLNESS adecuada I-PRESENT_ILLNESS ingesta, I-PRESENT_ILLNESS realizando I-PRESENT_ILLNESS una I-PRESENT_ILLNESS dieta I-PRESENT_ILLNESS equilibrada. I-PRESENT_ILLNESS Hábito I-PRESENT_ILLNESS deposicional I-PRESENT_ILLNESS conservado. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION edemas I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION e I-EXPLORATION IMC I-EXPLORATION contaminado I-EXPLORATION de I-EXPLORATION 21, I-EXPLORATION 7 I-EXPLORATION kg/m2. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica, I-EXPLORATION hipoalbuminemia I-EXPLORATION de I-EXPLORATION 2.002 I-EXPLORATION mg/dl. I-EXPLORATION Se I-EXPLORATION inicia I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION nutrición I-EXPLORATION enteral I-EXPLORATION domiciliaria I-EXPLORATION hiperproteica. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION control, I-EXPLORATION la I-EXPLORATION albúmina I-EXPLORATION ha I-EXPLORATION disminuido I-EXPLORATION a I-EXPLORATION 1.930 I-EXPLORATION mg/dl I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION piensa I-EXPLORATION en I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION malabsortiva I-EXPLORATION pese I-EXPLORATION a I-EXPLORATION no I-EXPLORATION referir I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION diarrea. I-EXPLORATION Se I-EXPLORATION realizan I-EXPLORATION test I-EXPLORATION de I-EXPLORATION la I-EXPLORATION D-xilosa I-EXPLORATION y I-EXPLORATION Van I-EXPLORATION de I-EXPLORATION Kammer, I-EXPLORATION siendo I-EXPLORATION ambos I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION descarta I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION celiaquía I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION gastroduodenal I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION grasa I-EXPLORATION subcutánea I-EXPLORATION no I-EXPLORATION refleja I-EXPLORATION amiloidosis. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION pierde I-EXPLORATION proteínas, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION aclaramiento I-EXPLORATION de I-EXPLORATION A1AT I-EXPLORATION en I-EXPLORATION heces I-EXPLORATION con I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION 218 I-EXPLORATION ml/día I-EXPLORATION (> I-EXPLORATION 24ml/día) I-EXPLORATION [A1AT I-EXPLORATION en I-EXPLORATION sangre: I-EXPLORATION 156 I-EXPLORATION mg/dL; I-EXPLORATION A1AT I-EXPLORATION en I-EXPLORATION heces: I-EXPLORATION 1, I-EXPLORATION 53 I-EXPLORATION mg/g; I-EXPLORATION peso I-EXPLORATION heces I-EXPLORATION en I-EXPLORATION 24 I-EXPLORATION h: I-EXPLORATION 222, I-EXPLORATION 57 I-EXPLORATION g] I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION es I-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION patología. I-EXPLORATION Pese I-EXPLORATION a I-EXPLORATION no I-EXPLORATION observar I-EXPLORATION otra I-EXPLORATION causa I-EXPLORATION subyacente, I-EXPLORATION no I-EXPLORATION es I-EXPLORATION posible I-EXPLORATION asegurar I-EXPLORATION que I-EXPLORATION su I-EXPLORATION alteración I-EXPLORATION cardiológica I-EXPLORATION sea I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION PLE. I-EXPLORATION En B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT domiciliaria, I-TREATMENT mantiene B-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION albúmina I-EVOLUTION estables. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY II. I-PAST_MEDICAL_HISTORY En B-EXPLORATION mayo I-EXPLORATION de I-EXPLORATION 2012 I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 27 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION probable I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION primera I-EXPLORATION costilla. I-EXPLORATION Fue I-EXPLORATION diagnosticada I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION Pancoast I-EXPLORATION con I-EXPLORATION un I-EXPLORATION estadiaje I-EXPLORATION inicial I-EXPLORATION T4N0M0. I-EXPLORATION En B-TREATMENT julio I-TREATMENT de I-TREATMENT 2012 I-TREATMENT recibió I-TREATMENT quimioterapia I-TREATMENT y I-TREATMENT radioterapia I-TREATMENT concomitante. I-TREATMENT Presentó B-EVOLUTION una I-EVOLUTION respuesta I-EVOLUTION completa I-EVOLUTION y, B-TREATMENT en I-TREATMENT octubre I-TREATMENT de I-TREATMENT 2012, I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT lobectomía I-TREATMENT superior I-TREATMENT derecha I-TREATMENT videotoracoscópica I-TREATMENT y I-TREATMENT linfadenectomía. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION fue I-EVOLUTION tórpido, I-EVOLUTION con I-EVOLUTION shock I-EVOLUTION séptico I-EVOLUTION de I-EVOLUTION origen I-EVOLUTION respiratorio, I-EVOLUTION insuficiencia I-EVOLUTION cardiaca, I-EVOLUTION fracaso I-EVOLUTION renal I-EVOLUTION agudo I-EVOLUTION y B-TREATMENT requirió I-TREATMENT ingreso I-TREATMENT en I-TREATMENT UVI I-TREATMENT por I-TREATMENT insuficiencia I-TREATMENT respiratoria, I-TREATMENT precisando I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT total I-TREATMENT (NPT). I-TREATMENT Allí B-EVOLUTION permaneció I-EVOLUTION ingresada I-EVOLUTION 2 I-EVOLUTION meses, I-EVOLUTION hasta I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION trasladada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION planta, I-EVOLUTION donde I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION abdomen I-EVOLUTION agudo, I-EVOLUTION practicándose I-EVOLUTION una I-EVOLUTION laparotomía I-EVOLUTION exploradora. I-EVOLUTION Tras B-TREATMENT observarse I-TREATMENT una I-TREATMENT ileítis I-TREATMENT con I-TREATMENT componente I-TREATMENT infeccioso I-TREATMENT y I-TREATMENT necrótico I-TREATMENT junto I-TREATMENT con I-TREATMENT asas I-TREATMENT isquémicas I-TREATMENT y I-TREATMENT abundante I-TREATMENT líquido I-TREATMENT libre I-TREATMENT de I-TREATMENT aspecto I-TREATMENT hemático I-TREATMENT antiguo I-TREATMENT y I-TREATMENT fecaloideo, I-TREATMENT se I-TREATMENT practicó I-TREATMENT resección I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 60 I-TREATMENT cm I-TREATMENT de I-TREATMENT íleon I-TREATMENT terminal I-TREATMENT hasta I-TREATMENT válvula I-TREATMENT cecal I-TREATMENT y I-TREATMENT se I-TREATMENT dejó I-TREATMENT ileostomía I-TREATMENT terminal I-TREATMENT en I-TREATMENT fosa I-TREATMENT ilíaca I-TREATMENT derecha. I-TREATMENT Los B-EXPLORATION cultivos I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION estafilococos I-EXPLORATION y I-EXPLORATION bacilos I-EXPLORATION gram I-EXPLORATION positivos, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT intravenoso I-TREATMENT empírico I-TREATMENT con I-TREATMENT piperacilina-tazobactam I-TREATMENT 4 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT y I-TREATMENT vancomicina I-TREATMENT 1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 14 I-TREATMENT días. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT dieta I-TREATMENT oral, I-TREATMENT suplementos I-TREATMENT hiperproteicos I-TREATMENT de I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT y I-TREATMENT complejo I-TREATMENT polivitamínico I-TREATMENT con I-TREATMENT minerales. I-TREATMENT I-TREATMENT Un B-EVOLUTION mes I-EVOLUTION después I-EVOLUTION del I-EVOLUTION alta, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION acudir I-EVOLUTION al I-EVOLUTION hospital I-EVOLUTION por I-EVOLUTION disnea, I-EVOLUTION fiebre, I-EVOLUTION náuseas, I-EVOLUTION vómitos I-EVOLUTION alimentarios, I-EVOLUTION febrícula, I-EVOLUTION astenia, I-EVOLUTION hiporexia I-EVOLUTION y I-EVOLUTION decaimiento I-EVOLUTION importantes, I-EVOLUTION acompañados I-EVOLUTION de I-EVOLUTION débito I-EVOLUTION elevado I-EVOLUTION por I-EVOLUTION la I-EVOLUTION ileostomia I-EVOLUTION (1.500-2.000 I-EVOLUTION mL/día). I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TC, I-EXPLORATION observándose I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION postquirúrgica I-EXPLORATION abundante I-EXPLORATION en I-EXPLORATION hemitórax I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION probable I-EXPLORATION fístula I-EXPLORATION broncopleural, I-EXPLORATION ingresando I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Cirugía I-EXPLORATION Torácica. I-EXPLORATION Se B-TREATMENT sospechó I-TREATMENT empiema I-TREATMENT y I-TREATMENT se I-TREATMENT colocaron I-TREATMENT dos I-TREATMENT drenajes I-TREATMENT "pigtail". I-TREATMENT Se I-TREATMENT inició I-TREATMENT antibioterapia I-TREATMENT con I-TREATMENT piperacilina-tazobactam I-TREATMENT 4 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT y I-TREATMENT vancomicina I-TREATMENT 1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT catéter I-TREATMENT central I-TREATMENT de I-TREATMENT inserción I-TREATMENT periférica I-TREATMENT (PICC) I-TREATMENT en I-TREATMENT miembro I-TREATMENT superior I-TREATMENT izquierdo. I-TREATMENT No I-TREATMENT era I-TREATMENT posible I-TREATMENT otro I-TREATMENT acceso I-TREATMENT central, I-TREATMENT ya I-TREATMENT que I-TREATMENT presentaba I-TREATMENT trombosis I-TREATMENT completa I-TREATMENT de I-TREATMENT vena I-TREATMENT yugular I-TREATMENT derecha I-TREATMENT por I-TREATMENT su I-TREATMENT larga I-TREATMENT estancia I-TREATMENT en I-TREATMENT la I-TREATMENT UVI. I-TREATMENT En B-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION general I-EXPLORATION destacaba I-EXPLORATION hipocalcemia I-EXPLORATION (pese I-EXPLORATION a I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION Natecal® I-EXPLORATION 2 I-EXPLORATION comprimidos I-EXPLORATION al I-EXPLORATION día), I-EXPLORATION hipopotasemia I-EXPLORATION e I-EXPLORATION hipomagnesemia I-EXPLORATION que I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION previamente. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT intravenoso I-TREATMENT con I-TREATMENT gluconato I-TREATMENT cálcico I-TREATMENT 1 I-TREATMENT ampolla I-TREATMENT de I-TREATMENT 10 I-TREATMENT mL I-TREATMENT al I-TREATMENT 10% I-TREATMENT cada I-TREATMENT 6 I-TREATMENT horas, I-TREATMENT sulfato I-TREATMENT de I-TREATMENT magnesio I-TREATMENT 2 I-TREATMENT gramos I-TREATMENT cada I-TREATMENT 24 I-TREATMENT horas I-TREATMENT y I-TREATMENT suplementos I-TREATMENT orales I-TREATMENT de I-TREATMENT potasio I-TREATMENT (1 I-TREATMENT Boi-K® I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas), I-TREATMENT calcio I-TREATMENT (Natecal® I-TREATMENT 2 I-TREATMENT comprimidos I-TREATMENT al I-TREATMENT día) I-TREATMENT y I-TREATMENT magnesio I-TREATMENT (2 I-TREATMENT comprimidos I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas), I-TREATMENT solicitándose I-TREATMENT consulta I-TREATMENT al I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Nutrición. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION continuaba I-EVOLUTION con I-EVOLUTION diarrea I-EVOLUTION líquida I-EVOLUTION abundante I-EVOLUTION por I-EVOLUTION la I-EVOLUTION ileostomía I-EVOLUTION (más I-EVOLUTION de I-EVOLUTION 1500 I-EVOLUTION mL/día), I-EVOLUTION refería I-EVOLUTION anorexia, I-EVOLUTION astenia, I-EVOLUTION decaimiento I-EVOLUTION y I-EVOLUTION calambres. I-EVOLUTION Pese I-EVOLUTION a I-EVOLUTION la I-EVOLUTION suplementacion I-EVOLUTION oral, I-EVOLUTION continuaba I-EVOLUTION con I-EVOLUTION niveles I-EVOLUTION indectables I-EVOLUTION de I-EVOLUTION magnesio I-EVOLUTION (< I-EVOLUTION 0, I-EVOLUTION 6 I-EVOLUTION mg/dL). I-EVOLUTION Dada B-TREATMENT la I-TREATMENT baja I-TREATMENT ingesta I-TREATMENT y I-TREATMENT la I-TREATMENT mala I-TREATMENT tolerancia I-TREATMENT oral I-TREATMENT a I-TREATMENT los I-TREATMENT suplementos I-TREATMENT de I-TREATMENT magnesio, I-TREATMENT se I-TREATMENT decidió I-TREATMENT iniciar I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT central I-TREATMENT por I-TREATMENT el I-TREATMENT PICC. I-TREATMENT I-TREATMENT Tras I-TREATMENT la I-TREATMENT normalización I-TREATMENT hidroelectrolítica I-TREATMENT y I-TREATMENT un I-TREATMENT correcto I-TREATMENT aporte I-TREATMENT nutricional, I-TREATMENT la I-TREATMENT paciente I-TREATMENT fue I-TREATMENT intervenida I-TREATMENT para I-TREATMENT el I-TREATMENT cierre I-TREATMENT de I-TREATMENT la I-TREATMENT fístula I-TREATMENT broncopleural. I-TREATMENT Una B-EVOLUTION semana I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION tomaba I-EVOLUTION suplementos I-EVOLUTION nutricionales I-EVOLUTION y I-EVOLUTION dieta I-EVOLUTION por I-EVOLUTION vía I-EVOLUTION oral, I-EVOLUTION mejorando I-EVOLUTION los I-EVOLUTION calambres I-EVOLUTION y I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION anímico, I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antidepresivo. I-EVOLUTION La I-EVOLUTION hipomagnesemia I-EVOLUTION aislada I-EVOLUTION tardó I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION en I-EVOLUTION recuperarse, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT suplementos I-TREATMENT nutricionales I-TREATMENT orales I-TREATMENT y I-TREATMENT magnesio I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT comprimido I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas. I-TREATMENT Al I-TREATMENT no I-TREATMENT normalizarse I-TREATMENT completamente I-TREATMENT las I-TREATMENT cifras I-TREATMENT de I-TREATMENT magnesio I-TREATMENT y I-TREATMENT dada I-TREATMENT la I-TREATMENT buena I-TREATMENT tolerancia, I-TREATMENT se I-TREATMENT aumentó I-TREATMENT la I-TREATMENT dosis I-TREATMENT a I-TREATMENT 2 I-TREATMENT comprimidos I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas, I-TREATMENT consiguiendo B-EVOLUTION remontar I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION hasta I-EVOLUTION límites I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad. I-EVOLUTION Quedaron I-EVOLUTION descartadas I-EVOLUTION las I-EVOLUTION pérdidas I-EVOLUTION urinarias, I-EVOLUTION con I-EVOLUTION unos I-EVOLUTION niveles I-EVOLUTION magnesio I-EVOLUTION en I-EVOLUTION orina I-EVOLUTION indetectables I-EVOLUTION (< I-EVOLUTION 1, I-EVOLUTION 81 I-EVOLUTION mg/dL), I-EVOLUTION confirmando I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION malabsorción I-EVOLUTION intestinal. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Enfermedad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Huntington, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS deterioro I-PRESENT_ILLNESS cognitivo I-PRESENT_ILLNESS severo, I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS neurogénica, I-PRESENT_ILLNESS broncoaspiraciones I-PRESENT_ILLNESS y I-PRESENT_ILLNESS desnutrición, I-PRESENT_ILLNESS motivo B-TREATMENT por I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT realiza I-TREATMENT GEP I-TREATMENT para I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT domiciliaria. I-TREATMENT Durante I-TREATMENT el I-TREATMENT procedimiento, I-TREATMENT por I-TREATMENT imposibilidad I-TREATMENT de I-TREATMENT obtener I-TREATMENT un I-TREATMENT punto I-TREATMENT de I-TREATMENT contacto I-TREATMENT entre I-TREATMENT estómago I-TREATMENT y I-TREATMENT pared I-TREATMENT abdominal I-TREATMENT por I-TREATMENT transiluminación I-TREATMENT y I-TREATMENT digitopresión, I-TREATMENT se I-TREATMENT añadió I-TREATMENT la I-TREATMENT asistencia I-TREATMENT de I-TREATMENT laparoscópia I-TREATMENT para I-TREATMENT concluir I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT de I-TREATMENT inserción I-TREATMENT de I-TREATMENT la I-TREATMENT sonda I-TREATMENT de I-TREATMENT gastrostomía. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY hábito I-PAST_MEDICAL_HISTORY tabáquico, I-PAST_MEDICAL_HISTORY hipercolesterolemia I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY irregular I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dieta I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipocolesterolemiantes, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY (con I-PAST_MEDICAL_HISTORY infarto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY miocardio I-PAST_MEDICAL_HISTORY diafragmático I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1985). I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS para I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS angiográfico I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS angor, I-PRESENT_ILLNESS tanto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esfuerzo I-PRESENT_ILLNESS como I-PRESENT_ILLNESS de I-PRESENT_ILLNESS reposo, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS año I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS B-bloqueantes, I-PRESENT_ILLNESS nitratos, I-PRESENT_ILLNESS antiagregantes I-PRESENT_ILLNESS plaquetarios, I-PRESENT_ILLNESS calcioantagonistas, I-PRESENT_ILLNESS etc. I-PRESENT_ILLNESS Tras B-EXPLORATION la I-EXPLORATION realización I-EXPLORATION del I-EXPLORATION cateterismo I-EXPLORATION arterial I-EXPLORATION y I-EXPLORATION coronariografía I-EXPLORATION sin I-EXPLORATION incidencias I-EXPLORATION (se I-EXPLORATION constató I-EXPLORATION Enfermedad I-EXPLORATION de I-EXPLORATION Tres I-EXPLORATION Vasos) I-EXPLORATION fue B-EVOLUTION remitido I-EVOLUTION a I-EVOLUTION su I-EVOLUTION domicilio I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION y I-EVOLUTION 12 I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION inicia I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION disestesias I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION ambas I-EVOLUTION pantorrillas I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION incrementando I-EVOLUTION en I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION siguientes I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION acudió I-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION urgencias I-EVOLUTION del I-EVOLUTION hospital I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION remitido I-EVOLUTION a I-EVOLUTION su I-EVOLUTION domicilio I-EVOLUTION con B-TREATMENT medicación I-TREATMENT analgésica. I-TREATMENT Acude B-EVOLUTION nuevamente I-EVOLUTION a I-EVOLUTION dicho I-EVOLUTION servicio I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION por I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION múltiples I-EVOLUTION lesiones I-EVOLUTION eritematosas I-EVOLUTION en I-EVOLUTION la I-EVOLUTION piel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mitad I-EVOLUTION inferior I-EVOLUTION del I-EVOLUTION abdomen I-EVOLUTION y I-EVOLUTION en I-EVOLUTION extremidades I-EVOLUTION inferiores. I-EVOLUTION Ingresa I-EVOLUTION para I-EVOLUTION estudio. I-EVOLUTION Exploración B-EXPLORATION física: I-EXPLORATION Varón, I-EXPLORATION 44 I-EXPLORATION años, I-EXPLORATION normolineo; I-EXPLORATION afebril; I-EXPLORATION buena I-EXPLORATION coloración I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas; I-EXPLORATION xantelasma I-EXPLORATION bilateral. I-EXPLORATION PA: I-EXPLORATION 105/65. I-EXPLORATION ACP: I-EXPLORATION Frecuencia I-EXPLORATION central I-EXPLORATION rítmica I-EXPLORATION a I-EXPLORATION 62 I-EXPLORATION ppm. I-EXPLORATION Abdomen: I-EXPLORATION Blando, I-EXPLORATION indoloro I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION sin I-EXPLORATION visceromegalias I-EXPLORATION ni I-EXPLORATION masas. I-EXPLORATION Extremidades I-EXPLORATION sin I-EXPLORATION edemas, I-EXPLORATION con I-EXPLORATION masas I-EXPLORATION gemelares I-EXPLORATION dolorosas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION Pulsos I-EXPLORATION femoral, I-EXPLORATION tibial I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION pedio I-EXPLORATION palpables I-EXPLORATION y I-EXPLORATION siméticos. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION cutáneo I-EXPLORATION (en I-EXPLORATION mitad I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION extremidades I-EXPLORATION inferiores) I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION lesiones I-EXPLORATION eritematosas I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION livedo I-EXPLORATION reticularis I-EXPLORATION y I-EXPLORATION en I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pies I-EXPLORATION coloración I-EXPLORATION púrpura I-EXPLORATION con I-EXPLORATION temperatura I-EXPLORATION local I-EXPLORATION normal. I-EXPLORATION Pruebas I-EXPLORATION complementarias. I-EXPLORATION Hemograma: I-EXPLORATION Leucocitos I-EXPLORATION 10800 I-EXPLORATION (Seg I-EXPLORATION 43%, I-EXPLORATION L I-EXPLORATION 36%, I-EXPLORATION M I-EXPLORATION 6, I-EXPLORATION 1%, I-EXPLORATION Eosinófilos I-EXPLORATION 13%) I-EXPLORATION Hgb: I-EXPLORATION 13, I-EXPLORATION 9 I-EXPLORATION g/dl, I-EXPLORATION Hct: I-EXPLORATION 42, I-EXPLORATION 7%, I-EXPLORATION Plaquetas I-EXPLORATION 203.000. I-EXPLORATION VSG: I-EXPLORATION 16. I-EXPLORATION Bioquímica: I-EXPLORATION Glu I-EXPLORATION 129 I-EXPLORATION mg/dl, I-EXPLORATION Urea I-EXPLORATION 30 I-EXPLORATION mg/dl, I-EXPLORATION Cre I-EXPLORATION 1, I-EXPLORATION 1 I-EXPLORATION mg/dl, I-EXPLORATION Na I-EXPLORATION 138 I-EXPLORATION mEq/l, I-EXPLORATION K I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION mEq/l, I-EXPLORATION GOT I-EXPLORATION 25, I-EXPLORATION GPT I-EXPLORATION 31, I-EXPLORATION CK I-EXPLORATION 50, I-EXPLORATION LDH I-EXPLORATION 337, I-EXPLORATION Aldolasa I-EXPLORATION <8 I-EXPLORATION U/l, I-EXPLORATION Colesterol I-EXPLORATION total I-EXPLORATION 232, I-EXPLORATION HDL I-EXPLORATION 28, I-EXPLORATION LDL I-EXPLORATION 168, I-EXPLORATION TG I-EXPLORATION 179, I-EXPLORATION APO I-EXPLORATION B/ I-EXPLORATION APO I-EXPLORATION A1: I-EXPLORATION >1.51. I-EXPLORATION Hemostasia: I-EXPLORATION Quick I-EXPLORATION 100%, I-EXPLORATION Fibrinógeno I-EXPLORATION 335. I-EXPLORATION Orina: I-EXPLORATION 25 I-EXPLORATION leucos/ I-EXPLORATION campo. I-EXPLORATION PTG: I-EXPLORATION Prot I-EXPLORATION total I-EXPLORATION 6, I-EXPLORATION 3 I-EXPLORATION g/l, I-EXPLORATION Alb I-EXPLORATION 64%, I-EXPLORATION Alfa I-EXPLORATION 1-G I-EXPLORATION 3, I-EXPLORATION 5%, I-EXPLORATION Alfa I-EXPLORATION 2-G I-EXPLORATION 9, I-EXPLORATION 8%, I-EXPLORATION Beta-G I-EXPLORATION 11, I-EXPLORATION 2%, I-EXPLORATION Gamma-G I-EXPLORATION 12, I-EXPLORATION 8%. I-EXPLORATION Complemento: I-EXPLORATION C3 I-EXPLORATION 111 I-EXPLORATION (83-177 I-EXPLORATION mg/dl), I-EXPLORATION C4 I-EXPLORATION 27 I-EXPLORATION (15-45). I-EXPLORATION Detección I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION antitejido: I-EXPLORATION Negativa. I-EXPLORATION Complejos I-EXPLORATION inmunocirculantes: I-EXPLORATION Positivos I-EXPLORATION para I-EXPLORATION Ig I-EXPLORATION M. I-EXPLORATION Radiografía I-EXPLORATION tórax/abdomen: I-EXPLORATION Sin I-EXPLORATION hallazgos. I-EXPLORATION Eco-Doppler I-EXPLORATION MMII: I-EXPLORATION Venas I-EXPLORATION ilíacas, I-EXPLORATION femorales I-EXPLORATION y I-EXPLORATION poplíteas I-EXPLORATION permeables, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION y I-EXPLORATION con I-EXPLORATION flujo I-EXPLORATION normal. I-EXPLORATION ECG: I-EXPLORATION RS I-EXPLORATION a I-EXPLORATION 62 I-EXPLORATION ppm, I-EXPLORATION BCRDHH, I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION cara I-EXPLORATION inferior I-EXPLORATION residual. I-EXPLORATION Examen I-EXPLORATION oftalmológico: I-EXPLORATION Normal. I-EXPLORATION EMG I-EXPLORATION (realizado I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 21 I-EXPLORATION días): I-EXPLORATION Se I-EXPLORATION apreció I-EXPLORATION lesión I-EXPLORATION radicular I-EXPLORATION irritativa I-EXPLORATION en I-EXPLORATION evolución I-EXPLORATION S1 I-EXPLORATION derecha I-EXPLORATION leve. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION cutánea I-EXPLORATION de I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION pie I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION pequeñas I-EXPLORATION arteriolas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION dermis I-EXPLORATION media I-EXPLORATION y I-EXPLORATION profunda I-EXPLORATION de I-EXPLORATION cristales I-EXPLORATION de I-EXPLORATION colesterol I-EXPLORATION enclavado I-EXPLORATION intraluminalmente I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION ocasionales I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION fagocitando I-EXPLORATION en I-EXPLORATION parte I-EXPLORATION estos I-EXPLORATION cristales. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION enfermo I-EVOLUTION fue I-EVOLUTION satisfactoria, I-EVOLUTION sin I-EVOLUTION afectación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION y I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION livedo I-EVOLUTION reticularis I-EVOLUTION y I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION coloración I-EVOLUTION violácea I-EVOLUTION de I-EVOLUTION los I-EVOLUTION dedos. I-EVOLUTION Se B-TREATMENT siguió I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT sintomático I-TREATMENT (con I-TREATMENT analgesia I-TREATMENT y I-TREATMENT su I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT cardiopatía I-TREATMENT isquémica) I-TREATMENT y I-TREATMENT fue I-TREATMENT dado I-TREATMENT de I-TREATMENT alta I-TREATMENT siguiéndose I-TREATMENT su I-TREATMENT evolución I-TREATMENT en I-TREATMENT consultas I-TREATMENT externas. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 64 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Dermatología I-DERIVED_FROM/TO por I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO unos I-DERIVED_FROM/TO 45 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO de I-DERIVED_FROM/TO nódulos I-DERIVED_FROM/TO cutáneos I-DERIVED_FROM/TO recidivantes, I-DERIVED_FROM/TO indoloros I-DERIVED_FROM/TO e I-DERIVED_FROM/TO indurados I-DERIVED_FROM/TO localizados I-DERIVED_FROM/TO en I-DERIVED_FROM/TO miembros I-DERIVED_FROM/TO inferiores. I-DERIVED_FROM/TO No B-EXPLORATION impresionaba I-EXPLORATION de I-EXPLORATION enfermedad, I-EXPLORATION ni I-EXPLORATION refería I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION fiebre, I-EXPLORATION ni I-EXPLORATION síndrome I-EXPLORATION constitucional. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaban I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION placas I-EXPLORATION nodulares I-EXPLORATION subcutáneas I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION a I-EXPLORATION 3 I-EXPLORATION cm. I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION eritemato-violáceas, I-EXPLORATION simétricas, I-EXPLORATION duras I-EXPLORATION e I-EXPLORATION indoloras, I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION caras I-EXPLORATION internas I-EXPLORATION de I-EXPLORATION muslos, I-EXPLORATION pantorrilla, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION hombro I-EXPLORATION izquierdo. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION visceromegalias I-EXPLORATION y I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION tromboflebitis I-EXPLORATION superficial I-EXPLORATION en I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION derecho. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION objetivó: I-EXPLORATION leucocitos I-EXPLORATION 12, I-EXPLORATION 3 I-EXPLORATION x I-EXPLORATION 109/L I-EXPLORATION (neutrófilos I-EXPLORATION 6, I-EXPLORATION 8, I-EXPLORATION linfocitos I-EXPLORATION 1, I-EXPLORATION 1, I-EXPLORATION monocitos I-EXPLORATION 4.3, I-EXPLORATION eosinófilos I-EXPLORATION 0, I-EXPLORATION 1), I-EXPLORATION Hb I-EXPLORATION 120 I-EXPLORATION g/L, I-EXPLORATION VCM I-EXPLORATION 109, I-EXPLORATION 8 I-EXPLORATION fL; I-EXPLORATION Hto. I-EXPLORATION 32%; I-EXPLORATION plaquetas I-EXPLORATION 133 I-EXPLORATION x I-EXPLORATION 109/L. I-EXPLORATION Se I-EXPLORATION observaban I-EXPLORATION algunos I-EXPLORATION granulocitos I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION pelgueroide I-EXPLORATION (núcleo I-EXPLORATION no I-EXPLORATION segmentado I-EXPLORATION o I-EXPLORATION hiposegmentado) I-EXPLORATION y I-EXPLORATION anisocitosis I-EXPLORATION discreta. I-EXPLORATION Reticulocitos: I-EXPLORATION 2, I-EXPLORATION 4% I-EXPLORATION (totales I-EXPLORATION 86, I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 109/L), I-EXPLORATION VSG I-EXPLORATION 60 I-EXPLORATION mm/h; I-EXPLORATION inmunoglobulinas, I-EXPLORATION proteinograma, I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION hemostasia, I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION sedimento, I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION hierro, I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION fólico, I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION Eco-doppler I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION inferiores, I-EXPLORATION demostrándose I-EXPLORATION una I-EXPLORATION tromboflebitis I-EXPLORATION superficial I-EXPLORATION de I-EXPLORATION safena I-EXPLORATION interna I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION dicha I-EXPLORATION vena I-EXPLORATION e I-EXPLORATION importante I-EXPLORATION componente I-EXPLORATION edematoso I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION graso I-EXPLORATION circundante, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION profunda. I-EXPLORATION En I-EXPLORATION varios I-EXPLORATION hemogramas I-EXPLORATION posteriores I-EXPLORATION se I-EXPLORATION mantuvo I-EXPLORATION significativamente I-EXPLORATION elevada I-EXPLORATION la I-EXPLORATION cifra I-EXPLORATION de I-EXPLORATION monocitos I-EXPLORATION en I-EXPLORATION sangre. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cutánea I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION en I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION paniculitis I-EXPLORATION granulomatosa I-EXPLORATION panlobular I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION lobulillar I-EXPLORATION tipo I-EXPLORATION eritema I-EXPLORATION indurado I-EXPLORATION de I-EXPLORATION Bazin I-EXPLORATION o I-EXPLORATION vasculitis I-EXPLORATION nodular, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION organizada. I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION batería I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION diagnósticas I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION causas I-EXPLORATION Infecciosas I-EXPLORATION (BK, I-EXPLORATION cultivo I-EXPLORATION y I-EXPLORATION análisis I-EXPLORATION por I-EXPLORATION PCR I-EXPLORATION para I-EXPLORATION Mycobacterium I-EXPLORATION tuberculosis: I-EXPLORATION negativos; I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION infección I-EXPLORATION reciente I-EXPLORATION por I-EXPLORATION Toxoplasma, I-EXPLORATION Legionela, I-EXPLORATION Mycoplasma I-EXPLORATION pneumoniae I-EXPLORATION y I-EXPLORATION para I-EXPLORATION fiebre I-EXPLORATION Q: I-EXPLORATION negativas; I-EXPLORATION ASLO, I-EXPLORATION negativo; I-EXPLORATION Singer I-EXPLORATION Plotz I-EXPLORATION y I-EXPLORATION VDRL, I-EXPLORATION negativos), I-EXPLORATION causas I-EXPLORATION neoplásicas I-EXPLORATION (alfa-feto-proteína, I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario, I-EXPLORATION b2-microglobulina, I-EXPLORATION Ca-19.9, I-EXPLORATION PSA: I-EXPLORATION normales; I-EXPLORATION TAC I-EXPLORATION abdominopélvico: I-EXPLORATION moderado I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION del I-EXPLORATION mesenterio I-EXPLORATION en I-EXPLORATION flanco I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION impronta I-EXPLORATION asas I-EXPLORATION intestinales, I-EXPLORATION en I-EXPLORATION probable I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION paniculitis) I-EXPLORATION y I-EXPLORATION enfermedades I-EXPLORATION sistémicas I-EXPLORATION (factor I-EXPLORATION reumatoideo I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antinúcleo I-EXPLORATION negativos; I-EXPLORATION niveles I-EXPLORATION normales I-EXPLORATION de I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION C4, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva, I-EXPLORATION enzima I-EXPLORATION convertidor I-EXPLORATION de I-EXPLORATION angiotensina I-EXPLORATION y I-EXPLORATION alfa-1 I-EXPLORATION antitripsina). I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Ziehl-Neelsen I-EXPLORATION en I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION biopsia I-EXPLORATION cutánea I-EXPLORATION (pues I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION microscópica I-EXPLORATION observada I-EXPLORATION debe I-EXPLORATION establecerse I-EXPLORATION principalmente I-EXPLORATION con I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION cutánea I-EXPLORATION por I-EXPLORATION micobacterias) I-EXPLORATION fue I-EXPLORATION así I-EXPLORATION mismo I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION La B-DERIVED_FROM/TO presencia I-DERIVED_FROM/TO en I-DERIVED_FROM/TO sangre I-DERIVED_FROM/TO de I-DERIVED_FROM/TO formas I-DERIVED_FROM/TO granulocíticas I-DERIVED_FROM/TO displásicas I-DERIVED_FROM/TO motivó I-DERIVED_FROM/TO que I-DERIVED_FROM/TO el I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fuera I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO Servicio, I-DERIVED_FROM/TO en B-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION aspirado I-EXPLORATION medular, I-EXPLORATION observándose I-EXPLORATION una I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION hipercelular I-EXPLORATION con I-EXPLORATION megacariocitos I-EXPLORATION conservados I-EXPLORATION y I-EXPLORATION algún I-EXPLORATION micromegacariocito I-EXPLORATION ocasionalmente, I-EXPLORATION destacando I-EXPLORATION una I-EXPLORATION hiperplasia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION serie I-EXPLORATION monocítica I-EXPLORATION (21% I-EXPLORATION de I-EXPLORATION la I-EXPLORATION celularidad I-EXPLORATION medular I-EXPLORATION global, I-EXPLORATION entre I-EXPLORATION promonocitos I-EXPLORATION y I-EXPLORATION monocitos) I-EXPLORATION e I-EXPLORATION hipoplasia I-EXPLORATION moderada I-EXPLORATION de I-EXPLORATION la I-EXPLORATION serie I-EXPLORATION roja I-EXPLORATION (13%) I-EXPLORATION con I-EXPLORATION displasia I-EXPLORATION leve I-EXPLORATION (puentes I-EXPLORATION intercitoplasmáticos I-EXPLORATION y I-EXPLORATION algunas I-EXPLORATION formas I-EXPLORATION gigantes), I-EXPLORATION y I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION una I-EXPLORATION disgranulopoyesis I-EXPLORATION significativa I-EXPLORATION (citoplasmas I-EXPLORATION francamente I-EXPLORATION agranulares, I-EXPLORATION frecuentes I-EXPLORATION elementos I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION pelgueroide, I-EXPLORATION asincronismo I-EXPLORATION madurativo I-EXPLORATION núcleo-citoplasmático I-EXPLORATION y I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION formas I-EXPLORATION madurativas I-EXPLORATION intermedias); I-EXPLORATION la I-EXPLORATION blastosis I-EXPLORATION constituía I-EXPLORATION sólo I-EXPLORATION un I-EXPLORATION 3%. I-EXPLORATION El I-EXPLORATION cariotipo I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION 46XY. I-EXPLORATION Con I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION el I-EXPLORATION enfermo I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION de I-EXPLORATION LMMC I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION cutánea I-EXPLORATION inespecífica I-EXPLORATION tipo I-EXPLORATION paniculitis I-EXPLORATION lobulillar. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT corticoides I-TREATMENT orales I-TREATMENT (prednisona I-TREATMENT 30 I-TREATMENT mg/día, I-TREATMENT con I-TREATMENT pauta I-TREATMENT de I-TREATMENT descenso I-TREATMENT semanal), I-TREATMENT resolviéndose I-TREATMENT las I-TREATMENT lesiones I-TREATMENT cutáneas I-TREATMENT pocos I-TREATMENT días I-TREATMENT después I-TREATMENT de I-TREATMENT comenzar I-TREATMENT este I-TREATMENT tratamiento. I-TREATMENT En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION tres I-EVOLUTION años I-EVOLUTION después I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION tratamiento I-EVOLUTION desde I-EVOLUTION entonces, I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION anemia I-EVOLUTION leve, I-EVOLUTION VCM I-EVOLUTION 110.9 I-EVOLUTION fL, I-EVOLUTION plaquetas I-EVOLUTION 143 I-EVOLUTION x I-EVOLUTION 109/L, I-EVOLUTION y I-EVOLUTION monocitosis I-EVOLUTION de I-EVOLUTION 2, I-EVOLUTION 3 I-EVOLUTION x I-EVOLUTION 109/L I-EVOLUTION en I-EVOLUTION sangre, I-EVOLUTION haciéndose I-EVOLUTION controles I-EVOLUTION trimestrales; I-EVOLUTION en I-EVOLUTION médula I-EVOLUTION ósea I-EVOLUTION persiste I-EVOLUTION la I-EVOLUTION displasia I-EVOLUTION trilineal I-EVOLUTION con I-EVOLUTION una I-EVOLUTION blastosis I-EVOLUTION del I-EVOLUTION 6% I-EVOLUTION y I-EVOLUTION un I-EVOLUTION componente I-EVOLUTION monocítico I-EVOLUTION del I-EVOLUTION 25%. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colecistectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY artrosis I-PAST_MEDICAL_HISTORY poliarticular I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ibuprofeno. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS acuosa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS este I-PRESENT_ILLNESS tiempo. I-PRESENT_ILLNESS Exploración B-EXPLORATION física: I-EXPLORATION anodina. I-EXPLORATION Pruebas I-EXPLORATION complementarias: I-EXPLORATION hematimetría, I-EXPLORATION coagulación, I-EXPLORATION bioquímica I-EXPLORATION completa I-EXPLORATION con I-EXPLORATION ionograma, I-EXPLORATION transaminasas I-EXPLORATION hepáticas, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION total: I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION TSH I-EXPLORATION y I-EXPLORATION hormonas I-EXPLORATION tiroideas: I-EXPLORATION valores I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION Niveles I-EXPLORATION plasmáticos I-EXPLORATION de I-EXPLORATION péptido I-EXPLORATION intestinal I-EXPLORATION vasoactivo I-EXPLORATION (VIP): I-EXPLORATION 5 I-EXPLORATION pg/ml I-EXPLORATION (valores I-EXPLORATION normales: I-EXPLORATION 0-70 I-EXPLORATION pg/ml). I-EXPLORATION Niveles I-EXPLORATION de I-EXPLORATION ácido I-EXPLORATION 5-hidroxindol-acético I-EXPLORATION (5HIAA) I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas: I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION mg/24 I-EXPLORATION horas I-EXPLORATION (las I-EXPLORATION cifras I-EXPLORATION normales I-EXPLORATION son I-EXPLORATION inferiores I-EXPLORATION a I-EXPLORATION 10 I-EXPLORATION mg/24 I-EXPLORATION horas). I-EXPLORATION PCR: I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION (cifras I-EXPLORATION normales I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION laboratorio I-EXPLORATION hasta I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION mg/dl), I-EXPLORATION VSG: I-EXPLORATION 46 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION 1ª I-EXPLORATION hora. I-EXPLORATION Anticuerpos I-EXPLORATION antiendomisio I-EXPLORATION y I-EXPLORATION antigliadina I-EXPLORATION negativos I-EXPLORATION Leucocitos I-EXPLORATION en I-EXPLORATION heces: I-EXPLORATION negativos. I-EXPLORATION Coprocultivos, I-EXPLORATION e I-EXPLORATION investigación I-EXPLORATION de I-EXPLORATION Cl I-EXPLORATION difficile, I-EXPLORATION de I-EXPLORATION parásitos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION huevos I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION en I-EXPLORATION heces: I-EXPLORATION negativos. I-EXPLORATION Tránsito I-EXPLORATION esófago-gastro-duodenal I-EXPLORATION (TEGD): I-EXPLORATION normal. I-EXPLORATION Ecografía I-EXPLORATION abdominal: I-EXPLORATION normal I-EXPLORATION salvo I-EXPLORATION aerobilia I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION vesícula I-EXPLORATION biliar. I-EXPLORATION Colonoscopia I-EXPLORATION e I-EXPLORATION ileoscopia: I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION macroscópicas. I-EXPLORATION Se I-EXPLORATION toman I-EXPLORATION 6 I-EXPLORATION biopsias I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION (incluido I-EXPLORATION sigma I-EXPLORATION y I-EXPLORATION recto), I-EXPLORATION observándose I-EXPLORATION en I-EXPLORATION todas I-EXPLORATION ellas I-EXPLORATION un I-EXPLORATION importante I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION con I-EXPLORATION gran I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION intraepiteliales. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY kg I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY artralgias I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hombros I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY rodillas. I-PAST_MEDICAL_HISTORY Había B-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS brotes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS episódica I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS patológicos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS febrícula. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION advirtió I-EXPLORATION una I-EXPLORATION hiperpigmentación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION desnutrición I-EXPLORATION importante. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION básica I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION microcítica, I-EXPLORATION eosinofilia I-EXPLORATION en I-EXPLORATION sangre, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION (VSG) I-EXPLORATION 57 I-EXPLORATION seg, I-EXPLORATION albúmina I-EXPLORATION 2, I-EXPLORATION 46 I-EXPLORATION g/dl, I-EXPLORATION colesterol I-EXPLORATION 82mg/dl, I-EXPLORATION sideremia I-EXPLORATION 12 I-EXPLORATION mcg/dl, I-EXPLORATION ferritina I-EXPLORATION 12 I-EXPLORATION ng/ml, I-EXPLORATION Van I-EXPLORATION de I-EXPLORATION Kamer I-EXPLORATION 9, I-EXPLORATION 2 I-EXPLORATION g I-EXPLORATION de I-EXPLORATION grasa/día. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION (TAC) I-EXPLORATION mostró I-EXPLORATION gran I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION adenopatías I-EXPLORATION retroperitoneales I-EXPLORATION y I-EXPLORATION mesentéricas I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION significativo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION oral I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION y I-EXPLORATION un I-EXPLORATION punteado I-EXPLORATION blanquecino I-EXPLORATION en I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION duodenal. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION duodenal I-EXPLORATION demostró I-EXPLORATION macrófagos I-EXPLORATION positivos I-EXPLORATION al I-EXPLORATION ácido I-EXPLORATION peryódico I-EXPLORATION de I-EXPLORATION Schiff I-EXPLORATION (PAS) I-EXPLORATION y I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Ziehl I-EXPLORATION negativa, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Whipple. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT se I-TREATMENT empezó I-TREATMENT a I-TREATMENT tratar I-TREATMENT con I-TREATMENT penicilina I-TREATMENT y I-TREATMENT estreptomicina I-TREATMENT 15 I-TREATMENT días I-TREATMENT y I-TREATMENT luego I-TREATMENT trimetroprim-sulfametoxazol I-TREATMENT (TM-SF) I-TREATMENT pero I-TREATMENT presentó I-TREATMENT una I-TREATMENT reacción I-TREATMENT urticarial, I-TREATMENT por I-TREATMENT la I-TREATMENT cual I-TREATMENT hubo I-TREATMENT que I-TREATMENT suspender I-TREATMENT este I-TREATMENT último, I-TREATMENT pasando I-TREATMENT a I-TREATMENT doxiciclina. I-TREATMENT Tuvo B-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION aumentó I-EVOLUTION de I-EVOLUTION peso, I-EVOLUTION pero I-EVOLUTION al I-EVOLUTION persistir I-EVOLUTION los I-EVOLUTION macrófagos I-EVOLUTION PAS I-EVOLUTION positivos I-EVOLUTION en I-EVOLUTION la I-EVOLUTION biopsia, I-EVOLUTION se I-EVOLUTION repiten I-EVOLUTION hasta I-EVOLUTION dos I-EVOLUTION ciclos I-EVOLUTION más I-EVOLUTION de I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION penicilina I-EVOLUTION y I-EVOLUTION estreptomicina. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION tuvo I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION inestabilidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION marcha I-EVOLUTION y I-EVOLUTION sensación I-EVOLUTION de I-EVOLUTION mareo I-EVOLUTION secundarios I-EVOLUTION a I-EVOLUTION toxicidad I-EVOLUTION laberíntica I-EVOLUTION por I-EVOLUTION estreptomicina, I-EVOLUTION que I-EVOLUTION inicialmente I-EVOLUTION planteó I-EVOLUTION diagnóstico I-EVOLUTION diferencial I-EVOLUTION con I-EVOLUTION afectación I-EVOLUTION neurológica I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION Se B-TREATMENT retiró I-TREATMENT entonces I-TREATMENT la I-TREATMENT doxiciclina, I-TREATMENT por I-TREATMENT asociarse I-TREATMENT a I-TREATMENT mayor I-TREATMENT número I-TREATMENT de I-TREATMENT recidivas, I-TREATMENT y I-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT cefixima. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION cumplió I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antibiótico I-EVOLUTION estando I-EVOLUTION asintomático I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS torácico. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS recurrentes I-PRESENT_ILLNESS similares I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ocasión I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY diagnosticó I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY probable I-PAST_MEDICAL_HISTORY abdomen I-PAST_MEDICAL_HISTORY agudo, I-PAST_MEDICAL_HISTORY habiendo I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY punto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY laparotomizado. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS ºC, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS pleurítico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemitórax I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION doloroso, I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacaba I-EXPLORATION PCR I-EXPLORATION 25 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION leucocitos I-EXPLORATION 18.109/ml I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION datos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION apendicitis I-EXPLORATION aguda. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT analgésico I-TREATMENT con I-TREATMENT remisión I-TREATMENT del I-TREATMENT cuadro I-TREATMENT en I-TREATMENT 24 I-TREATMENT horas, I-TREATMENT siendo I-TREATMENT dado I-TREATMENT de I-TREATMENT alta. I-TREATMENT Posteriormente B-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION ambulatorio I-EXPLORATION con I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION fibrocolonoscopia I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION remisión I-EXPLORATION total I-EXPLORATION de I-EXPLORATION la I-EXPLORATION clínica, I-EXPLORATION los I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION episodios I-EXPLORATION recurrentes I-EXPLORATION y I-EXPLORATION la I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION practicadas I-EXPLORATION se I-EXPLORATION orientó I-EXPLORATION como I-EXPLORATION una I-EXPLORATION posible I-EXPLORATION FMF, I-EXPLORATION procediéndose I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION genético. I-EXPLORATION Este I-EXPLORATION mostró I-EXPLORATION dos I-EXPLORATION mutaciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION MEFV: I-EXPLORATION una I-EXPLORATION en I-EXPLORATION el I-EXPLORATION exón I-EXPLORATION 2, I-EXPLORATION detectándose I-EXPLORATION la I-EXPLORATION sustitución I-EXPLORATION del I-EXPLORATION nucleótido I-EXPLORATION guanina I-EXPLORATION por I-EXPLORATION citosina I-EXPLORATION en I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION posición I-EXPLORATION del I-EXPLORATION triplete I-EXPLORATION 148, I-EXPLORATION dando I-EXPLORATION lugar I-EXPLORATION al I-EXPLORATION cambio I-EXPLORATION de I-EXPLORATION aminoácido I-EXPLORATION glutámico I-EXPLORATION por I-EXPLORATION glutamina. I-EXPLORATION Dicha I-EXPLORATION mutuación I-EXPLORATION recibe I-EXPLORATION el I-EXPLORATION nombre I-EXPLORATION de I-EXPLORATION E148Q, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION en I-EXPLORATION un I-EXPLORATION solo I-EXPLORATION alelo, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION heterozigoto I-EXPLORATION para I-EXPLORATION esta I-EXPLORATION mutuación. I-EXPLORATION Se I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION mutuación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION exón I-EXPLORATION 10, I-EXPLORATION que I-EXPLORATION consistía I-EXPLORATION en I-EXPLORATION la I-EXPLORATION sustitución I-EXPLORATION del I-EXPLORATION nucleótido I-EXPLORATION guanina I-EXPLORATION por I-EXPLORATION adenina I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION posición I-EXPLORATION del I-EXPLORATION triplete I-EXPLORATION 694, I-EXPLORATION dando I-EXPLORATION lugar I-EXPLORATION al I-EXPLORATION cambio I-EXPLORATION de I-EXPLORATION aminoácido I-EXPLORATION metionina I-EXPLORATION por I-EXPLORATION isoleucina. I-EXPLORATION Dicha I-EXPLORATION mutuación I-EXPLORATION recibe I-EXPLORATION el I-EXPLORATION nombre I-EXPLORATION de I-EXPLORATION M694I I-EXPLORATION y I-EXPLORATION también I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION en I-EXPLORATION un I-EXPLORATION solo I-EXPLORATION alelo, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION también I-EXPLORATION heterozigoto I-EXPLORATION para I-EXPLORATION esta I-EXPLORATION mutuación. I-EXPLORATION Ambas I-EXPLORATION mutaciones I-EXPLORATION están I-EXPLORATION descritas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION FMF. I-EXPLORATION Asimismo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION exón I-EXPLORATION 3 I-EXPLORATION de I-EXPLORATION la I-EXPLORATION proteina I-EXPLORATION sérica I-EXPLORATION del I-EXPLORATION amiloide I-EXPLORATION SAA-1, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION genotipo I-EXPLORATION alfa/beta, I-EXPLORATION considerado I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION riesgo I-EXPLORATION para I-EXPLORATION el I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION amiloidosis. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT colchicina I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/día I-TREATMENT con B-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION y I-EVOLUTION desaparición I-EVOLUTION paulatina I-EVOLUTION de I-EVOLUTION las I-EVOLUTION crisis. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS mestiza, B-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ingresó I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY primera I-PAST_MEDICAL_HISTORY vez I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY febrero I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1999 I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY hospital. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY diez I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY comenzado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY rodillas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tobillos, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY aparentes I-PAST_MEDICAL_HISTORY signos I-PAST_MEDICAL_HISTORY inflamatorios, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY aliviaban I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Indometacina I-PAST_MEDICAL_HISTORY y, I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY acompañaba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY astenia. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY llegara I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY etiológico. I-PAST_MEDICAL_HISTORY Este B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS articular I-PRESENT_ILLNESS evolucionaba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS episodios, I-PRESENT_ILLNESS acompañándose I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS anemia I-PRESENT_ILLNESS comprobada. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION sólo I-EXPLORATION mostró I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mucosas, I-EXPLORATION ligero I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION tobillos, I-EXPLORATION adenopatía I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm, I-EXPLORATION movible I-EXPLORATION y I-EXPLORATION elástica I-EXPLORATION en I-EXPLORATION región I-EXPLORATION inguinal I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION ingreso I-EXPLORATION fueron I-EXPLORATION los I-EXPLORATION siguientes: I-EXPLORATION hemoglobina I-EXPLORATION 98 I-EXPLORATION g/l, I-EXPLORATION hematocrito I-EXPLORATION 30 I-EXPLORATION vol%, I-EXPLORATION leucograma I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION normales, I-EXPLORATION reticolocitos, I-EXPLORATION glucemias, I-EXPLORATION creatinina, I-EXPLORATION TGO I-EXPLORATION y I-EXPLORATION TGP, I-EXPLORATION fosfatasa I-EXPLORATION alcalina, I-EXPLORATION TP I-EXPLORATION y I-EXPLORATION TPT, I-EXPLORATION todos I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hipergammaglobulinemia I-EXPLORATION 32, I-EXPLORATION 85 I-EXPLORATION g/l, I-EXPLORATION eritrosedimentación I-EXPLORATION 115 I-EXPLORATION mm/h I-EXPLORATION y I-EXPLORATION 106 I-EXPLORATION en I-EXPLORATION la I-EXPLORATION segunda I-EXPLORATION oportunidad. I-EXPLORATION El I-EXPLORATION ultrasonido I-EXPLORATION de I-EXPLORATION hemiabdomen I-EXPLORATION superior I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION ninguna I-EXPLORATION alteración. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION diagnóstico I-EVOLUTION preciso. I-EVOLUTION Reingresa I-EVOLUTION en I-EVOLUTION enero I-EVOLUTION del I-EVOLUTION 2004 I-EVOLUTION por I-EVOLUTION astenia I-EVOLUTION y I-EVOLUTION fiebre I-EVOLUTION de I-EVOLUTION 38 I-EVOLUTION a I-EVOLUTION 39 I-EVOLUTION ºC I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION periódica I-EVOLUTION de I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION duración I-EVOLUTION con I-EVOLUTION intervalos I-EVOLUTION de I-EVOLUTION remisiones I-EVOLUTION espontáneas I-EVOLUTION cada I-EVOLUTION dos I-EVOLUTION o I-EVOLUTION tres I-EVOLUTION meses. I-EVOLUTION Mantenía I-EVOLUTION dolores I-EVOLUTION articulares I-EVOLUTION en I-EVOLUTION rodillas I-EVOLUTION y I-EVOLUTION tobillos I-EVOLUTION que I-EVOLUTION mejoraban I-EVOLUTION con I-EVOLUTION medicamentos I-EVOLUTION antinflamatorios I-EVOLUTION no I-EVOLUTION esteroideos. I-EVOLUTION I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION en I-EXPLORATION región I-EXPLORATION supraclavicular I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION fija I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION profundos. I-EXPLORATION I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION hemoglobina I-EXPLORATION 110 I-EXPLORATION g/l, I-EXPLORATION eritrosedimentación I-EXPLORATION 130 I-EXPLORATION mm/h, I-EXPLORATION hipergammaglobulinemia I-EXPLORATION policlonal I-EXPLORATION de I-EXPLORATION 36 I-EXPLORATION g/l; I-EXPLORATION medulograma: I-EXPLORATION médula I-EXPLORATION reactiva I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION plasmocitos. I-EXPLORATION Ultrasonido I-EXPLORATION de I-EXPLORATION abdomen: I-EXPLORATION ligera I-EXPLORATION hepatomegalia I-EXPLORATION difusa I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ecorrefringencia; I-EXPLORATION placa I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION ensanchamiento I-EXPLORATION del I-EXPLORATION contorno I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION del I-EXPLORATION mediastino; I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION mediastino: I-EXPLORATION adenomegalia I-EXPLORATION en I-EXPLORATION mediastino I-EXPLORATION superior I-EXPLORATION derecho, I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION los I-EXPLORATION campos I-EXPLORATION pulmonares. I-EXPLORATION I-EXPLORATION Biopsia I-EXPLORATION de I-EXPLORATION ganglio I-EXPLORATION linfático I-EXPLORATION cervical: I-EXPLORATION pérdida I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arquitectura I-EXPLORATION con I-EXPLORATION hiperplasia I-EXPLORATION linfoide I-EXPLORATION focal I-EXPLORATION marcada I-EXPLORATION y I-EXPLORATION expansión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION interfolicular, I-EXPLORATION ocupada I-EXPLORATION por I-EXPLORATION abundantes I-EXPLORATION plasmocitos I-EXPLORATION y I-EXPLORATION cuerpos I-EXPLORATION de I-EXPLORATION Russel. I-EXPLORATION I-EXPLORATION Inmunohistoquímica: I-EXPLORATION CD20 I-EXPLORATION positivo I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION T, I-EXPLORATION kappa I-EXPLORATION y I-EXPLORATION lambda I-EXPLORATION positivo I-EXPLORATION en I-EXPLORATION plasmocitos. I-EXPLORATION I-EXPLORATION Conclusiones: I-EXPLORATION EC I-EXPLORATION plasmocelular. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT consistió I-TREATMENT en I-TREATMENT un I-TREATMENT esquema I-TREATMENT de I-TREATMENT poliquimioterapia I-TREATMENT con I-TREATMENT adriamicina, I-TREATMENT vincristina, I-TREATMENT bleomicina I-TREATMENT y I-TREATMENT prednisona I-TREATMENT y B-EVOLUTION fue I-EVOLUTION egresada I-EVOLUTION para I-EVOLUTION seguimiento I-EVOLUTION ambulatorio. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS usuaria B-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY drogas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY parenteral, I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY VHC I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antirretroviral I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY resolución. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY (hacía I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY mes), I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY droga I-PAST_MEDICAL_HISTORY (heroína), I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY foliculitis I-PAST_MEDICAL_HISTORY candidiásica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY costocondritis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2º I-PAST_MEDICAL_HISTORY arco I-PAST_MEDICAL_HISTORY costal I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY respectivamente. I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fluconazol I-PAST_MEDICAL_HISTORY 400 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY precisando, I-PAST_MEDICAL_HISTORY además, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cartílago I-PAST_MEDICAL_HISTORY costal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY trayecto I-PAST_MEDICAL_HISTORY fistuloso. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS explicaba I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS productiva I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS purulenta, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS características I-PRESENT_ILLNESS pleuríticas, I-PRESENT_ILLNESS adelgazamiento I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuantificado I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS característica I-PRESENT_ILLNESS mecánicas. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION no I-EXPLORATION impresionaba I-EXPLORATION de I-EXPLORATION afectada, I-EXPLORATION destacando I-EXPLORATION semiología I-EXPLORATION de I-EXPLORATION neumonía I-EXPLORATION en I-EXPLORATION 1/3 I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION hemotórax I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION apófisis I-EXPLORATION espinosas I-EXPLORATION de I-EXPLORATION última I-EXPLORATION vértebra I-EXPLORATION dorsal I-EXPLORATION y I-EXPLORATION primeras I-EXPLORATION lumbares. I-EXPLORATION I-EXPLORATION En I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION complementarios: I-EXPLORATION leucocitos I-EXPLORATION 11.800 I-EXPLORATION (67%N), I-EXPLORATION hemoglobina I-EXPLORATION 10, I-EXPLORATION 6, I-EXPLORATION hematocrito I-EXPLORATION 34, I-EXPLORATION VCM I-EXPLORATION 123 I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION normales. I-EXPLORATION VSG I-EXPLORATION de I-EXPLORATION 117 I-EXPLORATION mm I-EXPLORATION a I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION hora. I-EXPLORATION Los I-EXPLORATION parámetros I-EXPLORATION bioquímicos I-EXPLORATION de I-EXPLORATION rutina, I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION elemental I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION alteraciones. I-EXPLORATION Las I-EXPLORATION determinaciones I-EXPLORATION de I-EXPLORATION subpoblaciones I-EXPLORATION linfocitarias I-EXPLORATION CD4 I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 944/mm3 I-EXPLORATION y I-EXPLORATION la I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION de I-EXPLORATION VIH I-EXPLORATION indetectable. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION microbiológicos, I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION brucella I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION constataron I-EXPLORATION vegetaciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION ecocardiográfica. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION radioopacidad I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION inferior I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION asociado. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION microbiológicos I-EXPLORATION de I-EXPLORATION esputo I-EXPLORATION resultaron I-EXPLORATION estériles I-EXPLORATION con I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION BAAR I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION (exudado I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION mononuclear) I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION candida I-EXPLORATION albicans. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Tac I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION dorso-lumbar I-EXPLORATION se I-EXPLORATION hallaron I-EXPLORATION signos I-EXPLORATION radiológicos I-EXPLORATION de I-EXPLORATION espondilodiscitis I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION D-11, I-EXPLORATION D-12 I-EXPLORATION y I-EXPLORATION L-1, I-EXPLORATION como I-EXPLORATION de I-EXPLORATION espacios I-EXPLORATION intervertebrales I-EXPLORATION D10-D11, I-EXPLORATION D11-D12 I-EXPLORATION y I-EXPLORATION D12-L1, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos I-EXPLORATION paravertebral I-EXPLORATION y I-EXPLORATION afectación I-EXPLORATION intrarraquídea I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION epidural I-EXPLORATION anterior. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION punción I-EXPLORATION directa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION paravertebral. I-EXPLORATION Se I-EXPLORATION obtuvo I-EXPLORATION material I-EXPLORATION purulento I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION la I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION BAAR I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Candida I-EXPLORATION albicans. I-EXPLORATION Se B-TREATMENT establecieron I-TREATMENT medidas I-TREATMENT ortésicas I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT secuencial I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT liposomal I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 150 I-TREATMENT mg/día I-TREATMENT durante I-TREATMENT 20 I-TREATMENT días, I-TREATMENT seguido I-TREATMENT de I-TREATMENT fluconazol I-TREATMENT 400 I-TREATMENT mg/día I-TREATMENT durante I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 6 I-TREATMENT meses, I-TREATMENT evolucionando B-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION radiológica I-EVOLUTION (tanto I-EVOLUTION de I-EVOLUTION la I-EVOLUTION neumonía I-EVOLUTION como I-EVOLUTION del I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION y I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION de I-EVOLUTION espondilodiscitis I-EVOLUTION con I-EVOLUTION afectación I-EVOLUTION de I-EVOLUTION cuerpos I-EVOLUTION vertebrales). I-EVOLUTION I-EVOLUTION En I-EVOLUTION la I-EVOLUTION Tabla I-EVOLUTION I I-EVOLUTION se I-EVOLUTION exponen I-EVOLUTION diversas I-EVOLUTION características I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION casos. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 31 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumadora B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY paquetes/año, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anticonceptivos I-PAST_MEDICAL_HISTORY orales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY intermitente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS octubre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1997 I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS orinas I-PRESENT_ILLNESS colúricas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS heces I-PRESENT_ILLNESS acólicas. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION eritema I-EXPLORATION palmar I-EXPLORATION bilateral, I-EXPLORATION ictericia I-EXPLORATION y I-EXPLORATION hepatomegalia. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION (ecografía I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION abdominal) I-EXPLORATION se I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION hepatomegalia I-EXPLORATION homogénea. I-EXPLORATION Los I-EXPLORATION análisis I-EXPLORATION practicados I-EXPLORATION demostraron: I-EXPLORATION GOT I-EXPLORATION 384 I-EXPLORATION UI/L, I-EXPLORATION GPT I-EXPLORATION 496 I-EXPLORATION UI/L, I-EXPLORATION GGT I-EXPLORATION 78 I-EXPLORATION UI/L, I-EXPLORATION FA I-EXPLORATION 553 I-EXPLORATION UI/L I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION 11, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION (directa I-EXPLORATION 4, I-EXPLORATION 8 I-EXPLORATION mg/dl), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION hipergammaglobulinemia I-EXPLORATION policlonal, I-EXPLORATION con I-EXPLORATION 3030 I-EXPLORATION mg/dl I-EXPLORATION de I-EXPLORATION IgG. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION a I-EXPLORATION VHA, I-EXPLORATION VHB I-EXPLORATION y I-EXPLORATION VHC I-EXPLORATION resultaron I-EXPLORATION negativas. I-EXPLORATION Los I-EXPLORATION ANA I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Los I-EXPLORATION AMA I-EXPLORATION resultaron I-EXPLORATION positivos I-EXPLORATION (1/1280), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION los I-EXPLORATION ASMA I-EXPLORATION (1/320), I-EXPLORATION Anti-LKM1 I-EXPLORATION (1/640) I-EXPLORATION y I-EXPLORATION ANCA I-EXPLORATION (1/40). I-EXPLORATION Se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION leve I-EXPLORATION distorsión I-EXPLORATION focal I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION bandas I-EXPLORATION fibrosas I-EXPLORATION porto-portales I-EXPLORATION ocasionales, I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION linfocitario I-EXPLORATION en I-EXPLORATION los I-EXPLORATION espacios I-EXPLORATION porta I-EXPLORATION formando I-EXPLORATION folículos I-EXPLORATION linfoides, I-EXPLORATION en I-EXPLORATION ocasiones I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION los I-EXPLORATION ductos I-EXPLORATION biliares. I-EXPLORATION Dicho I-EXPLORATION infiltrado I-EXPLORATION traspasaba I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION porta, I-EXPLORATION observándose I-EXPLORATION necrosis I-EXPLORATION "piecemeal" I-EXPLORATION moderada/severa. I-EXPLORATION Se I-EXPLORATION apreciaron I-EXPLORATION hepatocitos I-EXPLORATION alrededor I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION porta I-EXPLORATION con I-EXPLORATION acúmulo I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION transportadora I-EXPLORATION de I-EXPLORATION cobre, I-EXPLORATION e I-EXPLORATION incremento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION celularidad I-EXPLORATION inflamatoria I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lobulillo, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION sinusoides I-EXPLORATION como I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima, I-EXPLORATION con I-EXPLORATION citolisis I-EXPLORATION e I-EXPLORATION incremento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION trama I-EXPLORATION fibrosa I-EXPLORATION intersticial. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT 30 I-TREATMENT mg I-TREATMENT de I-TREATMENT prednisona I-TREATMENT con I-TREATMENT posterior I-TREATMENT reducción I-TREATMENT de I-TREATMENT su I-TREATMENT dosis, I-TREATMENT 50 I-TREATMENT mg I-TREATMENT de I-TREATMENT azatioprina I-TREATMENT y I-TREATMENT ácido I-TREATMENT ursodesoxicólico. I-TREATMENT Se B-EVOLUTION produjo I-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION clínico I-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION los I-EVOLUTION análisis, I-EVOLUTION persistiendo I-EVOLUTION discretamente I-EVOLUTION elevadas, I-EVOLUTION después I-EVOLUTION de I-EVOLUTION seis I-EVOLUTION años I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION la I-EVOLUTION FA I-EVOLUTION y I-EVOLUTION la I-EVOLUTION GGT. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que B-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO cuando I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO detectó I-DERIVED_FROM/TO un I-DERIVED_FROM/TO bloqueo I-DERIVED_FROM/TO auriculoventricular I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tercer I-DERIVED_FROM/TO grado I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO un I-DERIVED_FROM/TO examen I-DERIVED_FROM/TO rutinario. I-DERIVED_FROM/TO La B-TREATMENT paciente I-TREATMENT quedó I-TREATMENT ingresada I-TREATMENT y I-TREATMENT se I-TREATMENT implantó I-TREATMENT un I-TREATMENT marcapasos I-TREATMENT temporal I-TREATMENT endovenoso I-TREATMENT 7F I-TREATMENT (electrodos I-TREATMENT de I-TREATMENT platino) I-TREATMENT en I-TREATMENT el I-TREATMENT ventrículo I-TREATMENT derecho I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT yugular I-TREATMENT interna I-TREATMENT derecha. I-TREATMENT Fue I-TREATMENT necesario I-TREATMENT recolocarlo I-TREATMENT en I-TREATMENT cinco I-TREATMENT ocasiones I-TREATMENT durante I-TREATMENT las I-TREATMENT primeras I-TREATMENT 24 I-TREATMENT horas I-TREATMENT debido I-TREATMENT a I-TREATMENT un I-TREATMENT insuficiente I-TREATMENT sensado I-TREATMENT auricular. I-TREATMENT El I-TREATMENT tercer I-TREATMENT día I-TREATMENT de I-TREATMENT ingreso I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT marcapasos I-TREATMENT permanente I-TREATMENT VDD I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT subclavia I-TREATMENT izquierda I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT Al B-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION febrícula I-EVOLUTION y B-TREATMENT fue I-TREATMENT tratada I-TREATMENT ambulatoriamente I-TREATMENT con I-TREATMENT cloxacilina. I-TREATMENT Los B-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Diez B-EVOLUTION días I-EVOLUTION mas I-EVOLUTION tarde, I-EVOLUTION ingresó I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION febrícula I-EVOLUTION intermitente, I-EVOLUTION disnea, I-EVOLUTION tos I-EVOLUTION no I-EVOLUTION productiva I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION pleurítico I-EVOLUTION en I-EVOLUTION hemitórax I-EVOLUTION derecho. I-EVOLUTION La B-EXPLORATION herida I-EXPLORATION quirúrgica I-EXPLORATION estaba I-EXPLORATION limpia I-EXPLORATION e I-EXPLORATION indolora. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION reveló I-EXPLORATION cardiomegalia I-EXPLORATION y I-EXPLORATION un I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho. I-EXPLORATION El I-EXPLORATION ECG I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION bloqueo I-EXPLORATION auriculoventricular I-EXPLORATION de I-EXPLORATION tercer I-EXPLORATION grado I-EXPLORATION con I-EXPLORATION ritmo I-EXPLORATION de I-EXPLORATION escape I-EXPLORATION de I-EXPLORATION marcapasos. I-EXPLORATION No B-TREATMENT había I-TREATMENT sensado I-TREATMENT de I-TREATMENT la I-TREATMENT onda I-TREATMENT P, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT aumentó I-TREATMENT la I-TREATMENT sensibilidad I-TREATMENT del I-TREATMENT electrodo I-TREATMENT auricular I-TREATMENT y I-TREATMENT el I-TREATMENT dispositivo I-TREATMENT funcionó I-TREATMENT adecuadamente. I-TREATMENT Al B-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION tenía I-EVOLUTION mayor I-EVOLUTION disnea, I-EVOLUTION ingurgitación I-EVOLUTION yugular I-EVOLUTION y I-EVOLUTION edemas I-EVOLUTION en I-EVOLUTION miembros I-EVOLUTION inferiores. I-EVOLUTION Se B-EXPLORATION auscultó I-EXPLORATION por I-EXPLORATION primera I-EXPLORATION vez I-EXPLORATION un I-EXPLORATION fuerte I-EXPLORATION roce I-EXPLORATION pericárdico I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION región I-EXPLORATION precordial. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION ecocardiograma I-EXPLORATION se I-EXPLORATION vio I-EXPLORATION un I-EXPLORATION derrame I-EXPLORATION pericárdico I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION sin I-EXPLORATION colapso I-EXPLORATION ventricular I-EXPLORATION derecho. I-EXPLORATION El I-EXPLORATION cable I-EXPLORATION del I-EXPLORATION electrodo I-EXPLORATION estaba I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION tracto I-EXPLORATION de I-EXPLORATION salida I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION proteína I-EXPLORATION C-reactiva I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 153 I-EXPLORATION mg/dl, I-EXPLORATION el I-EXPLORATION fibrinógeno I-EXPLORATION de I-EXPLORATION 659 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION la I-EXPLORATION VSG I-EXPLORATION de I-EXPLORATION 57 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION hora. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION antinucleares, I-EXPLORATION anticuerpos I-EXPLORATION antimúsculo I-EXPLORATION cardiaco, I-EXPLORATION complemento I-EXPLORATION y I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION frente I-EXPLORATION Coxsackie I-EXPLORATION B1 I-EXPLORATION a I-EXPLORATION B6 I-EXPLORATION y I-EXPLORATION Echovirus I-EXPLORATION fueron I-EXPLORATION también I-EXPLORATION negativos. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratada I-TREATMENT con I-TREATMENT diuréticos I-TREATMENT y I-TREATMENT prednisona I-TREATMENT (30 I-TREATMENT mg/día). I-TREATMENT Su B-EVOLUTION estado I-EVOLUTION mejoró I-EVOLUTION rápidamente. I-EVOLUTION Dos I-EVOLUTION semanas I-EVOLUTION después, I-EVOLUTION el I-EVOLUTION roce I-EVOLUTION pericárdico I-EVOLUTION y I-EVOLUTION el I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION habían I-EVOLUTION desaparecido I-EVOLUTION y I-EVOLUTION los I-EVOLUTION marcadores I-EVOLUTION inflamatorios I-EVOLUTION se I-EVOLUTION habían I-EVOLUTION normalizado. I-EVOLUTION La B-TREATMENT dosis I-TREATMENT de I-TREATMENT prednisona I-TREATMENT fue I-TREATMENT reduciéndose I-TREATMENT gradualmente I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT meses I-TREATMENT hasta I-TREATMENT suspender, I-TREATMENT con I-TREATMENT recurrencia I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas I-TREATMENT (dolor I-TREATMENT torácico I-TREATMENT pleurítico I-TREATMENT y I-TREATMENT elevación I-TREATMENT de I-TREATMENT los I-TREATMENT marcadores I-TREATMENT de I-TREATMENT inflamación) I-TREATMENT dos I-TREATMENT meses I-TREATMENT después. I-TREATMENT Se I-TREATMENT trató I-TREATMENT con I-TREATMENT un I-TREATMENT nuevo I-TREATMENT curso I-TREATMENT de I-TREATMENT prednisona I-TREATMENT sin I-TREATMENT recurrencias I-TREATMENT posteriores. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY esencial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY valsartan I-PAST_MEDICAL_HISTORY (80 I-PAST_MEDICAL_HISTORY mg/día), I-PAST_MEDICAL_HISTORY temblor I-PAST_MEDICAL_HISTORY esencial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY propanolol I-PAST_MEDICAL_HISTORY (80 I-PAST_MEDICAL_HISTORY mg/día), I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY venosa I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY miembros I-PAST_MEDICAL_HISTORY inferiores I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY medidas I-PAST_MEDICAL_HISTORY higiénico-posturales, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS externa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Medicina I-PRESENT_ILLNESS Interna I-PRESENT_ILLNESS para I-PRESENT_ILLNESS valoración I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seguimiento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS venosa I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS referir I-PRESENT_ILLNESS ninguna I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION estaba I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION salvo I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION soplo I-EXPLORATION sistólico I-EXPLORATION grado I-EXPLORATION II/VI I-EXPLORATION en I-EXPLORATION borde I-EXPLORATION esternal I-EXPLORATION izquierdo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION cardiaca I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION venosa I-EXPLORATION crónica I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION exploraciones I-EXPLORATION complementarias I-EXPLORATION destacaba I-EXPLORATION hemograma, I-EXPLORATION VSG, I-EXPLORATION coagulación, I-EXPLORATION bioquímica I-EXPLORATION y I-EXPLORATION orina I-EXPLORATION normales. I-EXPLORATION ECG: I-EXPLORATION normal. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION imagen I-EXPLORATION vascular I-EXPLORATION bien I-EXPLORATION delimitada I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION mediastino I-EXPLORATION superior I-EXPLORATION izquierdo. I-EXPLORATION Ecocardiografía I-EXPLORATION doppler: I-EXPLORATION normal. I-EXPLORATION TAC I-EXPLORATION torácica I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION intravenoso: I-EXPLORATION dilatación I-EXPLORATION aneurismática I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 47x75 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos. I-EXPLORATION Cateterismo I-EXPLORATION cardiaco I-EXPLORATION con I-EXPLORATION angiografía I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION coronaria: I-EXPLORATION coronarias I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION aneurismática I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION izquierda. I-EXPLORATION La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Cardiovascular I-DERIVED_FROM/TO de I-DERIVED_FROM/TO referencia, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO sometida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO intervención I-DERIVED_FROM/TO quirúrgica, I-DERIVED_FROM/TO objetivándose B-TREATMENT en I-TREATMENT el I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT una I-TREATMENT arteria I-TREATMENT pulmonar I-TREATMENT derecha I-TREATMENT de I-TREATMENT calibre I-TREATMENT normal I-TREATMENT y I-TREATMENT realizándose I-TREATMENT resección I-TREATMENT parcial I-TREATMENT y I-TREATMENT plicatura I-TREATMENT de I-TREATMENT las I-TREATMENT arterias I-TREATMENT pulmonares I-TREATMENT común I-TREATMENT e I-TREATMENT izquierda I-TREATMENT hasta I-TREATMENT reducir I-TREATMENT a I-TREATMENT un I-TREATMENT diámetro I-TREATMENT de I-TREATMENT 2-3 I-TREATMENT centímetros, I-TREATMENT cursando B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION permaneciendo I-EVOLUTION asintomática I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Dos B-PRESENT_ILLNESS pacientes I-PRESENT_ILLNESS varones I-PRESENT_ILLNESS A I-PRESENT_ILLNESS y I-PRESENT_ILLNESS B, I-PRESENT_ILLNESS diagnosticados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS inflamatoria I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentaron I-PRESENT_ILLNESS urticaria I-PRESENT_ILLNESS generalizada I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mesalazina. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS A, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 31 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS había I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS urticaria I-PRESENT_ILLNESS generalizada I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS toma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mesalazina I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS así B-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY reacciones I-PAST_MEDICAL_HISTORY previas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY urticaria I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY angioedema I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY toma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY AAS I-PAST_MEDICAL_HISTORY (ácido I-PAST_MEDICAL_HISTORY acetilsalicílico). I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS B, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mesalazina, I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS rash I-PRESENT_ILLNESS maculopapuloso I-PRESENT_ILLNESS generalizado, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS retira. I-PRESENT_ILLNESS Seis I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS más I-PRESENT_ILLNESS tarde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS reinicia I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mesalazina, I-PRESENT_ILLNESS aunque I-PRESENT_ILLNESS había I-PRESENT_ILLNESS introducido I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS budesonida I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS oral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rectal. I-PRESENT_ILLNESS Tras I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS todo I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS retirada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS corticoides, I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS urticaria I-PRESENT_ILLNESS generalizada. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Test B-EXPLORATION cutáneos I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION pruebas I-EXPLORATION cutáneas I-EXPLORATION según I-EXPLORATION las I-EXPLORATION recomendaciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Academia I-EXPLORATION Europea I-EXPLORATION de I-EXPLORATION Alergología I-EXPLORATION e I-EXPLORATION Inmunología I-EXPLORATION Clínica I-EXPLORATION (EAACI) I-EXPLORATION (5). I-EXPLORATION Prick I-EXPLORATION a I-EXPLORATION 1/10 I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 1/1 I-EXPLORATION con I-EXPLORATION mesalazina I-EXPLORATION (10 I-EXPLORATION mg/ml I-EXPLORATION de I-EXPLORATION Claversal®) I-EXPLORATION y I-EXPLORATION sulfasalazina I-EXPLORATION (10 I-EXPLORATION mg/ml I-EXPLORATION de I-EXPLORATION Salazopyrina®). I-EXPLORATION Se I-EXPLORATION usó I-EXPLORATION histamina I-EXPLORATION a I-EXPLORATION 1/10 I-EXPLORATION y I-EXPLORATION 1/1 I-EXPLORATION como I-EXPLORATION control I-EXPLORATION positivo. I-EXPLORATION El I-EXPLORATION suero I-EXPLORATION salino I-EXPLORATION en I-EXPLORATION prick I-EXPLORATION se I-EXPLORATION utilizó I-EXPLORATION como I-EXPLORATION control I-EXPLORATION negativo. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION se I-EXPLORATION consideran I-EXPLORATION negativos I-EXPLORATION cuando I-EXPLORATION la I-EXPLORATION pápula I-EXPLORATION obtenida I-EXPLORATION es I-EXPLORATION < I-EXPLORATION o I-EXPLORATION igual I-EXPLORATION a I-EXPLORATION 3 I-EXPLORATION mm I-EXPLORATION o I-EXPLORATION menor I-EXPLORATION que I-EXPLORATION la I-EXPLORATION histamina. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION prick I-EXPLORATION en I-EXPLORATION 10 I-EXPLORATION pacientes I-EXPLORATION sanos I-EXPLORATION no I-EXPLORATION expuestos I-EXPLORATION a I-EXPLORATION 5-ASA I-EXPLORATION previamente. I-EXPLORATION I-EXPLORATION Provocación I-EXPLORATION oral I-EXPLORATION controlada I-EXPLORATION con I-EXPLORATION placebo I-EXPLORATION a I-EXPLORATION simple I-EXPLORATION ciego I-EXPLORATION I-EXPLORATION Tras B-TREATMENT la I-TREATMENT toma I-TREATMENT de I-TREATMENT un I-TREATMENT placebo, I-TREATMENT se I-TREATMENT administran I-TREATMENT dosis I-TREATMENT crecientes I-TREATMENT del I-TREATMENT fármaco I-TREATMENT implicado I-TREATMENT en I-TREATMENT una I-TREATMENT reacción I-TREATMENT durante I-TREATMENT un I-TREATMENT tiempo I-TREATMENT determinado, I-TREATMENT a I-TREATMENT partir I-TREATMENT del I-TREATMENT cual I-TREATMENT se I-TREATMENT llega I-TREATMENT a I-TREATMENT la I-TREATMENT dosis I-TREATMENT deseada I-TREATMENT para I-TREATMENT el I-TREATMENT tratamiento, I-TREATMENT la I-TREATMENT cual I-TREATMENT se I-TREATMENT mantiene I-TREATMENT desde I-TREATMENT entonces. I-TREATMENT I-TREATMENT Se I-TREATMENT deben I-TREATMENT descartar I-TREATMENT enfermedades I-TREATMENT o I-TREATMENT tratamientos I-TREATMENT que I-TREATMENT contraindiquen I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT adrenalina, I-TREATMENT o I-TREATMENT enfermedades I-TREATMENT mal I-TREATMENT controladas I-TREATMENT (hipertensión I-TREATMENT arterial, I-TREATMENT diabetes). I-TREATMENT I-TREATMENT Se I-TREATMENT deben I-TREATMENT suspender I-TREATMENT medicaciones I-TREATMENT que I-TREATMENT puedan I-TREATMENT interferir I-TREATMENT los I-TREATMENT resultados I-TREATMENT de I-TREATMENT las I-TREATMENT pruebas I-TREATMENT (corticoides, I-TREATMENT antihistamínicos, I-TREATMENT etc.). I-TREATMENT I-TREATMENT Si I-TREATMENT aparecen I-TREATMENT reacciones I-TREATMENT durante I-TREATMENT la I-TREATMENT administración, I-TREATMENT como I-TREATMENT urticaria, I-TREATMENT angioedema, I-TREATMENT etc., I-TREATMENT se I-TREATMENT le I-TREATMENT administra I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT preciso I-TREATMENT para I-TREATMENT revertirlas I-TREATMENT en I-TREATMENT cada I-TREATMENT caso I-TREATMENT y I-TREATMENT se I-TREATMENT suspende I-TREATMENT la I-TREATMENT provocación. I-TREATMENT I-TREATMENT "Desensibilización" I-TREATMENT a I-TREATMENT mesalazina I-TREATMENT I-TREATMENT Se I-TREATMENT pide I-TREATMENT consentimiento I-TREATMENT informado I-TREATMENT firmado I-TREATMENT por I-TREATMENT el I-TREATMENT paciente I-TREATMENT para I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT pruebas I-TREATMENT cutáneas I-TREATMENT y I-TREATMENT de I-TREATMENT provocación I-TREATMENT oral. I-TREATMENT I-TREATMENT Se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT de I-TREATMENT forma I-TREATMENT ambulatoria I-TREATMENT el I-TREATMENT protocolo I-TREATMENT de I-TREATMENT desensibilización, I-TREATMENT elaborado I-TREATMENT en I-TREATMENT nuestro I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Alergia I-TREATMENT como I-TREATMENT se I-TREATMENT puede I-TREATMENT observar I-TREATMENT en I-TREATMENT la I-TREATMENT Tabla I-TREATMENT I. I-TREATMENT I-TREATMENT En I-TREATMENT el I-TREATMENT caso I-TREATMENT B, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT budesonida I-TREATMENT en I-TREATMENT enemas I-TREATMENT 7 I-TREATMENT días I-TREATMENT antes I-TREATMENT de I-TREATMENT iniciar I-TREATMENT la I-TREATMENT desensibilización. I-TREATMENT I-TREATMENT Con I-TREATMENT este I-TREATMENT protocolo I-TREATMENT se I-TREATMENT administran I-TREATMENT en I-TREATMENT 17 I-TREATMENT días I-TREATMENT dosis I-TREATMENT (mg) I-TREATMENT crecientes I-TREATMENT de I-TREATMENT mesalazina, I-TREATMENT con I-TREATMENT varias I-TREATMENT dosis I-TREATMENT diarias, I-TREATMENT con I-TREATMENT un I-TREATMENT intervalo I-TREATMENT de I-TREATMENT tiempo I-TREATMENT que I-TREATMENT va I-TREATMENT aumentando I-TREATMENT cada I-TREATMENT día I-TREATMENT (45 I-TREATMENT minutos, I-TREATMENT 1 I-TREATMENT hora I-TREATMENT y I-TREATMENT 8 I-TREATMENT horas). I-TREATMENT Se I-TREATMENT administran I-TREATMENT dosis I-TREATMENT hasta I-TREATMENT alcanzar I-TREATMENT la I-TREATMENT tolerancia I-TREATMENT de I-TREATMENT la I-TREATMENT dosis I-TREATMENT terapéutica I-TREATMENT requerida I-TREATMENT por I-TREATMENT el I-TREATMENT paciente. I-TREATMENT Se I-TREATMENT señala I-TREATMENT en I-TREATMENT la I-TREATMENT tabla I-TREATMENT I I-TREATMENT la I-TREATMENT dosis I-TREATMENT diaria I-TREATMENT tolerada I-TREATMENT y I-TREATMENT la I-TREATMENT acumulada I-TREATMENT (la I-TREATMENT suma I-TREATMENT de I-TREATMENT los I-TREATMENT miligramos I-TREATMENT tolerados I-TREATMENT por I-TREATMENT el I-TREATMENT paciente I-TREATMENT hasta I-TREATMENT ese I-TREATMENT momento). I-TREATMENT I-TREATMENT El I-TREATMENT día I-TREATMENT 17 I-TREATMENT se I-TREATMENT administran I-TREATMENT finalmente I-TREATMENT 1.000 I-TREATMENT mg/1.000 I-TREATMENT mg/1.000 I-TREATMENT mg I-TREATMENT de I-TREATMENT mesalazina I-TREATMENT (3.000 I-TREATMENT mg I-TREATMENT al I-TREATMENT día). I-TREATMENT I-TREATMENT Prick B-EXPLORATION a I-EXPLORATION 1/10 I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 1/1 I-EXPLORATION con I-EXPLORATION mesalazina I-EXPLORATION y I-EXPLORATION sulfasalazina I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION pacientes I-EXPLORATION y I-EXPLORATION en I-EXPLORATION los I-EXPLORATION controles. I-EXPLORATION Provocación I-EXPLORATION oral I-EXPLORATION en I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION A I-EXPLORATION con I-EXPLORATION ácido I-EXPLORATION acetilsalicílico I-EXPLORATION hasta I-EXPLORATION 500 I-EXPLORATION mg, I-EXPLORATION con I-EXPLORATION urticaria I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION cara. I-EXPLORATION "Desensibilización" B-TREATMENT a I-TREATMENT mesalazina I-TREATMENT desarrollado I-TREATMENT en I-TREATMENT 17 I-TREATMENT días, I-TREATMENT con I-TREATMENT tolerancia I-TREATMENT de I-TREATMENT 1.000 I-TREATMENT mg I-TREATMENT de I-TREATMENT mesalazina I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT (3.000 I-TREATMENT mg I-TREATMENT al I-TREATMENT día) I-TREATMENT en I-TREATMENT el I-TREATMENT paciente I-TREATMENT A I-TREATMENT y I-TREATMENT B. I-TREATMENT Desde B-EVOLUTION entonces, I-EVOLUTION y I-EVOLUTION durante I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION existe I-EVOLUTION buena I-EVOLUTION tolerancia I-EVOLUTION a I-EVOLUTION la I-EVOLUTION mesalazina I-EVOLUTION y I-EVOLUTION mantienen I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION dosis I-EVOLUTION tolerada I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION continuada, I-EVOLUTION para I-EVOLUTION evitar I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION nuevas I-EVOLUTION reacciones. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 76 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS fumador B-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY cesó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY hábito, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY habitual. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS pleurítico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS habituales. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 38 I-EXPLORATION ºC I-EXPLORATION y I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION difusa I-EXPLORATION del I-EXPLORATION murmullo I-EXPLORATION vesicular I-EXPLORATION con I-EXPLORATION crepitantes I-EXPLORATION y I-EXPLORATION sibilancias I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION pulmonar I-EXPLORATION izda. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION general I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION destacaron I-EXPLORATION 18.600 I-EXPLORATION leucocitos/mm3, I-EXPLORATION 92% I-EXPLORATION neutrófilos, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION gasometría I-EXPLORATION con I-EXPLORATION pCO2 I-EXPLORATION de I-EXPLORATION 27 I-EXPLORATION mm I-EXPLORATION Hg, I-EXPLORATION pO2 I-EXPLORATION 56, I-EXPLORATION 8, I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 48 I-EXPLORATION y I-EXPLORATION HCO3 I-EXPLORATION 23, I-EXPLORATION 6 I-EXPLORATION con I-EXPLORATION una I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION O2 I-EXPLORATION del I-EXPLORATION 92%. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION torácica I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION alveolar I-EXPLORATION en I-EXPLORATION LII, I-EXPLORATION LSI I-EXPLORATION y I-EXPLORATION língula I-EXPLORATION y I-EXPLORATION cardiomegalia. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT al I-TREATMENT ingreso I-TREATMENT del I-TREATMENT paciente I-TREATMENT iniciando I-TREATMENT oxigenoterapia, I-TREATMENT administración I-TREATMENT de I-TREATMENT broncodilatadores I-TREATMENT inhalados, I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT a I-TREATMENT dosis I-TREATMENT profiláctica I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT levofloxacino I-TREATMENT intravenoso I-TREATMENT (500 I-TREATMENT mg/24 I-TREATMENT horas). I-TREATMENT El B-EVOLUTION cuadro I-EVOLUTION evolucionó I-EVOLUTION lentamente, I-EVOLUTION manteniéndose I-EVOLUTION la I-EVOLUTION febrícula I-EVOLUTION y I-EVOLUTION la I-EVOLUTION insuficiencia I-EVOLUTION respiratoria I-EVOLUTION y B-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION esputo I-EXPLORATION para I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION no I-EXPLORATION fueron I-EXPLORATION valorables, I-EXPLORATION resultando I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION negativos. I-EXPLORATION Por I-EXPLORATION todo I-EXPLORATION ello, I-EXPLORATION 6 I-EXPLORATION días I-EXPLORATION después I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION fibrobroncoscopia. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION del I-EXPLORATION aspirado I-EXPLORATION bronquial I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION abundantes I-EXPLORATION polimorfonucleares I-EXPLORATION (> I-EXPLORATION 25 I-EXPLORATION PMN/c I-EXPLORATION x100) I-EXPLORATION y I-EXPLORATION bacilos I-EXPLORATION gram I-EXPLORATION positivos I-EXPLORATION difterimorfos I-EXPLORATION extra I-EXPLORATION e I-EXPLORATION intracelulares, I-EXPLORATION creciendo I-EXPLORATION posteriormente I-EXPLORATION en I-EXPLORATION cultivo I-EXPLORATION puro I-EXPLORATION C. I-EXPLORATION pseudodiphteriticum I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION clindamicina, I-EXPLORATION eritromicina I-EXPLORATION y I-EXPLORATION ciprofloxacina I-EXPLORATION y I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION penilina, I-EXPLORATION amoxicilina-clavulánico, I-EXPLORATION cefalosporinas I-EXPLORATION de I-EXPLORATION 2ª I-EXPLORATION y I-EXPLORATION 3ª I-EXPLORATION generación I-EXPLORATION y I-EXPLORATION glicopéptidos. I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION frotis I-EXPLORATION del I-EXPLORATION exudado I-EXPLORATION bronquial I-EXPLORATION como I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION agudo I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION lesiones. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT neumonía I-TREATMENT por I-TREATMENT C. I-TREATMENT pseudodiphteriticum I-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT amoxicilina-clavulánico I-TREATMENT 2 I-TREATMENT g/ I-TREATMENT 8 I-TREATMENT h I-TREATMENT i.v., I-TREATMENT evolucionando B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS laterocervicales I-PRESENT_ILLNESS izquierdas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS odinofagia. I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS se I-PRESENT_ILLNESS asoció I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION salvo I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION fiebre I-EXPLORATION (38 I-EXPLORATION ºC), I-EXPLORATION conglomerado I-EXPLORATION adenopático I-EXPLORATION látero-cervical I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION mínimas I-EXPLORATION adenopatías I-EXPLORATION latero-cervicales I-EXPLORATION derechas. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION practicó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION adenopatías I-EXPLORATION cervicales, I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION con I-EXPLORATION leucopenia I-EXPLORATION y I-EXPLORATION trombopenia I-EXPLORATION y I-EXPLORATION biopsia I-EXPLORATION ganglionar I-EXPLORATION informada I-EXPLORATION de I-EXPLORATION linfadenitis I-EXPLORATION aguda. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacaba: I-EXPLORATION leucocitos I-EXPLORATION 2.500 I-EXPLORATION con I-EXPLORATION 26% I-EXPLORATION linfocitos, I-EXPLORATION plaquetas I-EXPLORATION 57.000 I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION 816 I-EXPLORATION U/L. I-EXPLORATION I-EXPLORATION La I-EXPLORATION PPD I-EXPLORATION 5U I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION los I-EXPLORATION hemocultivos, I-EXPLORATION coprocultivo I-EXPLORATION RPR I-EXPLORATION y I-EXPLORATION serologías I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION CMV, I-EXPLORATION VEB, I-EXPLORATION Brucella, I-EXPLORATION Leptospira, I-EXPLORATION Francisella I-EXPLORATION tularensis I-EXPLORATION y I-EXPLORATION Bartonella I-EXPLORATION fueron I-EXPLORATION así I-EXPLORATION mismo I-EXPLORATION negativas. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fiebre I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION nueva I-EXPLORATION biopsia I-EXPLORATION cervical I-EXPLORATION observándose I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cortical-paracortical I-EXPLORATION una I-EXPLORATION linfadenitis I-EXPLORATION necrotizante I-EXPLORATION parcheada, I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION restos I-EXPLORATION celulares I-EXPLORATION y I-EXPLORATION rodeada I-EXPLORATION por I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION CD4+, I-EXPLORATION histiocitos I-EXPLORATION CD68, I-EXPLORATION escasos I-EXPLORATION polimorfonucleares I-EXPLORATION y I-EXPLORATION células I-EXPLORATION plasmáticas.; I-EXPLORATION características I-EXPLORATION histopatológicas I-EXPLORATION que I-EXPLORATION definen I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Kikuchi. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT antiinflamatorios I-TREATMENT no I-TREATMENT esteroides I-TREATMENT con B-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fiebre. I-EVOLUTION Año I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION después I-EVOLUTION sigue I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO pediatra I-DERIVED_FROM/TO al I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO para I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO adenopatía I-DERIVED_FROM/TO cervical I-DERIVED_FROM/TO dolorosa I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO semana I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución, I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO respuesta I-DERIVED_FROM/TO al I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO con I-DERIVED_FROM/TO amoxicilina-clavulánico. I-DERIVED_FROM/TO No B-PRESENT_ILLNESS refería I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION adenopatías I-EXPLORATION laterocervicales I-EXPLORATION izquierdas I-EXPLORATION menores I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION adenopatía I-EXPLORATION laterocervical I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION dura, I-EXPLORATION no I-EXPLORATION adherida, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios I-EXPLORATION asociados. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION destacaba I-EXPLORATION hemograma, I-EXPLORATION bioquímica I-EXPLORATION y I-EXPLORATION coagulación I-EXPLORATION normales, I-EXPLORATION VSG I-EXPLORATION 30 I-EXPLORATION mm, I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION y I-EXPLORATION factor I-EXPLORATION reumatoideo I-EXPLORATION negativos. I-EXPLORATION PPD I-EXPLORATION 5U I-EXPLORATION negativo. I-EXPLORATION Serología I-EXPLORATION Herpesvirus I-EXPLORATION 6 I-EXPLORATION IgM I-EXPLORATION positiva. I-EXPLORATION Serologías I-EXPLORATION CMV, I-EXPLORATION VEB, I-EXPLORATION VHS I-EXPLORATION I I-EXPLORATION - I-EXPLORATION II, I-EXPLORATION Hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION VIH, I-EXPLORATION Toxoplasma I-EXPLORATION gondii, I-EXPLORATION Bartonella I-EXPLORATION henselae, I-EXPLORATION Parvovirus I-EXPLORATION B19 I-EXPLORATION y I-EXPLORATION Salmonella I-EXPLORATION typhi I-EXPLORATION negativas. I-EXPLORATION La I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION se I-EXPLORATION confirmaron I-EXPLORATION las I-EXPLORATION adenopatías. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION adenopatías I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION biopsia I-EXPLORATION abierta I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 18 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION evolución. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION mostró I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION paracortical, I-EXPLORATION rodeados I-EXPLORATION por I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION CD4 I-EXPLORATION y I-EXPLORATION CD8 I-EXPLORATION + I-EXPLORATION y I-EXPLORATION abundantes I-EXPLORATION histiocitos I-EXPLORATION CD68+, I-EXPLORATION entremezclados I-EXPLORATION con I-EXPLORATION células I-EXPLORATION plasmocitoides I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION significativa I-EXPLORATION de I-EXPLORATION neutrófilos. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Auramina, I-EXPLORATION cultivo I-EXPLORATION para I-EXPLORATION micobacterias, I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION Enterovirus, I-EXPLORATION HSV, I-EXPLORATION VVZ, I-EXPLORATION CMV, I-EXPLORATION VEB I-EXPLORATION y I-EXPLORATION Herpesvirus I-EXPLORATION tipos I-EXPLORATION 6, I-EXPLORATION 7 I-EXPLORATION y I-EXPLORATION 8 I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION ganglionar I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El B-EVOLUTION curso I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION autolimitado. I-EVOLUTION Dos I-EVOLUTION años I-EVOLUTION después I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 73 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antidiabéticos I-PAST_MEDICAL_HISTORY orales, I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY paroxística I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY amiodarona, I-PAST_MEDICAL_HISTORY calcioantagonistas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antiagregantes I-PAST_MEDICAL_HISTORY plaquetarios. I-PAST_MEDICAL_HISTORY Refería B-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea. I-PRESENT_ILLNESS En B-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION destacaban I-EXPLORATION anemia I-EXPLORATION normocítica, I-EXPLORATION hipoxemia, I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda I-EXPLORATION e I-EXPLORATION infiltrados I-EXPLORATION "parcheados" I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION hemitórax I-EXPLORATION con I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION múltiples I-EXPLORATION estudios I-EXPLORATION microbiológicos, I-EXPLORATION serológicos, I-EXPLORATION citológicos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION o I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT estableció I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT presunción I-TREATMENT bronquiolitis I-TREATMENT obliterante I-TREATMENT con I-TREATMENT neumonía I-TREATMENT organizada I-TREATMENT (BONO) I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 60 I-TREATMENT mg/día I-TREATMENT con I-TREATMENT desaparición I-TREATMENT de I-TREATMENT la I-TREATMENT fiebre I-TREATMENT y I-TREATMENT mejoría I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas I-TREATMENT respiratorios, I-TREATMENT de I-TREATMENT la I-TREATMENT anemia I-TREATMENT y I-TREATMENT de I-TREATMENT los I-TREATMENT reactantes I-TREATMENT de I-TREATMENT fase I-TREATMENT aguda. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION ingresada I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION un I-EVOLUTION mes I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION por I-EVOLUTION disnea I-EVOLUTION de I-EVOLUTION reposo, I-EVOLUTION edemas I-EVOLUTION y I-EVOLUTION oliguria. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaban I-EXPLORATION taquipnea, I-EXPLORATION taquicardia I-EXPLORATION rítmica I-EXPLORATION sin I-EXPLORATION soplos, I-EXPLORATION disminución I-EXPLORATION global I-EXPLORATION del I-EXPLORATION murmullo I-EXPLORATION vesicular I-EXPLORATION con I-EXPLORATION crepitantes I-EXPLORATION en I-EXPLORATION bases I-EXPLORATION y I-EXPLORATION edemas I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION inferiores. I-EXPLORATION Entre I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaban I-EXPLORATION 20.600 I-EXPLORATION leucocitos/mm3, I-EXPLORATION con I-EXPLORATION 85% I-EXPLORATION polimorfonucleares, I-EXPLORATION LDH I-EXPLORATION 537 I-EXPLORATION U/L, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION 249 I-EXPLORATION U/L, I-EXPLORATION albúmina I-EXPLORATION 2, I-EXPLORATION 3 I-EXPLORATION g/dL, I-EXPLORATION pO2 I-EXPLORATION 58 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION CA I-EXPLORATION 19.9 I-EXPLORATION 214 I-EXPLORATION U/L I-EXPLORATION (normal I-EXPLORATION 0-27 I-EXPLORATION U/L). I-EXPLORATION Eran I-EXPLORATION normales I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION hemoglobina, I-EXPLORATION plaquetas, I-EXPLORATION glucemia, I-EXPLORATION bilirrubina, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION calcio, I-EXPLORATION electrolitos, I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario, I-EXPLORATION CA I-EXPLORATION 125 I-EXPLORATION y I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION hormonas I-EXPLORATION tiroideas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION torácica I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION densidad I-EXPLORATION bilateral I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION pulmonar, I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION perihiliar. I-EXPLORATION El I-EXPLORATION mediastino I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION no I-EXPLORATION había I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION embolismo I-EXPLORATION pulmonar I-EXPLORATION en I-EXPLORATION la I-EXPLORATION angio-TC. I-EXPLORATION Un I-EXPLORATION ecocardiograma I-EXPLORATION transtorácico I-EXPLORATION y I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION toracocentesis I-EXPLORATION bilateral I-EXPLORATION obteniendo I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION casos I-EXPLORATION un I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION lechoso, I-EXPLORATION con I-EXPLORATION características I-EXPLORATION de I-EXPLORATION exudado, I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION triglicéridos I-EXPLORATION de I-EXPLORATION 433 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION 163 I-EXPLORATION mg/dL I-EXPLORATION respectivamente, I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION quilomicrones. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION citológicos I-EXPLORATION y I-EXPLORATION microbiológicos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION líquidos I-EXPLORATION pleurales I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION broncoscopia I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION transbronquial I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION bronquial I-EXPLORATION infiltrada I-EXPLORATION por I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION neoplásica I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION adenocarcinoma. I-EXPLORATION Las I-EXPLORATION citologías I-EXPLORATION y I-EXPLORATION estudios I-EXPLORATION microbiológicos I-EXPLORATION del I-EXPLORATION broncoaspirado I-EXPLORATION y I-EXPLORATION del I-EXPLORATION lavado I-EXPLORATION broncoalveolar I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se B-TREATMENT incrementó I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT esteroides I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tubo I-TREATMENT de I-TREATMENT drenaje I-TREATMENT torácico I-TREATMENT bilateral I-TREATMENT y I-TREATMENT nutrición I-TREATMENT parenteral. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION se I-EVOLUTION caracterizó I-EVOLUTION por I-EVOLUTION una I-EVOLUTION insuficiencia I-EVOLUTION respiratoria I-EVOLUTION progresiva I-EVOLUTION que I-EVOLUTION condujo I-EVOLUTION al I-EVOLUTION fallecimiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION necropsia I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION linfangitis I-EXPLORATION carcinomatosa I-EXPLORATION diseminada I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION pulmones, I-EXPLORATION hígado, I-EXPLORATION pericardio, I-EXPLORATION páncreas I-EXPLORATION y I-EXPLORATION suprarrenales, I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION primario I-EXPLORATION desconocido. I-EXPLORATION I-EXPLORATION Paciente, B-PRESENT_ILLNESS mujer, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Crohn I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY prolapso I-PAST_MEDICAL_HISTORY genital I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY III. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución., I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS discreta I-PRESENT_ILLNESS rigidez I-PRESENT_ILLNESS en I-PRESENT_ILLNESS musculatura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cintura I-PRESENT_ILLNESS escapular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pelviana. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS aquejaba I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS visuales I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS claudicación I-PRESENT_ILLNESS mandibular. I-PRESENT_ILLNESS Un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS visita I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS intervenida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS histerectomía I-PRESENT_ILLNESS y I-PRESENT_ILLNESS colpoperineoplastia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS prolapso I-PRESENT_ILLNESS uterino I-PRESENT_ILLNESS grado I-PRESENT_ILLNESS III. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS descripción I-PRESENT_ILLNESS microscópica I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS uterino I-PRESENT_ILLNESS se I-PRESENT_ILLNESS aprecian I-PRESENT_ILLNESS vasos I-PRESENT_ILLNESS arteriales I-PRESENT_ILLNESS con I-PRESENT_ILLNESS esclerosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pared I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS granulomatosa I-PRESENT_ILLNESS con I-PRESENT_ILLNESS células I-PRESENT_ILLNESS gigantes, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS necrosis, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS capas I-PRESENT_ILLNESS media I-PRESENT_ILLNESS y I-PRESENT_ILLNESS perivascular I-PRESENT_ILLNESS aconsejándose I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS clínico. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION coloración I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas I-EXPLORATION normal. I-EXPLORATION Auscultación I-EXPLORATION cardíaca I-EXPLORATION y I-EXPLORATION pulmonar I-EXPLORATION anodina. I-EXPLORATION Abdomen I-EXPLORATION blando, I-EXPLORATION depresible, I-EXPLORATION no I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION cicatriz I-EXPLORATION de I-EXPLORATION histerectomía I-EXPLORATION con I-EXPLORATION buen I-EXPLORATION aspecto. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpan I-EXPLORATION masas. I-EXPLORATION No I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION edemas I-EXPLORATION maleolares. I-EXPLORATION Los I-EXPLORATION pulsos I-EXPLORATION periféricos I-EXPLORATION estaban I-EXPLORATION conservados. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemograma, I-EXPLORATION el I-EXPLORATION hematocrito I-EXPLORATION era I-EXPLORATION del I-EXPLORATION 37, I-EXPLORATION 5% I-EXPLORATION y I-EXPLORATION la I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 11'9 I-EXPLORATION g/dl, I-EXPLORATION serie I-EXPLORATION blanca I-EXPLORATION y I-EXPLORATION hemostasia I-EXPLORATION normales. I-EXPLORATION VSG I-EXPLORATION 52 I-EXPLORATION mm/1ª I-EXPLORATION hora I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION 66, I-EXPLORATION 3 I-EXPLORATION g/dl. I-EXPLORATION La I-EXPLORATION bioquímica I-EXPLORATION y I-EXPLORATION sedimento I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION FR, I-EXPLORATION ANA I-EXPLORATION y I-EXPLORATION ANCA I-EXPLORATION negativos. I-EXPLORATION HLA I-EXPLORATION B27 I-EXPLORATION positivo. I-EXPLORATION Proteinograma I-EXPLORATION normal. I-EXPLORATION Mantoux I-EXPLORATION negativo. I-EXPLORATION Rx I-EXPLORATION tórax: I-EXPLORATION no I-EXPLORATION cardiomegalia, I-EXPLORATION campos I-EXPLORATION pulmonares I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION practicó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION arteria I-EXPLORATION temporal I-EXPLORATION izquierda I-EXPLORATION que I-EXPLORATION es I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT ACG I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Prednisona I-TREATMENT 1 I-TREATMENT mg/kg/día. I-TREATMENT Dos B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permanecía I-EVOLUTION asintomática I-EVOLUTION con B-TREATMENT dosis I-TREATMENT de I-TREATMENT 20 I-TREATMENT mg/día. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS consultado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 38º I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nauseas, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kilogramos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY exfumador, I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatopatía I-PAST_MEDICAL_HISTORY criptogenética, I-PAST_MEDICAL_HISTORY taquicardia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY aberrante I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY ablación I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY angor I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY coronariografía I-PAST_MEDICAL_HISTORY normal, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY ansioso-depresivo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ulcus I-PAST_MEDICAL_HISTORY duodenal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY apendicitis. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY recientemente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY prácticas I-PAST_MEDICAL_HISTORY sexuales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION se I-EXPLORATION objetivaba I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 39, I-EXPLORATION 7 I-EXPLORATION ºC, I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION hepatomegalia I-EXPLORATION a I-EXPLORATION unos I-EXPLORATION 3-4 I-EXPLORATION centímetros I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION costal, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION a I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION destacaban I-EXPLORATION 15.900/mm3 I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda, I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 10.5 I-EXPLORATION g/dl I-EXPLORATION y I-EXPLORATION una I-EXPLORATION VSG I-EXPLORATION de I-EXPLORATION 101 I-EXPLORATION mm. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION hepáticos: I-EXPLORATION GOT I-EXPLORATION 101 I-EXPLORATION U/l, I-EXPLORATION GPT I-EXPLORATION 128 I-EXPLORATION U/l, I-EXPLORATION FA I-EXPLORATION 208 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 172 I-EXPLORATION U/l, I-EXPLORATION LDH I-EXPLORATION 1366 I-EXPLORATION UI/l. I-EXPLORATION La I-EXPLORATION PCR I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION asimismo I-EXPLORATION elevada. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION Mantoux I-EXPLORATION negativo. I-EXPLORATION Serologías I-EXPLORATION de I-EXPLORATION Brucella, I-EXPLORATION Leishmania, I-EXPLORATION C. I-EXPLORATION Burnetti, I-EXPLORATION lúes, I-EXPLORATION Salmonella, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION y I-EXPLORATION VIH I-EXPLORATION negativos. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION serologías I-EXPLORATION de I-EXPLORATION citomegalovirus, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein-Barr I-EXPLORATION y I-EXPLORATION toxoplasma I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION IgG I-EXPLORATION + I-EXPLORATION y I-EXPLORATION IgM I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Hemocultivos I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION ambulatorio I-EXPLORATION y I-EXPLORATION hospitalizado I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION hígado, I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION vesícula, I-EXPLORATION porción I-EXPLORATION visible I-EXPLORATION de I-EXPLORATION retroperitoneo I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION porta I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION ecográficos I-EXPLORATION significativos. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION efectúo I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION engrosamiento I-EXPLORATION mamelonado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION y I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud, I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION de I-EXPLORATION colon; I-EXPLORATION gran I-EXPLORATION lesión I-EXPLORATION sólida I-EXPLORATION con I-EXPLORATION captación I-EXPLORATION heterogénea I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo I-EXPLORATION segmento I-EXPLORATION IV, I-EXPLORATION sugestiva I-EXPLORATION de I-EXPLORATION metástasis. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION en I-EXPLORATION "corazón I-EXPLORATION de I-EXPLORATION manzana" I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION con I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION en I-EXPLORATION un I-EXPLORATION tramo I-EXPLORATION aproximadamente I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION centímetros. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION circunferencial I-EXPLORATION a I-EXPLORATION 110 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION ano I-EXPLORATION que I-EXPLORATION impedía I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio, I-EXPLORATION tomándose I-EXPLORATION biopsias. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION granulación I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION en I-EXPLORATION los I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION densos I-EXPLORATION infiltrados I-EXPLORATION linfocitarios I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION CD20+ I-EXPLORATION que I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION expresaban I-EXPLORATION tinción I-EXPLORATION nuclear I-EXPLORATION bcl-6. I-EXPLORATION Los I-EXPLORATION cambios I-EXPLORATION morfológicos I-EXPLORATION sugerían I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION tipo I-EXPLORATION B I-EXPLORATION aunque I-EXPLORATION no I-EXPLORATION era I-EXPLORATION concluyente I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION PAAF I-EXPLORATION hepática I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION linfoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes I-EXPLORATION difuso I-EXPLORATION tipo I-EXPLORATION B. I-EXPLORATION I-EXPLORATION Posteriormente B-DERIVED_FROM/TO se I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO hematología, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO inició I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO de I-DERIVED_FROM/TO quimioterapia I-DERIVED_FROM/TO siguiendo I-DERIVED_FROM/TO el I-DERIVED_FROM/TO esquema I-DERIVED_FROM/TO CHOP I-DERIVED_FROM/TO (ciclofosfamida, I-DERIVED_FROM/TO doxorrubicina, I-DERIVED_FROM/TO vincristina I-DERIVED_FROM/TO y I-DERIVED_FROM/TO prednisona) I-DERIVED_FROM/TO y I-DERIVED_FROM/TO de I-DERIVED_FROM/TO momento I-DERIVED_FROM/TO no I-DERIVED_FROM/TO tenemos I-DERIVED_FROM/TO datos I-DERIVED_FROM/TO sobre I-DERIVED_FROM/TO la I-DERIVED_FROM/TO eventual I-DERIVED_FROM/TO respuesta I-DERIVED_FROM/TO tumoral. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cefaleas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo. I-PAST_MEDICAL_HISTORY Desde B-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión I-PRESENT_ILLNESS borrosa, I-PRESENT_ILLNESS notando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS alguna I-PRESENT_ILLNESS ocasión I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS visual I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemicampo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS acompañándose I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefaleas I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedían I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS analgésico. I-PRESENT_ILLNESS Hace I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS ictal I-PRESENT_ILLNESS transitorio I-PRESENT_ILLNESS hemisférico I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS desapareció I-PRESENT_ILLNESS pasados I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS minutos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mañana I-PRESENT_ILLNESS del I-PRESENT_ILLNESS presente I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS notó I-PRESENT_ILLNESS torpeza I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS desviación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS comisura I-PRESENT_ILLNESS bucal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS articulación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS palabra. I-PRESENT_ILLNESS Por I-PRESENT_ILLNESS este I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS valorada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS neurólogo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS objetivó I-PRESENT_ILLNESS paresia I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS supranuclear I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS y I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS disartria, I-PRESENT_ILLNESS inestabilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS con I-PRESENT_ILLNESS torpeza I-PRESENT_ILLNESS para I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS finos I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipoestesia I-PRESENT_ILLNESS táctil I-PRESENT_ILLNESS y I-PRESENT_ILLNESS algésica I-PRESENT_ILLNESS facio-braquial I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS En B-EXPLORATION urgencias I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ECG, I-EXPLORATION en I-EXPLORATION ritmo I-EXPLORATION sinusal, I-EXPLORATION TAC I-EXPLORATION craneal I-EXPLORATION que I-EXPLORATION inicialmente I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION infarto I-EXPLORATION y I-EXPLORATION Doppler I-EXPLORATION de I-EXPLORATION troncos I-EXPLORATION supraaórticos I-EXPLORATION y I-EXPLORATION transcraneal I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION planta, I-EXPLORATION solicitándose I-EXPLORATION perfiles I-EXPLORATION analíticos I-EXPLORATION completos I-EXPLORATION incluyendo I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION hipercoagulabilidad, I-EXPLORATION ANAS, I-EXPLORATION c-ANCA, I-EXPLORATION p-ANCA, I-EXPLORATION DNA I-EXPLORATION nativo I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antimitocondriales. I-EXPLORATION También I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen: I-EXPLORATION RNM I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION ecocardiografía. I-EXPLORATION I-EXPLORATION La I-EXPLORATION RNM I-EXPLORATION mostró I-EXPLORATION infarto I-EXPLORATION isquémico I-EXPLORATION agudo I-EXPLORATION en I-EXPLORATION territorio I-EXPLORATION silviano I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION media I-EXPLORATION izquierda. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION antineutrófilos, I-EXPLORATION anticuerpos I-EXPLORATION antinucleares, I-EXPLORATION anticentrómero I-EXPLORATION y I-EXPLORATION antimitocondrias I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION trombofilia I-EXPLORATION tan I-EXPLORATION sólo I-EXPLORATION detectó I-EXPLORATION ligera I-EXPLORATION hiperfibrinogenemia. I-EXPLORATION I-EXPLORATION Finalmente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION ecocardiografía, I-EXPLORATION prueba I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION crucial I-EXPLORATION al I-EXPLORATION proporcionar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION definitivo, I-EXPLORATION observándose I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION pedunculada I-EXPLORATION en I-EXPLORATION AI I-EXPLORATION que I-EXPLORATION prolapsaba I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION mitral I-EXPLORATION en I-EXPLORATION diástole, I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION mixoma I-EXPLORATION (35 I-EXPLORATION x I-EXPLORATION 26 I-EXPLORATION mm), I-EXPLORATION con I-EXPLORATION pedículo I-EXPLORATION en I-EXPLORATION región I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION oval. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programó I-TREATMENT para I-TREATMENT cirugía I-TREATMENT realizándose I-TREATMENT previamente I-TREATMENT RNM I-TREATMENT cardiaca I-TREATMENT para I-TREATMENT determinar I-TREATMENT con I-TREATMENT mayor I-TREATMENT precisión I-TREATMENT las I-TREATMENT características I-TREATMENT morfológicas I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT auricular. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT atriotomía I-TREATMENT izquierda, I-TREATMENT extrayéndose I-TREATMENT el I-TREATMENT tumor I-TREATMENT en I-TREATMENT su I-TREATMENT totalidad, I-TREATMENT siendo I-TREATMENT éste I-TREATMENT de I-TREATMENT aspecto I-TREATMENT morulado. I-TREATMENT Se I-TREATMENT abrió I-TREATMENT también I-TREATMENT aurícula I-TREATMENT derecha I-TREATMENT y I-TREATMENT se I-TREATMENT resecó I-TREATMENT la I-TREATMENT zona I-TREATMENT de I-TREATMENT implantación, I-TREATMENT cerrándose I-TREATMENT posteriormente I-TREATMENT la I-TREATMENT comunicación I-TREATMENT interauricular I-TREATMENT creada. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION posquirúrgica I-EVOLUTION resultó I-EVOLUTION muy I-EVOLUTION satisfactoria, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION déficit I-EVOLUTION neurológico. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY moderado, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS incremento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS acompañante. I-PRESENT_ILLNESS En B-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION solicitadas I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION coagulación I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION Glucosa, I-EXPLORATION urea, I-EXPLORATION ácido I-EXPLORATION úrico, I-EXPLORATION creatinina, I-EXPLORATION calcio I-EXPLORATION total, I-EXPLORATION fósforo, I-EXPLORATION triglicéridos, I-EXPLORATION colesterol I-EXPLORATION LDL, I-EXPLORATION bilirrubina I-EXPLORATION total, I-EXPLORATION GOT, I-EXPLORATION GPT, I-EXPLORATION GGT, I-EXPLORATION LDH, I-EXPLORATION fosfatasa I-EXPLORATION alcalina, I-EXPLORATION amilasa, I-EXPLORATION proteínas I-EXPLORATION totales, I-EXPLORATION albúmina, I-EXPLORATION sodio, I-EXPLORATION potasio, I-EXPLORATION cloro, I-EXPLORATION ferritina, I-EXPLORATION transferrina, I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION y I-EXPLORATION folato I-EXPLORATION normales. I-EXPLORATION Colesterol I-EXPLORATION total I-EXPLORATION 243 I-EXPLORATION mg/dl I-EXPLORATION (110-200), I-EXPLORATION colesterol I-EXPLORATION HDL I-EXPLORATION 120 I-EXPLORATION mg/dl I-EXPLORATION (42-68), I-EXPLORATION hierro I-EXPLORATION 44 I-EXPLORATION microg/dl I-EXPLORATION (65-165); I-EXPLORATION Ca I-EXPLORATION 19, I-EXPLORATION 9, I-EXPLORATION 82, I-EXPLORATION 03 I-EXPLORATION U/l I-EXPLORATION (< I-EXPLORATION 40). I-EXPLORATION CEA, I-EXPLORATION PSA I-EXPLORATION y I-EXPLORATION alfa-fetoproteína I-EXPLORATION normales. I-EXPLORATION Velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION 41 I-EXPLORATION mm I-EXPLORATION (< I-EXPLORATION 14). I-EXPLORATION En I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION Ca I-EXPLORATION 19, I-EXPLORATION 9, I-EXPLORATION 91, I-EXPLORATION 23 I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION normales. I-EXPLORATION Resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION abdomino-pelvica: I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION multilobulada I-EXPLORATION abdomino I-EXPLORATION pelvica, I-EXPLORATION cuya I-EXPLORATION señal I-EXPLORATION a I-EXPLORATION excepción I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tabiques I-EXPLORATION es I-EXPLORATION preferentemente I-EXPLORATION grasa. I-EXPLORATION Las I-EXPLORATION dimensiones I-EXPLORATION máximas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION son I-EXPLORATION de I-EXPLORATION 26 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION cráneo I-EXPLORATION caudal, I-EXPLORATION 24, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION transverso I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 21 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION anteroposterior. I-EXPLORATION Cruza I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION y I-EXPLORATION produce I-EXPLORATION importante I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION al I-EXPLORATION que I-EXPLORATION rota I-EXPLORATION y I-EXPLORATION desplaza I-EXPLORATION cranealmente, I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION uropatía I-EXPLORATION obstructiva. I-EXPLORATION También I-EXPLORATION ejerce I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION izquierdo, I-EXPLORATION desplazándolo I-EXPLORATION contra I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION son I-EXPLORATION muy I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION liposarcoma. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT suprainfraumbilical I-TREATMENT donde I-TREATMENT se I-TREATMENT encontró I-TREATMENT una I-TREATMENT gran I-TREATMENT masa I-TREATMENT de I-TREATMENT aspecto I-TREATMENT lipomatoso I-TREATMENT desde I-TREATMENT la I-TREATMENT celda I-TREATMENT renal I-TREATMENT izquierda I-TREATMENT hasta I-TREATMENT espacio I-TREATMENT retrovesical. I-TREATMENT Se I-TREATMENT intentó I-TREATMENT extirpación I-TREATMENT en I-TREATMENT bloque I-TREATMENT con I-TREATMENT resección I-TREATMENT de I-TREATMENT fibras I-TREATMENT del I-TREATMENT psoas I-TREATMENT izquierdo I-TREATMENT infiltrado. I-TREATMENT I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION extraída I-EXPLORATION fue I-EXPLORATION en I-EXPLORATION su I-EXPLORATION descripción I-EXPLORATION macroscópica: I-EXPLORATION Pieza I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION x I-EXPLORATION 40 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION cm. I-EXPLORATION con I-EXPLORATION un I-EXPLORATION peso I-EXPLORATION de I-EXPLORATION 6.300 I-EXPLORATION gr. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION coloración I-EXPLORATION amarillenta, I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sección I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION que I-EXPLORATION mantiene I-EXPLORATION esta I-EXPLORATION coloración I-EXPLORATION con I-EXPLORATION finos I-EXPLORATION tractos I-EXPLORATION conectivos, I-EXPLORATION sin I-EXPLORATION apreciarse I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION clara I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION y I-EXPLORATION sí I-EXPLORATION una I-EXPLORATION distribución I-EXPLORATION en I-EXPLORATION lóbulos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION descripción I-EXPLORATION microscópica I-EXPLORATION las I-EXPLORATION secciones I-EXPLORATION histológicas I-EXPLORATION muestran I-EXPLORATION todas I-EXPLORATION ellas I-EXPLORATION un I-EXPLORATION mismo I-EXPLORATION aspecto: I-EXPLORATION en I-EXPLORATION su I-EXPLORATION mayor I-EXPLORATION parte I-EXPLORATION están I-EXPLORATION constituidas I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION con I-EXPLORATION células I-EXPLORATION adiposas I-EXPLORATION con I-EXPLORATION tamaño I-EXPLORATION grande I-EXPLORATION de I-EXPLORATION vacuola I-EXPLORATION grande I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION maduro. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION también I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION atípicos I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION focal, I-EXPLORATION con I-EXPLORATION citoplasma I-EXPLORATION vacuolado. I-EXPLORATION Estas I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION maduro I-EXPLORATION están I-EXPLORATION distribuidas I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION difusa I-EXPLORATION por I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION neoplasia, I-EXPLORATION y I-EXPLORATION los I-EXPLORATION focos I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION atípicos, I-EXPLORATION en I-EXPLORATION ocasiones I-EXPLORATION hipercromáticos I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION aislada. I-EXPLORATION Diagnóstico: I-EXPLORATION Liposarcoma I-EXPLORATION bien I-EXPLORATION diferenciado. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION Ca I-EXPLORATION 19, I-EXPLORATION 9, I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION quirúrgica I-EXPLORATION presenta I-EXPLORATION normalización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION (24, I-EXPLORATION 17 I-EXPLORATION U/l), I-EXPLORATION manteniéndose I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION normales. I-EXPLORATION Posteriormente B-TREATMENT se I-TREATMENT realiza I-TREATMENT radioterapia I-TREATMENT complementaria, I-TREATMENT presentando I-TREATMENT una I-TREATMENT evolución I-TREATMENT favorable I-TREATMENT y I-TREATMENT permaneciendo I-TREATMENT asintomático. I-TREATMENT La B-EXPLORATION RM I-EXPLORATION abdominopélvica I-EXPLORATION de I-EXPLORATION control I-EXPLORATION realizada I-EXPLORATION a I-EXPLORATION los I-EXPLORATION cinco I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION quirurgica I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION estado I-EXPLORATION postoperatorio I-EXPLORATION del I-EXPLORATION liposarcoma I-EXPLORATION retroperitoneal, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION macroscópica I-EXPLORATION de I-EXPLORATION lesión. I-EXPLORATION Así B-EVOLUTION este I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION permaneciendo I-EVOLUTION asintomático I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION transcurriendo I-EVOLUTION más I-EVOLUTION de I-EVOLUTION un I-EVOLUTION año I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS artritis. I-PRESENT_ILLNESS Tres B-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY comienza I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fiebre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 39º I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carácter I-PAST_MEDICAL_HISTORY intermitente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY artralgias I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tumefacción I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ambos I-PAST_MEDICAL_HISTORY tobillos, I-PAST_MEDICAL_HISTORY rodillas, I-PAST_MEDICAL_HISTORY codos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY muñecas. I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destaca I-EXPLORATION palidez I-EXPLORATION y I-EXPLORATION discreto I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION difuso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda. I-EXPLORATION Datos I-EXPLORATION analíticos: I-EXPLORATION Hb I-EXPLORATION 9, I-EXPLORATION 6 I-EXPLORATION mg/dL; I-EXPLORATION HTO I-EXPLORATION 31%, I-EXPLORATION VCM I-EXPLORATION 65 I-EXPLORATION mm, I-EXPLORATION 660.000 I-EXPLORATION plaquetas/mL, I-EXPLORATION ferritina I-EXPLORATION 65 I-EXPLORATION ng/mL, I-EXPLORATION Fe I-EXPLORATION 15 I-EXPLORATION microg/dL, I-EXPLORATION fibrinógeno I-EXPLORATION 644 I-EXPLORATION mg/dL, I-EXPLORATION PCR I-EXPLORATION 55 I-EXPLORATION mg/dL. I-EXPLORATION Resto I-EXPLORATION de I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION bioquímicos, I-EXPLORATION serológicos I-EXPLORATION e I-EXPLORATION inmunológicos I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Ecografía I-EXPLORATION abdominal I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION sigmoide I-EXPLORATION hasta I-EXPLORATION ciego, I-EXPLORATION observándose I-EXPLORATION úlceras I-EXPLORATION transversales I-EXPLORATION y I-EXPLORATION longitudinales I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION La I-EXPLORATION colonoscopia I-EXPLORATION demuestra I-EXPLORATION en I-EXPLORATION colon I-EXPLORATION descendente I-EXPLORATION y I-EXPLORATION sigmoide, I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION eritematosa I-EXPLORATION y I-EXPLORATION edematosa, I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION ulceraciones I-EXPLORATION y I-EXPLORATION pseudopólipos I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION anatomopatológicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION son I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn. I-EXPLORATION I-EXPLORATION Curso B-EVOLUTION evolutivo: I-EVOLUTION la I-EVOLUTION enferma I-EVOLUTION cursó I-EVOLUTION posteriormente I-EVOLUTION con I-EVOLUTION diarrea I-EVOLUTION con I-EVOLUTION 2-3 I-EVOLUTION deposiciones I-EVOLUTION líquidas I-EVOLUTION diarias I-EVOLUTION sin I-EVOLUTION productos I-EVOLUTION patológicos I-EVOLUTION y I-EVOLUTION lesiones I-EVOLUTION cutáneas I-EVOLUTION de I-EVOLUTION eritema I-EVOLUTION nodoso. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Cowden I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY formaciones I-PAST_MEDICAL_HISTORY papilomatosas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dorso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY lengua I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tamaño I-PAST_MEDICAL_HISTORY variable, I-PAST_MEDICAL_HISTORY macroglosia I-PAST_MEDICAL_HISTORY saburral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pápulas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY color I-PAST_MEDICAL_HISTORY piel I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY mucosa I-PAST_MEDICAL_HISTORY lingual I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY modo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY empedrado. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY resultado I-PAST_MEDICAL_HISTORY anatomopatoógico I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY fibroepiteliales I-PAST_MEDICAL_HISTORY (12). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tras I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY dermatológico I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY extensión: I-PAST_MEDICAL_HISTORY a) I-PAST_MEDICAL_HISTORY tránsito I-PAST_MEDICAL_HISTORY EGD I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enema I-PAST_MEDICAL_HISTORY opaco I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY evidencian I-PAST_MEDICAL_HISTORY numerosos I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antro I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ampolla I-PAST_MEDICAL_HISTORY rectal; I-PAST_MEDICAL_HISTORY b) I-PAST_MEDICAL_HISTORY endoscopias I-PAST_MEDICAL_HISTORY digestivas I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY baja: I-PAST_MEDICAL_HISTORY parcheado I-PAST_MEDICAL_HISTORY difuso I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY esófago I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY cardias I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY histológicamente I-PAST_MEDICAL_HISTORY coincide I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY acantosis I-PAST_MEDICAL_HISTORY glucogénica; I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY sésiles I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alguno I-PAST_MEDICAL_HISTORY pediculado I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY estómago I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY ampolla I-PAST_MEDICAL_HISTORY rectal I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY corresponden I-PAST_MEDICAL_HISTORY histológicamente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY hamartomatosos; I-PAST_MEDICAL_HISTORY c) I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY tiroidea: I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY nódulos I-PAST_MEDICAL_HISTORY sólidos, I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY lóbulo. I-PAST_MEDICAL_HISTORY Tras I-PAST_MEDICAL_HISTORY punción I-PAST_MEDICAL_HISTORY (PAAF) I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY diagnostica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY coloidal; I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY d) I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY tomografía I-PAST_MEDICAL_HISTORY computerizada I-PAST_MEDICAL_HISTORY craneal I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY demostró I-PAST_MEDICAL_HISTORY alteraciones I-PAST_MEDICAL_HISTORY significativas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS actualidad I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cefalea. I-PRESENT_ILLNESS Dada B-EXPLORATION su I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION base I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION demostrándose I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION en I-EXPLORATION hemisferio I-EXPLORATION cerebeloso I-EXPLORATION derecho I-EXPLORATION descrita I-EXPLORATION como I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION mal I-EXPLORATION delimitada I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION discreta I-EXPLORATION hipodensidad I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION discreta I-EXPLORATION hiperdensidad I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION T2 I-EXPLORATION y I-EXPLORATION FLAIR I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION cerebelosa I-EXPLORATION en I-EXPLORATION región I-EXPLORATION posterolateral I-EXPLORATION y I-EXPLORATION que I-EXPLORATION condiciona I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION desplazamiento I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION izquierda I-EXPLORATION del I-EXPLORATION IV I-EXPLORATION ventrículo I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION hidrocefalia I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION supratentorial. I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION paramagnético I-EXPLORATION no I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION captación I-EXPLORATION significativa I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION parece I-EXPLORATION tratarse I-EXPLORATION de I-EXPLORATION un I-EXPLORATION gangliocitoma I-EXPLORATION displásico I-EXPLORATION cerebeloso I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION capas I-EXPLORATION del I-EXPLORATION cerebelo I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION produce I-EXPLORATION un I-EXPLORATION aparente I-EXPLORATION laminado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cortical. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY vivido I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Amazonas I-PAST_MEDICAL_HISTORY (desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 28 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 35 I-PAST_MEDICAL_HISTORY años), I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY profesión I-PAST_MEDICAL_HISTORY médica, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY dispepsia I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY regular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Niega B-EXPLORATION fiebre, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION tabaquismo, I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION fármacos I-EXPLORATION o I-EXPLORATION drogas I-EXPLORATION ilícitas. I-EXPLORATION I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION datos I-EXPLORATION significativos I-EXPLORATION al I-EXPLORATION exámen I-EXPLORATION físico. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION laboratorio, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION eritrosedimentación I-EXPLORATION globular I-EXPLORATION (VSG), I-EXPLORATION hormonas I-EXPLORATION tiroideas, I-EXPLORATION proteinograma I-EXPLORATION electroforético I-EXPLORATION y I-EXPLORATION complemento, I-EXPLORATION encontrándose I-EXPLORATION todos I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION orina I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION (3 I-EXPLORATION pares I-EXPLORATION de I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION orina). I-EXPLORATION Reacción I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION y I-EXPLORATION serologías I-EXPLORATION virales, I-EXPLORATION bacterianas I-EXPLORATION y I-EXPLORATION parasitarias I-EXPLORATION negativas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION agregaron I-EXPLORATION factor I-EXPLORATION reumatoideo, I-EXPLORATION factor I-EXPLORATION antinuclear, I-EXPLORATION ANCA I-EXPLORATION C I-EXPLORATION y I-EXPLORATION P, I-EXPLORATION siendo I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION patología. I-EXPLORATION I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION dispepsia I-EXPLORATION y I-EXPLORATION pirosis, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION enfermedad I-EXPLORATION por I-EXPLORATION RGE I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION esofagitis I-EXPLORATION grado I-EXPLORATION dos. I-EXPLORATION Inició B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT omeprazol I-TREATMENT 40 I-TREATMENT mg/día, I-TREATMENT desapareciendo B-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION así I-EVOLUTION como I-EVOLUTION también I-EVOLUTION la I-EVOLUTION sudoración I-EVOLUTION nocturna, I-EVOLUTION y I-EVOLUTION reapareciendo I-EVOLUTION esta I-EVOLUTION última I-EVOLUTION al I-EVOLUTION suspender I-EVOLUTION el I-EVOLUTION fármaco. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION pHmetría I-EXPLORATION de I-EXPLORATION control I-EXPLORATION no I-EXPLORATION demostrando I-EXPLORATION reflujo. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY leve, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY celiaca, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Graves I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY drogas I-PAST_MEDICAL_HISTORY anti-tiroideas, I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vasculitis I-PAST_MEDICAL_HISTORY ANCA I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY positiva I-PAST_MEDICAL_HISTORY (enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Wegener I-PAST_MEDICAL_HISTORY limitada). I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY meprednisona I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ciclofosfamida I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY mg/kg/día I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY mes I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY internación. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS UTI I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS súbita I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS estridor I-PRESENT_ILLNESS laríngeo I-PRESENT_ILLNESS inspiratorio, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS sibilancias. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS horas, I-PRESENT_ILLNESS permaneciendo I-PRESENT_ILLNESS asintomática I-PRESENT_ILLNESS intercrisis. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION fibrolaringoscopía I-EXPLORATION hasta I-EXPLORATION cuarto I-EXPLORATION anillo I-EXPLORATION traqueal I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION la I-EXPLORATION movilidad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cuerdas I-EXPLORATION impresionó I-EXPLORATION normal I-EXPLORATION fuera I-EXPLORATION de I-EXPLORATION la I-EXPLORATION crisis. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cuello I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION calibre I-EXPLORATION en I-EXPLORATION región I-EXPLORATION glótica I-EXPLORATION en I-EXPLORATION inspiración I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION simétrica I-EXPLORATION y I-EXPLORATION la I-EXPLORATION traquea I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION RGE I-EXPLORATION y I-EXPLORATION este I-EXPLORATION se I-EXPLORATION diagnóstico I-EXPLORATION mediante I-EXPLORATION SEGD. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION EFR I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION obstrucción I-EXPLORATION moderada I-EXPLORATION fija, I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION curva I-EXPLORATION inspiratoria. I-EXPLORATION Permanece B-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT corticoides, I-TREATMENT beta I-TREATMENT 2 I-TREATMENT inhalados I-TREATMENT de I-TREATMENT larga I-TREATMENT duración I-TREATMENT y I-TREATMENT omeprazol I-TREATMENT 40 I-TREATMENT mg/día. I-TREATMENT No I-TREATMENT se I-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT psicológico I-TREATMENT ni I-TREATMENT fonoudiológico. I-TREATMENT Se B-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION desde I-EVOLUTION hace I-EVOLUTION 4 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS del I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS leucoderma, I-PRESENT_ILLNESS fue B-DERIVED_FROM/TO enviado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Ambulatorio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Estomatología I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Clínicas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Porto I-DERIVED_FROM/TO Alegre I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO Cirujano I-DERIVED_FROM/TO Dentista I-DERIVED_FROM/TO debido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO múltiples I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO papilomatosas I-DERIVED_FROM/TO dispersas I-DERIVED_FROM/TO por I-DERIVED_FROM/TO la I-DERIVED_FROM/TO mucosa I-DERIVED_FROM/TO bucal. I-DERIVED_FROM/TO La B-FAMILY_HISTORY madre I-FAMILY_HISTORY del I-FAMILY_HISTORY paciente I-FAMILY_HISTORY relató I-FAMILY_HISTORY que I-FAMILY_HISTORY la I-FAMILY_HISTORY hermana I-FAMILY_HISTORY del I-FAMILY_HISTORY paciente I-FAMILY_HISTORY presentaba I-FAMILY_HISTORY lesiones I-FAMILY_HISTORY semejantes, I-FAMILY_HISTORY las I-FAMILY_HISTORY cuales I-FAMILY_HISTORY fueron I-FAMILY_HISTORY tratadas I-FAMILY_HISTORY por I-FAMILY_HISTORY cauterización. I-FAMILY_HISTORY En B-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION físico I-EXPLORATION intraoral, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION papilomatosas, I-EXPLORATION algunas I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION nodular, I-EXPLORATION otras I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION verrugas, I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION coloración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION bucal I-EXPLORATION e I-EXPLORATION indoloras. I-EXPLORATION Las I-EXPLORATION lesiones I-EXPLORATION se I-EXPLORATION localizaban I-EXPLORATION en I-EXPLORATION la I-EXPLORATION comisura I-EXPLORATION labial I-EXPLORATION bilateral, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION retrocomisural, I-EXPLORATION bilateral, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION superior I-EXPLORATION e I-EXPLORATION inferior, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION borde I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION 1/3 I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION palato I-EXPLORATION duro, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION de I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION mediana. I-EXPLORATION El I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION variaba I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION La I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION Hiperplasia I-EXPLORATION Focal I-EXPLORATION del I-EXPLORATION Epitelio. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION excisional I-EXPLORATION de I-EXPLORATION una I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION comisura I-EXPLORATION labial I-EXPLORATION lado I-EXPLORATION derecho. I-EXPLORATION El I-EXPLORATION aspecto I-EXPLORATION histopatológico I-EXPLORATION demostró I-EXPLORATION acantosis I-EXPLORATION del I-EXPLORATION epitelio, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION crestas I-EXPLORATION interpapilares I-EXPLORATION ensanchadas, I-EXPLORATION coilocitosis I-EXPLORATION y I-EXPLORATION alteración I-EXPLORATION nuclear, I-EXPLORATION conocida I-EXPLORATION como I-EXPLORATION figura I-EXPLORATION mitosoide. I-EXPLORATION La I-EXPLORATION presencia I-EXPLORATION del I-EXPLORATION virus I-EXPLORATION del I-EXPLORATION HPV I-EXPLORATION 13 I-EXPLORATION fue I-EXPLORATION comprobada I-EXPLORATION por I-EXPLORATION análisis I-EXPLORATION inmunohistoquímica. I-EXPLORATION Esas I-EXPLORATION características I-EXPLORATION llevan I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION de I-EXPLORATION Hiperplasia I-EXPLORATION Focal I-EXPLORATION del I-EXPLORATION Epitelio. I-EXPLORATION A B-EVOLUTION la I-EVOLUTION madre I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION le I-EVOLUTION informó I-EVOLUTION sobre I-EVOLUTION las I-EVOLUTION características I-EVOLUTION de I-EVOLUTION benignidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION y, I-EVOLUTION se I-EVOLUTION espera I-EVOLUTION que I-EVOLUTION disminuyan I-EVOLUTION las I-EVOLUTION lesiones. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION en I-EVOLUTION acompañamiento I-EVOLUTION semestral. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS femenina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 84 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que B-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Estomatología I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Oral I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Universidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cartagena I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO molestia I-DERIVED_FROM/TO en I-DERIVED_FROM/TO cavidad I-DERIVED_FROM/TO oral. I-DERIVED_FROM/TO Al B-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION múltiples I-EXPLORATION placas, I-EXPLORATION manchas I-EXPLORATION y I-EXPLORATION verrugosidades I-EXPLORATION distribuidas I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION irregular I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION paladar I-EXPLORATION duro I-EXPLORATION comprometiendo I-EXPLORATION tercio I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION medio, I-EXPLORATION del I-EXPLORATION lado I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION derecho; I-EXPLORATION con I-EXPLORATION una I-EXPLORATION coloración I-EXPLORATION de I-EXPLORATION tonalidad I-EXPLORATION variante I-EXPLORATION desde I-EXPLORATION un I-EXPLORATION blanco I-EXPLORATION grisáceo I-EXPLORATION hasta I-EXPLORATION un I-EXPLORATION blanco I-EXPLORATION amarillo; I-EXPLORATION tamaño I-EXPLORATION que I-EXPLORATION oscila I-EXPLORATION aproximadamente I-EXPLORATION sobre I-EXPLORATION 3×5 I-EXPLORATION cm, I-EXPLORATION forma I-EXPLORATION variada I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION verrugosa I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION blanda, I-EXPLORATION bordes I-EXPLORATION definidos, I-EXPLORATION asintomática; I-EXPLORATION no I-EXPLORATION desprende I-EXPLORATION al I-EXPLORATION raspado I-EXPLORATION e I-EXPLORATION imperceptible I-EXPLORATION por I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY reporta I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY invertida I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY fumar I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día. I-PAST_MEDICAL_HISTORY En B-EXPLORATION esta I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION da I-EXPLORATION una I-EXPLORATION impresión I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION leucoplasia I-EXPLORATION homogénea I-EXPLORATION y, I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION definitivo, I-EXPLORATION se I-EXPLORATION programó I-EXPLORATION biopsia I-EXPLORATION incisional. I-EXPLORATION I-EXPLORATION Procedimiento B-TREATMENT I-TREATMENT Previo I-TREATMENT consentimiento I-TREATMENT informado, I-TREATMENT se I-TREATMENT aplica I-TREATMENT técnica I-TREATMENT anestésica I-TREATMENT nasopalatina I-TREATMENT y I-TREATMENT palatina I-TREATMENT anterior I-TREATMENT bilateral, I-TREATMENT utilizando I-TREATMENT lidocaína I-TREATMENT con I-TREATMENT epinefrina I-TREATMENT al I-TREATMENT 2%; I-TREATMENT luego I-TREATMENT se I-TREATMENT realizó I-TREATMENT incisión I-TREATMENT romboidal I-TREATMENT con I-TREATMENT hoja I-TREATMENT de I-TREATMENT bisturí I-TREATMENT número I-TREATMENT 15 I-TREATMENT en I-TREATMENT borde I-TREATMENT anterior I-TREATMENT de I-TREATMENT paladar I-TREATMENT duro I-TREATMENT del I-TREATMENT lado I-TREATMENT derecho, I-TREATMENT seguido I-TREATMENT de I-TREATMENT la I-TREATMENT disección I-TREATMENT del I-TREATMENT tejido, I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT tomó I-TREATMENT con I-TREATMENT pinza I-TREATMENT Alix I-TREATMENT para I-TREATMENT proteger I-TREATMENT y I-TREATMENT manipular I-TREATMENT mejor I-TREATMENT la I-TREATMENT muestra I-TREATMENT de I-TREATMENT tejido, I-TREATMENT se I-TREATMENT hace I-TREATMENT hemostasia I-TREATMENT con I-TREATMENT una I-TREATMENT torunda I-TREATMENT de I-TREATMENT gasa I-TREATMENT estéril, I-TREATMENT tomando I-TREATMENT cuatro I-TREATMENT puntos I-TREATMENT de I-TREATMENT sutura I-TREATMENT con I-TREATMENT seda I-TREATMENT 3/0, I-TREATMENT lavado I-TREATMENT y I-TREATMENT secado I-TREATMENT de I-TREATMENT la I-TREATMENT zona. I-TREATMENT Se I-TREATMENT dieron I-TREATMENT indicaciones I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT de I-TREATMENT forma I-TREATMENT verbal I-TREATMENT y I-TREATMENT por I-TREATMENT escrito. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION regresa I-EVOLUTION a I-EVOLUTION un I-EVOLUTION control I-EVOLUTION posquirúrgico I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION observándose I-EVOLUTION tejidos I-EVOLUTION en I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION y I-EVOLUTION en I-EVOLUTION proceso I-EVOLUTION de I-EVOLUTION cicatrización. I-EVOLUTION El B-EXPLORATION reporte I-EXPLORATION histopatológico I-EXPLORATION indica I-EXPLORATION mucosa I-EXPLORATION palatina I-EXPLORATION con I-EXPLORATION marcada I-EXPLORATION queratosis I-EXPLORATION sin I-EXPLORATION "displasia". I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizan I-EXPLORATION controles I-EXPLORATION mensuales I-EXPLORATION observando I-EXPLORATION la I-EXPLORATION desaparición I-EXPLORATION casi I-EXPLORATION total I-EXPLORATION de I-EXPLORATION la I-EXPLORATION patología; I-EXPLORATION sin B-EVOLUTION embargo I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION reporta I-EVOLUTION que I-EVOLUTION ha I-EVOLUTION iniciado I-EVOLUTION otra I-EVOLUTION vez I-EVOLUTION el I-EVOLUTION hábito I-EVOLUTION de I-EVOLUTION fumar I-EVOLUTION invertido I-EVOLUTION y, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION último I-EVOLUTION control, I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION aparición I-EVOLUTION nuevamente I-EVOLUTION de I-EVOLUTION las I-EVOLUTION placas I-EVOLUTION blancas. I-EVOLUTION Observamos I-EVOLUTION entonces I-EVOLUTION una I-EVOLUTION fuerte I-EVOLUTION asociación I-EVOLUTION entre I-EVOLUTION el I-EVOLUTION fumar I-EVOLUTION invertido I-EVOLUTION y I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION premalignas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino; I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS reiterados I-PRESENT_ILLNESS accesos I-PRESENT_ILLNESS dolorosos I-PRESENT_ILLNESS caracterizados I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hemicrania I-PRESENT_ILLNESS pulsátil, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS urente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS neurálgico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS área I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS retroorbitaria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fenómenos I-PRESENT_ILLNESS productivos I-PRESENT_ILLNESS autonómicos I-PRESENT_ILLNESS homolaterales I-PRESENT_ILLNESS (rinorrea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lagrimeo). I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS eran I-PRESENT_ILLNESS de I-PRESENT_ILLNESS corta I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS (de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS segundos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS minutos), I-PRESENT_ILLNESS reiterados, I-PRESENT_ILLNESS subintrantes, I-PRESENT_ILLNESS postraban I-PRESENT_ILLNESS al I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deterioraban I-PRESENT_ILLNESS sensiblemente I-PRESENT_ILLNESS su I-PRESENT_ILLNESS actividad I-PRESENT_ILLNESS diaria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS su I-PRESENT_ILLNESS vigilia. I-PRESENT_ILLNESS Ocasionalmente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompañaban I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Este I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS presentaba, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio, I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución; I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS analgésico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS antimigrañoso I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS totalmente I-PRESENT_ILLNESS ineficaz. I-PRESENT_ILLNESS Examen B-EXPLORATION neurológico I-EXPLORATION intercrítico I-EXPLORATION normal. I-EXPLORATION Valoración I-EXPLORATION oftalmológica I-EXPLORATION y I-EXPLORATION otorrinolaringológica I-EXPLORATION normales. I-EXPLORATION Psicodiagnóstico I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION de I-EXPLORATION personalidad I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION remarcables. I-EXPLORATION Se I-EXPLORATION efectuaron I-EXPLORATION neuroimágenes I-EXPLORATION (RMN/RMN I-EXPLORATION angiográfica), I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT empleó I-TREATMENT indometacina, I-TREATMENT con I-TREATMENT muy I-TREATMENT pobres I-TREATMENT resultados. I-TREATMENT Los B-EVOLUTION indicadores I-EVOLUTION de I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION y I-EVOLUTION el I-EVOLUTION calendario I-EVOLUTION de I-EVOLUTION cefaleas I-EVOLUTION mostraban I-EVOLUTION un I-EVOLUTION importante I-EVOLUTION deterioro. I-EVOLUTION I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT usar I-TREATMENT entonces I-TREATMENT alguno I-TREATMENT de I-TREATMENT los I-TREATMENT fármacos I-TREATMENT que I-TREATMENT cumplen I-TREATMENT un I-TREATMENT rol I-TREATMENT de I-TREATMENT estabilizadores I-TREATMENT de I-TREATMENT membrana, I-TREATMENT como I-TREATMENT el I-TREATMENT grupo I-TREATMENT de I-TREATMENT drogas I-TREATMENT antiepilépticas I-TREATMENT (DAE) I-TREATMENT relativamente I-TREATMENT nuevas, I-TREATMENT entre I-TREATMENT las I-TREATMENT cuales I-TREATMENT se I-TREATMENT eligió I-TREATMENT el I-TREATMENT topiramato I-TREATMENT (TPM). I-TREATMENT Tal I-TREATMENT decisión I-TREATMENT tuvo I-TREATMENT en I-TREATMENT cuenta I-TREATMENT informes I-TREATMENT sobre I-TREATMENT indicios I-TREATMENT de I-TREATMENT eficacia I-TREATMENT en I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT del I-TREATMENT SUNCT8 I-TREATMENT y I-TREATMENT su I-TREATMENT mejor I-TREATMENT perfil I-TREATMENT de I-TREATMENT bioseguridad, I-TREATMENT respecto I-TREATMENT de I-TREATMENT los I-TREATMENT otros I-TREATMENT agentes I-TREATMENT (gabapentín, I-TREATMENT lamotrigina). I-TREATMENT Se I-TREATMENT comenzó I-TREATMENT con I-TREATMENT 25 I-TREATMENT mg/d I-TREATMENT en I-TREATMENT una I-TREATMENT sola I-TREATMENT toma I-TREATMENT nocturna I-TREATMENT hasta I-TREATMENT llegar I-TREATMENT a I-TREATMENT 75 I-TREATMENT mg/d I-TREATMENT con I-TREATMENT idéntica I-TREATMENT posología. I-TREATMENT La B-EVOLUTION introducción I-EVOLUTION del I-EVOLUTION TPM I-EVOLUTION en I-EVOLUTION el I-EVOLUTION esquema I-EVOLUTION redundó I-EVOLUTION en I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION parcial I-EVOLUTION importante I-EVOLUTION (50-75%, I-EVOLUTION no I-EVOLUTION completa) I-EVOLUTION de I-EVOLUTION los I-EVOLUTION episodios, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION evidente I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION documentada I-EVOLUTION por I-EVOLUTION el I-EVOLUTION MIDAS, I-EVOLUTION instrumento I-EVOLUTION que I-EVOLUTION si I-EVOLUTION bien I-EVOLUTION no I-EVOLUTION fue I-EVOLUTION desarrollado I-EVOLUTION específicamente I-EVOLUTION para I-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION este I-EVOLUTION cuadro I-EVOLUTION permite I-EVOLUTION valorar, I-EVOLUTION mediante I-EVOLUTION una I-EVOLUTION escala I-EVOLUTION global, I-EVOLUTION el I-EVOLUTION compromiso I-EVOLUTION diario I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION afectado. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS niño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY relevantes, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS foco I-PRESENT_ILLNESS detectable. I-PRESENT_ILLNESS A B-EXPLORATION las I-EXPLORATION 72 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION iniciado I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico, I-EXPLORATION el I-EXPLORATION niño I-EXPLORATION refiere I-EXPLORATION dolor I-EXPLORATION e I-EXPLORATION impotencia I-EXPLORATION funcional I-EXPLORATION en I-EXPLORATION hombro I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION flogosis I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION del I-EXPLORATION hombro I-EXPLORATION afectado, I-EXPLORATION ambos I-EXPLORATION estudios I-EXPLORATION con I-EXPLORATION resultados I-EXPLORATION normales. I-EXPLORATION Luego I-EXPLORATION de I-EXPLORATION presentar I-EXPLORATION fiebre I-EXPLORATION elevada I-EXPLORATION y I-EXPLORATION persistente I-EXPLORATION durante I-EXPLORATION 6 I-EXPLORATION días, I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION detecta I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION esternoclavicular I-EXPLORATION derecha, I-EXPLORATION motivo I-EXPLORATION por I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION su I-EXPLORATION internación. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION iniciales I-EXPLORATION revelan I-EXPLORATION leucocitosis I-EXPLORATION (GB: I-EXPLORATION 19.890/mm3 I-EXPLORATION ) I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (85%) I-EXPLORATION proteína I-EXPLORATION C-reactiva I-EXPLORATION (PC-R: I-EXPLORATION 90) I-EXPLORATION y I-EXPLORATION eritrosedimentación I-EXPLORATION elevadas I-EXPLORATION (ERS: I-EXPLORATION 57 I-EXPLORATION mm). I-EXPLORATION La I-EXPLORATION CPK I-EXPLORATION informa I-EXPLORATION valores I-EXPLORATION normales I-EXPLORATION (50 I-EXPLORATION UI/L). I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION un I-EXPLORATION foco I-EXPLORATION profundo I-EXPLORATION de I-EXPLORATION infección, I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RMN) I-EXPLORATION que I-EXPLORATION evidencia I-EXPLORATION un I-EXPLORATION intenso I-EXPLORATION mioedema I-EXPLORATION que I-EXPLORATION compromete I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION trapecio I-EXPLORATION y I-EXPLORATION pectoral I-EXPLORATION mayor I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizan I-EXPLORATION dos I-EXPLORATION hemocultivos I-EXPLORATION y B-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cefalotina I-TREATMENT por I-TREATMENT vía I-TREATMENT parenteral. I-TREATMENT Luego B-EVOLUTION de I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION continúa I-EVOLUTION febril; I-EVOLUTION además, I-EVOLUTION presenta I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION eritema I-EVOLUTION y I-EVOLUTION edema I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION afectada. I-EVOLUTION Se B-EXPLORATION reciben I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION tomados I-EXPLORATION al I-EXPLORATION ingreso, I-EXPLORATION que I-EXPLORATION resultan I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION SAMRC I-EXPLORATION (resistente I-EXPLORATION a I-EXPLORATION clindamicina); I-EXPLORATION se B-TREATMENT modifica I-TREATMENT el I-TREATMENT esquema I-TREATMENT terapéutico I-TREATMENT y I-TREATMENT se I-TREATMENT indica I-TREATMENT vancomicina I-TREATMENT por I-TREATMENT vía I-TREATMENT endovenosa I-TREATMENT y I-TREATMENT rifampicina I-TREATMENT por I-TREATMENT vía I-TREATMENT oral. I-TREATMENT Dos B-EVOLUTION días I-EVOLUTION más I-EVOLUTION tarde, I-EVOLUTION la I-EVOLUTION fiebre I-EVOLUTION comienza I-EVOLUTION a I-EVOLUTION disminuir I-EVOLUTION y I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION se I-EVOLUTION torna I-EVOLUTION circunscripta I-EVOLUTION y I-EVOLUTION fluctuante. I-EVOLUTION Aparece I-EVOLUTION además I-EVOLUTION un I-EVOLUTION exantema I-EVOLUTION cutáneo I-EVOLUTION eritematopustuloso I-EVOLUTION con I-EVOLUTION descamación I-EVOLUTION que I-EVOLUTION predomina I-EVOLUTION en I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION axila. I-EVOLUTION Se B-EXPLORATION realiza I-EXPLORATION hisopado I-EXPLORATION nasal, I-EXPLORATION axilar I-EXPLORATION y I-EXPLORATION anal, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION obtiene I-EXPLORATION el I-EXPLORATION germen I-EXPLORATION aislado I-EXPLORATION previamente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION nasal. I-EXPLORATION I-EXPLORATION En I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION RMN, I-EXPLORATION se I-EXPLORATION comprueba I-EXPLORATION mayor I-EXPLORATION jerarquía I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION en I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION trapecio I-EXPLORATION y I-EXPLORATION pectoral I-EXPLORATION mayor I-EXPLORATION derecho, I-EXPLORATION extendiéndose I-EXPLORATION el I-EXPLORATION proceso I-EXPLORATION a I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION pectoral I-EXPLORATION menor, I-EXPLORATION subclavio, I-EXPLORATION romboides I-EXPLORATION y I-EXPLORATION al I-EXPLORATION tejido I-EXPLORATION blando I-EXPLORATION adyacente. I-EXPLORATION Formación I-EXPLORATION de I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION que I-EXPLORATION rodea I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION clavícula I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION Posteriormente, B-TREATMENT se I-TREATMENT realiza I-TREATMENT el I-TREATMENT drenaje I-TREATMENT del I-TREATMENT absceso I-TREATMENT por I-TREATMENT punción I-TREATMENT y I-TREATMENT se I-TREATMENT solicita I-TREATMENT un I-TREATMENT centellograma I-TREATMENT que I-TREATMENT descarta I-TREATMENT el I-TREATMENT compromiso I-TREATMENT óseo. I-TREATMENT El B-EVOLUTION niño I-EVOLUTION evoluciona I-EVOLUTION favorablemente I-EVOLUTION y B-TREATMENT completa I-TREATMENT diez I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT por I-TREATMENT vía I-TREATMENT parenteral I-TREATMENT y I-TREATMENT luego, I-TREATMENT veinte I-TREATMENT días I-TREATMENT con I-TREATMENT trimetroprimasulfametoxasol I-TREATMENT por I-TREATMENT vía I-TREATMENT oral. I-TREATMENT I-TREATMENT Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY patología I-PAST_MEDICAL_HISTORY alérgica, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urticaria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS angioedema I-PRESENT_ILLNESS intratable I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Pese B-TREATMENT a I-TREATMENT utilizarse I-TREATMENT dosis I-TREATMENT máximas I-TREATMENT de I-TREATMENT varios I-TREATMENT antihistamínicos I-TREATMENT combinados, I-TREATMENT antileucotrienos I-TREATMENT y I-TREATMENT esteroides I-TREATMENT orales I-TREATMENT no I-TREATMENT se I-TREATMENT observó I-TREATMENT respuesta I-TREATMENT al I-TREATMENT tratamiento. I-TREATMENT I-TREATMENT El B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS repercutía I-PRESENT_ILLNESS sobremanera I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS calidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS niña, I-PRESENT_ILLNESS tanto I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS continuo I-PRESENT_ILLNESS como I-PRESENT_ILLNESS por I-PRESENT_ILLNESS las I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS por I-PRESENT_ILLNESS placa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS angioedema I-PRESENT_ILLNESS claramente I-PRESENT_ILLNESS visibles, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS afectan I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sueño, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS escolaridad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS interpersonal. I-PRESENT_ILLNESS El B-EXPLORATION laboratorio I-EXPLORATION presentaba, I-EXPLORATION como I-EXPLORATION datos I-EXPLORATION positivos: I-EXPLORATION PCR, I-EXPLORATION 21; I-EXPLORATION factor I-EXPLORATION reumatoideo, I-EXPLORATION 24 I-EXPLORATION UI/ml I-EXPLORATION (normal I-EXPLORATION hasta I-EXPLORATION 20). I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION posibles I-EXPLORATION causas I-EXPLORATION infecciosas. I-EXPLORATION I-EXPLORATION Una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION vasculitis. I-EXPLORATION Se I-EXPLORATION efectuaron I-EXPLORATION dietas I-EXPLORATION de I-EXPLORATION exclusión I-EXPLORATION de I-EXPLORATION alimentos, I-EXPLORATION aditivos I-EXPLORATION y I-EXPLORATION colorantes, I-EXPLORATION sin I-EXPLORATION mejoría I-EXPLORATION sintomática. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION suero I-EXPLORATION autólogo, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION hasta I-EXPLORATION una I-EXPLORATION dilución I-EXPLORATION 1: I-EXPLORATION 100, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION urticaria I-EXPLORATION crónica I-EXPLORATION autoinmunitaria. I-EXPLORATION Previamente B-TREATMENT a I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT omalizumab I-TREATMENT se I-TREATMENT evaluaron I-TREATMENT los I-TREATMENT beneficios I-TREATMENT y I-TREATMENT riesgos I-TREATMENT de I-TREATMENT otros I-TREATMENT tratamientos, I-TREATMENT como I-TREATMENT ciclosporina I-TREATMENT o I-TREATMENT gammaglobulina I-TREATMENT intravenosa, I-TREATMENT y I-TREATMENT dadas I-TREATMENT las I-TREATMENT potenciales I-TREATMENT y I-TREATMENT mayores I-TREATMENT complicaciones I-TREATMENT y I-TREATMENT riesgos I-TREATMENT de I-TREATMENT estos I-TREATMENT tratamientos, I-TREATMENT se I-TREATMENT decidió I-TREATMENT iniciar I-TREATMENT omalizumab I-TREATMENT en I-TREATMENT una I-TREATMENT dosis I-TREATMENT calculada I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT al I-TREATMENT valor I-TREATMENT de I-TREATMENT IgE I-TREATMENT total I-TREATMENT y I-TREATMENT del I-TREATMENT peso I-TREATMENT corporal, I-TREATMENT según I-TREATMENT la I-TREATMENT dosificación I-TREATMENT aprobada I-TREATMENT para I-TREATMENT asma I-TREATMENT bronquial I-TREATMENT (150 I-TREATMENT mg I-TREATMENT subcutáneos I-TREATMENT mensuales). I-TREATMENT Luego B-EVOLUTION de I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION dosis I-EVOLUTION recrudecieron I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION por I-EVOLUTION 3 I-EVOLUTION días I-EVOLUTION y, I-EVOLUTION posteriormente, I-EVOLUTION la I-EVOLUTION urticaria I-EVOLUTION permaneció I-EVOLUTION activa, I-EVOLUTION pero I-EVOLUTION estable. I-EVOLUTION Luego I-EVOLUTION de I-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION dosis I-EVOLUTION se I-EVOLUTION repite I-EVOLUTION el I-EVOLUTION patrón, I-EVOLUTION pero I-EVOLUTION posteriormente I-EVOLUTION comienza I-EVOLUTION a I-EVOLUTION disminuir I-EVOLUTION la I-EVOLUTION intensidad I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pápulas I-EVOLUTION y I-EVOLUTION del I-EVOLUTION angioedema; I-EVOLUTION esta I-EVOLUTION mejoría I-EVOLUTION que I-EVOLUTION se I-EVOLUTION torna I-EVOLUTION más I-EVOLUTION notable I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION tercera I-EVOLUTION dosis, I-EVOLUTION al I-EVOLUTION cuarto I-EVOLUTION mes I-EVOLUTION (cuarta I-EVOLUTION dosis) I-EVOLUTION llega I-EVOLUTION a I-EVOLUTION una I-EVOLUTION aparente I-EVOLUTION remisión, I-EVOLUTION hecho B-TREATMENT que I-TREATMENT permite I-TREATMENT suspender I-TREATMENT en I-TREATMENT forma I-TREATMENT sucesiva I-TREATMENT el I-TREATMENT montelukast I-TREATMENT y I-TREATMENT la I-TREATMENT ranitidina, I-TREATMENT y I-TREATMENT reducir I-TREATMENT a I-TREATMENT la I-TREATMENT mitad I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT hidroxicina I-TREATMENT sin I-TREATMENT signos I-TREATMENT de I-TREATMENT recaída. I-TREATMENT Hacia B-EVOLUTION el I-EVOLUTION quinto I-EVOLUTION mes, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION por I-EVOLUTION completo I-EVOLUTION asintomática, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspenden I-TREATMENT los I-TREATMENT antihistamínicos I-TREATMENT remanentes. I-TREATMENT Al B-EXPLORATION sexto I-EXPLORATION mes, I-EXPLORATION se I-EXPLORATION repite I-EXPLORATION la I-EXPLORATION prueba I-EXPLORATION del I-EXPLORATION suero I-EXPLORATION autólogo, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION negativa; I-EXPLORATION se I-EXPLORATION verifica I-EXPLORATION normalización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION PCR I-EXPLORATION y I-EXPLORATION del I-EXPLORATION factor I-EXPLORATION reumatoideo. I-EXPLORATION Posteriormente B-EVOLUTION se I-EVOLUTION completan I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION omalizumab. I-EVOLUTION Seis I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION del I-EVOLUTION tratamiento, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION continuó I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION alteraciones I-EVOLUTION del I-EVOLUTION laboratorio. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS que I-PRESENT_ILLNESS concurre I-PRESENT_ILLNESS al I-PRESENT_ILLNESS consultorio I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS interpretado, I-PRESENT_ILLNESS doce I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS antes, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia, I-PRESENT_ILLNESS como I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS broncoobstrucción I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS trató I-PRESENT_ILLNESS con I-PRESENT_ILLNESS salbutamol I-PRESENT_ILLNESS y I-PRESENT_ILLNESS prednisolona. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY niño I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY eutrófico, I-PAST_MEDICAL_HISTORY recién I-PAST_MEDICAL_HISTORY nacido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY término, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY destacar. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presenta I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION fiebre I-EXPLORATION de I-EXPLORATION 38, I-EXPLORATION 2ºC, I-EXPLORATION tumoración I-EXPLORATION bilateral I-EXPLORATION en I-EXPLORATION cuello, I-EXPLORATION blanda, I-EXPLORATION dolorosa I-EXPLORATION y I-EXPLORATION con I-EXPLORATION crepitación I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION submandibular. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION es I-EXPLORATION normal, I-EXPLORATION a I-EXPLORATION excepción I-EXPLORATION de I-EXPLORATION una I-EXPLORATION otitis I-EXPLORATION media I-EXPLORATION aguda I-EXPLORATION (OMA) I-EXPLORATION congestiva I-EXPLORATION izquierda. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION respiratorio I-EXPLORATION presenta I-EXPLORATION tos I-EXPLORATION húmeda I-EXPLORATION leve, I-EXPLORATION sin I-EXPLORATION disnea I-EXPLORATION ni I-EXPLORATION polipnea; I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION 30 I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION sin I-EXPLORATION tiraje; I-EXPLORATION buena I-EXPLORATION entrada I-EXPLORATION de I-EXPLORATION aire I-EXPLORATION bilateral; I-EXPLORATION rales I-EXPLORATION subcrepitantes I-EXPLORATION diseminados. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION auscultan I-EXPLORATION roncus I-EXPLORATION o I-EXPLORATION sibilancias I-EXPLORATION (última I-EXPLORATION nebulización I-EXPLORATION con I-EXPLORATION salbutamol I-EXPLORATION hacía I-EXPLORATION 7 I-EXPLORATION h). I-EXPLORATION Se I-EXPLORATION interpreta I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION como I-EXPLORATION enfisema I-EXPLORATION subcutáneo I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION acceso I-EXPLORATION de I-EXPLORATION tos I-EXPLORATION intensa I-EXPLORATION y I-EXPLORATION se I-EXPLORATION solicitan I-EXPLORATION radiografías I-EXPLORATION con I-EXPLORATION nota I-EXPLORATION al I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Urgencias I-EXPLORATION para I-EXPLORATION eventual I-EXPLORATION internación. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION interna I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza: I-EXPLORATION saturometría I-EXPLORATION O2 I-EXPLORATION (FIO2 I-EXPLORATION aire I-EXPLORATION ambiental): I-EXPLORATION 97%, I-EXPLORATION hemograma: I-EXPLORATION glóbulos I-EXPLORATION blancos: I-EXPLORATION 6.000 I-EXPLORATION por I-EXPLORATION mm3, I-EXPLORATION hemoglobina: I-EXPLORATION 11 I-EXPLORATION g%, I-EXPLORATION fórmula I-EXPLORATION leucocitaria: I-EXPLORATION 6/72/2/0/16/4; I-EXPLORATION proteína I-EXPLORATION C-reactiva: I-EXPLORATION 45 I-EXPLORATION mg/dl; I-EXPLORATION medio I-EXPLORATION interno I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION bacterias I-EXPLORATION atípicas. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION TAC. I-EXPLORATION Se I-EXPLORATION interna I-EXPLORATION por I-EXPLORATION 72 I-EXPLORATION h, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION constatan I-EXPLORATION sibilancias I-EXPLORATION ni I-EXPLORATION espiración I-EXPLORATION prolongada I-EXPLORATION y B-TREATMENT se I-TREATMENT da I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT sostén I-TREATMENT con I-TREATMENT analgesia, I-TREATMENT O2 I-TREATMENT por I-TREATMENT cánula I-TREATMENT nasal I-TREATMENT y I-TREATMENT amoxicilina I-TREATMENT para I-TREATMENT la I-TREATMENT OMA. I-TREATMENT Presenta B-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION tumoración I-EVOLUTION cervical, I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION cervical I-EVOLUTION y I-EVOLUTION la I-EVOLUTION fiebre. I-EVOLUTION La B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION al I-EXPLORATION alta I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION 5 I-EXPLORATION to I-EXPLORATION día I-EXPLORATION de I-EXPLORATION evolución, I-EXPLORATION ya I-EXPLORATION en I-EXPLORATION seguimiento I-EXPLORATION ambulatorio, I-EXPLORATION se I-EXPLORATION recibe I-EXPLORATION serología: I-EXPLORATION IgM I-EXPLORATION e I-EXPLORATION IgG I-EXPLORATION anti-Clamidia I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION anti-Mycoplasma I-EXPLORATION pneumoniae: I-EXPLORATION negativos. I-EXPLORATION La I-EXPLORATION IgG I-EXPLORATION anti-Mycoplasma I-EXPLORATION pneumoniae I-EXPLORATION fue I-EXPLORATION positiva: I-EXPLORATION 1/80 I-EXPLORATION por I-EXPLORATION inmunofluorescencia I-EXPLORATION indirecta. I-EXPLORATION Se B-TREATMENT decide I-TREATMENT rotar I-TREATMENT la I-TREATMENT amoxicilina I-TREATMENT por I-TREATMENT claritromicina I-TREATMENT y I-TREATMENT repetir I-TREATMENT serología I-TREATMENT a I-TREATMENT los I-TREATMENT 15 I-TREATMENT días I-TREATMENT de I-TREATMENT evolución. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION d I-EVOLUTION ías I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático. I-EVOLUTION Serología: B-EXPLORATION IgM I-EXPLORATION anti-Mycoplasma: I-EXPLORATION negativa I-EXPLORATION e I-EXPLORATION IgG I-EXPLORATION anti-Mycoplasma: I-EXPLORATION positiva I-EXPLORATION 1/64 I-EXPLORATION (IFI). I-EXPLORATION IgA: I-EXPLORATION 108 I-EXPLORATION mg/dl, I-EXPLORATION IgE: I-EXPLORATION 31, I-EXPLORATION 1 I-EXPLORATION UI/ml I-EXPLORATION (vn: I-EXPLORATION 60-144), I-EXPLORATION IgG: I-EXPLORATION 818 I-EXPLORATION mg/dl I-EXPLORATION (vn: I-EXPLORATION 315-1236), I-EXPLORATION IgM: I-EXPLORATION 72 I-EXPLORATION mg/dl I-EXPLORATION (vn: I-EXPLORATION 43-207), I-EXPLORATION proteinograma: I-EXPLORATION proteínas I-EXPLORATION totales: I-EXPLORATION 7, I-EXPLORATION 51, I-EXPLORATION albúmina: I-EXPLORATION 4, I-EXPLORATION 49, I-EXPLORATION alfa I-EXPLORATION 1: I-EXPLORATION 0, I-EXPLORATION 27, I-EXPLORATION alfa I-EXPLORATION 2: I-EXPLORATION 101 I-EXPLORATION (elevada), I-EXPLORATION β-globulina: I-EXPLORATION 0, I-EXPLORATION 90, I-EXPLORATION gamma: I-EXPLORATION 0, I-EXPLORATION 84. I-EXPLORATION Relación I-EXPLORATION albúmina-globulina: I-EXPLORATION 1, I-EXPLORATION 49 I-EXPLORATION (normal). I-EXPLORATION Luego B-EVOLUTION de I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION recurrencias. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY salud I-PAST_MEDICAL_HISTORY relevantes, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Universitario I-PRESENT_ILLNESS Austral I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Se B-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION normotenso I-EXPLORATION y I-EXPLORATION afebril; I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION placa I-EXPLORATION eritematosa I-EXPLORATION y I-EXPLORATION dolorosa I-EXPLORATION en I-EXPLORATION planta I-EXPLORATION izquierda. I-EXPLORATION Por B-EVOLUTION sospecha I-EVOLUTION de I-EVOLUTION un I-EVOLUTION proceso I-EVOLUTION infeccioso I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION su I-EVOLUTION internación. I-EVOLUTION Se B-EXPLORATION realizaron I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION que I-EXPLORATION demostraron I-EXPLORATION leucocitosis I-EXPLORATION leve I-EXPLORATION y I-EXPLORATION eritrosedimentación I-EXPLORATION elevada; I-EXPLORATION dos I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION punción I-EXPLORATION por I-EXPLORATION piel I-EXPLORATION sana, I-EXPLORATION todos I-EXPLORATION ellos I-EXPLORATION negativos. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION solicitaron: I-EXPLORATION radiografía, I-EXPLORATION centellografía I-EXPLORATION y I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION afectado, I-EXPLORATION descartándose I-EXPLORATION compromiso I-EXPLORATION óseo. I-EXPLORATION Se B-TREATMENT indicaron I-TREATMENT ibuprofeno I-TREATMENT 400 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 6 I-TREATMENT h I-TREATMENT y I-TREATMENT cefalotina I-TREATMENT 100 I-TREATMENT mg/kg/día I-TREATMENT cada I-TREATMENT 6 I-TREATMENT h I-TREATMENT asociada I-TREATMENT a I-TREATMENT gentamicina I-TREATMENT 5 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT 3 I-TREATMENT días. I-TREATMENT Por I-TREATMENT evolución I-TREATMENT desfavorable I-TREATMENT se I-TREATMENT rotó I-TREATMENT a I-TREATMENT clindamicina, I-TREATMENT 40 I-TREATMENT mg/kg/día I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h I-TREATMENT asociada I-TREATMENT a I-TREATMENT rifampicina, I-TREATMENT 20 I-TREATMENT mg/kg/día I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h. I-TREATMENT Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION internación, I-EVOLUTION por I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION nódulos I-EVOLUTION en I-EVOLUTION miembros I-EVOLUTION superiores, I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION artralgias I-EVOLUTION de I-EVOLUTION tobillos I-EVOLUTION y I-EVOLUTION muñecas I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION una I-EVOLUTION interconsulta I-EVOLUTION con I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Dermatología. I-EVOLUTION En B-EXPLORATION esa I-EXPLORATION oportunidad, I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION múltiples I-EXPLORATION nódulos I-EXPLORATION eritematosos, I-EXPLORATION dolorosos, I-EXPLORATION de I-EXPLORATION 1-2 I-EXPLORATION cm, I-EXPLORATION agrupados I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores; I-EXPLORATION otros I-EXPLORATION nódulos I-EXPLORATION eritematopurpúricos, I-EXPLORATION de I-EXPLORATION mayor I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION en I-EXPLORATION arco I-EXPLORATION interno I-EXPLORATION de I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION otro I-EXPLORATION en I-EXPLORATION región I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION tobillo I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenomegalias I-EXPLORATION ni I-EXPLORATION se I-EXPLORATION evidenciaban I-EXPLORATION livedo I-EXPLORATION reticular, I-EXPLORATION ulceraciones I-EXPLORATION u I-EXPLORATION otros I-EXPLORATION signos I-EXPLORATION cutáneos. I-EXPLORATION Con I-EXPLORATION diagnósticos I-EXPLORATION presuntivos I-EXPLORATION de I-EXPLORATION panarteritis I-EXPLORATION nudosa I-EXPLORATION cutánea I-EXPLORATION (PANC), I-EXPLORATION eritema I-EXPLORATION nudoso I-EXPLORATION atípico I-EXPLORATION u I-EXPLORATION otras I-EXPLORATION paniculitis, I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION estudios I-EXPLORATION complementarios: I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION glóbulos I-EXPLORATION blancos, I-EXPLORATION 10.900 I-EXPLORATION (neutrófilos I-EXPLORATION 61%; I-EXPLORATION linfocitos I-EXPLORATION 29%); I-EXPLORATION hemoglobina, I-EXPLORATION 13, I-EXPLORATION 5 I-EXPLORATION mg/dl; I-EXPLORATION hematocrito, I-EXPLORATION 40%; I-EXPLORATION plaquetas, I-EXPLORATION 292.000/ I-EXPLORATION mm3; I-EXPLORATION ESD I-EXPLORATION 32 I-EXPLORATION mm/h, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina, I-EXPLORATION 96%; I-EXPLORATION KPTT I-EXPLORATION 36 I-EXPLORATION seg; I-EXPLORATION ASTO I-EXPLORATION 400 I-EXPLORATION UI/ml I-EXPLORATION (VN<200 I-EXPLORATION UI/ I-EXPLORATION ml); I-EXPLORATION complemento: I-EXPLORATION C3 I-EXPLORATION 214 I-EXPLORATION (VN: I-EXPLORATION 90-180); I-EXPLORATION C4 I-EXPLORATION 45, I-EXPLORATION 3 I-EXPLORATION (VN: I-EXPLORATION 10-40); I-EXPLORATION FAN, I-EXPLORATION ANCA, I-EXPLORATION FR, I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION VHB, I-EXPLORATION VHC, I-EXPLORATION Bartonella, I-EXPLORATION Mycoplasma I-EXPLORATION y I-EXPLORATION EBV: I-EXPLORATION negativas. I-EXPLORATION Cultivo I-EXPLORATION de I-EXPLORATION fauces: I-EXPLORATION negativo. I-EXPLORATION La I-EXPLORATION PPD I-EXPLORATION 2 I-EXPLORATION UT I-EXPLORATION fue I-EXPLORATION no I-EXPLORATION reactiva. I-EXPLORATION Además, I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION estudios I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION compromiso I-EXPLORATION sistémico: I-EXPLORATION hepatograma, I-EXPLORATION urea, I-EXPLORATION creatinina, I-EXPLORATION ionograma, I-EXPLORATION gases I-EXPLORATION en I-EXPLORATION sangre, I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION orina, I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo, I-EXPLORATION presión I-EXPLORATION ocular, I-EXPLORATION ecocardiografía I-EXPLORATION Doppler, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION Doppler I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION inferiores, I-EXPLORATION sin I-EXPLORATION evidenciarse I-EXPLORATION alteraciones. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION demostró I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION interfaz I-EXPLORATION dermohipodérmica I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION hipodermis, I-EXPLORATION compromiso I-EXPLORATION inflamatorio I-EXPLORATION neutrofílico I-EXPLORATION y I-EXPLORATION material I-EXPLORATION fibrinoide I-EXPLORATION en I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION y I-EXPLORATION arterias I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION calibre, I-EXPLORATION con I-EXPLORATION oclusión I-EXPLORATION luminal I-EXPLORATION focal I-EXPLORATION y I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION algunos I-EXPLORATION linfocitos I-EXPLORATION y I-EXPLORATION numerosos I-EXPLORATION eosinófilos. I-EXPLORATION Estos I-EXPLORATION hallazgos I-EXPLORATION histopatológicos I-EXPLORATION permiten I-EXPLORATION arribar I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION vasculitis I-EXPLORATION de I-EXPLORATION pequeños I-EXPLORATION vasos I-EXPLORATION dermohipodérmicos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION arterias I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION calibre. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION las I-EXPLORATION manifestaciones I-EXPLORATION cutáneas I-EXPLORATION y I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION complementarios I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION PANC. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT la I-TREATMENT suspensión I-TREATMENT del I-TREATMENT antibiótico I-TREATMENT y I-TREATMENT comenzar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT meprednisona I-TREATMENT 1 I-TREATMENT mg/kg/día, I-TREATMENT dosis I-TREATMENT diaria I-TREATMENT total I-TREATMENT de I-TREATMENT 40 I-TREATMENT mg I-TREATMENT y I-TREATMENT penicilina I-TREATMENT profiláctica, I-TREATMENT por I-TREATMENT el I-TREATMENT antecedente I-TREATMENT de I-TREATMENT un I-TREATMENT ASTO I-TREATMENT positivo. I-TREATMENT Hubo B-EVOLUTION mejoría I-EVOLUTION parcial I-EVOLUTION al I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento, I-EVOLUTION pero I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION lesiones, I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION artralgias, I-EVOLUTION se B-TREATMENT aumentó I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT meprednisona I-TREATMENT a I-TREATMENT 60 I-TREATMENT mg/día I-TREATMENT a I-TREATMENT los I-TREATMENT ocho I-TREATMENT días I-TREATMENT con B-EVOLUTION respuesta I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION rebrote I-EVOLUTION en I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION posteriores. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS derivada B-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO guardia I-DERIVED_FROM/TO del I-DERIVED_FROM/TO sanatorio I-DERIVED_FROM/TO con I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO celulitis I-DERIVED_FROM/TO orbitaria I-DERIVED_FROM/TO para I-DERIVED_FROM/TO internación, I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO antibiótico I-DERIVED_FROM/TO endovenoso I-DERIVED_FROM/TO y I-DERIVED_FROM/TO evaluación I-DERIVED_FROM/TO urgente I-DERIVED_FROM/TO por I-DERIVED_FROM/TO oftalmología. I-DERIVED_FROM/TO Datos B-EXPLORATION positivos I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico: I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION párpado I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION que I-EXPLORATION dificultaba I-EXPLORATION la I-EXPLORATION apertura I-EXPLORATION ocular, I-EXPLORATION limitación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mirada I-EXPLORATION vertical, I-EXPLORATION prurito I-EXPLORATION y I-EXPLORATION crepitación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION del I-EXPLORATION párpado. I-EXPLORATION Se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION y I-EXPLORATION afebril. I-EXPLORATION I-EXPLORATION Al B-PAST_MEDICAL_HISTORY profundizar I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY interrogatorio, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY descubre I-PAST_MEDICAL_HISTORY mínimo I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cara I-PAST_MEDICAL_HISTORY ocurrido I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY previas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estornudo I-PAST_MEDICAL_HISTORY inmediatamente I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY clínico. I-PAST_MEDICAL_HISTORY Con B-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION enfisema I-EXPLORATION subcutáneo I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION fractura I-EXPLORATION de I-EXPLORATION seno I-EXPLORATION etmoidal I-EXPLORATION se I-EXPLORATION solicita: I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION senos I-EXPLORATION paranasales I-EXPLORATION (velamiento I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho), I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION orbita I-EXPLORATION en I-EXPLORATION cortes I-EXPLORATION axiales I-EXPLORATION y I-EXPLORATION coronales I-EXPLORATION (zona I-EXPLORATION de I-EXPLORATION hipodensidad I-EXPLORATION en I-EXPLORATION párpado I-EXPLORATION superior I-EXPLORATION derecho, I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho I-EXPLORATION levemente I-EXPLORATION hiperdensa, I-EXPLORATION desplazamiento I-EXPLORATION del I-EXPLORATION globo I-EXPLORATION ocular I-EXPLORATION derecho I-EXPLORATION hacia I-EXPLORATION abajo). I-EXPLORATION Lámpara I-EXPLORATION de I-EXPLORATION hendidura, I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION y I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION diagnostica I-EXPLORATION fractura I-EXPLORATION de I-EXPLORATION lámina I-EXPLORATION papirácea I-EXPLORATION del I-EXPLORATION etmoides. I-EXPLORATION El B-EVOLUTION enfisema I-EVOLUTION subcutáneo I-EVOLUTION secundario I-EVOLUTION se I-EVOLUTION reabsorbe I-EVOLUTION espontáneamente I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION completa I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION evolución. I-EVOLUTION Recibió B-TREATMENT tratamiento I-TREATMENT profiláctico I-TREATMENT con I-TREATMENT amoxicilina/clavulánico I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT sintomático. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (39 I-PRESENT_ILLNESS ºC) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY recién I-PAST_MEDICAL_HISTORY nacido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gesta I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY controlado, I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY normal, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY (40 I-PAST_MEDICAL_HISTORY semanas), I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY adecuado I-PAST_MEDICAL_HISTORY (3360 I-PAST_MEDICAL_HISTORY kg). I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY diagnosticaron I-PAST_MEDICAL_HISTORY miopía, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encuentra I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY oftalmología. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tracto I-PAST_MEDICAL_HISTORY urinario I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Escherichia I-PAST_MEDICAL_HISTORY coli, I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY ambulatorio, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY realizaron I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY posteriores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esta I-PAST_MEDICAL_HISTORY patología. I-PAST_MEDICAL_HISTORY Refiere I-PAST_MEDICAL_HISTORY poliuria I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY polidipsia I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY temprana I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY Antecedentes B-FAMILY_HISTORY familiares: I-FAMILY_HISTORY abuela I-FAMILY_HISTORY paterna I-FAMILY_HISTORY hipoacúsica, I-FAMILY_HISTORY primo I-FAMILY_HISTORY paterno I-FAMILY_HISTORY con I-FAMILY_HISTORY litiasis I-FAMILY_HISTORY renal, I-FAMILY_HISTORY padre I-FAMILY_HISTORY con I-FAMILY_HISTORY microhematuria. I-FAMILY_HISTORY Al B-EXPLORATION ingreso, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION eutrófica I-EXPLORATION (peso: I-EXPLORATION 17.400 I-EXPLORATION kg, I-EXPLORATION talla: I-EXPLORATION 104 I-EXPLORATION cm), I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION febril, I-EXPLORATION normotensa. I-EXPLORATION Por I-EXPLORATION presentar I-EXPLORATION orina I-EXPLORATION patológica I-EXPLORATION se I-EXPLORATION solicitan: I-EXPLORATION urocultivo, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION informa I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Escherichia I-EXPLORATION coli, I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION evidencian I-EXPLORATION imágenes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION nefrocalcinosis. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION calcificaciones I-EXPLORATION renales. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION manifestaron I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION (depuración I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION 50 I-EXPLORATION ml/min/1, I-EXPLORATION 73, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION calculó I-EXPLORATION por I-EXPLORATION fórmula), I-EXPLORATION hipercalciuria I-EXPLORATION (13 I-EXPLORATION mg/kg/d), I-EXPLORATION hipomagnesemia, I-EXPLORATION hipermagnesuria, I-EXPLORATION anemia I-EXPLORATION y I-EXPLORATION acidosis. I-EXPLORATION I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION cardiológica I-EXPLORATION y I-EXPLORATION otorrinolaringológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION oftalmología I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION "coriorretinitis I-EXPLORATION cicatrizal I-EXPLORATION macular, I-EXPLORATION coriopatía I-EXPLORATION miópica". I-EXPLORATION Se I-EXPLORATION arriba I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION por I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hipercalciuria, I-EXPLORATION nefrocalcinosis, I-EXPLORATION hipomagnesemia, I-EXPLORATION hipermagnesuria I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION renal, I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION patología I-EXPLORATION ocular I-EXPLORATION y I-EXPLORATION antecedentes I-EXPLORATION personales I-EXPLORATION y I-EXPLORATION familiares I-EXPLORATION compatibles. I-EXPLORATION Cumplió B-TREATMENT tratamiento I-TREATMENT para I-TREATMENT infección I-TREATMENT urinaria. I-TREATMENT Se I-TREATMENT indicó I-TREATMENT citrato I-TREATMENT de I-TREATMENT potasio, I-TREATMENT amiloride-hidroclorotiazida I-TREATMENT 25 I-TREATMENT mg/día, I-TREATMENT pidolato I-TREATMENT de I-TREATMENT magnesio I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT g/ I-TREATMENT día, I-TREATMENT ácido I-TREATMENT fólico I-TREATMENT 5 I-TREATMENT mg/día, I-TREATMENT sulfato I-TREATMENT ferroso I-TREATMENT 3 I-TREATMENT mg/ I-TREATMENT kg/día, I-TREATMENT dieta I-TREATMENT hiposódica I-TREATMENT controlada I-TREATMENT en I-TREATMENT proteínas I-TREATMENT y I-TREATMENT líquidos I-TREATMENT a I-TREATMENT demanda. I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION presentó I-EVOLUTION nueva I-EVOLUTION infección I-EVOLUTION urinaria I-EVOLUTION a I-EVOLUTION E. I-EVOLUTION coli, I-EVOLUTION se B-EXPLORATION realizó I-EXPLORATION cistouretrografía I-EXPLORATION miccional, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION y B-TREATMENT se I-TREATMENT inició I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT con I-TREATMENT nitrofurantoína. I-TREATMENT Se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT hidroclorotiazida I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT meses I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT por I-TREATMENT brusco I-TREATMENT aumento I-TREATMENT de I-TREATMENT urea I-TREATMENT y I-TREATMENT creatinina, I-TREATMENT con I-TREATMENT mejoría I-TREATMENT posterior I-TREATMENT y I-TREATMENT mantenimiento I-TREATMENT de I-TREATMENT valores I-TREATMENT de I-TREATMENT calciuria I-TREATMENT dentro I-TREATMENT de I-TREATMENT la I-TREATMENT normalidad. I-TREATMENT Se B-EVOLUTION mantiene I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION el I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION la I-EVOLUTION medicación. I-EVOLUTION I-EVOLUTION Embarazada B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-FAMILY_HISTORY de I-FAMILY_HISTORY Embarcación I-FAMILY_HISTORY (Salta), I-FAMILY_HISTORY que I-FAMILY_HISTORY cursaba I-FAMILY_HISTORY su I-FAMILY_HISTORY segunda I-FAMILY_HISTORY gesta I-FAMILY_HISTORY en I-FAMILY_HISTORY semana I-FAMILY_HISTORY 38 I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY patológicos. I-FAMILY_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (39,4°C), I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS internó I-PRESENT_ILLNESS para I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratamiento. I-PRESENT_ILLNESS Al B-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION sangrado I-EVOLUTION de I-EVOLUTION mucosas, I-EVOLUTION en I-EVOLUTION zonas I-EVOLUTION de I-EVOLUTION venopuntura I-EVOLUTION y I-EVOLUTION deterioro I-EVOLUTION progresivo I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general. I-EVOLUTION Veinticuatro B-TREATMENT horas I-TREATMENT más I-TREATMENT tarde I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT cesárea I-TREATMENT de I-TREATMENT urgencia I-TREATMENT por I-TREATMENT sufrimiento I-TREATMENT fetal I-TREATMENT agudo, I-TREATMENT con I-TREATMENT una I-TREATMENT grave I-TREATMENT metrorragia I-TREATMENT posparto. I-TREATMENT La B-EVOLUTION madre I-EVOLUTION recibió I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION sostén I-EVOLUTION que I-EVOLUTION requirió I-EVOLUTION múltiples I-EVOLUTION transfusiones I-EVOLUTION sanguíneas. I-EVOLUTION Se I-EVOLUTION recuperó I-EVOLUTION favorablemente I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION h I-EVOLUTION posparto. I-EVOLUTION El I-EVOLUTION niño I-EVOLUTION nació I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 38 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION edad I-EVOLUTION gestacional, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 3900 I-EVOLUTION g I-EVOLUTION y I-EVOLUTION puntaje I-EVOLUTION de I-EVOLUTION Apgar I-EVOLUTION 4/4. I-EVOLUTION Durante I-EVOLUTION la I-EVOLUTION internación I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION cuidado I-EVOLUTION intensivo I-EVOLUTION neonatal I-EVOLUTION requirió I-EVOLUTION asistencia I-EVOLUTION respiratoria I-EVOLUTION mecánica I-EVOLUTION por I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION aspiración I-EVOLUTION meconial I-EVOLUTION e I-EVOLUTION hipertensión I-EVOLUTION pulmonar I-EVOLUTION y I-EVOLUTION luminoterapia I-EVOLUTION por I-EVOLUTION su I-EVOLUTION ictericia. I-EVOLUTION Al I-EVOLUTION 5to I-EVOLUTION día I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION (39°C), I-EVOLUTION hepatomegalia I-EVOLUTION y I-EVOLUTION un I-EVOLUTION exantema I-EVOLUTION evanescente I-EVOLUTION generalizado. I-EVOLUTION Pasadas I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION se I-EVOLUTION agregaron I-EVOLUTION hemorragias I-EVOLUTION por I-EVOLUTION sonda I-EVOLUTION nasogástrica I-EVOLUTION y I-EVOLUTION en I-EVOLUTION las I-EVOLUTION venopunturas. I-EVOLUTION El B-EXPLORATION hemograma I-EXPLORATION presentó I-EXPLORATION 5800 I-EXPLORATION glóbulos I-EXPLORATION blancos I-EXPLORATION (linfocitos I-EXPLORATION 43%, I-EXPLORATION neutrófilos I-EXPLORATION segmentados I-EXPLORATION 47%, I-EXPLORATION monocitos I-EXPLORATION 6%, I-EXPLORATION basófilos I-EXPLORATION 4%), I-EXPLORATION hematócrito I-EXPLORATION 34%, I-EXPLORATION hemoglobina I-EXPLORATION 11, I-EXPLORATION 2 I-EXPLORATION mg% I-EXPLORATION y I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION de I-EXPLORATION 13 I-EXPLORATION 000/mm³. I-EXPLORATION Con I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION de I-EXPLORATION sepsis I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizaron I-EXPLORATION hemocultivos, I-EXPLORATION urocultivo I-EXPLORATION y I-EXPLORATION punción I-EXPLORATION lumbar. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION dengue. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION indicaron I-EXPLORATION antibióticos I-EXPLORATION y I-EXPLORATION transfusiones I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION plaquetas. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION para I-EXPLORATION gérmenes I-EXPLORATION comunes I-EXPLORATION y I-EXPLORATION hongos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION informó I-EXPLORATION IgM I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION dengue. I-EXPLORATION Para I-EXPLORATION la I-EXPLORATION confirmación I-EXPLORATION del I-EXPLORATION resultado I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Enfermedades I-EXPLORATION Virales I-EXPLORATION Humanas I-EXPLORATION de I-EXPLORATION Pergamino, I-EXPLORATION quienes I-EXPLORATION certificaron I-EXPLORATION por I-EXPLORATION pruebas I-EXPLORATION serológicas I-EXPLORATION de I-EXPLORATION ELISA, I-EXPLORATION neutralización I-EXPLORATION y I-EXPLORATION detección I-EXPLORATION molecular I-EXPLORATION del I-EXPLORATION genoma I-EXPLORATION viral I-EXPLORATION (RT-PCR), I-EXPLORATION la I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION serotipo I-EXPLORATION DEN-1. I-EXPLORATION Se B-EVOLUTION administró I-EVOLUTION oxígeno I-EVOLUTION hasta I-EVOLUTION los I-EVOLUTION 26 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION comienzo I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION se I-EVOLUTION normalizó I-EVOLUTION el I-EVOLUTION recuento I-EVOLUTION de I-EVOLUTION plaquetas. I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION Como I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION asfixia I-EVOLUTION perinatal I-EVOLUTION relacionada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION forma I-EVOLUTION de I-EVOLUTION dengue I-EVOLUTION grave I-EVOLUTION de I-EVOLUTION la I-EVOLUTION madre, I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION presentó I-EVOLUTION encefalopatía I-EVOLUTION hipóxico-isquémica I-EVOLUTION y I-EVOLUTION compromiso I-EVOLUTION respiratorio I-EVOLUTION secuelar. I-EVOLUTION Se I-EVOLUTION le I-EVOLUTION realizaron I-EVOLUTION controles I-EVOLUTION clínicos I-EVOLUTION y I-EVOLUTION serológicos I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION y I-EVOLUTION 13 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION títulos I-EVOLUTION de I-EVOLUTION anticuerpos I-EVOLUTION IgG I-EVOLUTION antidengue, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION confirmó I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION infección I-EVOLUTION congénita. I-EVOLUTION Los B-EXPLORATION resultados I-EXPLORATION serológicos I-EXPLORATION mediante I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION mostraron I-EXPLORATION títulos I-EXPLORATION positivos I-EXPLORATION elevados, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION RP I-EXPLORATION 1, I-EXPLORATION 92 I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 37 I-EXPLORATION para I-EXPLORATION dengue I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 8 I-EXPLORATION y I-EXPLORATION 13 I-EXPLORATION meses, I-EXPLORATION respectivamente. I-EXPLORATION Actualmente, B-EVOLUTION el I-EVOLUTION niño I-EVOLUTION realiza I-EVOLUTION estimulación I-EVOLUTION neurológica I-EVOLUTION y I-EVOLUTION tratamiento I-EVOLUTION preventivo I-EVOLUTION respiratorio I-EVOLUTION con I-EVOLUTION corticoides I-EVOLUTION inhalatorios, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución. I-EVOLUTION I-EVOLUTION Neonato B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida, I-PRESENT_ILLNESS nacida B-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY adecuado I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY 7/9, I-PAST_MEDICAL_HISTORY de B-FAMILY_HISTORY padres I-FAMILY_HISTORY sanos, I-FAMILY_HISTORY no I-FAMILY_HISTORY consanguíneos. I-FAMILY_HISTORY Tiene I-FAMILY_HISTORY tres I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY vivos I-FAMILY_HISTORY y I-FAMILY_HISTORY sanos. I-FAMILY_HISTORY Sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY abortos I-FAMILY_HISTORY maternos. I-FAMILY_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS ampollas, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentaron I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS nacimiento, I-PRESENT_ILLNESS dispuestas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS (MI) I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS siguiendo I-PRESENT_ILLNESS las I-PRESENT_ILLNESS líneas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Blaschko, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS correr I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS días I-PRESENT_ILLNESS aumentaron I-PRESENT_ILLNESS en I-PRESENT_ILLNESS número. I-PRESENT_ILLNESS Recibe B-TREATMENT cefotaxima-oxacilina I-TREATMENT parenteral I-TREATMENT (VP) I-TREATMENT por I-TREATMENT dos I-TREATMENT días, I-TREATMENT con I-TREATMENT mejoría. I-TREATMENT Es B-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION e I-EVOLUTION indicación I-EVOLUTION de I-EVOLUTION continuar I-EVOLUTION con I-EVOLUTION cefixima I-EVOLUTION oral I-EVOLUTION (VO). I-EVOLUTION Dos I-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION aparecen I-EVOLUTION nuevas I-EVOLUTION lesiones I-EVOLUTION de I-EVOLUTION iguales I-EVOLUTION características I-EVOLUTION en I-EVOLUTION MI I-EVOLUTION derecho I-EVOLUTION y I-EVOLUTION en I-EVOLUTION miembro I-EVOLUTION superior I-EVOLUTION (MS) I-EVOLUTION izquierdo, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION queda I-EVOLUTION internada. I-EVOLUTION Se B-TREATMENT reinicia I-TREATMENT cefotaxima-oxacilina I-TREATMENT VP, I-TREATMENT se B-EXPLORATION solicitan I-EXPLORATION frotis I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION lesiones, I-EXPLORATION y I-EXPLORATION VDRL. I-EXPLORATION Con I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION negativos I-EXPLORATION se B-EVOLUTION decide I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION y B-TREATMENT se I-TREATMENT indica I-TREATMENT aplicar I-TREATMENT ácido I-TREATMENT fusídico I-TREATMENT tópico I-TREATMENT sobre I-TREATMENT las I-TREATMENT vesículas I-TREATMENT cutáneas I-TREATMENT y I-TREATMENT continuar I-TREATMENT con I-TREATMENT cefixima I-TREATMENT VO. I-TREATMENT Dos B-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION consulta I-EVOLUTION a I-EVOLUTION nuestro I-EVOLUTION servicio I-EVOLUTION por I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION lesiones. I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION general I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION dermatológico I-EXPLORATION se I-EXPLORATION constatan I-EXPLORATION múltiples I-EXPLORATION vesículas, I-EXPLORATION firmes, I-EXPLORATION amarillentas, I-EXPLORATION sobre I-EXPLORATION una I-EXPLORATION base I-EXPLORATION inflamatoria, I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION lineal I-EXPLORATION que I-EXPLORATION afectan I-EXPLORATION MS I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION ambos I-EXPLORATION MI. I-EXPLORATION El I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION es I-EXPLORATION variable, I-EXPLORATION con I-EXPLORATION diámetros I-EXPLORATION que I-EXPLORATION oscilan I-EXPLORATION entre I-EXPLORATION 0, I-EXPLORATION 1-1 I-EXPLORATION cm. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION afectación I-EXPLORATION ungueal. I-EXPLORATION Se B-DERIVED_FROM/TO la I-DERIVED_FROM/TO remite I-DERIVED_FROM/TO al I-DERIVED_FROM/TO neurólogo I-DERIVED_FROM/TO y I-DERIVED_FROM/TO oftalmólogo, I-DERIVED_FROM/TO que I-DERIVED_FROM/TO descartan I-DERIVED_FROM/TO afectación I-DERIVED_FROM/TO en I-DERIVED_FROM/TO tales I-DERIVED_FROM/TO áreas. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Métodos B-EXPLORATION auxiliares I-EXPLORATION de I-EXPLORATION diagnóstico: I-EXPLORATION hemograma: I-EXPLORATION Hb: I-EXPLORATION 15, I-EXPLORATION 4 I-EXPLORATION g/dl; I-EXPLORATION leucocitos: I-EXPLORATION 16 I-EXPLORATION 700 I-EXPLORATION cél./mm3; I-EXPLORATION N: I-EXPLORATION 68%; I-EXPLORATION L: I-EXPLORATION 20%; I-EXPLORATION Eo: I-EXPLORATION 10%; I-EXPLORATION plaquetas: I-EXPLORATION 330 I-EXPLORATION 000 I-EXPLORATION cél./mm3. I-EXPLORATION Examen I-EXPLORATION directo I-EXPLORATION y I-EXPLORATION cultivo: I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION bacterias. I-EXPLORATION Dos I-EXPLORATION hemocultivos: I-EXPLORATION negativos. I-EXPLORATION VDRL: I-EXPLORATION no I-EXPLORATION reactiva. I-EXPLORATION Biopsia I-EXPLORATION cutánea: I-EXPLORATION Se I-EXPLORATION efectúa I-EXPLORATION biopsia I-EXPLORATION cutánea I-EXPLORATION incisional I-EXPLORATION de I-EXPLORATION una I-EXPLORATION de I-EXPLORATION las I-EXPLORATION vesículas I-EXPLORATION de I-EXPLORATION MI, I-EXPLORATION se I-EXPLORATION fija I-EXPLORATION en I-EXPLORATION formol I-EXPLORATION neutro I-EXPLORATION tamponado I-EXPLORATION al I-EXPLORATION 10% I-EXPLORATION y I-EXPLORATION se I-EXPLORATION procesa I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION convencional. I-EXPLORATION Se I-EXPLORATION efectúa I-EXPLORATION coloración I-EXPLORATION HE. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informa: I-EXPLORATION dermatitis I-EXPLORATION psoriasiforme I-EXPLORATION perivascular I-EXPLORATION superficial, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION marcada I-EXPLORATION espongiosis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION epitelio I-EXPLORATION con I-EXPLORATION exocitosis I-EXPLORATION eosinofílica I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION disqueratósicas. I-EXPLORATION En I-EXPLORATION dermis I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION perivascular I-EXPLORATION superficial I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION con I-EXPLORATION eosinófilos I-EXPLORATION y I-EXPLORATION edema. I-EXPLORATION I-EXPLORATION Diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION final: I-EXPLORATION incontinentia I-EXPLORATION pigmenti I-EXPLORATION estadio I-EXPLORATION eritemato-ampollar. I-EXPLORATION Evolución B-TREATMENT y I-TREATMENT tratamiento: I-TREATMENT Se I-TREATMENT higienizan I-TREATMENT las I-TREATMENT lesiones I-TREATMENT con I-TREATMENT infusión I-TREATMENT de I-TREATMENT manzanilla I-TREATMENT fría I-TREATMENT y I-TREATMENT pasta I-TREATMENT al I-TREATMENT agua I-TREATMENT luego I-TREATMENT de I-TREATMENT la I-TREATMENT higiene, I-TREATMENT dos I-TREATMENT veces I-TREATMENT por I-TREATMENT día, I-TREATMENT hasta I-TREATMENT la I-TREATMENT desaparición I-TREATMENT de I-TREATMENT las I-TREATMENT ampollas. I-TREATMENT Acude B-EVOLUTION a I-EVOLUTION control I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días, I-EVOLUTION con I-EVOLUTION marcada I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION ampollas I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION nuevas I-EVOLUTION lesiones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS producto B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY tercera I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 34 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY padre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consanguíneos; I-PAST_MEDICAL_HISTORY con B-FAMILY_HISTORY dos I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY aparentemente I-FAMILY_HISTORY sanos; I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia. I-FAMILY_HISTORY Durante I-FAMILY_HISTORY todo I-FAMILY_HISTORY el I-FAMILY_HISTORY embarazo I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY cursó I-FAMILY_HISTORY con I-FAMILY_HISTORY tos I-FAMILY_HISTORY productiva, I-FAMILY_HISTORY persistente, I-FAMILY_HISTORY sin I-FAMILY_HISTORY predominio I-FAMILY_HISTORY de I-FAMILY_HISTORY horario, I-FAMILY_HISTORY tratada I-FAMILY_HISTORY con I-FAMILY_HISTORY nebulizaciones I-FAMILY_HISTORY con I-FAMILY_HISTORY salbutamol I-FAMILY_HISTORY y, I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY segundo I-FAMILY_HISTORY trimestre I-FAMILY_HISTORY de I-FAMILY_HISTORY gestación, I-FAMILY_HISTORY con I-FAMILY_HISTORY infecciones I-FAMILY_HISTORY vaginales I-FAMILY_HISTORY reiteradas I-FAMILY_HISTORY cuyo I-FAMILY_HISTORY manejo I-FAMILY_HISTORY se I-FAMILY_HISTORY desconoce. I-FAMILY_HISTORY El B-PAST_MEDICAL_HISTORY producto I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY obtenido I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 36 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gestación; I-PAST_MEDICAL_HISTORY peso: I-PAST_MEDICAL_HISTORY 2800 I-PAST_MEDICAL_HISTORY g, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY atresia I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY coanas I-PAST_MEDICAL_HISTORY (ABC), I-PAST_MEDICAL_HISTORY encefalocele, I-PAST_MEDICAL_HISTORY hidrocefalia, I-PAST_MEDICAL_HISTORY microftalmía I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY restos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bandas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY constricción I-PAST_MEDICAL_HISTORY oscuras I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dedos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pies; I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY características I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY placenta. I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY 5to I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY colocó I-PAST_MEDICAL_HISTORY válvula I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY derivación I-PAST_MEDICAL_HISTORY ventriculoperitoneal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY plastia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY encefalocele; I-PAST_MEDICAL_HISTORY a B-PRESENT_ILLNESS las I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS desarrolla I-PRESENT_ILLNESS neumonía I-PRESENT_ILLNESS nosocomial. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION actual, I-EXPLORATION peso: I-EXPLORATION 3150 I-EXPLORATION g I-EXPLORATION (percentil I-EXPLORATION 3); I-EXPLORATION talla: I-EXPLORATION 52 I-EXPLORATION cm I-EXPLORATION (percentil I-EXPLORATION 20); I-EXPLORATION plagiocefalia I-EXPLORATION frontotemporal I-EXPLORATION izquierda, I-EXPLORATION dolicocefalia, I-EXPLORATION cicatriz I-EXPLORATION de I-EXPLORATION plastia I-EXPLORATION en I-EXPLORATION región I-EXPLORATION occipital I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION y I-EXPLORATION válvula I-EXPLORATION de I-EXPLORATION pudens I-EXPLORATION en I-EXPLORATION región I-EXPLORATION temporal I-EXPLORATION derecha, I-EXPLORATION frontal I-EXPLORATION prominente; I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION cejas; I-EXPLORATION microftalmía I-EXPLORATION derecha; I-EXPLORATION puente I-EXPLORATION nasal I-EXPLORATION deprimido; I-EXPLORATION hiperplasia I-EXPLORATION gingival; I-EXPLORATION paladar I-EXPLORATION ojival; I-EXPLORATION pectus I-EXPLORATION excavatum; I-EXPLORATION hernia I-EXPLORATION umbilical; I-EXPLORATION marca I-EXPLORATION de I-EXPLORATION constricción I-EXPLORATION circular I-EXPLORATION por I-EXPLORATION bandas I-EXPLORATION en I-EXPLORATION región I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION antebrazo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION dedos I-EXPLORATION 2, I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION 4; I-EXPLORATION además I-EXPLORATION de I-EXPLORATION aplasia I-EXPLORATION ungueal I-EXPLORATION y I-EXPLORATION acrosindactilia I-EXPLORATION de I-EXPLORATION éstos; I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION marca I-EXPLORATION de I-EXPLORATION constricción I-EXPLORATION circular I-EXPLORATION por I-EXPLORATION bandas I-EXPLORATION en I-EXPLORATION 4to I-EXPLORATION dedo I-EXPLORATION y I-EXPLORATION acrosindactilia I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION ungueal I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION 2do I-EXPLORATION y I-EXPLORATION 3ro; I-EXPLORATION pie I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION acrosindactilia I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION 2do I-EXPLORATION y I-EXPLORATION 3ro; I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION dedos I-EXPLORATION 1ro, I-EXPLORATION 2do I-EXPLORATION y I-EXPLORATION 3ro, I-EXPLORATION acrosindactilia I-EXPLORATION y I-EXPLORATION marca I-EXPLORATION de I-EXPLORATION banda I-EXPLORATION de I-EXPLORATION constricción I-EXPLORATION de I-EXPLORATION 5to I-EXPLORATION dedo. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION normales; I-EXPLORATION el I-EXPLORATION cariotipo I-EXPLORATION con I-EXPLORATION resolución I-EXPLORATION de I-EXPLORATION 550 I-EXPLORATION bandas I-EXPLORATION y I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION bandeo I-EXPLORATION G I-EXPLORATION en I-EXPLORATION 40 I-EXPLORATION metafases I-EXPLORATION se I-EXPLORATION informó: I-EXPLORATION 46, I-EXPLORATION XY; I-EXPLORATION en I-EXPLORATION las I-EXPLORATION radiografías I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION 2da I-EXPLORATION falange I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 2da I-EXPLORATION y I-EXPLORATION 3era I-EXPLORATION falanges I-EXPLORATION distales I-EXPLORATION en I-EXPLORATION mano I-EXPLORATION izquierda; I-EXPLORATION pie I-EXPLORATION derecho, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION falanges I-EXPLORATION medias I-EXPLORATION y I-EXPLORATION distales; I-EXPLORATION en I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION falanges I-EXPLORATION distales. I-EXPLORATION Ecocardiograma I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION reveló: I-EXPLORATION microftalmía I-EXPLORATION derecha, I-EXPLORATION encefalocele I-EXPLORATION frontoparietal I-EXPLORATION y I-EXPLORATION megaventrículo I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION ABC I-EXPLORATION con I-EXPLORATION placa I-EXPLORATION atrésica I-EXPLORATION mixta I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada, I-EXPLORATION realizándose I-EXPLORATION corrección I-EXPLORATION vía I-EXPLORATION endoscópica I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION edad. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS recién I-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5ºC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rechazo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS alimentación. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY controlado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY normal; I-PAST_MEDICAL_HISTORY serologías I-PAST_MEDICAL_HISTORY negativas I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY virus I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY C, I-PAST_MEDICAL_HISTORY virus I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY inmunodeficiencia I-PAST_MEDICAL_HISTORY humana, I-PAST_MEDICAL_HISTORY sífilis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY toxoplasma; I-PAST_MEDICAL_HISTORY frotis I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY negativo I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY Streptococcus I-PAST_MEDICAL_HISTORY grupo I-PAST_MEDICAL_HISTORY B; I-PAST_MEDICAL_HISTORY ruptura I-PAST_MEDICAL_HISTORY espontánea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY membranas I-PAST_MEDICAL_HISTORY intraparto, I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY instrumental I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fórceps I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 41 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3880 I-PAST_MEDICAL_HISTORY g. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY prueba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY minuto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY minutos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 9, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY requerir I-PAST_MEDICAL_HISTORY reanimación. I-PAST_MEDICAL_HISTORY Comenzó I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY esquema I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inmunización. I-PAST_MEDICAL_HISTORY Alimentación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lactancia I-PAST_MEDICAL_HISTORY materna I-PAST_MEDICAL_HISTORY exclusiva. I-PAST_MEDICAL_HISTORY Respecto B-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares, I-FAMILY_HISTORY los I-FAMILY_HISTORY padres I-FAMILY_HISTORY refirieron I-FAMILY_HISTORY haber I-FAMILY_HISTORY padecido I-FAMILY_HISTORY amigdalitis I-FAMILY_HISTORY los I-FAMILY_HISTORY días I-FAMILY_HISTORY previos. I-FAMILY_HISTORY La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION mostró I-EXPLORATION decaimiento I-EXPLORATION y I-EXPLORATION regular I-EXPLORATION perfusión I-EXPLORATION periférica I-EXPLORATION con I-EXPLORATION constantes I-EXPLORATION vitales I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetivasen I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION foco. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION inicial I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION cuantitativa I-EXPLORATION (PC-R) I-EXPLORATION 133, I-EXPLORATION 4 I-EXPLORATION mg/L, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION coagulado I-EXPLORATION y I-EXPLORATION un I-EXPLORATION sedimento I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION resultó I-EXPLORATION hemorrágica. I-EXPLORATION Ingresó B-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT síndrome I-TREATMENT febril I-TREATMENT sin I-TREATMENT foco I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT antibioterapia I-TREATMENT empírica I-TREATMENT con I-TREATMENT ampicilina I-TREATMENT y I-TREATMENT cefotaxima I-TREATMENT intravenosas I-TREATMENT tras I-TREATMENT la I-TREATMENT toma I-TREATMENT de I-TREATMENT cultivos. I-TREATMENT En B-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION repetido I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION 5800 I-EXPLORATION leucocitos/mm3, I-EXPLORATION con I-EXPLORATION fórmula I-EXPLORATION normal, I-EXPLORATION 13, I-EXPLORATION 4 I-EXPLORATION g/dl I-EXPLORATION de I-EXPLORATION hemoglobina, I-EXPLORATION 32 I-EXPLORATION 000 I-EXPLORATION plaquetas/mm3. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION 18 I-EVOLUTION h I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION empeoró I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION y I-EVOLUTION presentó I-EVOLUTION crisis I-EVOLUTION convulsivas I-EVOLUTION generalizadas I-EVOLUTION que B-TREATMENT requirieron I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT fenobarbital I-TREATMENT y I-TREATMENT perfusión I-TREATMENT de I-TREATMENT midazolam. I-TREATMENT En B-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION desarrolló I-EVOLUTION afectación I-EVOLUTION sistémica I-EVOLUTION con I-EVOLUTION hipotensión I-EVOLUTION arterial, I-EVOLUTION acidosis I-EVOLUTION metabólica, I-EVOLUTION hiponatremia, I-EVOLUTION oliguria I-EVOLUTION y I-EVOLUTION plaquetopenia I-EVOLUTION grave; I-EVOLUTION requirió B-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT convencional, I-TREATMENT transfusión I-TREATMENT de I-TREATMENT hemoderivados, I-TREATMENT soporte I-TREATMENT inotrópico I-TREATMENT con I-TREATMENT dopamina I-TREATMENT y I-TREATMENT diurético I-TREATMENT con I-TREATMENT furosemida. I-TREATMENT El B-EXPLORATION tercer I-EXPLORATION día I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION el I-EXPLORATION aislamiento I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemocultivo I-EXPLORATION de I-EXPLORATION Streptococcus I-EXPLORATION pyogenes I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION penicilina, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT ampicilina I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cefotaxima I-TREATMENT intravenosa. I-TREATMENT Tras B-EVOLUTION su I-EVOLUTION estabilización I-EVOLUTION presentó I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION analítica, I-EVOLUTION que B-TREATMENT permitió I-TREATMENT suspender I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT inotrópico I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT h I-TREATMENT y I-TREATMENT realizar I-TREATMENT extubación I-TREATMENT al I-TREATMENT cuarto I-TREATMENT día. I-TREATMENT No B-EVOLUTION se I-EVOLUTION repitieron I-EVOLUTION las I-EVOLUTION crisis I-EVOLUTION clínicas I-EVOLUTION y B-EXPLORATION el I-EXPLORATION electroencefalograma I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT anticomicial. I-TREATMENT Se B-EXPLORATION repitió I-EXPLORATION la I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION sin I-EXPLORATION éxito. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION la I-EXPLORATION angiorresonancia I-EXPLORATION iniciales I-EXPLORATION mostraron I-EXPLORATION hemorragia I-EXPLORATION intraventricular I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION ventriculomegalia I-EXPLORATION y I-EXPLORATION lesiones I-EXPLORATION hemisféricas I-EXPLORATION cortico-subcorticales I-EXPLORATION bilaterales, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION meningoencefalitis. I-EXPLORATION No I-EXPLORATION superó I-EXPLORATION el I-EXPLORATION tamizaje I-EXPLORATION auditivo I-EXPLORATION realizado I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION potenciales I-EXPLORATION provocados I-EXPLORATION auditivos I-EXPLORATION de I-EXPLORATION tronco I-EXPLORATION cerebral I-EXPLORATION automatizados I-EXPLORATION (PEATC-A I-EXPLORATION > I-EXPLORATION 40 I-EXPLORATION dB). I-EXPLORATION En I-EXPLORATION las I-EXPLORATION ecografías I-EXPLORATION cerebrales I-EXPLORATION de I-EXPLORATION control I-EXPLORATION presentó I-EXPLORATION buena I-EXPLORATION evolución I-EXPLORATION sin I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION dilatación I-EXPLORATION ventricular. I-EXPLORATION I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 34 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION después I-EVOLUTION de I-EVOLUTION completar I-EVOLUTION 21 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION cefotaxima, I-EVOLUTION se I-EVOLUTION otorgó I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION con I-EVOLUTION una I-EVOLUTION exploración I-EVOLUTION neurológica I-EVOLUTION normal, I-EVOLUTION excepto I-EVOLUTION una I-EVOLUTION leve I-EVOLUTION hipotonía I-EVOLUTION de I-EVOLUTION eje. I-EVOLUTION Se I-EVOLUTION realizó I-EVOLUTION seguimiento I-EVOLUTION por I-EVOLUTION especialistas I-EVOLUTION de I-EVOLUTION las I-EVOLUTION unidades I-EVOLUTION de I-EVOLUTION rehabilitación, I-EVOLUTION otorrinolaringología I-EVOLUTION y I-EVOLUTION neurología; I-EVOLUTION al I-EVOLUTION año I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION no I-EVOLUTION presentaba I-EVOLUTION patología I-EVOLUTION auditiva I-EVOLUTION ni I-EVOLUTION neurológica I-EVOLUTION residual. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS agrega I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS atrás I-PRESENT_ILLNESS erección I-PRESENT_ILLNESS peneana I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS moderado, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS zonal, I-PRESENT_ILLNESS donde B-TREATMENT le I-TREATMENT indican I-TREATMENT analgésicos I-TREATMENT y I-TREATMENT medios I-TREATMENT físicos I-TREATMENT citándose I-TREATMENT a I-TREATMENT las I-TREATMENT 24 I-TREATMENT h I-TREATMENT para I-TREATMENT control. I-TREATMENT Al B-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION concurre I-EVOLUTION a I-EVOLUTION dicho I-EVOLUTION hospital, I-EVOLUTION donde I-EVOLUTION por I-EVOLUTION continuar I-EVOLUTION con I-EVOLUTION erección I-EVOLUTION peneana I-EVOLUTION y I-EVOLUTION palidez I-EVOLUTION generalizada I-EVOLUTION deciden B-EXPLORATION realizar I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION que I-EXPLORATION muestran: I-EXPLORATION plaquetopenia I-EXPLORATION (plaquetas I-EXPLORATION 60 I-EXPLORATION 000/mm3), I-EXPLORATION anemia I-EXPLORATION (hematócrito I-EXPLORATION 12%) I-EXPLORATION e I-EXPLORATION hiperleucocitosis I-EXPLORATION (glóbulos I-EXPLORATION blancos I-EXPLORATION 312 I-EXPLORATION 000/mm3) I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION 2056 I-EXPLORATION UI/ml, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION su I-EXPLORATION internación I-EXPLORATION y B-DERIVED_FROM/TO se I-DERIVED_FROM/TO solicita I-DERIVED_FROM/TO su I-DERIVED_FROM/TO derivación I-DERIVED_FROM/TO a I-DERIVED_FROM/TO un I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO mayor I-DERIVED_FROM/TO complejidad. I-DERIVED_FROM/TO A B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION al I-EXPLORATION Hospital I-EXPLORATION Posadas I-EXPLORATION se I-EXPLORATION constata I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION palidez I-EXPLORATION cutáneomucosa, I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION equimosis I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores. I-EXPLORATION Se I-EXPLORATION palpa I-EXPLORATION esplenomegalia. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION pene I-EXPLORATION erecto I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION la I-EXPLORATION coloración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION del I-EXPLORATION cuerpo, I-EXPLORATION palidez I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION cianosis I-EXPLORATION del I-EXPLORATION glande. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT interconsulta I-TREATMENT con I-TREATMENT urología, I-TREATMENT quien I-TREATMENT realiza I-TREATMENT drenaje I-TREATMENT de I-TREATMENT cuerpos I-TREATMENT cavernosos I-TREATMENT con I-TREATMENT solución I-TREATMENT fisiológica I-TREATMENT y I-TREATMENT adrenalina; I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT arroja I-TREATMENT sangre I-TREATMENT oscura I-TREATMENT y I-TREATMENT coagulada. I-TREATMENT Por B-EVOLUTION presentar I-EVOLUTION registro I-EVOLUTION febril, I-EVOLUTION se B-EXPLORATION realizan I-EXPLORATION hemocultivos I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION y B-TREATMENT se I-TREATMENT decide I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT ceftazidima-amikacina I-TREATMENT y I-TREATMENT transfundir I-TREATMENT glóbulos I-TREATMENT rojos I-TREATMENT desplasmatizados. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION en I-EVOLUTION mal I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION con I-EVOLUTION dificultad I-EVOLUTION respiratoria I-EVOLUTION creciente, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION lo I-EVOLUTION traslada I-EVOLUTION a I-EVOLUTION terapia I-EVOLUTION intensiva. I-EVOLUTION Se I-EVOLUTION realiza I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION leucemia I-EVOLUTION mieloide I-EVOLUTION crónica I-EVOLUTION por I-EVOLUTION biopsia I-EVOLUTION de I-EVOLUTION medula I-EVOLUTION ósea I-EVOLUTION y I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION blastos I-EVOLUTION en I-EVOLUTION sangre I-EVOLUTION periférica. I-EVOLUTION Se I-EVOLUTION descartan I-EVOLUTION otros I-EVOLUTION diagnósticos, I-EVOLUTION como I-EVOLUTION la I-EVOLUTION anemia I-EVOLUTION de I-EVOLUTION células I-EVOLUTION falciforme, I-EVOLUTION por I-EVOLUTION no I-EVOLUTION presentar I-EVOLUTION depranocitos I-EVOLUTION en I-EVOLUTION frotis I-EVOLUTION de I-EVOLUTION sangre I-EVOLUTION periférica; I-EVOLUTION causa I-EVOLUTION medicamentosa, I-EVOLUTION por I-EVOLUTION no I-EVOLUTION presentar I-EVOLUTION ingesta I-EVOLUTION de I-EVOLUTION medicamentos; I-EVOLUTION causa I-EVOLUTION traumática, I-EVOLUTION por I-EVOLUTION falta I-EVOLUTION de I-EVOLUTION traumatismos I-EVOLUTION previos I-EVOLUTION en I-EVOLUTION el I-EVOLUTION pene; I-EVOLUTION asimismo, I-EVOLUTION se I-EVOLUTION descartan I-EVOLUTION tumores I-EVOLUTION sólidos I-EVOLUTION genitourinarios I-EVOLUTION y I-EVOLUTION enfermedades I-EVOLUTION neurológicas I-EVOLUTION e I-EVOLUTION infecciosas. I-EVOLUTION Actualmente, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION con I-EVOLUTION disfunción I-EVOLUTION eréctil I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION priapismo I-EVOLUTION y I-EVOLUTION permanece I-EVOLUTION en I-EVOLUTION tratamiento I-EVOLUTION oncológico I-EVOLUTION por I-EVOLUTION su I-EVOLUTION patología I-EVOLUTION de I-EVOLUTION base. I-EVOLUTION I-EVOLUTION Una B-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cirrosis I-PRESENT_ILLNESS fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO para I-DERIVED_FROM/TO evaluación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO trasplante I-DERIVED_FROM/TO hepático. I-DERIVED_FROM/TO Se B-EXPLORATION presentó I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION referido I-EXPLORATION como I-EXPLORATION de I-EXPLORATION reciente I-EXPLORATION comienzo, I-EXPLORATION aunque I-EXPLORATION por I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION y I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION estudios I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hepatopatía I-EXPLORATION crónica. I-EXPLORATION Presentaba I-EXPLORATION estigmas I-EXPLORATION de I-EXPLORATION cronicidad I-EXPLORATION como I-EXPLORATION eritema I-EXPLORATION palmar, I-EXPLORATION telangiectasias, I-EXPLORATION circulación I-EXPLORATION colateral I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION esplenomegalia. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION un I-EXPLORATION hígado I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION con I-EXPLORATION heterogeneidad I-EXPLORATION y I-EXPLORATION bazo I-EXPLORATION con I-EXPLORATION diámetro I-EXPLORATION longitudinal I-EXPLORATION aumentado. I-EXPLORATION No B-TREATMENT recibía I-TREATMENT medicación I-TREATMENT antes I-TREATMENT de I-TREATMENT la I-TREATMENT admisión I-TREATMENT en I-TREATMENT nuestro I-TREATMENT hospital. I-TREATMENT En B-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY contexto I-PAST_MEDICAL_HISTORY social I-PAST_MEDICAL_HISTORY complejo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY poca I-PAST_MEDICAL_HISTORY percepción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enfermedad, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY consultado I-PAST_MEDICAL_HISTORY previamente. I-PAST_MEDICAL_HISTORY Tampoco I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY periódico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY salud. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso, I-EXPLORATION el I-EXPLORATION puntaje I-EXPLORATION de I-EXPLORATION gravedad I-EXPLORATION PELD I-EXPLORATION (Pediatric I-EXPLORATION End-Stage I-EXPLORATION Liver I-EXPLORATION Disease, I-EXPLORATION hepatopatía I-EXPLORATION terminal I-EXPLORATION pediátrica) I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 24, I-EXPLORATION con I-EXPLORATION bilirrubina I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION mg/dl, I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION relación I-EXPLORATION internacional I-EXPLORATION normalizada I-EXPLORATION (RIN) I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5, I-EXPLORATION albúmina I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION g/dl; I-EXPLORATION su I-EXPLORATION peso I-EXPLORATION y I-EXPLORATION talla I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION kg I-EXPLORATION y I-EXPLORATION 127 I-EXPLORATION cm, I-EXPLORATION respectivamente. I-EXPLORATION Mientras B-EVOLUTION esperaba I-EVOLUTION en I-EVOLUTION lista I-EVOLUTION de I-EVOLUTION trasplante I-EVOLUTION hepático, I-EVOLUTION desarrolló I-EVOLUTION encefalopatía I-EVOLUTION hepática I-EVOLUTION espontánea, I-EVOLUTION de I-EVOLUTION tipo I-EVOLUTION C, I-EVOLUTION grado I-EVOLUTION II-III1 I-EVOLUTION con I-EVOLUTION períodos I-EVOLUTION de I-EVOLUTION conducta I-EVOLUTION inapropiada I-EVOLUTION que I-EVOLUTION alternaban I-EVOLUTION con I-EVOLUTION confusión I-EVOLUTION y I-EVOLUTION excitación. I-EVOLUTION Previamente, I-EVOLUTION no I-EVOLUTION había I-EVOLUTION presentado I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION encefalopatía. I-EVOLUTION Su B-EXPLORATION amonio I-EXPLORATION sérico I-EXPLORATION aumentó I-EXPLORATION de I-EXPLORATION 139 I-EXPLORATION µg% I-EXPLORATION a I-EXPLORATION 324 I-EXPLORATION µg% I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION 19-82 I-EXPLORATION µg%). I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION factores I-EXPLORATION precipitantes I-EXPLORATION conocidos I-EXPLORATION de I-EXPLORATION encefalopatía I-EXPLORATION hepática, I-EXPLORATION como I-EXPLORATION medicaciones, I-EXPLORATION sangrado I-EXPLORATION gastrointestinal, I-EXPLORATION infecciones I-EXPLORATION bacterianas, I-EXPLORATION constipación, I-EXPLORATION fallo I-EXPLORATION renal, I-EXPLORATION desequilibrios I-EXPLORATION electrolíticos, I-EXPLORATION hipovolemia I-EXPLORATION o I-EXPLORATION hipoxemia. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION ascitis I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION abdominal. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT una I-TREATMENT dieta I-TREATMENT con I-TREATMENT restricción I-TREATMENT de I-TREATMENT proteínas I-TREATMENT (0, I-TREATMENT 8 I-TREATMENT g/kg/día) I-TREATMENT y I-TREATMENT lactulosa I-TREATMENT por I-TREATMENT vía I-TREATMENT oral I-TREATMENT (40 I-TREATMENT ml/día, I-TREATMENT divididos I-TREATMENT en I-TREATMENT 4 I-TREATMENT tomas), I-TREATMENT logrando I-TREATMENT 3-4 I-TREATMENT deposiciones I-TREATMENT blandas I-TREATMENT por I-TREATMENT día. I-TREATMENT A B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION estas I-EVOLUTION medidas, I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION neurológico I-EVOLUTION no I-EVOLUTION mejoró I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION días. I-EVOLUTION Sobre B-TREATMENT la I-TREATMENT base I-TREATMENT de I-TREATMENT experiencias I-TREATMENT en I-TREATMENT pacientes I-TREATMENT adultos, I-TREATMENT se I-TREATMENT decidió I-TREATMENT agregar I-TREATMENT rifaximina I-TREATMENT (20 I-TREATMENT mg/kg/día, I-TREATMENT por I-TREATMENT vía I-TREATMENT oral, I-TREATMENT divididos I-TREATMENT en I-TREATMENT dos I-TREATMENT tomas), I-TREATMENT con I-TREATMENT previa I-TREATMENT firma I-TREATMENT del I-TREATMENT consentimiento I-TREATMENT informado I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT los I-TREATMENT padres. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION mostró I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION días, I-EVOLUTION sin I-EVOLUTION confusión I-EVOLUTION ni I-EVOLUTION excitación I-EVOLUTION y I-EVOLUTION con I-EVOLUTION ritmo I-EVOLUTION sueño/ I-EVOLUTION vigilia I-EVOLUTION normal. I-EVOLUTION La I-EVOLUTION concentración I-EVOLUTION de I-EVOLUTION amonio I-EVOLUTION descendió I-EVOLUTION gradualmente I-EVOLUTION (236 I-EVOLUTION µg% I-EVOLUTION y I-EVOLUTION 162 I-EVOLUTION µg%, I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION respectivamente). I-EVOLUTION No I-EVOLUTION presentó I-EVOLUTION cefaleas, I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION náuseas I-EVOLUTION ni I-EVOLUTION vómitos I-EVOLUTION relacionados I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION rifaximina. I-EVOLUTION Finalmente, B-TREATMENT la I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT trasplante I-TREATMENT hepático I-TREATMENT pasado I-TREATMENT un I-TREATMENT mes I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT rifaximina, I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS internada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS según I-PRESENT_ILLNESS referencia I-PRESENT_ILLNESS materna I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS frontoparietal I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS que I-PRESENT_ILLNESS empeoró I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS previas I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ingreso. I-PRESENT_ILLNESS Antecedentes: B-PAST_MEDICAL_HISTORY recién I-PAST_MEDICAL_HISTORY nacida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY término, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY adecuado I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional. I-PAST_MEDICAL_HISTORY Tuvo I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY progresión I-PAST_MEDICAL_HISTORY ponderal I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY ictericia I-PAST_MEDICAL_HISTORY clínica. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY ictericia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY siete I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida. I-PAST_MEDICAL_HISTORY Evolución: B-EVOLUTION al I-EVOLUTION ingreso I-EVOLUTION presentaba I-EVOLUTION sopor, I-EVOLUTION ictericia I-EVOLUTION generalizada, I-EVOLUTION hepatomegalia I-EVOLUTION y I-EVOLUTION tumoración I-EVOLUTION frontoparietal I-EVOLUTION izquierda. I-EVOLUTION Laboratorio B-EXPLORATION de I-EXPLORATION ingreso: I-EXPLORATION GOT I-EXPLORATION 262 I-EXPLORATION UI/L, I-EXPLORATION GPT I-EXPLORATION 143 I-EXPLORATION UI/L, I-EXPLORATION FAL I-EXPLORATION 2289 I-EXPLORATION UI/L, I-EXPLORATION bilirrubinemia I-EXPLORATION total I-EXPLORATION 12, I-EXPLORATION 3 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION directa I-EXPLORATION 8, I-EXPLORATION 6 I-EXPLORATION mg/ I-EXPLORATION dl, I-EXPLORATION coagulograma I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION "no I-EXPLORATION coagula". I-EXPLORATION TC: I-EXPLORATION hemorragia I-EXPLORATION de I-EXPLORATION ventrículos I-EXPLORATION laterales I-EXPLORATION e I-EXPLORATION intraparenquimatosa I-EXPLORATION temporal I-EXPLORATION derecha. I-EXPLORATION Fue B-DERIVED_FROM/TO evaluada I-DERIVED_FROM/TO por I-DERIVED_FROM/TO Neurocirugía I-DERIVED_FROM/TO con I-DERIVED_FROM/TO indicación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO conducta I-DERIVED_FROM/TO expectante. I-DERIVED_FROM/TO Recibió B-EXPLORATION vitamina I-EXPLORATION K I-EXPLORATION 5 I-EXPLORATION mg I-EXPLORATION diarios I-EXPLORATION por I-EXPLORATION 48 I-EXPLORATION h I-EXPLORATION como I-EXPLORATION único I-EXPLORATION tratamiento I-EXPLORATION corrector I-EXPLORATION de I-EXPLORATION su I-EXPLORATION coagulopatía I-EXPLORATION con I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION control I-EXPLORATION normal: I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 100%, I-EXPLORATION KPTT I-EXPLORATION 45 I-EXPLORATION segundos, I-EXPLORATION fibrinógeno I-EXPLORATION 274 I-EXPLORATION mg/dl. I-EXPLORATION El I-EXPLORATION centellograma I-EXPLORATION con I-EXPLORATION HIDA I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION captación I-EXPLORATION hepática I-EXPLORATION del I-EXPLORATION contraste, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION ni I-EXPLORATION extrahepática, I-EXPLORATION ni I-EXPLORATION pasaje I-EXPLORATION al I-EXPLORATION intestino I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION h. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT portoentero-anastomosis, I-TREATMENT después I-TREATMENT de I-TREATMENT confirmar I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT atresia I-TREATMENT de I-TREATMENT vías I-TREATMENT biliares I-TREATMENT durante I-TREATMENT la I-TREATMENT cirugía. I-TREATMENT En B-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION presentaba I-EVOLUTION valoración I-EVOLUTION clínico-neurológica I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION recibió I-EVOLUTION trasplante I-EVOLUTION de I-EVOLUTION hígado I-EVOLUTION al I-EVOLUTION año I-EVOLUTION de I-EVOLUTION edad. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS lactante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vacunación I-PAST_MEDICAL_HISTORY según I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY calendario I-PAST_MEDICAL_HISTORY (primera I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY HBV), I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY después B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS recibir I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vacuna I-PRESENT_ILLNESS correspondiente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS subsector I-PRESENT_ILLNESS privado I-PRESENT_ILLNESS (vacuna I-PRESENT_ILLNESS séxtuple I-PRESENT_ILLNESS [DTPa, I-PRESENT_ILLNESS Hib, I-PRESENT_ILLNESS IPV, I-PRESENT_ILLNESS HB] I-PRESENT_ILLNESS y I-PRESENT_ILLNESS meningocócica I-PRESENT_ILLNESS C), I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS llevado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS instauración I-PRESENT_ILLNESS brusca I-PRESENT_ILLNESS de I-PRESENT_ILLNESS palidez I-PRESENT_ILLNESS cutánea I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipotonía I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hiporreactividad. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION se I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION cianosis I-EXPLORATION y I-EXPLORATION frialdad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION hipotonía I-EXPLORATION y I-EXPLORATION escasa I-EXPLORATION respuesta I-EXPLORATION a I-EXPLORATION los I-EXPLORATION estímulos. I-EXPLORATION Las I-EXPLORATION constantes I-EXPLORATION vitales I-EXPLORATION (frecuencia I-EXPLORATION cardíaca, I-EXPLORATION frecuencia I-EXPLORATION respiratoria, I-EXPLORATION tensión I-EXPLORATION arterial) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION respirando I-EXPLORATION aire I-EXPLORATION ambiente I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION normales; I-EXPLORATION la I-EXPLORATION temperatura I-EXPLORATION rectal I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 38, I-EXPLORATION 6ºC. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT inicial I-TREATMENT de I-TREATMENT un I-TREATMENT cuadro I-TREATMENT séptico, I-TREATMENT se I-TREATMENT inició I-TREATMENT expansión I-TREATMENT volumétrica I-TREATMENT y, I-TREATMENT después I-TREATMENT de I-TREATMENT practicar I-TREATMENT un I-TREATMENT estudio I-TREATMENT analítico I-TREATMENT y I-TREATMENT de I-TREATMENT obtener I-TREATMENT muestras I-TREATMENT para I-TREATMENT cultivo, I-TREATMENT se I-TREATMENT comenzó I-TREATMENT con I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT empírico. I-TREATMENT En B-EVOLUTION las I-EVOLUTION dos I-EVOLUTION horas I-EVOLUTION sucesivas I-EVOLUTION al I-EVOLUTION ingreso, I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION llamativa, I-EVOLUTION con I-EVOLUTION recuperación I-EVOLUTION del I-EVOLUTION tono I-EVOLUTION muscular I-EVOLUTION y I-EVOLUTION reactividad I-EVOLUTION a I-EVOLUTION los I-EVOLUTION estímulos I-EVOLUTION normales, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION buena I-EVOLUTION perfusión I-EVOLUTION tisular, I-EVOLUTION observándose I-EVOLUTION un I-EVOLUTION lactante I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION con I-EVOLUTION examen I-EVOLUTION físico I-EVOLUTION normal. I-EVOLUTION Tanto B-EXPLORATION el I-EXPLORATION despistaje I-EXPLORATION infeccioso I-EXPLORATION inicial I-EXPLORATION como I-EXPLORATION los I-EXPLORATION diversos I-EXPLORATION cultivos I-EXPLORATION obtenidos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sangre, I-EXPLORATION la I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION resultaron I-EXPLORATION negativos, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION replanteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION sepsis I-EXPLORATION y I-EXPLORATION se I-EXPLORATION atribuyó I-EXPLORATION el I-EXPLORATION episodio I-EXPLORATION a I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION efecto I-EXPLORATION adverso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vacuna I-EXPLORATION acelular I-EXPLORATION contra I-EXPLORATION la I-EXPLORATION tos I-EXPLORATION ferina. I-EXPLORATION Siguiendo B-TREATMENT las I-TREATMENT recomendaciones I-TREATMENT del I-TREATMENT Comité I-TREATMENT de I-TREATMENT Enfermedades I-TREATMENT Infecciosas I-TREATMENT de I-TREATMENT la I-TREATMENT Academia I-TREATMENT Estadounidense I-TREATMENT de I-TREATMENT Pediatría I-TREATMENT y, I-TREATMENT ante I-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT contraindicaciones I-TREATMENT absolutas, I-TREATMENT se I-TREATMENT administró I-TREATMENT la I-TREATMENT dosis I-TREATMENT correspondiente I-TREATMENT a I-TREATMENT la I-TREATMENT vacunación I-TREATMENT de I-TREATMENT los I-TREATMENT 4 I-TREATMENT meses I-TREATMENT bajo I-TREATMENT observación I-TREATMENT hospitalaria, I-TREATMENT sin I-TREATMENT que I-TREATMENT se I-TREATMENT presentaran I-TREATMENT manifestaciones I-TREATMENT clínicas I-TREATMENT en I-TREATMENT las I-TREATMENT 48 I-TREATMENT horas I-TREATMENT siguientes. I-TREATMENT I-TREATMENT Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS eritematosas, I-PRESENT_ILLNESS redondeadas, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bordes I-PRESENT_ILLNESS definidos, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS más I-PRESENT_ILLNESS pálido I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS rostro, I-PRESENT_ILLNESS los I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS superiores, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aspecto I-PRESENT_ILLNESS reticulado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Hepatoesplenomegalia. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Madre B-FAMILY_HISTORY y I-FAMILY_HISTORY abuela I-FAMILY_HISTORY materna I-FAMILY_HISTORY con I-FAMILY_HISTORY diagnóstico I-FAMILY_HISTORY de I-FAMILY_HISTORY Lupus I-FAMILY_HISTORY Eritematoso I-FAMILY_HISTORY sistémico I-FAMILY_HISTORY (LES) I-FAMILY_HISTORY I-FAMILY_HISTORY Exámenes B-EXPLORATION complementarios: I-EXPLORATION Hb I-EXPLORATION 10g/dl, I-EXPLORATION Hto I-EXPLORATION 30%, I-EXPLORATION GPT I-EXPLORATION 78 I-EXPLORATION UI/L, I-EXPLORATION C3 I-EXPLORATION 53 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION C4 I-EXPLORATION 3mg/dl, I-EXPLORATION FAN+ I-EXPLORATION 1/100, I-EXPLORATION acs. I-EXPLORATION anti I-EXPLORATION Ro, I-EXPLORATION anti I-EXPLORATION La, I-EXPLORATION anti I-EXPLORATION Sm I-EXPLORATION y I-EXPLORATION anti I-EXPLORATION U1RNP I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Estudio I-EXPLORATION histopatológico: I-EXPLORATION hiperqueratosis, I-EXPLORATION atrofia I-EXPLORATION epidérmica, I-EXPLORATION vacuolización I-EXPLORATION de I-EXPLORATION queratinocitos I-EXPLORATION basales I-EXPLORATION e I-EXPLORATION infiltrado I-EXPLORATION difuso I-EXPLORATION mononuclear I-EXPLORATION en I-EXPLORATION dermis I-EXPLORATION superficial. I-EXPLORATION Inmunofluorescencia I-EXPLORATION directa I-EXPLORATION (IFD): I-EXPLORATION banda I-EXPLORATION segmentaria I-EXPLORATION dermoepidérmica I-EXPLORATION de I-EXPLORATION disposición I-EXPLORATION granular I-EXPLORATION fina I-EXPLORATION IgG+ I-EXPLORATION y I-EXPLORATION C3+. I-EXPLORATION I-EXPLORATION Valoración I-EXPLORATION cardiológica I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Tratamiento: B-TREATMENT hidrocortisona I-TREATMENT 1% I-TREATMENT crema. I-TREATMENT I-TREATMENT Resolución B-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION cutáneas, I-EVOLUTION negativización I-EVOLUTION del I-EVOLUTION FAN I-EVOLUTION y I-EVOLUTION normalización I-EVOLUTION del I-EVOLUTION hepatograma I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hermano I-PRESENT_ILLNESS del I-PRESENT_ILLNESS anterior, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS revisión. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS hemeralopia I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tiene I-PRESENT_ILLNESS conocimiento I-PRESENT_ILLNESS y, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS tiempos, I-PRESENT_ILLNESS ligera I-PRESENT_ILLNESS fotodisforia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS agudeza I-PRESENT_ILLNESS visual. I-PRESENT_ILLNESS La B-EXPLORATION visión I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 0 I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos; I-EXPLORATION tanto I-EXPLORATION el I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION como I-EXPLORATION la I-EXPLORATION angiografía I-EXPLORATION son I-EXPLORATION similares I-EXPLORATION a I-EXPLORATION las I-EXPLORATION de I-EXPLORATION su I-EXPLORATION hermano, I-EXPLORATION aunque I-EXPLORATION con I-EXPLORATION menores I-EXPLORATION alteraciones I-EXPLORATION maculares I-EXPLORATION y I-EXPLORATION del I-EXPLORATION EPR. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION campimetría I-EXPLORATION aparece I-EXPLORATION un I-EXPLORATION estotoma I-EXPLORATION central. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizan I-EXPLORATION sendos I-EXPLORATION estudios I-EXPLORATION electrofisiológicos I-EXPLORATION no I-EXPLORATION estandarizados I-EXPLORATION consistentes I-EXPLORATION en I-EXPLORATION un I-EXPLORATION primer I-EXPLORATION electrorretinograma I-EXPLORATION (ERG) I-EXPLORATION basal I-EXPLORATION y I-EXPLORATION un I-EXPLORATION segundo I-EXPLORATION realizado I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 180 I-EXPLORATION minutos I-EXPLORATION de I-EXPLORATION adaptación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION oscuridad. I-EXPLORATION En I-EXPLORATION ambos I-EXPLORATION casos, I-EXPLORATION el I-EXPLORATION ERG I-EXPLORATION basal I-EXPLORATION revela I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION evidente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION amplitud I-EXPLORATION de I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION ondas. I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION adaptación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION oscuridad, I-EXPLORATION se I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION en I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION caso I-EXPLORATION una I-EXPLORATION tendencia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION normalización I-EXPLORATION del I-EXPLORATION flash I-EXPLORATION y I-EXPLORATION escotópico, I-EXPLORATION no I-EXPLORATION modificándose I-EXPLORATION ni I-EXPLORATION el I-EXPLORATION flicker I-EXPLORATION ni I-EXPLORATION el I-EXPLORATION fotópico. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION caso, I-EXPLORATION la I-EXPLORATION adaptación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION oscuridad I-EXPLORATION normaliza I-EXPLORATION las I-EXPLORATION ondas, I-EXPLORATION incluido I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION conos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION queda I-EXPLORATION en I-EXPLORATION el I-EXPLORATION límite I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION para I-EXPLORATION su I-EXPLORATION edad. I-EXPLORATION I-EXPLORATION La B-PRESENT_ILLNESS paciente, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS estudiada B-DERIVED_FROM/TO por I-DERIVED_FROM/TO retraso I-DERIVED_FROM/TO psicomotor, I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO sección I-DERIVED_FROM/TO de I-DERIVED_FROM/TO motilidad I-DERIVED_FROM/TO por I-DERIVED_FROM/TO déficit I-DERIVED_FROM/TO de I-DERIVED_FROM/TO fijación I-DERIVED_FROM/TO ocular. I-DERIVED_FROM/TO Se B-EXPLORATION observaba I-EXPLORATION que, I-EXPLORATION para I-EXPLORATION cambiar I-EXPLORATION la I-EXPLORATION dirección I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mirada, I-EXPLORATION la I-EXPLORATION niña I-EXPLORATION se I-EXPLORATION veía I-EXPLORATION obligada I-EXPLORATION a I-EXPLORATION realizar I-EXPLORATION unos I-EXPLORATION movimientos I-EXPLORATION bruscos I-EXPLORATION laterales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION con I-EXPLORATION los I-EXPLORATION que I-EXPLORATION arrastraba I-EXPLORATION sus I-EXPLORATION ojos I-EXPLORATION al I-EXPLORATION nuevo I-EXPLORATION objeto. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION habitual I-EXPLORATION para I-EXPLORATION buscar I-EXPLORATION alteraciones I-EXPLORATION que I-EXPLORATION justificasen I-EXPLORATION esa I-EXPLORATION dificultad: I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION ocular, I-EXPLORATION BMC I-EXPLORATION y I-EXPLORATION F.O. I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION siguió I-EXPLORATION con I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION neurooftalmológica: I-EXPLORATION el I-EXPLORATION reflejo I-EXPLORATION optocinético I-EXPLORATION aparecía I-EXPLORATION alterado I-EXPLORATION en I-EXPLORATION su I-EXPLORATION fase I-EXPLORATION rápida I-EXPLORATION (disminuida I-EXPLORATION o I-EXPLORATION ausente) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION plano I-EXPLORATION horizontal. I-EXPLORATION Los I-EXPLORATION potenciales I-EXPLORATION evocados I-EXPLORATION visuales I-EXPLORATION (P.E.V.) I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION electrorretinograma I-EXPLORATION (ERG) I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION corta I-EXPLORATION edad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION evidenciaba I-EXPLORATION hipertonía I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION con I-EXPLORATION hiperreflexia. I-EXPLORATION Las I-EXPLORATION exploraciones I-EXPLORATION encaminadas I-EXPLORATION a I-EXPLORATION detectar I-EXPLORATION procesos I-EXPLORATION neurológicos I-EXPLORATION o I-EXPLORATION sistémicos I-EXPLORATION (EEG, I-EXPLORATION RM I-EXPLORATION cerebral, I-EXPLORATION aminoácidos I-EXPLORATION en I-EXPLORATION sangre, I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION LCR, I-EXPLORATION amoníaco, I-EXPLORATION ácido I-EXPLORATION pirúvico I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION LCR, I-EXPLORATION ácidos I-EXPLORATION grasos I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION larga, I-EXPLORATION serología I-EXPLORATION TORCH) I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Sólo I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION ácido I-EXPLORATION láctico I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION levemente I-EXPLORATION altas, I-EXPLORATION sin I-EXPLORATION demostrarse I-EXPLORATION enfermedad. I-EXPLORATION Por I-EXPLORATION PCR I-EXPLORATION se I-EXPLORATION amplificó I-EXPLORATION virus I-EXPLORATION del I-EXPLORATION herpes I-EXPLORATION humano I-EXPLORATION tipo I-EXPLORATION 6 I-EXPLORATION (HHV-6), I-EXPLORATION del I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION han I-EXPLORATION descrito I-EXPLORATION asociaciones I-EXPLORATION con I-EXPLORATION apraxia I-EXPLORATION oculomotora. I-EXPLORATION I-EXPLORATION Fue I-EXPLORATION diagnosticada I-EXPLORATION de I-EXPLORATION C.O.M.A. I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION piramidal I-EXPLORATION bilateral I-EXPLORATION inespecífica. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS epífora I-PRESENT_ILLNESS bilateral, I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS (OI), I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dacriocistitis I-PRESENT_ILLNESS aguda. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY drenaje I-PAST_MEDICAL_HISTORY quirúrgico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY senos I-PAST_MEDICAL_HISTORY etmoidales I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sinusitis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY juventud. I-PAST_MEDICAL_HISTORY Presenta B-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 3 I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos. I-EXPLORATION Esta I-EXPLORATION visión I-EXPLORATION estaba I-EXPLORATION justificada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION cataratas I-EXPLORATION y I-EXPLORATION además I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION obstrucción I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION lagrimal. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT dacriocistografía I-TREATMENT izquierda I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT le I-TREATMENT implantó I-TREATMENT una I-TREATMENT prótesis I-TREATMENT recta I-TREATMENT de I-TREATMENT Wacrees I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION comienzó I-EVOLUTION una I-EVOLUTION inflamación I-EVOLUTION palpebral I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION región I-EVOLUTION orbitaria I-EVOLUTION izquierda. I-EVOLUTION Tras I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION refirió I-EVOLUTION pérdida I-EVOLUTION brusca I-EVOLUTION de I-EVOLUTION agudeza I-EVOLUTION visual I-EVOLUTION del I-EVOLUTION OI I-EVOLUTION con I-EVOLUTION mal I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION y I-EVOLUTION febrícula I-EVOLUTION (37,6º). I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION horas I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION urgencias, I-EVOLUTION presentando I-EVOLUTION una I-EVOLUTION visión I-EVOLUTION de I-EVOLUTION movimiento I-EVOLUTION de I-EVOLUTION manos I-EVOLUTION a I-EVOLUTION 50 I-EVOLUTION cms, I-EVOLUTION marcado I-EVOLUTION exoftalmos I-EVOLUTION con I-EVOLUTION clínica I-EVOLUTION inflamatoria I-EVOLUTION periocular, I-EVOLUTION oftalmoplejia I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION a I-EVOLUTION los I-EVOLUTION movimientos I-EVOLUTION oculares I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION biomicroscopía I-EVOLUTION midriasis I-EVOLUTION paralítica I-EVOLUTION en I-EVOLUTION el I-EVOLUTION OI I-EVOLUTION con I-EVOLUTION anestesia I-EVOLUTION corneal. I-EVOLUTION Oftalmoscópicamente B-EXPLORATION la I-EXPLORATION papila I-EXPLORATION era I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal I-EXPLORATION con I-EXPLORATION pulso I-EXPLORATION venoso I-EXPLORATION espontáneo I-EXPLORATION negativo. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION de I-EXPLORATION urgencias I-EXPLORATION presentaba I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION craneal I-EXPLORATION realizado I-EXPLORATION era I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION celulitis I-EXPLORATION orbitaria I-EXPLORATION OI. I-EXPLORATION Asimismo I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION neuritis I-EXPLORATION óptica I-EXPLORATION izquierda I-EXPLORATION por I-EXPLORATION compresión I-EXPLORATION intraorbitaria. I-EXPLORATION I-EXPLORATION Se B-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT sistémico I-TREATMENT con I-TREATMENT metil-prednisolona I-TREATMENT (250 I-TREATMENT mgr/iv/6 I-TREATMENT h), I-TREATMENT ceftriaxona I-TREATMENT (2 I-TREATMENT gr/iv/12 I-TREATMENT h) I-TREATMENT y I-TREATMENT Vancomicina I-TREATMENT (1 I-TREATMENT gr/iv/12 I-TREATMENT h), I-TREATMENT así I-TREATMENT como I-TREATMENT tratamiento I-TREATMENT tópico I-TREATMENT en I-TREATMENT OI. I-TREATMENT I-TREATMENT El B-EVOLUTION cuadro I-EVOLUTION inflamatorio I-EVOLUTION periocular I-EVOLUTION mejoró I-EVOLUTION notablemente I-EVOLUTION en I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 24 I-EVOLUTION horas, I-EVOLUTION pero I-EVOLUTION no I-EVOLUTION la I-EVOLUTION agudeza I-EVOLUTION visual, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION limitaba I-EVOLUTION a I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION colores I-EVOLUTION parcheados I-EVOLUTION (azul, I-EVOLUTION marrón). I-EVOLUTION I-EVOLUTION Transcurrida B-EXPLORATION 1 I-EXPLORATION semana I-EXPLORATION se I-EXPLORATION retiró I-EXPLORATION la I-EXPLORATION prótesis I-EXPLORATION lacrimonasal, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION su I-EXPLORATION buena I-EXPLORATION localización I-EXPLORATION y I-EXPLORATION funcionamiento, I-EXPLORATION haciéndose I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION y I-EXPLORATION aislándose I-EXPLORATION tres I-EXPLORATION gérmenes: I-EXPLORATION Streptococcus I-EXPLORATION mitis, I-EXPLORATION Staphylococcus I-EXPLORATION epidérmidis I-EXPLORATION y I-EXPLORATION un I-EXPLORATION bacilo I-EXPLORATION gram I-EXPLORATION negativo I-EXPLORATION oxidasa I-EXPLORATION positivo I-EXPLORATION (sin I-EXPLORATION determinar). I-EXPLORATION I-EXPLORATION Durante B-TREATMENT la I-TREATMENT evolución I-TREATMENT se I-TREATMENT desarrolló I-TREATMENT un I-TREATMENT piocele I-TREATMENT que I-TREATMENT precisó I-TREATMENT dacriocistectomía I-TREATMENT izquierda. I-TREATMENT I-TREATMENT En B-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION en I-EVOLUTION el I-EVOLUTION OI I-EVOLUTION una I-EVOLUTION visión I-EVOLUTION de I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION luz, I-EVOLUTION con I-EVOLUTION leve I-EVOLUTION midriasis I-EVOLUTION arreactiva I-EVOLUTION y I-EVOLUTION atrofia I-EVOLUTION óptica I-EVOLUTION izquierda. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION angiografía I-EXPLORATION fluoresceínica I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION hipofluorescencia I-EXPLORATION papilar I-EXPLORATION durante I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION angiograma I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION RMN I-EXPLORATION un I-EXPLORATION dudoso I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION tardío I-EXPLORATION en I-EXPLORATION el I-EXPLORATION nervio I-EXPLORATION óptico. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY reumatoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY leflunomida, I-PAST_MEDICAL_HISTORY deflazacort I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antiinflamatorios I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY esteroideos I-PAST_MEDICAL_HISTORY (AINEs), I-PAST_MEDICAL_HISTORY es B-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Inflamación I-DERIVED_FROM/TO Ocular I-DERIVED_FROM/TO por I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ojo I-DERIVED_FROM/TO derecho I-DERIVED_FROM/TO rojo I-DERIVED_FROM/TO y I-DERIVED_FROM/TO doloroso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO dos I-DERIVED_FROM/TO semanas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO asociado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO empeoramiento I-DERIVED_FROM/TO clínico I-DERIVED_FROM/TO y I-DERIVED_FROM/TO de I-DERIVED_FROM/TO laboratorio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO enfermedad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO base. I-DERIVED_FROM/TO I-DERIVED_FROM/TO La B-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION inicial I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 6 I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION (OD) I-EXPLORATION y I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION (OI). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION biomicroscopía I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION ingurgitación I-EXPLORATION vascular I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION engrosamiento I-EXPLORATION escleral I-EXPLORATION temporal I-EXPLORATION superior I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION escleritis I-EXPLORATION anterior I-EXPLORATION difusa I-EXPLORATION severa. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION AO. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT esteroideo I-TREATMENT oral I-TREATMENT con I-TREATMENT prednisona I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/kg/día, I-TREATMENT manteniendo I-TREATMENT el I-TREATMENT resto I-TREATMENT del I-TREATMENT tratamiento, I-TREATMENT sin I-TREATMENT obtener I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT tras I-TREATMENT tres I-TREATMENT semanas I-TREATMENT de I-TREATMENT seguimiento. I-TREATMENT Una B-EXPLORATION vez I-EXPLORATION realizadas I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION un I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION se B-TREATMENT decidió I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT Infliximab I-TREATMENT (Remicade®, I-TREATMENT Schering-Plough, I-TREATMENT Welwyn I-TREATMENT Garden I-TREATMENT City, I-TREATMENT UK) I-TREATMENT en I-TREATMENT tres I-TREATMENT dosis I-TREATMENT intravenosas I-TREATMENT de I-TREATMENT 3 I-TREATMENT mg/kg/día I-TREATMENT en I-TREATMENT las I-TREATMENT semanas I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT y I-TREATMENT 6. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION dosis I-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ingurgitación I-EVOLUTION vascular I-EVOLUTION y I-EVOLUTION del I-EVOLUTION edema I-EVOLUTION escleral I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION tercera I-EVOLUTION se I-EVOLUTION obtuvo I-EVOLUTION una I-EVOLUTION desaparición I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION inflamación I-EVOLUTION escleral, I-EVOLUTION quedando I-EVOLUTION un I-EVOLUTION cierto I-EVOLUTION adelgazamiento I-EVOLUTION residual I-EVOLUTION con I-EVOLUTION transparencia I-EVOLUTION del I-EVOLUTION tejido I-EVOLUTION uveal I-EVOLUTION subyacente. I-EVOLUTION Paralelamente, I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION en I-EVOLUTION los I-EVOLUTION signos I-EVOLUTION y I-EVOLUTION síntomas I-EVOLUTION articulares, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION actividad I-EVOLUTION global I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION representada I-EVOLUTION por I-EVOLUTION el I-EVOLUTION Disease I-EVOLUTION Activity I-EVOLUTION Score I-EVOLUTION (DAS I-EVOLUTION 28), I-EVOLUTION obteniéndose I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION un I-EVOLUTION 40% I-EVOLUTION en I-EVOLUTION el I-EVOLUTION DAS I-EVOLUTION 28. I-EVOLUTION I-EVOLUTION Tras I-EVOLUTION un I-EVOLUTION período I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION no I-EVOLUTION se I-EVOLUTION han I-EVOLUTION detectado I-EVOLUTION recidivas I-EVOLUTION en I-EVOLUTION la I-EVOLUTION inflamación I-EVOLUTION escleral. I-EVOLUTION La B-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION (AO). I-EXPLORATION La B-TREATMENT paciente I-TREATMENT sigue I-TREATMENT en I-TREATMENT la I-TREATMENT actualidad I-TREATMENT tratamiento I-TREATMENT sistémico I-TREATMENT únicamente I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 7, I-TREATMENT 5 I-TREATMENT mg/día, I-TREATMENT leflunomida I-TREATMENT y I-TREATMENT AINEs. I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY herida I-PAST_MEDICAL_HISTORY corneal I-PAST_MEDICAL_HISTORY postraumática I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY (OI), I-PAST_MEDICAL_HISTORY suturada I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY accidente, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY cuerpo I-PAST_MEDICAL_HISTORY extraño I-PAST_MEDICAL_HISTORY intraocular, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antibióticos, I-PAST_MEDICAL_HISTORY ciclopléjicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY esteroides I-PAST_MEDICAL_HISTORY tópicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sistémicos. I-PAST_MEDICAL_HISTORY Al B-DERIVED_FROM/TO suspender I-DERIVED_FROM/TO los I-DERIVED_FROM/TO esteroides, I-DERIVED_FROM/TO presentó I-DERIVED_FROM/TO disminución I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO agudeza I-DERIVED_FROM/TO visual I-DERIVED_FROM/TO del I-DERIVED_FROM/TO ojo I-DERIVED_FROM/TO no I-DERIVED_FROM/TO traumatizado, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO se I-DERIVED_FROM/TO reinició I-DERIVED_FROM/TO la I-DERIVED_FROM/TO administración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO prednisona I-DERIVED_FROM/TO vía I-DERIVED_FROM/TO oral I-DERIVED_FROM/TO y I-DERIVED_FROM/TO se I-DERIVED_FROM/TO envió I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO institución I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO oftalmía I-DERIVED_FROM/TO simpática. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION su I-EXPLORATION ingreso, I-EXPLORATION un I-EXPLORATION mes I-EXPLORATION y I-EXPLORATION medio I-EXPLORATION después I-EXPLORATION del I-EXPLORATION traumatismo, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION refería I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION (OD) I-EXPLORATION de I-EXPLORATION 21 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION y I-EXPLORATION un I-EXPLORATION escotoma I-EXPLORATION central I-EXPLORATION relativo I-EXPLORATION en I-EXPLORATION AO. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION AV I-EXPLORATION de I-EXPLORATION 20/60 I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 20/400 I-EXPLORATION OI, I-EXPLORATION presión I-EXPLORATION intraocular I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION mmHg I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 12 I-EXPLORATION mmHg I-EXPLORATION OI. I-EXPLORATION El I-EXPLORATION OD I-EXPLORATION presentaba I-EXPLORATION además I-EXPLORATION células I-EXPLORATION de I-EXPLORATION pigmento I-EXPLORATION 1/2 I-EXPLORATION + I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cámara I-EXPLORATION anterior, I-EXPLORATION sin I-EXPLORATION flare. I-EXPLORATION El I-EXPLORATION segmento I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION OI I-EXPLORATION presentaba I-EXPLORATION conjuntiva I-EXPLORATION hiperémica, I-EXPLORATION herida I-EXPLORATION corneal I-EXPLORATION suturada I-EXPLORATION con I-EXPLORATION leucoma I-EXPLORATION temporal, I-EXPLORATION sinequias I-EXPLORATION posteriores I-EXPLORATION y I-EXPLORATION opacidad I-EXPLORATION subcapsular I-EXPLORATION posterior I-EXPLORATION +. I-EXPLORATION La I-EXPLORATION funduscopia I-EXPLORATION del I-EXPLORATION OD I-EXPLORATION mostraba I-EXPLORATION pliegues I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mácula I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION lesiones I-EXPLORATION blanco I-EXPLORATION amarillentas I-EXPLORATION con I-EXPLORATION líquido I-EXPLORATION subretiniano; I-EXPLORATION el I-EXPLORATION OI I-EXPLORATION tenía I-EXPLORATION tres I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION características I-EXPLORATION similares, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION panuveítis I-EXPLORATION bilateral. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT que I-TREATMENT recibía I-TREATMENT consistía I-TREATMENT en I-TREATMENT prednisona I-TREATMENT 75 I-TREATMENT mg/día I-TREATMENT po, I-TREATMENT acetato I-TREATMENT de I-TREATMENT prednisolona I-TREATMENT 1% I-TREATMENT cada I-TREATMENT 2 I-TREATMENT h, I-TREATMENT ciclopentolato I-TREATMENT 1% I-TREATMENT bid, I-TREATMENT fenilefrina I-TREATMENT 10% I-TREATMENT bid. I-TREATMENT I-TREATMENT El B-EXPLORATION aspecto I-EXPLORATION clínico I-EXPLORATION hizo I-EXPLORATION sospechar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION CSC. I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION angiográfico. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION desprendimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hialoides I-EXPLORATION posterior I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION DRS I-EXPLORATION en I-EXPLORATION área I-EXPLORATION macular I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OI; I-EXPLORATION el I-EXPLORATION grosor I-EXPLORATION coroideo I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION AO. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION angiográfico I-EXPLORATION mostró I-EXPLORATION dos I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION hiperfluorescencia I-EXPLORATION que I-EXPLORATION aumentaban I-EXPLORATION progresivamente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION tres I-EXPLORATION lesiones I-EXPLORATION similares I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OI. I-EXPLORATION I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION CSC I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION focos I-EXPLORATION múltiples. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ciclopléjicos I-TREATMENT y I-TREATMENT se I-TREATMENT redujeron I-TREATMENT rápidamente I-TREATMENT los I-TREATMENT esteroides I-TREATMENT tópicos I-TREATMENT y I-TREATMENT sistémicos. I-TREATMENT Un B-EVOLUTION mes I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION la I-EVOLUTION agudeza I-EVOLUTION visual I-EVOLUTION era I-EVOLUTION de I-EVOLUTION 1 I-EVOLUTION OD I-EVOLUTION y I-EVOLUTION 0, I-EVOLUTION 2 I-EVOLUTION OI; I-EVOLUTION el I-EVOLUTION aspecto I-EVOLUTION clínico I-EVOLUTION del I-EVOLUTION fondo I-EVOLUTION de I-EVOLUTION ojo I-EVOLUTION mostraba I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION pigmentadas I-EVOLUTION sin I-EVOLUTION líquido I-EVOLUTION subretiniano I-EVOLUTION en I-EVOLUTION AO. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS enviado I-PRESENT_ILLNESS para I-PRESENT_ILLNESS evaluar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS exoftalmos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS (OD) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION primera I-EXPLORATION visita I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION pediátrica I-EXPLORATION general I-EXPLORATION era I-EXPLORATION buena I-EXPLORATION y I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION anomalías I-EXPLORATION neurológicas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica, I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION proptosis I-EXPLORATION e I-EXPLORATION hipertropia I-EXPLORATION del I-EXPLORATION OD I-EXPLORATION con I-EXPLORATION franca I-EXPLORATION asimetría I-EXPLORATION facial. I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION fronto-temporal I-EXPLORATION el I-EXPLORATION niño I-EXPLORATION tenía I-EXPLORATION dolor. I-EXPLORATION El I-EXPLORATION segmento I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION OD I-EXPLORATION explorado I-EXPLORATION con I-EXPLORATION linterna I-EXPLORATION era I-EXPLORATION aparentemente I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION motilidad I-EXPLORATION intrínseca I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION mientras I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION extrínseca I-EXPLORATION presentaba I-EXPLORATION limitación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION abducción I-EXPLORATION y I-EXPLORATION descenso I-EXPLORATION del I-EXPLORATION OD. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION infiltrante I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION el I-EXPLORATION globo I-EXPLORATION ocular I-EXPLORATION hacia I-EXPLORATION arriba I-EXPLORATION con I-EXPLORATION destrucción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION orbitaria I-EXPLORATION lateral I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION sacabocado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION calota I-EXPLORATION craneal. I-EXPLORATION Otros I-EXPLORATION estudios I-EXPLORATION radiológicos I-EXPLORATION demostraron I-EXPLORATION lesiones I-EXPLORATION semejantes I-EXPLORATION en I-EXPLORATION las I-EXPLORATION vértebras I-EXPLORATION y I-EXPLORATION en I-EXPLORATION los I-EXPLORATION huesos I-EXPLORATION largos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION piernas. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION hematológicas I-EXPLORATION y I-EXPLORATION bioquímicas I-EXPLORATION mostraron I-EXPLORATION valores I-EXPLORATION normales. I-EXPLORATION Una I-EXPLORATION biopsia I-EXPLORATION ósea I-EXPLORATION del I-EXPLORATION fémur I-EXPLORATION demostró I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Langerhans I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION immunohistológico I-EXPLORATION para I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION S100 I-EXPLORATION (indica I-EXPLORATION su I-EXPLORATION origen I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cresta I-EXPLORATION neural) I-EXPLORATION y I-EXPLORATION para I-EXPLORATION las I-EXPLORATION proteínas I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION CD68 I-EXPLORATION (proteína I-EXPLORATION lisosomal I-EXPLORATION que I-EXPLORATION se I-EXPLORATION expresa I-EXPLORATION en I-EXPLORATION macrófagos I-EXPLORATION y I-EXPLORATION en I-EXPLORATION células I-EXPLORATION dendríticas I-EXPLORATION inmaduras) I-EXPLORATION y I-EXPLORATION CD1a I-EXPLORATION (glicoproteína I-EXPLORATION de I-EXPLORATION membrana I-EXPLORATION de I-EXPLORATION 49 I-EXPLORATION KDa I-EXPLORATION que I-EXPLORATION se I-EXPLORATION expresa I-EXPLORATION en I-EXPLORATION asociación I-EXPLORATION a I-EXPLORATION ß2 I-EXPLORATION microglobulinas) I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION histiocitosis I-EXPLORATION de I-EXPLORATION Langerhans. I-EXPLORATION Dos B-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION estaba I-EVOLUTION hipersomnoliento I-EVOLUTION día I-EVOLUTION y I-EVOLUTION noche I-EVOLUTION con I-EVOLUTION ingesta I-EVOLUTION excesiva I-EVOLUTION de I-EVOLUTION líquidos. I-EVOLUTION En B-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION RMN I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION infiltrante I-EXPLORATION que I-EXPLORATION afectaba I-EXPLORATION a I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION hipotálamo-hipofisaria I-EXPLORATION con I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION añadió I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION diabetes I-EXPLORATION insípida. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS miope B-PAST_MEDICAL_HISTORY magna, I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cristalino I-PAST_MEDICAL_HISTORY transparente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ambos I-PAST_MEDICAL_HISTORY ojos, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY junio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2000. I-PAST_MEDICAL_HISTORY Un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY capsulotomía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY láser I-PAST_MEDICAL_HISTORY YAG. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY 2003 I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY DR I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY OD, I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY vitrectomía I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY inyección I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aceite I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY silicona I-PAST_MEDICAL_HISTORY (AS), I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY retiró I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY después. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2004 I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS brusca I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS OD. I-PRESENT_ILLNESS En B-EXPLORATION urgencias I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 1, I-EXPLORATION un I-EXPLORATION tyndall I-EXPLORATION de I-EXPLORATION 3+, I-EXPLORATION una I-EXPLORATION cámara I-EXPLORATION anterior I-EXPLORATION amplia I-EXPLORATION y I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION intraocular I-EXPLORATION (PIO) I-EXPLORATION de I-EXPLORATION 48 I-EXPLORATION mmHg. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION del I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION la I-EXPLORATION retina I-EXPLORATION estaba I-EXPLORATION aplicada, I-EXPLORATION la I-EXPLORATION excavación I-EXPLORATION papilar I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 8, I-EXPLORATION y I-EXPLORATION no I-EXPLORATION había I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION silicona I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION posterior. I-EXPLORATION Se B-TREATMENT pautó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT dexametasona I-TREATMENT alcohol I-TREATMENT (maxidex®; I-TREATMENT Alcon I-TREATMENT Cusí, I-TREATMENT S. I-TREATMENT A.; I-TREATMENT Barcelona; I-TREATMENT España) I-TREATMENT 1 I-TREATMENT gota I-TREATMENT cada I-TREATMENT 2 I-TREATMENT horas, I-TREATMENT atropina I-TREATMENT 1% I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas, I-TREATMENT maleato I-TREATMENT de I-TREATMENT timolol I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT (timoftol® I-TREATMENT 0, I-TREATMENT 5%; I-TREATMENT Merck I-TREATMENT Sharp I-TREATMENT & I-TREATMENT Dohme, I-TREATMENT S.A.; I-TREATMENT Madrid; I-TREATMENT España) I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT y I-TREATMENT acetazolamida I-TREATMENT vía I-TREATMENT oral I-TREATMENT (edemox®; I-TREATMENT Chiesi I-TREATMENT Wasserman I-TREATMENT S. I-TREATMENT A.; I-TREATMENT Barcelona; I-TREATMENT España) I-TREATMENT 250 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas. I-TREATMENT I-TREATMENT Una B-EVOLUTION semana I-EVOLUTION después I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION nuestra I-EVOLUTION consulta I-EVOLUTION sin I-EVOLUTION mejoría I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION del I-EVOLUTION tratamiento. I-EVOLUTION A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION la I-EXPLORATION AV I-EXPLORATION se I-EXPLORATION mantenía I-EXPLORATION en I-EXPLORATION 0, I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION la I-EXPLORATION PIO I-EXPLORATION en I-EXPLORATION 33 I-EXPLORATION mmHg. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION figura I-EXPLORATION 1 I-EXPLORATION se I-EXPLORATION muestra I-EXPLORATION el I-EXPLORATION aspecto I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION anterior. I-EXPLORATION Lo I-EXPLORATION que I-EXPLORATION inicialmente I-EXPLORATION se I-EXPLORATION habían I-EXPLORATION identificado I-EXPLORATION como I-EXPLORATION células I-EXPLORATION inflamatorias I-EXPLORATION resultaron I-EXPLORATION ser I-EXPLORATION microburbujas I-EXPLORATION de I-EXPLORATION aceite I-EXPLORATION de I-EXPLORATION silicona I-EXPLORATION emulsificadas I-EXPLORATION en I-EXPLORATION cámara I-EXPLORATION anterior, I-EXPLORATION responsables I-EXPLORATION del I-EXPLORATION glaucoma I-EXPLORATION secundario. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT falta I-TREATMENT de I-TREATMENT respuesta I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT se I-TREATMENT planteó I-TREATMENT la I-TREATMENT implantación I-TREATMENT de I-TREATMENT un I-TREATMENT dispositivo I-TREATMENT de I-TREATMENT drenaje I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT rechazó, I-TREATMENT no I-TREATMENT acudiendo I-TREATMENT a I-TREATMENT las I-TREATMENT revisiones I-TREATMENT citadas I-TREATMENT posteriormente. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS proptosis I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS (OI) I-PRESENT_ILLNESS e I-PRESENT_ILLNESS infiltración I-PRESENT_ILLNESS palpebral I-PRESENT_ILLNESS dolorosa, I-PRESENT_ILLNESS caliente I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS consistencia I-PRESENT_ILLNESS dura, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS limitación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mirada I-PRESENT_ILLNESS vertical I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes, I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY mixto I-PAST_MEDICAL_HISTORY ductal I-PAST_MEDICAL_HISTORY lobulillar I-PAST_MEDICAL_HISTORY infiltrante I-PAST_MEDICAL_HISTORY multifocal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY multicéntrico I-PAST_MEDICAL_HISTORY (carcinoma I-PAST_MEDICAL_HISTORY escirro, I-PAST_MEDICAL_HISTORY T4 I-PAST_MEDICAL_HISTORY N3 I-PAST_MEDICAL_HISTORY M0) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mama I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY siete I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY sometida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY mastectomía I-PAST_MEDICAL_HISTORY radical I-PAST_MEDICAL_HISTORY modificada I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY Madden, I-PAST_MEDICAL_HISTORY disección I-PAST_MEDICAL_HISTORY axilar, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY ciclos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY quimioterapia I-PAST_MEDICAL_HISTORY (Epirrubicina I-PAST_MEDICAL_HISTORY 75 I-PAST_MEDICAL_HISTORY mg/m2), I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY remitió I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY encontrándose I-PAST_MEDICAL_HISTORY restos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY misma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY estudios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY extensión. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION era I-EXPLORATION 7/10 I-EXPLORATION con I-EXPLORATION ambos I-EXPLORATION ojos, I-EXPLORATION cataratas I-EXPLORATION nucleares I-EXPLORATION +, I-EXPLORATION presión I-EXPLORATION intraocular I-EXPLORATION OI I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION 14 I-EXPLORATION mmHg. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos. I-EXPLORATION Presentaba I-EXPLORATION un I-EXPLORATION exoftalmos I-EXPLORATION unilateral I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION OI. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION difusa I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas, I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION ósea, I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION el I-EXPLORATION nervio I-EXPLORATION óptico I-EXPLORATION y I-EXPLORATION el I-EXPLORATION globo I-EXPLORATION ocular. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION realzaba I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION con I-EXPLORATION Tecnecio I-EXPLORATION 99 I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION múltiples I-EXPLORATION metástasis I-EXPLORATION por I-EXPLORATION acúmulo I-EXPLORATION de I-EXPLORATION radiotrazador I-EXPLORATION en I-EXPLORATION calota, I-EXPLORATION raquis, I-EXPLORATION parrilla I-EXPLORATION costal, I-EXPLORATION húmeros I-EXPLORATION y I-EXPLORATION pelvis. I-EXPLORATION Ante I-EXPLORATION el I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION rehusó I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION diagnóstica. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quimioterapia, I-TREATMENT tres I-TREATMENT ciclos I-TREATMENT de I-TREATMENT Taxotere I-TREATMENT 100 I-TREATMENT mg/m2, I-TREATMENT un I-TREATMENT ciclo I-TREATMENT de I-TREATMENT Mitoxantrone I-TREATMENT 12 I-TREATMENT mg/m2 I-TREATMENT y I-TREATMENT dos I-TREATMENT ciclos I-TREATMENT de I-TREATMENT Vinorelbina I-TREATMENT 25 I-TREATMENT mg/m2, I-TREATMENT y I-TREATMENT esteroides I-TREATMENT (6-metil-prednisolona) I-TREATMENT (1 I-TREATMENT mg/m2) I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT reducir I-TREATMENT el I-TREATMENT edema I-TREATMENT y I-TREATMENT la I-TREATMENT congestión I-TREATMENT orbitaria. I-TREATMENT Pese B-EVOLUTION al I-EVOLUTION tratamiento, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia I-PAST_MEDICAL_HISTORY quien B-PRESENT_ILLNESS desarrolló I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS conjuntival I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS (OD) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Clínicamente B-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION pigmentada I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION conjuntiva I-EXPLORATION nasal I-EXPLORATION que I-EXPLORATION invadía I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION la I-EXPLORATION córnea I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION afectaba I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION visual. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION inicial, I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION de I-EXPLORATION 20/20 I-EXPLORATION y I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION intraocular I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION mmHg I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos. I-EXPLORATION Tanto I-EXPLORATION la I-EXPLORATION biomicroscopía I-EXPLORATION como I-EXPLORATION la I-EXPLORATION oftalmoscopía I-EXPLORATION indirecta I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION (OI) I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION biomicroscopía I-EXPLORATION del I-EXPLORATION OD I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION densamente I-EXPLORATION pigmentada, I-EXPLORATION elevada, I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 4 I-EXPLORATION mm., I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION delimitados, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION sector I-EXPLORATION nasal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION conjuntiva I-EXPLORATION bulbar I-EXPLORATION y I-EXPLORATION que I-EXPLORATION invadía I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION la I-EXPLORATION córnea. I-EXPLORATION La I-EXPLORATION masa I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION rodeada I-EXPLORATION por I-EXPLORATION algunos I-EXPLORATION vasos I-EXPLORATION nutricios I-EXPLORATION prominentes. I-EXPLORATION No I-EXPLORATION hubo I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION melanosis I-EXPLORATION adquirida I-EXPLORATION primaria I-EXPLORATION adyacente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica, I-EXPLORATION incluyendo I-EXPLORATION la I-EXPLORATION fundoscopía, I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION escisión I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION quirúrgicos I-EXPLORATION amplios. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION macroscópico I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION con I-EXPLORATION dimensiones I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 3 I-EXPLORATION mm, I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION nodular, I-EXPLORATION superficie I-EXPLORATION externa I-EXPLORATION lisa, I-EXPLORATION multilobulada, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION café I-EXPLORATION negruzco I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION mucoso. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION histopatológico I-EXPLORATION demostró I-EXPLORATION epitelio I-EXPLORATION de I-EXPLORATION revestimiento I-EXPLORATION conjuntival I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION de I-EXPLORATION papilomatosis I-EXPLORATION y I-EXPLORATION acantosis I-EXPLORATION irregular, I-EXPLORATION esta I-EXPLORATION última I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION células I-EXPLORATION basaloides, I-EXPLORATION mismas I-EXPLORATION que I-EXPLORATION estaban I-EXPLORATION mezcladas I-EXPLORATION con I-EXPLORATION pequeños I-EXPLORATION grupos I-EXPLORATION de I-EXPLORATION células I-EXPLORATION escamosas I-EXPLORATION y I-EXPLORATION algunos I-EXPLORATION melanocitos I-EXPLORATION dendríticos. I-EXPLORATION La I-EXPLORATION sustancia I-EXPLORATION propia I-EXPLORATION presentaba I-EXPLORATION además, I-EXPLORATION áreas I-EXPLORATION con I-EXPLORATION degeneración I-EXPLORATION elastótica, I-EXPLORATION vasos I-EXPLORATION sanguíneos I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION calibre I-EXPLORATION dilatados I-EXPLORATION y I-EXPLORATION cúmulos I-EXPLORATION variables I-EXPLORATION de I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION formados I-EXPLORATION por I-EXPLORATION linfocitos I-EXPLORATION maduros, I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION y I-EXPLORATION algunos I-EXPLORATION melanófagos. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION queratosis I-EXPLORATION seborreica I-EXPLORATION (QS) I-EXPLORATION de I-EXPLORATION la I-EXPLORATION conjuntiva. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agudeza I-PRESENT_ILLNESS visual I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY insulino I-PAST_MEDICAL_HISTORY dependiente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY padecido I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY contuso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Refería B-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión I-PRESENT_ILLNESS asintomático I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS La B-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION tomada I-EXPLORATION mediante I-EXPLORATION el I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Snellen I-EXPLORATION era I-EXPLORATION 1 I-EXPLORATION para I-EXPLORATION su I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION para I-EXPLORATION su I-EXPLORATION ojo I-EXPLORATION izquierdo, I-EXPLORATION mejorando I-EXPLORATION este I-EXPLORATION último I-EXPLORATION a I-EXPLORATION 1 I-EXPLORATION con I-EXPLORATION una I-EXPLORATION corrección I-EXPLORATION esférica I-EXPLORATION de I-EXPLORATION +1, I-EXPLORATION 5D. I-EXPLORATION I-EXPLORATION Tanto I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION ocular I-EXPLORATION intrínseca I-EXPLORATION como I-EXPLORATION extrínseca, I-EXPLORATION biomicroscopía I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION tonometría I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION La I-EXPLORATION funduscopia I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION yuxtapapilar I-EXPLORATION de I-EXPLORATION color I-EXPLORATION rojo-anaranjado I-EXPLORATION brillante, I-EXPLORATION sobreelevada, I-EXPLORATION bien I-EXPLORATION delimitada. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION del I-EXPLORATION epitelio I-EXPLORATION pigmentario I-EXPLORATION en I-EXPLORATION región I-EXPLORATION macular I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION capa I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION nerviosas I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION oftalmoscópica I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION adelfo I-EXPLORATION presentaba I-EXPLORATION asimismo I-EXPLORATION una I-EXPLORATION leve I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION epitelio I-EXPLORATION pigmentario. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION angiografía I-EXPLORATION fluoresceínica I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION el I-EXPLORATION relleno I-EXPLORATION de I-EXPLORATION un I-EXPLORATION árbol I-EXPLORATION vascular I-EXPLORATION intratumoral I-EXPLORATION compuesto I-EXPLORATION de I-EXPLORATION finos I-EXPLORATION capilares I-EXPLORATION con I-EXPLORATION exudación I-EXPLORATION en I-EXPLORATION tiempos I-EXPLORATION tardíos, I-EXPLORATION confirmando I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION hemangioma I-EXPLORATION capilar I-EXPLORATION yuxtapapilar. I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION fuga I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION ojos, I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION retinopatía I-EXPLORATION central I-EXPLORATION serosa. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION campo I-EXPLORATION visual I-EXPLORATION SITA- I-EXPLORATION Standard I-EXPLORATION 24-2 I-EXPLORATION (Zeiss-Humphrey I-EXPLORATION Instruments, I-EXPLORATION Dublin, I-EXPLORATION CA) I-EXPLORATION con I-EXPLORATION visión I-EXPLORATION corregida, I-EXPLORATION estímulo I-EXPLORATION III, I-EXPLORATION hallándose I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION infero-nasal I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Cuatro I-EXPLORATION semanas I-EXPLORATION más I-EXPLORATION tarde, I-EXPLORATION la I-EXPLORATION visión I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 6 I-EXPLORATION corregida I-EXPLORATION (+0.5 I-EXPLORATION esf I-EXPLORATION + I-EXPLORATION 1 I-EXPLORATION x I-EXPLORATION 48 I-EXPLORATION cil) I-EXPLORATION 1; I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION la I-EXPLORATION visión I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION corregida I-EXPLORATION (+0.5 I-EXPLORATION esf I-EXPLORATION +0.25 I-EXPLORATION x I-EXPLORATION 170 I-EXPLORATION cil) I-EXPLORATION 0, I-EXPLORATION 6. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION angiografía I-EXPLORATION fluoresceínica I-EXPLORATION demostró I-EXPLORATION que I-EXPLORATION la I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION se I-EXPLORATION debía I-EXPLORATION a I-EXPLORATION retinopatía I-EXPLORATION central I-EXPLORATION serosa. I-EXPLORATION I-EXPLORATION Ocho B-EVOLUTION semanas I-EVOLUTION después I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION se I-EVOLUTION encontró I-EVOLUTION una I-EVOLUTION regresión I-EVOLUTION espontánea I-EVOLUTION tanto I-EVOLUTION del I-EVOLUTION hemangioma I-EVOLUTION capilar I-EVOLUTION yuxtapapilar I-EVOLUTION como I-EVOLUTION de I-EVOLUTION la I-EVOLUTION retinopatía I-EVOLUTION central I-EVOLUTION serosa I-EVOLUTION bilateral, I-EVOLUTION regresando I-EVOLUTION la I-EVOLUTION AV I-EVOLUTION a I-EVOLUTION la I-EVOLUTION 1 I-EVOLUTION difícil I-EVOLUTION en I-EVOLUTION ambos I-EVOLUTION ojos. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS AV I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS ojos I-PRESENT_ILLNESS (0, I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS OD I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS OI I-PRESENT_ILLNESS ). I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION EMQ I-EXPLORATION bilateral. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION angiografía I-EXPLORATION fluoresceínica I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION epiteliopatía I-EXPLORATION pigmentaria I-EXPLORATION difusa I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION exudativo I-EXPLORATION y I-EXPLORATION desprendimientos I-EXPLORATION retinianos I-EXPLORATION serosos I-EXPLORATION secundarios. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 5 I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION edad, I-EXPLORATION había I-EXPLORATION sido I-EXPLORATION tratada I-EXPLORATION con I-EXPLORATION éxito I-EXPLORATION de I-EXPLORATION una I-EXPLORATION histiocitosis I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Langerhans, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION sistémico I-EXPLORATION completo, I-EXPLORATION incluidas I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION craneal I-EXPLORATION y I-EXPLORATION orbitarias. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION ningún I-EXPLORATION hallazgo I-EXPLORATION significativo. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT terapia I-TREATMENT con I-TREATMENT corticosteroides I-TREATMENT tópicos, I-TREATMENT peribulbares I-TREATMENT y I-TREATMENT orales. I-TREATMENT I-TREATMENT Las I-TREATMENT inyecciones I-TREATMENT de I-TREATMENT triamcinolona I-TREATMENT peribulbar I-TREATMENT se I-TREATMENT repitieron I-TREATMENT en I-TREATMENT cuatro I-TREATMENT ocasiones I-TREATMENT a I-TREATMENT lo I-TREATMENT largo I-TREATMENT del I-TREATMENT siguiente I-TREATMENT año, I-TREATMENT logrando I-TREATMENT sólo I-TREATMENT mejorías I-TREATMENT transitorias I-TREATMENT del I-TREATMENT edema I-TREATMENT macular I-TREATMENT y I-TREATMENT los I-TREATMENT desprendimientos I-TREATMENT serosos. I-TREATMENT En I-TREATMENT septiembre I-TREATMENT de I-TREATMENT 2002, I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ciclosporina I-TREATMENT oral I-TREATMENT y I-TREATMENT en I-TREATMENT marzo I-TREATMENT de I-TREATMENT 2003 I-TREATMENT se I-TREATMENT añadió I-TREATMENT azatioprina, I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT persistencia I-TREATMENT del I-TREATMENT EMQ. I-TREATMENT Finalmente, I-TREATMENT se I-TREATMENT inyectaron I-TREATMENT 4 I-TREATMENT mg I-TREATMENT de I-TREATMENT triamcinolona I-TREATMENT intravítrea I-TREATMENT en I-TREATMENT ambos I-TREATMENT ojos I-TREATMENT en I-TREATMENT julio I-TREATMENT de I-TREATMENT 2003 I-TREATMENT con I-TREATMENT mejoría I-TREATMENT inicial I-TREATMENT del I-TREATMENT EMQ I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT AV. I-TREATMENT Se I-TREATMENT repitieron I-TREATMENT las I-TREATMENT inyecciones I-TREATMENT dos I-TREATMENT veces I-TREATMENT en I-TREATMENT el I-TREATMENT OD I-TREATMENT y I-TREATMENT una I-TREATMENT vez I-TREATMENT más I-TREATMENT en I-TREATMENT el I-TREATMENT OI. I-TREATMENT En B-EXPLORATION diciembre I-EXPLORATION de I-EXPLORATION 2004, I-EXPLORATION se I-EXPLORATION registraron I-EXPLORATION PIO I-EXPLORATION de I-EXPLORATION 27 I-EXPLORATION mmHg I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 26 I-EXPLORATION mmHg I-EXPLORATION OI, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION indica I-EXPLORATION terapia I-EXPLORATION tópica I-EXPLORATION con I-EXPLORATION timolol I-EXPLORATION 0, I-EXPLORATION 5% I-EXPLORATION y I-EXPLORATION dorzolamida I-EXPLORATION 0, I-EXPLORATION 02% I-EXPLORATION (Cosopt®). I-EXPLORATION En I-EXPLORATION marzo I-EXPLORATION de I-EXPLORATION 2005, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION AV I-EXPLORATION severa I-EXPLORATION bilateral I-EXPLORATION (<0,05) I-EXPLORATION por I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION cataratas I-EXPLORATION intumescentes. I-EXPLORATION Tras B-EVOLUTION cirugía I-EVOLUTION de I-EVOLUTION facoextracción I-EVOLUTION con I-EVOLUTION implantación I-EVOLUTION de I-EVOLUTION lente I-EVOLUTION intraocular I-EVOLUTION sin I-EVOLUTION complicaciones, I-EVOLUTION la I-EVOLUTION AV I-EVOLUTION es I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 3 I-EVOLUTION en I-EVOLUTION ambos I-EVOLUTION ojos. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO por I-DERIVED_FROM/TO Medicina I-DERIVED_FROM/TO Interna I-DERIVED_FROM/TO para I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO fondo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ojo I-DERIVED_FROM/TO por B-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS midriasis I-PRESENT_ILLNESS media I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION y I-EXPLORATION una I-EXPLORATION midriasis I-EXPLORATION bilateral I-EXPLORATION arreactiva; I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION incluídas I-EXPLORATION las I-EXPLORATION papilas, I-EXPLORATION es I-EXPLORATION normal, I-EXPLORATION salvo I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION cámaras I-EXPLORATION anteriores I-EXPLORATION estrechas I-EXPLORATION y I-EXPLORATION unas I-EXPLORATION presiones I-EXPLORATION intraoculares I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION y I-EXPLORATION 58 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION en I-EXPLORATION cada I-EXPLORATION ojo. I-EXPLORATION Ante I-EXPLORATION este I-EXPLORATION cuadro I-EXPLORATION se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION tomar I-EXPLORATION imágenes I-EXPLORATION del I-EXPLORATION polo I-EXPLORATION anterior I-EXPLORATION con I-EXPLORATION OCT I-EXPLORATION y I-EXPLORATION BMU, I-EXPLORATION mostrando I-EXPLORATION un I-EXPLORATION cierre I-EXPLORATION angular I-EXPLORATION en I-EXPLORATION los I-EXPLORATION 360º I-EXPLORATION y I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION bilateral. I-EXPLORATION Con B-TREATMENT estos I-TREATMENT datos, I-TREATMENT se I-TREATMENT establece I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT ataque I-TREATMENT agudo I-TREATMENT de I-TREATMENT glaucoma I-TREATMENT bilateral, I-TREATMENT se I-TREATMENT prescribe I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT para I-TREATMENT dicho I-TREATMENT cuadro I-TREATMENT y I-TREATMENT se I-TREATMENT realizan I-TREATMENT iridotomías I-TREATMENT bilaterales I-TREATMENT que I-TREATMENT resultan I-TREATMENT permeables I-TREATMENT como I-TREATMENT muestran I-TREATMENT las I-TREATMENT imágenes I-TREATMENT del I-TREATMENT OCT, I-TREATMENT ampliándose I-TREATMENT la I-TREATMENT profundidad I-TREATMENT camerular I-TREATMENT en I-TREATMENT ambos I-TREATMENT ojos. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que B-DERIVED_FROM/TO acude I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO por I-DERIVED_FROM/TO optometrista I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valorar I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nivel I-DERIVED_FROM/TO iridiano I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO repercusión I-DERIVED_FROM/TO funcional. I-DERIVED_FROM/TO A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION sobreelevada I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION quístico I-EXPLORATION y I-EXPLORATION contenido I-EXPLORATION lechoso I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION iris, I-EXPLORATION cerca I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION pupilar. I-EXPLORATION No B-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY oftalmológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION obtienen I-EXPLORATION imágenes I-EXPLORATION con I-EXPLORATION BMU I-EXPLORATION y I-EXPLORATION OCT I-EXPLORATION y I-EXPLORATION se I-EXPLORATION establece I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION estromal I-EXPLORATION primario I-EXPLORATION de I-EXPLORATION iris. I-EXPLORATION I-EXPLORATION En I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION anteriormente I-EXPLORATION mencionados, I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION utilizando I-EXPLORATION ambos I-EXPLORATION instrumentes I-EXPLORATION varío I-EXPLORATION considerablemente, I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION forma, I-EXPLORATION mediante I-EXPLORATION el I-EXPLORATION OCT I-EXPLORATION se I-EXPLORATION lograron I-EXPLORATION exploraciones I-EXPLORATION completas I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION anterior I-EXPLORATION en I-EXPLORATION tiempos I-EXPLORATION inferiores I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION minutos. I-EXPLORATION En I-EXPLORATION cambio, I-EXPLORATION la I-EXPLORATION BMU, I-EXPLORATION fundamentalmente I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION preparación I-EXPLORATION previa I-EXPLORATION que I-EXPLORATION conlleva, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION a I-EXPLORATION la I-EXPLORATION mayor I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION localizar I-EXPLORATION la I-EXPLORATION lesiones I-EXPLORATION a I-EXPLORATION estudiar I-EXPLORATION implicó I-EXPLORATION tiempos I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION superiores I-EXPLORATION a I-EXPLORATION 10 I-EXPLORATION minutos. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS con I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lagrimeo, I-PRESENT_ILLNESS conjuntivitis I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS congestión I-PRESENT_ILLNESS nasal. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION biomicroscópica I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION conjuntivocalasia I-EXPLORATION bilateral I-EXPLORATION marcada I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION aclaramiento I-EXPLORATION de I-EXPLORATION fluoresceína I-EXPLORATION (FCT) I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION secreción I-EXPLORATION basal I-EXPLORATION elevada, I-EXPLORATION un I-EXPLORATION aclaramiento I-EXPLORATION de I-EXPLORATION fluoresceína I-EXPLORATION enlentecido I-EXPLORATION y I-EXPLORATION una I-EXPLORATION secreción I-EXPLORATION lagrimal I-EXPLORATION refleja I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se B-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT lágrimas I-TREATMENT artificiales I-TREATMENT sin I-TREATMENT conservantes, I-TREATMENT limpieza I-TREATMENT palpebral I-TREATMENT diaria I-TREATMENT y I-TREATMENT oclusión I-TREATMENT ocular I-TREATMENT sin I-TREATMENT objetivarse I-TREATMENT mejoría I-TREATMENT sintomática. I-TREATMENT Se I-TREATMENT añade I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT colirio I-TREATMENT de I-TREATMENT metilprednisolona I-TREATMENT al I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT sin I-TREATMENT conservantes I-TREATMENT 3 I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 2 I-TREATMENT semanas. I-TREATMENT Se B-EVOLUTION produce I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION sintomática I-EVOLUTION transitoria, I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION reaparecen I-EVOLUTION al I-EVOLUTION interrumpir I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Debido B-TREATMENT a I-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT estos I-TREATMENT síntomas, I-TREATMENT se I-TREATMENT sugiere I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT bilateral, I-TREATMENT que I-TREATMENT se I-TREATMENT lleva I-TREATMENT a I-TREATMENT cabo I-TREATMENT según I-TREATMENT la I-TREATMENT técnica I-TREATMENT descrita I-TREATMENT por I-TREATMENT Tseng. I-TREATMENT Bajo I-TREATMENT anestesia I-TREATMENT tópica, I-TREATMENT se I-TREATMENT extirpa I-TREATMENT el I-TREATMENT exceso I-TREATMENT conjuntival. I-TREATMENT La I-TREATMENT esclera I-TREATMENT expuesta I-TREATMENT se I-TREATMENT recubre I-TREATMENT con I-TREATMENT membrana I-TREATMENT amniótica I-TREATMENT orientada I-TREATMENT con I-TREATMENT la I-TREATMENT membrana I-TREATMENT basal I-TREATMENT hacia I-TREATMENT arriba. I-TREATMENT Se I-TREATMENT pliega I-TREATMENT la I-TREATMENT membrana I-TREATMENT amniótica I-TREATMENT sobre I-TREATMENT sí I-TREATMENT misma I-TREATMENT para I-TREATMENT distribuir I-TREATMENT los I-TREATMENT dos I-TREATMENT componentes I-TREATMENT del I-TREATMENT pegamento I-TREATMENT de I-TREATMENT fibrinógeno I-TREATMENT (Tissucol®) I-TREATMENT sobre I-TREATMENT la I-TREATMENT esclera I-TREATMENT y I-TREATMENT sobre I-TREATMENT la I-TREATMENT cara I-TREATMENT estromal I-TREATMENT de I-TREATMENT la I-TREATMENT membrana I-TREATMENT amniótica. I-TREATMENT El I-TREATMENT pegamento I-TREATMENT se I-TREATMENT distribuye I-TREATMENT en I-TREATMENT pequeñas I-TREATMENT gotas I-TREATMENT con I-TREATMENT ayuda I-TREATMENT de I-TREATMENT una I-TREATMENT cánula I-TREATMENT de I-TREATMENT cámara I-TREATMENT anterior. I-TREATMENT Se I-TREATMENT estira I-TREATMENT bien I-TREATMENT la I-TREATMENT membrana I-TREATMENT amniótica I-TREATMENT sobre I-TREATMENT la I-TREATMENT esclera I-TREATMENT para I-TREATMENT que I-TREATMENT se I-TREATMENT produzca I-TREATMENT una I-TREATMENT buena I-TREATMENT adhesión I-TREATMENT de I-TREATMENT ambos I-TREATMENT tejidos I-TREATMENT y I-TREATMENT se I-TREATMENT reseca I-TREATMENT el I-TREATMENT exceso I-TREATMENT de I-TREATMENT membrana I-TREATMENT amniótica. I-TREATMENT La I-TREATMENT conjuntiva I-TREATMENT residual I-TREATMENT se I-TREATMENT pega I-TREATMENT sobre I-TREATMENT la I-TREATMENT membrana. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT postoperatorio I-TREATMENT consiste I-TREATMENT en I-TREATMENT colirio I-TREATMENT metilprednisolona I-TREATMENT sin I-TREATMENT conservantes I-TREATMENT al I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT 3 I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT colirio I-TREATMENT de I-TREATMENT ofloxacino I-TREATMENT 2 I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días I-TREATMENT sin I-TREATMENT necesidad I-TREATMENT de I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT oclusión I-TREATMENT postoperatoria. I-TREATMENT La B-EVOLUTION mejoría I-EVOLUTION biomicroscópica I-EVOLUTION y I-EVOLUTION sintomática I-EVOLUTION se I-EVOLUTION evidencia I-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato, I-EVOLUTION manteniéndose I-EVOLUTION en I-EVOLUTION los I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agudeza I-PRESENT_ILLNESS visual I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estrías I-PAST_MEDICAL_HISTORY angioides I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION lejana I-EXPLORATION de I-EXPLORATION unidad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION de I-EXPLORATION «contar I-EXPLORATION dedos» I-EXPLORATION a I-EXPLORATION dos I-EXPLORATION metros I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo. I-EXPLORATION La I-EXPLORATION tensión I-EXPLORATION ocular I-EXPLORATION y I-EXPLORATION la I-EXPLORATION biomicroscopía I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION oftalmoscopia I-EXPLORATION bajo I-EXPLORATION dilatación I-EXPLORATION mostró, I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos, I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION lineales I-EXPLORATION serpenteantes I-EXPLORATION radiales I-EXPLORATION al I-EXPLORATION disco I-EXPLORATION óptico I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendían I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION periferia. I-EXPLORATION Además, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo, I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cicatricial I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION movilización I-EXPLORATION de I-EXPLORATION pigmento I-EXPLORATION y I-EXPLORATION fibrosis I-EXPLORATION que I-EXPLORATION englobaba I-EXPLORATION toda I-EXPLORATION el I-EXPLORATION área I-EXPLORATION macular. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION angiografía I-EXPLORATION fluoresceínica I-EXPLORATION (AGF) I-EXPLORATION con I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION resultados: I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION unas I-EXPLORATION líneas I-EXPLORATION hipo I-EXPLORATION e I-EXPLORATION hiperfluorescentes I-EXPLORATION con I-EXPLORATION movilización I-EXPLORATION de I-EXPLORATION pigmento I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION macular I-EXPLORATION sin I-EXPLORATION difusión I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION la I-EXPLORATION mismas I-EXPLORATION lesiones I-EXPLORATION lineales I-EXPLORATION acompañadas I-EXPLORATION de I-EXPLORATION un I-EXPLORATION área I-EXPLORATION hipo I-EXPLORATION e I-EXPLORATION hiperfluorescente I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION macular I-EXPLORATION sin I-EXPLORATION difusión I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION en I-EXPLORATION tiempos I-EXPLORATION tardíos I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION estrías I-EXPLORATION angioides I-EXPLORATION bilaterales I-EXPLORATION y I-EXPLORATION además, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo, I-EXPLORATION complicadas I-EXPLORATION con I-EXPLORATION una I-EXPLORATION membrana I-EXPLORATION neovascular I-EXPLORATION subretiniana I-EXPLORATION no I-EXPLORATION susceptible I-EXPLORATION de I-EXPLORATION tratamiento. I-EXPLORATION Se B-EVOLUTION aconsejó I-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION clínico I-EVOLUTION periódico. I-EVOLUTION I-EVOLUTION Dos I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION acudió I-EVOLUTION refiriendo I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION agudeza I-EVOLUTION visual, I-EVOLUTION esta I-EVOLUTION vez, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION ojo I-EVOLUTION derecho. I-EVOLUTION La B-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION de I-EXPLORATION unidad I-EXPLORATION con I-EXPLORATION dificultad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION de I-EXPLORATION «contar I-EXPLORATION dedos» I-EXPLORATION a I-EXPLORATION dos I-EXPLORATION metros I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo. I-EXPLORATION Funduscópicamente, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION derecho, I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION hemorragia I-EXPLORATION y I-EXPLORATION movilización I-EXPLORATION de I-EXPLORATION pigmento I-EXPLORATION en I-EXPLORATION polo I-EXPLORATION posterior I-EXPLORATION con I-EXPLORATION estrías I-EXPLORATION anaranjadas, I-EXPLORATION ya I-EXPLORATION presentes I-EXPLORATION en I-EXPLORATION exploraciones I-EXPLORATION previas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION AGF I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION hiperfluorescencia I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION macular I-EXPLORATION desde I-EXPLORATION tiempos I-EXPLORATION iniciales I-EXPLORATION rodeada I-EXPLORATION de I-EXPLORATION un I-EXPLORATION halo I-EXPLORATION hipofluorescente I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fluorescencia I-EXPLORATION hacia I-EXPLORATION tiempos I-EXPLORATION tardíos I-EXPLORATION y I-EXPLORATION mínima I-EXPLORATION difusión, I-EXPLORATION no I-EXPLORATION existente I-EXPLORATION en I-EXPLORATION AGF I-EXPLORATION previas, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION membrana I-EXPLORATION neovascular I-EXPLORATION subfoveal. I-EXPLORATION Se I-EXPLORATION estableció, I-EXPLORATION por I-EXPLORATION tanto, I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION diagnóstico, I-EXPLORATION estrías I-EXPLORATION angioides I-EXPLORATION complicadas I-EXPLORATION con I-EXPLORATION membrana I-EXPLORATION neovascular I-EXPLORATION subfoveal I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION derecho. I-EXPLORATION Se B-TREATMENT le I-TREATMENT planteó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT TFD I-TREATMENT y I-TREATMENT tras I-TREATMENT la I-TREATMENT primera I-TREATMENT sesión I-TREATMENT se I-TREATMENT produjo I-TREATMENT la I-TREATMENT reabsorción I-TREATMENT parcial I-TREATMENT de I-TREATMENT la I-TREATMENT hemorragia I-TREATMENT con I-TREATMENT mantenimiento I-TREATMENT de I-TREATMENT la I-TREATMENT pigmentación I-TREATMENT central. I-TREATMENT Dichos I-TREATMENT hallazgos I-TREATMENT se I-TREATMENT confirmaron I-TREATMENT con I-TREATMENT la I-TREATMENT AGF I-TREATMENT que I-TREATMENT reveló I-TREATMENT una I-TREATMENT ligera I-TREATMENT difusión I-TREATMENT de I-TREATMENT contraste I-TREATMENT en I-TREATMENT tiempos I-TREATMENT tardíos. I-TREATMENT Por I-TREATMENT ello, I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT la I-TREATMENT recuperación I-TREATMENT visual, I-TREATMENT se I-TREATMENT decidió I-TREATMENT aplicar I-TREATMENT dos I-TREATMENT sesiones I-TREATMENT más I-TREATMENT de I-TREATMENT TFD. I-TREATMENT En B-EXPLORATION la I-EXPLORATION última I-EXPLORATION revisión I-EXPLORATION la I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION se I-EXPLORATION mantenía I-EXPLORATION en I-EXPLORATION la I-EXPLORATION unidad I-EXPLORATION y I-EXPLORATION angiográficamente I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipo I-EXPLORATION e I-EXPLORATION hiperfluorescente I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cicatricial I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION macular. I-EXPLORATION En I-EXPLORATION tiempos I-EXPLORATION angiográficos I-EXPLORATION medios I-EXPLORATION aparecía I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hiperfluorescencia I-EXPLORATION que I-EXPLORATION se I-EXPLORATION mantenía I-EXPLORATION en I-EXPLORATION tiempos I-EXPLORATION tardíos, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION difusión I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS fáquico, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS degeneración I-PRESENT_ILLNESS macular I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS exudativa I-PRESENT_ILLNESS (DMAE) I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS al B-TREATMENT que I-TREATMENT se I-TREATMENT le I-TREATMENT realiza I-TREATMENT terapia I-TREATMENT fotodinámica I-TREATMENT (TFD). I-TREATMENT 48 I-TREATMENT horas I-TREATMENT después I-TREATMENT se I-TREATMENT le I-TREATMENT inyecta I-TREATMENT en I-TREATMENT cámara I-TREATMENT vítrea I-TREATMENT 20 I-TREATMENT mg I-TREATMENT en I-TREATMENT 0, I-TREATMENT 1 I-TREATMENT ml I-TREATMENT de I-TREATMENT acetato I-TREATMENT de I-TREATMENT triamcinolona I-TREATMENT obtenida I-TREATMENT mediante I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT sedimentación. I-TREATMENT I-TREATMENT La I-TREATMENT operación I-TREATMENT se I-TREATMENT realizó I-TREATMENT en I-TREATMENT el I-TREATMENT quirófano I-TREATMENT bajo I-TREATMENT medidas I-TREATMENT asépticas. I-TREATMENT La I-TREATMENT inyección I-TREATMENT se I-TREATMENT hizo I-TREATMENT con I-TREATMENT aguja I-TREATMENT de I-TREATMENT 27 I-TREATMENT G I-TREATMENT a I-TREATMENT 4 I-TREATMENT mm I-TREATMENT del I-TREATMENT limbo I-TREATMENT en I-TREATMENT el I-TREATMENT cuadrante I-TREATMENT temporo-inferior I-TREATMENT ayudado I-TREATMENT de I-TREATMENT un I-TREATMENT blefarostato. I-TREATMENT Durante I-TREATMENT el I-TREATMENT procedimiento, I-TREATMENT y I-TREATMENT coincidiendo I-TREATMENT con I-TREATMENT un I-TREATMENT intento I-TREATMENT de I-TREATMENT cierre I-TREATMENT forzado I-TREATMENT de I-TREATMENT los I-TREATMENT párpados, I-TREATMENT se I-TREATMENT observó I-TREATMENT con I-TREATMENT el I-TREATMENT microscopio I-TREATMENT cómo I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT sustancia I-TREATMENT lechosa I-TREATMENT pasaba I-TREATMENT a I-TREATMENT cámara I-TREATMENT anterior. I-TREATMENT I-TREATMENT Se I-TREATMENT decidió I-TREATMENT actuar I-TREATMENT de I-TREATMENT forma I-TREATMENT expectante I-TREATMENT instilando I-TREATMENT colirio I-TREATMENT de I-TREATMENT ciprofloxacino I-TREATMENT y I-TREATMENT observando I-TREATMENT el I-TREATMENT pulso I-TREATMENT arterial I-TREATMENT espontáneo. I-TREATMENT Al B-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentaba I-EVOLUTION la I-EVOLUTION triamcinolona I-EVOLUTION precipitada I-EVOLUTION en I-EVOLUTION cámara I-EVOLUTION anterior I-EVOLUTION y I-EVOLUTION en I-EVOLUTION cámara I-EVOLUTION vítrea I-EVOLUTION sin I-EVOLUTION otros I-EVOLUTION signos I-EVOLUTION inflamatorios. I-EVOLUTION La B-TREATMENT PIO I-TREATMENT era I-TREATMENT de I-TREATMENT 25 I-TREATMENT mm I-TREATMENT Hg, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT prescribió I-TREATMENT maleato I-TREATMENT de I-TREATMENT timolol I-TREATMENT al I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT en I-TREATMENT colirio I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas. I-TREATMENT I-TREATMENT Se B-EVOLUTION le I-EVOLUTION realizaron I-EVOLUTION controles I-EVOLUTION periódicos I-EVOLUTION en I-EVOLUTION los I-EVOLUTION que I-EVOLUTION se I-EVOLUTION detectó I-EVOLUTION un I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION la I-EVOLUTION PIO I-EVOLUTION hasta I-EVOLUTION valores I-EVOLUTION normales, I-EVOLUTION una I-EVOLUTION reabsorción I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION triamcinolona I-EVOLUTION y I-EVOLUTION la I-EVOLUTION córnea I-EVOLUTION transparente I-EVOLUTION sin I-EVOLUTION reacción I-EVOLUTION inflamatoria. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION quedaban I-EVOLUTION escasos I-EVOLUTION restos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sustancia, I-EVOLUTION la I-EVOLUTION PIO I-EVOLUTION era I-EVOLUTION de I-EVOLUTION 17 I-EVOLUTION mm I-EVOLUTION Hg I-EVOLUTION sin I-EVOLUTION tratamiento I-EVOLUTION y I-EVOLUTION la I-EVOLUTION biomicroscopía I-EVOLUTION endotelial I-EVOLUTION resultó I-EVOLUTION un I-EVOLUTION recuento I-EVOLUTION celular I-EVOLUTION normal I-EVOLUTION e I-EVOLUTION igual I-EVOLUTION que I-EVOLUTION en I-EVOLUTION el I-EVOLUTION ojo I-EVOLUTION contralateral. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS sufrir I-PRESENT_ILLNESS una I-PRESENT_ILLNESS agresión I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS párpado I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS objeto I-PRESENT_ILLNESS metálico, I-PRESENT_ILLNESS fino I-PRESENT_ILLNESS y I-PRESENT_ILLNESS largo, I-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS deambulaba I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS calle. I-PRESENT_ILLNESS Presentaba I-PRESENT_ILLNESS un I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS fétor I-PRESENT_ILLNESS etílico I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inestabilidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION (OI) I-EXPLORATION poco I-EXPLORATION fiable I-EXPLORATION por I-EXPLORATION la I-EXPLORATION pésima I-EXPLORATION colaboración I-EXPLORATION del I-EXPLORATION paciente, I-EXPLORATION pero I-EXPLORATION que I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 7. I-EXPLORATION La I-EXPLORATION motilidad I-EXPLORATION ocular I-EXPLORATION intrínseca I-EXPLORATION y I-EXPLORATION extrínseca I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION refería I-EXPLORATION diplopía I-EXPLORATION en I-EXPLORATION ninguna I-EXPLORATION posición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mirada. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION objetivaba I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION palpebral I-EXPLORATION superior I-EXPLORATION con I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION herida I-EXPLORATION inciso-contusa, I-EXPLORATION superficial, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION precisó I-EXPLORATION ser I-EXPLORATION suturada. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biomicroscopía, I-EXPLORATION tensión I-EXPLORATION ocular I-EXPLORATION y I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION dejó I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION observación, I-EXPLORATION presentando I-EXPLORATION en I-EXPLORATION las I-EXPLORATION horas I-EXPLORATION siguientes I-EXPLORATION un I-EXPLORATION deterioro I-EXPLORATION neurológico I-EXPLORATION progresivo, I-EXPLORATION consistente I-EXPLORATION en I-EXPLORATION desorientación I-EXPLORATION temporoespacial, I-EXPLORATION respuestas I-EXPLORATION incoherentes, I-EXPLORATION somnolencia I-EXPLORATION progresiva I-EXPLORATION y I-EXPLORATION vómitos I-EXPLORATION de I-EXPLORATION repetición, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION Escala I-EXPLORATION del I-EXPLORATION Coma I-EXPLORATION de I-EXPLORATION Glasgow I-EXPLORATION (GCS), I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION orbitaria, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION periorbitario I-EXPLORATION izquierdo I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION y I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION óseo I-EXPLORATION con I-EXPLORATION fractura I-EXPLORATION asociado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION margen I-EXPLORATION superoposterior I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION izquierda, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION cerebral, I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION agudo I-EXPLORATION intraparenquimatoso I-EXPLORATION frontal I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION abría I-EXPLORATION al I-EXPLORATION asta I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION lateral I-EXPLORATION adyacente I-EXPLORATION y I-EXPLORATION al I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION ventricular I-EXPLORATION y I-EXPLORATION una I-EXPLORATION hemorragia I-EXPLORATION subaracnoidea I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cisura I-EXPLORATION de I-EXPLORATION Silvio I-EXPLORATION izquierda, I-EXPLORATION surcos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION convexidad I-EXPLORATION izquierda, I-EXPLORATION cisterna I-EXPLORATION supraselar I-EXPLORATION y I-EXPLORATION perimesencefálicas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION analítica, I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION cualquier I-EXPLORATION tendencia I-EXPLORATION hemorrágica I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION (tiempo I-EXPLORATION de I-EXPLORATION sangrado, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION tromboplastina I-EXPLORATION parcial I-EXPLORATION activada, I-EXPLORATION fibrinógeno I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION normales). I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION un I-EXPLORATION vaso I-EXPLORATION sangrante I-EXPLORATION activo I-EXPLORATION así I-EXPLORATION como I-EXPLORATION de I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION daño I-EXPLORATION arterial, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION arteriografía I-EXPLORATION por I-EXPLORATION sustracción I-EXPLORATION digital I-EXPLORATION (ASD) I-EXPLORATION cerebral, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT ingresado I-TREATMENT en I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Cuidados I-TREATMENT Intensivos. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION se I-EVOLUTION realizaron I-EVOLUTION TC I-EVOLUTION y I-EVOLUTION ASD I-EVOLUTION de I-EVOLUTION control I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION 1, I-EVOLUTION 2, I-EVOLUTION 3, I-EVOLUTION 7 I-EVOLUTION y I-EVOLUTION 14, I-EVOLUTION que I-EVOLUTION descartaron I-EVOLUTION nuevos I-EVOLUTION resangrados I-EVOLUTION ó I-EVOLUTION lesiones I-EVOLUTION vasculares. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION una I-EVOLUTION GCS I-EVOLUTION de I-EVOLUTION 15. I-EVOLUTION La B-EXPLORATION TC I-EXPLORATION al I-EXPLORATION alta I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION frontal I-EXPLORATION izquierdo I-EXPLORATION en I-EXPLORATION resolución I-EXPLORATION con I-EXPLORATION pequeño I-EXPLORATION componente I-EXPLORATION intraventricular I-EXPLORATION lateral I-EXPLORATION frontal I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION restos I-EXPLORATION hemáticos I-EXPLORATION isodensos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cisura I-EXPLORATION de I-EXPLORATION Silvio I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS presenta I-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 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tenía I-PRESENT_ILLNESS «el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS hundido» I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aportaba I-PRESENT_ILLNESS fotografías I-PRESENT_ILLNESS anteriores I-PRESENT_ILLNESS al I-PRESENT_ILLNESS problema I-PRESENT_ILLNESS para I-PRESENT_ILLNESS evidenciar I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS cambio I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sufrido. I-PRESENT_ILLNESS I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION sin I-EXPLORATION corrección I-EXPLORATION con I-EXPLORATION motilidad I-EXPLORATION ocular I-EXPLORATION intrínseca I-EXPLORATION y I-EXPLORATION extrínseca I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION exoftalmometría I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION izquierdo. I-EXPLORATION Se I-EXPLORATION apreciaba I-EXPLORATION un I-EXPLORATION desplazamiento I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION globo I-EXPLORATION ocular I-EXPLORATION derecho. I-EXPLORATION Había I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION surco I-EXPLORATION palpebral I-EXPLORATION superior, I-EXPLORATION con I-EXPLORATION retracción I-EXPLORATION palpebral I-EXPLORATION superior I-EXPLORATION a I-EXPLORATION la I-EXPLORATION mirada I-EXPLORATION inferior. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho I-EXPLORATION colapsado, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION volumen, I-EXPLORATION una I-EXPLORATION retracción I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION y I-EXPLORATION un I-EXPLORATION adelgazamiento I-EXPLORATION y I-EXPLORATION desplazamiento I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION suelo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita. I-EXPLORATION El I-EXPLORATION proceso I-EXPLORATION uncinado I-EXPLORATION estaba I-EXPLORATION retraído I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION orbitaria, I-EXPLORATION obstruyendo I-EXPLORATION el I-EXPLORATION infundíbulo I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Sturge-Weber I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS glaucoma I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS luxación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cristalino I-PRESENT_ILLNESS a I-PRESENT_ILLNESS cámara I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS y I-PRESENT_ILLNESS bloqueo I-PRESENT_ILLNESS pupilar, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS intervenido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION una I-EXPLORATION mancha I-EXPLORATION en I-EXPLORATION «vino I-EXPLORATION de I-EXPLORATION Oporto» I-EXPLORATION hemifacial I-EXPLORATION izquierda, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION territorio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION y I-EXPLORATION segunda I-EXPLORATION ramas I-EXPLORATION trigeminales, I-EXPLORATION exoftalmos I-EXPLORATION severo I-EXPLORATION con I-EXPLORATION rechazo I-EXPLORATION ínfero-temporal I-EXPLORATION del I-EXPLORATION globo I-EXPLORATION ocular I-EXPLORATION e I-EXPLORATION ingurgitación I-EXPLORATION marcada I-EXPLORATION de I-EXPLORATION vasos I-EXPLORATION epiesclerales I-EXPLORATION inferiores I-EXPLORATION «en I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION Medusa». I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION con I-EXPLORATION lámpara I-EXPLORATION de I-EXPLORATION hendidura I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION catarata I-EXPLORATION madura I-EXPLORATION totalmente I-EXPLORATION luxada I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cámara I-EXPLORATION anterior I-EXPLORATION en I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION el I-EXPLORATION endotelio I-EXPLORATION corneal I-EXPLORATION con I-EXPLORATION bloqueo I-EXPLORATION pupilar I-EXPLORATION y I-EXPLORATION presión I-EXPLORATION intraocular I-EXPLORATION de I-EXPLORATION 60 I-EXPLORATION mm I-EXPLORATION Hg, I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION desprendimiento I-EXPLORATION de I-EXPLORATION retina I-EXPLORATION en I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION posterior I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION subyacente I-EXPLORATION hiperecogénica. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT un I-TREATMENT infructuoso I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT hipotensor, I-TREATMENT se I-TREATMENT decide I-TREATMENT la I-TREATMENT intervención, I-TREATMENT realizándose I-TREATMENT extracción I-TREATMENT intracapsular I-TREATMENT de I-TREATMENT cristalino. I-TREATMENT El B-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION coroidea I-EXPLORATION peripapilar I-EXPLORATION nasal I-EXPLORATION superior I-EXPLORATION con I-EXPLORATION desprendimiento I-EXPLORATION de I-EXPLORATION retina I-EXPLORATION exudativo I-EXPLORATION asociado. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION lesiones I-EXPLORATION hiperintensas I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION T2 I-EXPLORATION en I-EXPLORATION leptomeninges I-EXPLORATION de I-EXPLORATION región I-EXPLORATION frontoparietal I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION calcificaciones I-EXPLORATION y I-EXPLORATION atrofia I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION frontal. I-EXPLORATION Una I-EXPLORATION lesión I-EXPLORATION coroidea I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION lesiones I-EXPLORATION orbitarias I-EXPLORATION extraconales I-EXPLORATION en I-EXPLORATION cuadrante I-EXPLORATION nasal I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION temporal I-EXPLORATION superior, I-EXPLORATION bien I-EXPLORATION delimitadas, I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION oftálmica I-EXPLORATION superior. I-EXPLORATION Todas I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION eran I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION hemangiomas I-EXPLORATION cavernosos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION presión I-EXPLORATION intraocular I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION se I-EXPLORATION mantuvo I-EXPLORATION entre I-EXPLORATION 10 I-EXPLORATION y I-EXPLORATION 16 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION sin I-EXPLORATION necesidad I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION antihipertensivo I-EXPLORATION y I-EXPLORATION la I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION final I-EXPLORATION fue I-EXPLORATION menor I-EXPLORATION de I-EXPLORATION 20/200 I-EXPLORATION (visión I-EXPLORATION de I-EXPLORATION bultos). I-EXPLORATION En B-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION coroideas I-EVOLUTION y I-EVOLUTION orbitarias I-EVOLUTION siguen I-EVOLUTION estables, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION no I-EVOLUTION precisan I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS periorbitario I-PRESENT_ILLNESS izquierdo 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 diplopía I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION motora I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION paresia I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION recto I-EXPLORATION superior I-EXPLORATION e I-EXPLORATION interno I-EXPLORATION y I-EXPLORATION ptosis I-EXPLORATION moderada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo. I-EXPLORATION No I-EXPLORATION hubo I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION oculares I-EXPLORATION o I-EXPLORATION neurológicos. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION nuclear I-EXPLORATION magnética I-EXPLORATION (RNM) I-EXPLORATION craneal I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT diagnosticó I-TREATMENT un I-TREATMENT síndrome I-TREATMENT de I-TREATMENT Tolosa-Hunt I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT corticoides. I-TREATMENT Dos B-EVOLUTION días I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION oftalmoplejía I-EVOLUTION dolorosa I-EVOLUTION persistía I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION referir I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION agudeza I-EVOLUTION visual I-EVOLUTION próxima. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION midriasis I-EXPLORATION izquierda. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION RNM I-EXPLORATION orbitaria I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION en I-EXPLORATION T2 I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION carótida I-EXPLORATION interna-comunicante I-EXPLORATION posterior I-EXPLORATION (CI-CP) I-EXPLORATION parcialmente I-EXPLORATION trombosado. I-EXPLORATION La I-EXPLORATION angio-tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION (angio-TAC) I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION CI-CP I-EXPLORATION izquierdo I-EXPLORATION multilobulado I-EXPLORATION de I-EXPLORATION 10x5 I-EXPLORATION mm. I-EXPLORATION Se B-TREATMENT realizaron I-TREATMENT angiografía I-TREATMENT cerebral I-TREATMENT y I-TREATMENT embolización, I-TREATMENT siendo I-TREATMENT rellenado I-TREATMENT completamente I-TREATMENT el I-TREATMENT aneurisma I-TREATMENT con I-TREATMENT Hydrocoil I-TREATMENT (MicroVention, I-TREATMENT Aliso I-TREATMENT Viejo, I-TREATMENT CA) I-TREATMENT Cerecyte® I-TREATMENT (Micrus, I-TREATMENT Sunnyvale, I-TREATMENT CA). I-TREATMENT El B-EVOLUTION tamaño I-EVOLUTION pupilar I-EVOLUTION se I-EVOLUTION normalizó I-EVOLUTION y I-EVOLUTION la I-EVOLUTION ptosis I-EVOLUTION y I-EVOLUTION la I-EVOLUTION adducción I-EVOLUTION mejoraron I-EVOLUTION completamente I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION embolización. I-EVOLUTION Ocho I-EVOLUTION meses I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION persistía I-EVOLUTION un I-EVOLUTION ligero I-EVOLUTION déficit I-EVOLUTION en I-EVOLUTION la I-EVOLUTION elevación, I-EVOLUTION sin I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refiriese I-EVOLUTION diplopía. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS conocida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS servicio, I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS traumático I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS (OI). I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacamos I-PAST_MEDICAL_HISTORY conjuntivitis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia, I-PAST_MEDICAL_HISTORY artrosis I-PAST_MEDICAL_HISTORY senil I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY hijos I-PAST_MEDICAL_HISTORY sanos. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION observamos I-EXPLORATION una I-EXPLORATION abrasión I-EXPLORATION corneal I-EXPLORATION en I-EXPLORATION OI, I-EXPLORATION que B-TREATMENT curará I-TREATMENT con I-TREATMENT oclusión I-TREATMENT y I-TREATMENT pomada I-TREATMENT epitelizante I-TREATMENT en I-TREATMENT 1 I-TREATMENT semana. I-TREATMENT Además B-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION (AO) I-EXPLORATION un I-EXPLORATION iris I-EXPLORATION atrófico, I-EXPLORATION desdoblado, I-EXPLORATION desflecado I-EXPLORATION con I-EXPLORATION atrofia I-EXPLORATION en I-EXPLORATION sector I-EXPLORATION inferior, I-EXPLORATION más I-EXPLORATION en I-EXPLORATION OI I-EXPLORATION y I-EXPLORATION una I-EXPLORATION reducción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cámara I-EXPLORATION anterior I-EXPLORATION visible I-EXPLORATION también I-EXPLORATION en I-EXPLORATION la I-EXPLORATION gonioscopia. I-EXPLORATION Presenta I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION tensión I-EXPLORATION ocular I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION mm I-EXPLORATION Hg. I-EXPLORATION en I-EXPLORATION AO, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION campo I-EXPLORATION visual I-EXPLORATION (Humphrey I-EXPLORATION 30-2) I-EXPLORATION con I-EXPLORATION una I-EXPLORATION reducción I-EXPLORATION general I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad. I-EXPLORATION Explorando I-EXPLORATION el I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION encontramos I-EXPLORATION lesiones I-EXPLORATION hiperpigmentadas I-EXPLORATION y I-EXPLORATION atróficas I-EXPLORATION (en I-EXPLORATION «sal I-EXPLORATION y I-EXPLORATION pimienta»). I-EXPLORATION I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION presunción I-EXPLORATION de I-EXPLORATION sífilis I-EXPLORATION congénita, I-EXPLORATION aún I-EXPLORATION sin I-EXPLORATION leucomas I-EXPLORATION propios I-EXPLORATION de I-EXPLORATION queratitis I-EXPLORATION intersticial I-EXPLORATION antigua, I-EXPLORATION solicitamos I-EXPLORATION pruebas I-EXPLORATION serológicas I-EXPLORATION para I-EXPLORATION lues I-EXPLORATION obteniendo I-EXPLORATION resultados I-EXPLORATION positivos I-EXPLORATION en I-EXPLORATION test I-EXPLORATION treponémicos I-EXPLORATION (TPHA, I-EXPLORATION FTA I-EXPLORATION abs) I-EXPLORATION y I-EXPLORATION negativos I-EXPLORATION en I-EXPLORATION los I-EXPLORATION no I-EXPLORATION treponémicos I-EXPLORATION (RPR). I-EXPLORATION I-EXPLORATION En B-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY punto I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY evaluada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY medicina I-PAST_MEDICAL_HISTORY interna I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY averiguamos I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY desconoce I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY causa I-PAST_MEDICAL_HISTORY real I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY conjuntivitis, I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY relata, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY detallada: I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY tratamientos I-PAST_MEDICAL_HISTORY recibidos I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY plena I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY preantibiótica, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY neobismuto I-PAST_MEDICAL_HISTORY oral, I-PAST_MEDICAL_HISTORY que B-FAMILY_HISTORY su I-FAMILY_HISTORY madre I-FAMILY_HISTORY «soltera» I-FAMILY_HISTORY muere I-FAMILY_HISTORY joven I-FAMILY_HISTORY «deformada» I-FAMILY_HISTORY y B-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY 60, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY inespecíficos I-PAST_MEDICAL_HISTORY articulares, I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY pautaron I-PAST_MEDICAL_HISTORY unas I-PAST_MEDICAL_HISTORY inyecciones I-PAST_MEDICAL_HISTORY semanales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mensuales I-PAST_MEDICAL_HISTORY (penicilina I-PAST_MEDICAL_HISTORY probablemente). I-PAST_MEDICAL_HISTORY Hallazgos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY anamnesis I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sífilis I-PAST_MEDICAL_HISTORY congénita I-PAST_MEDICAL_HISTORY tardía, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY queratitis I-PAST_MEDICAL_HISTORY intersticial I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY éxito, I-PAST_MEDICAL_HISTORY pues I-PAST_MEDICAL_HISTORY carece I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY leucomas. I-PAST_MEDICAL_HISTORY Adquirida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY trasplacentaria: I-PAST_MEDICAL_HISTORY madre B-FAMILY_HISTORY con I-FAMILY_HISTORY artropatía I-FAMILY_HISTORY severa I-FAMILY_HISTORY compatible I-FAMILY_HISTORY con I-FAMILY_HISTORY sífilis I-FAMILY_HISTORY secundaria. I-FAMILY_HISTORY Y B-PAST_MEDICAL_HISTORY curada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY resultado I-PAST_MEDICAL_HISTORY negativo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY test I-PAST_MEDICAL_HISTORY RPR. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO dermatólogo I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO IP, I-DERIVED_FROM/TO para I-DERIVED_FROM/TO descartar I-DERIVED_FROM/TO patología I-DERIVED_FROM/TO ocular I-DERIVED_FROM/TO asociada. I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION piel I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION lesiones I-EXPLORATION típicas I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION enfermedad, I-EXPLORATION las I-EXPLORATION denominadas I-EXPLORATION líneas I-EXPLORATION de I-EXPLORATION Blaschko. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION ocular I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION buen I-EXPLORATION comportamiento I-EXPLORATION visual I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION (AO), I-EXPLORATION segmento I-EXPLORATION anterior I-EXPLORATION normal, I-EXPLORATION motilidad I-EXPLORATION ocular I-EXPLORATION intrínseca I-EXPLORATION y I-EXPLORATION extrínseca I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION (FO) I-EXPLORATION con I-EXPLORATION oftalmoscopio I-EXPLORATION indirecto I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION (OD) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION (OI) I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION tenue I-EXPLORATION hemorragia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION nasal. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION dificultad I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION por I-EXPLORATION movimientos I-EXPLORATION continuos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente, I-EXPLORATION se I-EXPLORATION programó I-EXPLORATION nueva I-EXPLORATION exploración I-EXPLORATION del I-EXPLORATION FO I-EXPLORATION bajo I-EXPLORATION narcosis I-EXPLORATION y I-EXPLORATION angiografía I-EXPLORATION fluoresceinica I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION vasculares I-EXPLORATION ocultas. I-EXPLORATION En I-EXPLORATION dicha I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION nueva I-EXPLORATION exploración I-EXPLORATION del I-EXPLORATION FO I-EXPLORATION con I-EXPLORATION oftalmoscopio I-EXPLORATION indirecto I-EXPLORATION y I-EXPLORATION con I-EXPLORATION Retcam I-EXPLORATION II I-EXPLORATION (Massie I-EXPLORATION Lab.) I-EXPLORATION que I-EXPLORATION permite I-EXPLORATION archivar I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION en I-EXPLORATION formato I-EXPLORATION digital, I-EXPLORATION para I-EXPLORATION su I-EXPLORATION ulterior I-EXPLORATION análisis I-EXPLORATION detallado. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipopigmentada I-EXPLORATION paramacular I-EXPLORATION y I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION el I-EXPLORATION trayecto I-EXPLORATION de I-EXPLORATION un I-EXPLORATION vaso I-EXPLORATION en I-EXPLORATION extrema I-EXPLORATION periferia I-EXPLORATION temporal. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION OI I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hemorragia I-EXPLORATION lineal I-EXPLORATION en I-EXPLORATION periferia I-EXPLORATION nasal I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION hallazgos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION angiografía I-EXPLORATION fluoresceinica, I-EXPLORATION inyectando I-EXPLORATION vía I-EXPLORATION intravenosa I-EXPLORATION 5 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION fluoresceína I-EXPLORATION sódica I-EXPLORATION por I-EXPLORATION kilogramo I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION caso I-EXPLORATION fueron I-EXPLORATION 0, I-EXPLORATION 35 I-EXPLORATION ml. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION fotografías I-EXPLORATION seriadas I-EXPLORATION con I-EXPLORATION la I-EXPLORATION Retcam I-EXPLORATION II I-EXPLORATION que I-EXPLORATION pusieron I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION lesiones I-EXPLORATION no I-EXPLORATION observadas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION oftalmoscopia I-EXPLORATION previa. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION exudación I-EXPLORATION puntiforme I-EXPLORATION en I-EXPLORATION extrema I-EXPLORATION periferia I-EXPLORATION temporal. I-EXPLORATION En I-EXPLORATION OI I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION la I-EXPLORATION no I-EXPLORATION perfusión I-EXPLORATION de I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION periferia I-EXPLORATION nasal. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT láser I-TREATMENT de I-TREATMENT diodo I-TREATMENT toda I-TREATMENT la I-TREATMENT zona I-TREATMENT nasal I-TREATMENT afectada I-TREATMENT del I-TREATMENT OI I-TREATMENT (1.200 I-TREATMENT impactos, I-TREATMENT 300 I-TREATMENT mW, I-TREATMENT 300 I-TREATMENT ms). I-TREATMENT I-TREATMENT Una B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS sana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS acude B-DERIVED_FROM/TO referida I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO oftalmólogo I-DERIVED_FROM/TO para I-DERIVED_FROM/TO evaluación I-DERIVED_FROM/TO y I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ojo I-DERIVED_FROM/TO rojo I-DERIVED_FROM/TO doloroso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO aproximadamente I-DERIVED_FROM/TO un I-DERIVED_FROM/TO mes I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución. I-DERIVED_FROM/TO No B-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY excepción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY catarata I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY complicada I-PAST_MEDICAL_HISTORY (facoemulsificación) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY La B-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION sobreelevada I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION limbo I-EXPLORATION superonasal I-EXPLORATION de I-EXPLORATION su I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION (próxima I-EXPLORATION a I-EXPLORATION la I-EXPLORATION incisión I-EXPLORATION quirúrgica) I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION múltiples I-EXPLORATION microinfiltrados I-EXPLORATION corneales, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION ingurgitación I-EXPLORATION vascular I-EXPLORATION conjuntival I-EXPLORATION y I-EXPLORATION del I-EXPLORATION plexo I-EXPLORATION escleral I-EXPLORATION profundo. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT colirios I-TREATMENT antibióticos I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro, I-TREATMENT añadiéndose I-TREATMENT además I-TREATMENT instilaciones I-TREATMENT de I-TREATMENT colirios I-TREATMENT de I-TREATMENT suero I-TREATMENT autólogo I-TREATMENT y I-TREATMENT medroxiprogesterona. I-TREATMENT I-TREATMENT Debido B-EXPLORATION a I-EXPLORATION la I-EXPLORATION escasa I-EXPLORATION respuesta I-EXPLORATION al I-EXPLORATION tratamiento, I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION diversas I-EXPLORATION pruebas I-EXPLORATION serológicas I-EXPLORATION (incluyendo I-EXPLORATION bioquímica, I-EXPLORATION hemograma, I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda I-EXPLORATION y I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION autoinmunidad). I-EXPLORATION Paralelamente B-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT corticoides I-TREATMENT sistémicos I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/kg. I-TREATMENT Además I-TREATMENT decidimos I-TREATMENT tomar I-TREATMENT una I-TREATMENT muestra I-TREATMENT escleroconjuntival, I-TREATMENT previa I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT conjuntiva I-TREATMENT adyacente, I-TREATMENT con I-TREATMENT posterior I-TREATMENT implante I-TREATMENT de I-TREATMENT membrana I-TREATMENT amniótica I-TREATMENT (técnica I-TREATMENT «inlay») I-TREATMENT unido I-TREATMENT a I-TREATMENT la I-TREATMENT aplicación I-TREATMENT de I-TREATMENT adhesivo I-TREATMENT biológico I-TREATMENT (Fibrin I-TREATMENT Glue®) I-TREATMENT sobre I-TREATMENT el I-TREATMENT área I-TREATMENT de I-TREATMENT lesión. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION fue I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION granulomatosis I-EXPLORATION necrotizante I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION hiperplasia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION sin I-EXPLORATION indicios I-EXPLORATION de I-EXPLORATION vasculitis I-EXPLORATION acompañante. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION serológicas I-EXPLORATION realizadas I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Considerando B-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT ENIC, I-TREATMENT se I-TREATMENT decidió I-TREATMENT instaurar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Ciclosporina I-TREATMENT A I-TREATMENT (3 I-TREATMENT mg/kg/día) I-TREATMENT unido I-TREATMENT a I-TREATMENT los I-TREATMENT corticosteroides I-TREATMENT orales I-TREATMENT (1 I-TREATMENT mg/kg/día), I-TREATMENT pero I-TREATMENT unas I-TREATMENT ocho I-TREATMENT semanas I-TREATMENT tras I-TREATMENT su I-TREATMENT inicio I-TREATMENT el I-TREATMENT cuadro I-TREATMENT inflamatorio I-TREATMENT persistía I-TREATMENT y, I-TREATMENT dada I-TREATMENT su I-TREATMENT severidad, I-TREATMENT se I-TREATMENT decidió I-TREATMENT sustituir I-TREATMENT Ciclosporina I-TREATMENT por I-TREATMENT Azatioprina I-TREATMENT (100 I-TREATMENT mg/día) I-TREATMENT manteniendo I-TREATMENT los I-TREATMENT corticosteroides I-TREATMENT orales. I-TREATMENT I-TREATMENT Este B-EVOLUTION régimen I-EVOLUTION terapéutico I-EVOLUTION consiguió I-EVOLUTION progresivamente I-EVOLUTION controlar I-EVOLUTION el I-EVOLUTION proceso I-EVOLUTION inflamatorio. I-EVOLUTION Siete I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION continúa I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS craneoencefálico I-PRESENT_ILLNESS presenta, I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después, I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS medular I-PRESENT_ILLNESS incompleto I-PRESENT_ILLNESS sensitivo I-PRESENT_ILLNESS motor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS par I-PRESENT_ILLNESS VI I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS (OI) I-PRESENT_ILLNESS que I-PRESENT_ILLNESS produce I-PRESENT_ILLNESS diplopía I-PRESENT_ILLNESS en I-PRESENT_ILLNESS todas I-PRESENT_ILLNESS las I-PRESENT_ILLNESS posiciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mirada. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION motora I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION limitación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION abducción I-EXPLORATION de I-EXPLORATION -3, I-EXPLORATION tortícolis I-EXPLORATION cara I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 10o, I-EXPLORATION endotropía I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION r I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION primaria I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mirada I-EXPLORATION con I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION (OD) I-EXPLORATION fijador. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION sensorial, I-EXPLORATION la I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION Worth I-EXPLORATION muestra I-EXPLORATION supresión I-EXPLORATION intermitente I-EXPLORATION de I-EXPLORATION OI. I-EXPLORATION La I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION es I-EXPLORATION de I-EXPLORATION OD I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION de I-EXPLORATION OI I-EXPLORATION 1. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT dos I-TREATMENT inyecciones I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT 5 I-TREATMENT UI I-TREATMENT en I-TREATMENT recto I-TREATMENT medio I-TREATMENT del I-TREATMENT OI, I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT disminuyó I-TREATMENT la I-TREATMENT endotropía I-TREATMENT a I-TREATMENT 30 I-TREATMENT r I-TREATMENT sin I-TREATMENT mejorar I-TREATMENT la I-TREATMENT abducción. I-TREATMENT I-TREATMENT A I-TREATMENT los I-TREATMENT 6 I-TREATMENT meses I-TREATMENT se I-TREATMENT realiza I-TREATMENT TRV I-TREATMENT con I-TREATMENT fijación I-TREATMENT escleral I-TREATMENT en I-TREATMENT OI I-TREATMENT con I-TREATMENT anestesia I-TREATMENT general. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION exotropía I-EVOLUTION consecutiva I-EVOLUTION de I-EVOLUTION 45 I-EVOLUTION r, I-EVOLUTION inversión I-EVOLUTION del I-EVOLUTION tortícolis, I-EVOLUTION limitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION aducción I-EVOLUTION de I-EVOLUTION -1 I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION abducción I-EVOLUTION de I-EVOLUTION -1 I-EVOLUTION del I-EVOLUTION ojo I-EVOLUTION afectado I-EVOLUTION y I-EVOLUTION diplopía. I-EVOLUTION I-EVOLUTION A B-TREATMENT los I-TREATMENT 15 I-TREATMENT días I-TREATMENT se I-TREATMENT inyectan I-TREATMENT 5 I-TREATMENT U I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT en I-TREATMENT recto I-TREATMENT lateral I-TREATMENT del I-TREATMENT OI I-TREATMENT sin I-TREATMENT que I-TREATMENT se I-TREATMENT modificase I-TREATMENT el I-TREATMENT resultado, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT a I-TREATMENT los I-TREATMENT 2 I-TREATMENT meses I-TREATMENT se I-TREATMENT decide I-TREATMENT retirar I-TREATMENT la I-TREATMENT fijación I-TREATMENT escleral, I-TREATMENT lo I-TREATMENT que I-TREATMENT fue I-TREATMENT técnicamente I-TREATMENT imposible I-TREATMENT por I-TREATMENT las I-TREATMENT adherencias I-TREATMENT encontradas. I-TREATMENT Se I-TREATMENT reinterviene I-TREATMENT al I-TREATMENT paciente I-TREATMENT realizando I-TREATMENT una I-TREATMENT resección I-TREATMENT del I-TREATMENT recto I-TREATMENT medio I-TREATMENT de I-TREATMENT OI I-TREATMENT de I-TREATMENT 7 I-TREATMENT mm I-TREATMENT y I-TREATMENT se I-TREATMENT inyectan I-TREATMENT 5 I-TREATMENT U I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT en I-TREATMENT recto I-TREATMENT lateral I-TREATMENT del I-TREATMENT OI I-TREATMENT intraoperatoriamente. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION quedó I-EVOLUTION con I-EVOLUTION tortícolis I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION derecha I-EVOLUTION de I-EVOLUTION 10o, I-EVOLUTION limitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION abducción I-EVOLUTION de I-EVOLUTION -1, I-EVOLUTION exotropía I-EVOLUTION de I-EVOLUTION 10-15 I-EVOLUTION r I-EVOLUTION en I-EVOLUTION posición I-EVOLUTION primaria I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mirada I-EVOLUTION (PPM) I-EVOLUTION sin I-EVOLUTION diplopía. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION diplopía, I-EVOLUTION exotropÍa I-EVOLUTION de I-EVOLUTION 20-30 I-EVOLUTION r I-EVOLUTION en I-EVOLUTION PPM, I-EVOLUTION limitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION abducción I-EVOLUTION de I-EVOLUTION -1, I-EVOLUTION limitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION aducción I-EVOLUTION de I-EVOLUTION -1 I-EVOLUTION y I-EVOLUTION tortícolis I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION derecha I-EVOLUTION de I-EVOLUTION 20o. I-EVOLUTION I-EVOLUTION Se B-TREATMENT decide I-TREATMENT realizar I-TREATMENT una I-TREATMENT nueva I-TREATMENT resección I-TREATMENT del I-TREATMENT recto I-TREATMENT medio I-TREATMENT del I-TREATMENT OI I-TREATMENT de I-TREATMENT 6 I-TREATMENT mm. I-TREATMENT I-TREATMENT Un B-EVOLUTION año I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION última I-EVOLUTION cirugía I-EVOLUTION presenta: I-EVOLUTION limitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION abducción I-EVOLUTION de I-EVOLUTION -1, I-EVOLUTION tortícolis I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION derecha I-EVOLUTION de I-EVOLUTION 5o, I-EVOLUTION exotropía I-EVOLUTION de I-EVOLUTION 10-15 I-EVOLUTION r I-EVOLUTION en I-EVOLUTION PPM I-EVOLUTION sin I-EVOLUTION diplopía. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION satisfecho I-EVOLUTION con I-EVOLUTION el I-EVOLUTION resultado. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hepatitis I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS por I-PRESENT_ILLNESS virus I-PRESENT_ILLNESS C I-PRESENT_ILLNESS genotipo I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS carga I-PRESENT_ILLNESS viral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4.300.000 I-PRESENT_ILLNESS copias/ml I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipertensión I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS (HTA). I-PRESENT_ILLNESS Se B-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT IFN I-TREATMENT pegilado I-TREATMENT alpha-2b I-TREATMENT (180µg/semana) I-TREATMENT junto I-TREATMENT a I-TREATMENT ribavirina I-TREATMENT (800mg/día). I-TREATMENT Dados B-EXPLORATION sus I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION HTA I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 15 I-EXPLORATION días I-EXPLORATION del I-EXPLORATION inicio I-EXPLORATION del I-EXPLORATION tratamiento. I-EXPLORATION Presentó I-EXPLORATION una I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION (AV) I-EXPLORATION de I-EXPLORATION 10/10 I-EXPLORATION con I-EXPLORATION corrección I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION (FO): I-EXPLORATION papilas I-EXPLORATION y I-EXPLORATION máculas I-EXPLORATION normales. I-EXPLORATION Esclerosis I-EXPLORATION arterial I-EXPLORATION y I-EXPLORATION tortuosidad I-EXPLORATION venosa I-EXPLORATION con I-EXPLORATION cruces I-EXPLORATION arterio-venosos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses, I-EVOLUTION y I-EVOLUTION estando I-EVOLUTION asintomática, I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION valorada. I-EVOLUTION Presentó B-EXPLORATION la I-EXPLORATION misma I-EXPLORATION AV I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION el I-EXPLORATION FO I-EXPLORATION aparecían I-EXPLORATION múltiples I-EXPLORATION exudados I-EXPLORATION algodonosos I-EXPLORATION en I-EXPLORATION arcadas I-EXPLORATION y I-EXPLORATION polo I-EXPLORATION posterior, I-EXPLORATION con I-EXPLORATION respeto I-EXPLORATION de I-EXPLORATION área I-EXPLORATION macular, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION alguna I-EXPLORATION microhemorragia I-EXPLORATION y I-EXPLORATION microaneurisma. I-EXPLORATION Se B-TREATMENT etiquetó I-TREATMENT de I-TREATMENT retinopatía I-TREATMENT por I-TREATMENT IFN I-TREATMENT y I-TREATMENT se I-TREATMENT decidió I-TREATMENT continuar I-TREATMENT con I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT dada I-TREATMENT la I-TREATMENT nula I-TREATMENT repercusión I-TREATMENT en I-TREATMENT la I-TREATMENT AV, I-TREATMENT la I-TREATMENT carga I-TREATMENT viral I-TREATMENT alta I-TREATMENT y I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT un I-TREATMENT seguimiento I-TREATMENT estrecho. I-TREATMENT I-TREATMENT La I-TREATMENT respuesta I-TREATMENT virológica I-TREATMENT fue I-TREATMENT tardía I-TREATMENT en I-TREATMENT la I-TREATMENT semana I-TREATMENT 24, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT prolongó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT 72 I-TREATMENT semanas I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT Durante I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT produjo I-TREATMENT neutropenia I-TREATMENT que I-TREATMENT como I-TREATMENT máximo I-TREATMENT llegó I-TREATMENT a I-TREATMENT ser I-TREATMENT de I-TREATMENT 600/mm3 I-TREATMENT y I-TREATMENT anemia I-TREATMENT como I-TREATMENT máximo I-TREATMENT de I-TREATMENT 8, I-TREATMENT 5g/dl I-TREATMENT de I-TREATMENT hemoglobina, I-TREATMENT pero I-TREATMENT no I-TREATMENT se I-TREATMENT modificaron I-TREATMENT las I-TREATMENT dosis I-TREATMENT de I-TREATMENT IFN. I-TREATMENT I-TREATMENT En B-EVOLUTION los I-EVOLUTION sucesivos I-EVOLUTION controles I-EVOLUTION siempre I-EVOLUTION mantuvo I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION AV, I-EVOLUTION los I-EVOLUTION exudados I-EVOLUTION se I-EVOLUTION fueron I-EVOLUTION reabsorbiendo I-EVOLUTION y I-EVOLUTION quedó I-EVOLUTION sólo I-EVOLUTION una I-EVOLUTION microhemorragia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION arcada I-EVOLUTION vascular I-EVOLUTION temporal I-EVOLUTION superior I-EVOLUTION del I-EVOLUTION ojo I-EVOLUTION derecho. I-EVOLUTION I-EVOLUTION El B-PRESENT_ILLNESS cuarto I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS es I-PRESENT_ILLNESS el I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS visual I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS una I-PRESENT_ILLNESS intervención I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS refractiva I-PRESENT_ILLNESS con I-PRESENT_ILLNESS LASIK I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS antes. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY dudoso I-PAST_MEDICAL_HISTORY diagnostico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esclerosis I-PAST_MEDICAL_HISTORY múltiple I-PAST_MEDICAL_HISTORY dudosa I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY pruebas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY imagen I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY constataran. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION visión I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 05 I-EXPLORATION y I-EXPLORATION movimiento I-EXPLORATION de I-EXPLORATION manos. I-EXPLORATION El I-EXPLORATION flap I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION alteraciones. I-EXPLORATION Al I-EXPLORATION explorar I-EXPLORATION su I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION de I-EXPLORATION mielina I-EXPLORATION en I-EXPLORATION el I-EXPLORATION nervio I-EXPLORATION óptico I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION palidez I-EXPLORATION en I-EXPLORATION el I-EXPLORATION izquierdo. I-EXPLORATION La I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION simulación I-EXPLORATION surge I-EXPLORATION cuando I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION desenvuelve I-EXPLORATION perfectamente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION consulta, I-EXPLORATION llegando I-EXPLORATION a I-EXPLORATION enviar I-EXPLORATION un I-EXPLORATION mensaje I-EXPLORATION con I-EXPLORATION su I-EXPLORATION móvil. I-EXPLORATION Refiere I-EXPLORATION que I-EXPLORATION trabaja I-EXPLORATION y I-EXPLORATION conduce I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION su I-EXPLORATION supuesta I-EXPLORATION baja I-EXPLORATION visión. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION visión I-EXPLORATION binocular I-EXPLORATION y I-EXPLORATION la I-EXPLORATION estereopsis I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (120"-60"). I-EXPLORATION Pruebas I-EXPLORATION específicas I-EXPLORATION como I-EXPLORATION la I-EXPLORATION de I-EXPLORATION Bravais I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION escritura I-EXPLORATION o I-EXPLORATION Roth I-EXPLORATION resultaron I-EXPLORATION positivas. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION fue I-EXPLORATION capaz I-EXPLORATION de I-EXPLORATION escribir I-EXPLORATION su I-EXPLORATION nombre I-EXPLORATION con I-EXPLORATION visión I-EXPLORATION monocular I-EXPLORATION y I-EXPLORATION siguiendo I-EXPLORATION una I-EXPLORATION línea, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION interrumpirla I-EXPLORATION en I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tarea. I-EXPLORATION También I-EXPLORATION dibujó I-EXPLORATION una I-EXPLORATION línea I-EXPLORATION recta, I-EXPLORATION reanudando I-EXPLORATION el I-EXPLORATION trazo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION punto I-EXPLORATION en I-EXPLORATION que I-EXPLORATION lo I-EXPLORATION había I-EXPLORATION dejado I-EXPLORATION tras I-EXPLORATION distraerla I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION intencionada. I-EXPLORATION Pruebas I-EXPLORATION complementarias I-EXPLORATION como I-EXPLORATION la I-EXPLORATION AFG I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ERG I-EXPLORATION aportaron I-EXPLORATION resultados I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION PEV I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION leve I-EXPLORATION de I-EXPLORATION la I-EXPLORATION conducción I-EXPLORATION en I-EXPLORATION el I-EXPLORATION nervio I-EXPLORATION óptico I-EXPLORATION izquierdo. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION neurología I-EXPLORATION fue I-EXPLORATION descartada I-EXPLORATION la I-EXPLORATION esclerosis I-EXPLORATION múltiple, I-EXPLORATION con I-EXPLORATION RM I-EXPLORATION y I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY SA I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY alteraciones I-PAST_MEDICAL_HISTORY oculares I-PAST_MEDICAL_HISTORY (lenticono I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY retinopatía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY flecos), I-PAST_MEDICAL_HISTORY acudió B-PRESENT_ILLNESS por I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS AV I-PRESENT_ILLNESS en I-PRESENT_ILLNESS OD. I-PRESENT_ILLNESS Resultó B-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cataratas I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY La B-EXPLORATION OCT I-EXPLORATION previa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION detectó I-EXPLORATION disminución I-EXPLORATION bilateral I-EXPLORATION del I-EXPLORATION espesor I-EXPLORATION macular, I-EXPLORATION con I-EXPLORATION adelgazamiento I-EXPLORATION de I-EXPLORATION capas I-EXPLORATION internas I-EXPLORATION retinianas, I-EXPLORATION fundamentalmente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION macular I-EXPLORATION temporal. I-EXPLORATION La I-EXPLORATION AV I-EXPLORATION fue I-EXPLORATION 0, I-EXPLORATION 01 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 7 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OI. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION del I-EXPLORATION OD I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION un I-EXPLORATION AM I-EXPLORATION de I-EXPLORATION espesor I-EXPLORATION completo, I-EXPLORATION comprobado I-EXPLORATION mediante I-EXPLORATION OCT, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION diámetro I-EXPLORATION de I-EXPLORATION 1.400µm. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT decidió I-TREATMENT no I-TREATMENT ser I-TREATMENT intervenido, I-TREATMENT adquiriéndose I-TREATMENT actitud I-TREATMENT expectante. I-TREATMENT Actualmente B-EVOLUTION persiste I-EVOLUTION el I-EVOLUTION AM, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION diámetro I-EVOLUTION de I-EVOLUTION 2.900µm, I-EVOLUTION con I-EVOLUTION pérdida I-EVOLUTION importante I-EVOLUTION del I-EVOLUTION tejido I-EVOLUTION retiniano I-EVOLUTION y I-EVOLUTION alteraciones I-EVOLUTION quísticas. I-EVOLUTION El I-EVOLUTION OI I-EVOLUTION muestra I-EVOLUTION adelgazamiento I-EVOLUTION progresivo I-EVOLUTION similar I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION macular I-EVOLUTION temporal I-EVOLUTION con I-EVOLUTION espesores I-EVOLUTION de I-EVOLUTION 164µm. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS raza B-PAST_MEDICAL_HISTORY mestiza, I-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY área I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ciudad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Palmira I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY departamento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Valle I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Cauca I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Colombia. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por 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 evolución I-PRESENT_ILLNESS consistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS rechazo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS bipedestación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sedestación, I-PRESENT_ILLNESS principalmente I-PRESENT_ILLNESS manifestado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS ponerse I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pie. I-PRESENT_ILLNESS Afebril I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS toda I-PRESENT_ILLNESS su I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS manifestaciones I-PRESENT_ILLNESS intermitentes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS disminuía I-PRESENT_ILLNESS parcialmente I-PRESENT_ILLNESS con I-PRESENT_ILLNESS administración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS acetaminofeno, I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS mg/kg/dosis. I-PRESENT_ILLNESS I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraron I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trauma, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tejido I-PAST_MEDICAL_HISTORY conectivo, I-PAST_MEDICAL_HISTORY hipertensión, I-PAST_MEDICAL_HISTORY diabetes, I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY congénita I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY tuberculosis. I-PAST_MEDICAL_HISTORY Los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY perinatales I-PAST_MEDICAL_HISTORY eran I-PAST_MEDICAL_HISTORY desconocidos I-PAST_MEDICAL_HISTORY dado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY entregada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY adopción I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY protección I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY sustituta. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION eutrófica, I-EXPLORATION hemodinámicamente I-EXPLORATION estable. I-EXPLORATION Se I-EXPLORATION destaca I-EXPLORATION el I-EXPLORATION rechazo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bipedestación I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION marcha, I-EXPLORATION con I-EXPLORATION irritabilidad I-EXPLORATION a I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION de I-EXPLORATION las I-EXPLORATION caderas, I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION lumbar, I-EXPLORATION contractura I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION paraespinosos, I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lordosis I-EXPLORATION lumbar I-EXPLORATION y I-EXPLORATION localizaba I-EXPLORATION el I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION lumbar. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION la I-EXPLORATION maniobra I-EXPLORATION de I-EXPLORATION Gowers, I-EXPLORATION ni I-EXPLORATION afectación I-EXPLORATION neurológica. I-EXPLORATION I-EXPLORATION En I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION clínicos I-EXPLORATION iniciales I-EXPLORATION destacaba I-EXPLORATION hemograma I-EXPLORATION normal, I-EXPLORATION Proteína I-EXPLORATION C I-EXPLORATION Reactiva I-EXPLORATION (PCR) I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION mg/dl I-EXPLORATION (rango I-EXPLORATION de I-EXPLORATION 0 I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION mg/dl), I-EXPLORATION Velocidad I-EXPLORATION de I-EXPLORATION Sedimentación I-EXPLORATION Globular I-EXPLORATION (VSG) I-EXPLORATION de I-EXPLORATION 40 I-EXPLORATION mm/h), I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION normal, I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION hepática I-EXPLORATION normales, I-EXPLORATION antígenos I-EXPLORATION para I-EXPLORATION Salmonella I-EXPLORATION negativos, I-EXPLORATION Anticuerpos I-EXPLORATION Antinucleares I-EXPLORATION (AAN) I-EXPLORATION negativos, I-EXPLORATION Creatin I-EXPLORATION Fosfoquinasa I-EXPLORATION (CPK) I-EXPLORATION normal. I-EXPLORATION Entre I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION imagenológicos I-EXPLORATION destacó I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION de I-EXPLORATION región I-EXPLORATION lumbosacra I-EXPLORATION y I-EXPLORATION de I-EXPLORATION caderas I-EXPLORATION informadas I-EXPLORATION como I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION Resonancia I-EXPLORATION Magnética I-EXPLORATION (RM) I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION de I-EXPLORATION pelvis I-EXPLORATION con I-EXPLORATION énfasis I-EXPLORATION en I-EXPLORATION cadera I-EXPLORATION izquierda, I-EXPLORATION evidenció I-EXPLORATION compromiso I-EXPLORATION articular I-EXPLORATION coxofemoral, I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION femoral I-EXPLORATION normales, I-EXPLORATION acetábulo I-EXPLORATION adecuado I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION coronal I-EXPLORATION y I-EXPLORATION sagital. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION alteración I-EXPLORATION del I-EXPLORATION disco I-EXPLORATION L5-S1, I-EXPLORATION con I-EXPLORATION erosiones I-EXPLORATION óseas I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION espondilodiscitis. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION búsqueda I-EXPLORATION intencionada I-EXPLORATION para I-EXPLORATION tuberculosis I-EXPLORATION y I-EXPLORATION descartar I-EXPLORATION Mal I-EXPLORATION de I-EXPLORATION Pott I-EXPLORATION como I-EXPLORATION diagnóstico I-EXPLORATION diferencial; I-EXPLORATION con I-EXPLORATION Prueba I-EXPLORATION de I-EXPLORATION Tuberculina I-EXPLORATION (PPD), I-EXPLORATION tres I-EXPLORATION baciloscopias I-EXPLORATION (BK) I-EXPLORATION seriados I-EXPLORATION en I-EXPLORATION jugo I-EXPLORATION gástrico, I-EXPLORATION tres I-EXPLORATION BK I-EXPLORATION seriados I-EXPLORATION en I-EXPLORATION orina, I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION contrastado, I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION total, I-EXPLORATION sin I-EXPLORATION encontrarse I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION estas I-EXPLORATION ayudas I-EXPLORATION diagnósticas. I-EXPLORATION I-EXPLORATION Durante B-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION se I-EVOLUTION documentó I-EVOLUTION exacerbación I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION manifestado I-EVOLUTION en I-EVOLUTION rechazo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION bipedestación I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION marcha, I-EVOLUTION con I-EVOLUTION irritabilidad I-EVOLUTION a I-EVOLUTION la I-EVOLUTION flexión I-EVOLUTION de I-EVOLUTION las I-EVOLUTION caderas. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION con I-EVOLUTION reactantes I-EVOLUTION de I-EVOLUTION fase I-EVOLUTION aguda I-EVOLUTION destacó I-EVOLUTION elevación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION PCR I-EVOLUTION a I-EVOLUTION 12 I-EVOLUTION mg/dl I-EVOLUTION y I-EVOLUTION VSG I-EVOLUTION a I-EVOLUTION 60 I-EVOLUTION mm/h. I-EVOLUTION I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION exploración I-EXPLORATION quirúrgica I-EXPLORATION y I-EXPLORATION drenaje I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cc I-EXPLORATION de I-EXPLORATION secreción I-EXPLORATION de I-EXPLORATION material I-EXPLORATION purulento, I-EXPLORATION cultivo I-EXPLORATION y I-EXPLORATION biopsia. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION reportó: I-EXPLORATION Trabécula I-EXPLORATION ósea I-EXPLORATION usual I-EXPLORATION y I-EXPLORATION medula I-EXPLORATION ósea I-EXPLORATION con I-EXPLORATION espacio I-EXPLORATION medular I-EXPLORATION con I-EXPLORATION celularidad I-EXPLORATION del I-EXPLORATION 30%, I-EXPLORATION conservación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION relación I-EXPLORATION granulo-eritroide, I-EXPLORATION sin I-EXPLORATION evidenciarse I-EXPLORATION inflamación I-EXPLORATION granulomatosa I-EXPLORATION o I-EXPLORATION proceso I-EXPLORATION neoplásico. I-EXPLORATION Reporte I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION cultivos I-EXPLORATION (incluyendo I-EXPLORATION estudios I-EXPLORATION para I-EXPLORATION Brucella I-EXPLORATION y I-EXPLORATION Bartonella), I-EXPLORATION neoplasia I-EXPLORATION y I-EXPLORATION tuberculosis. I-EXPLORATION I-EXPLORATION En B-TREATMENT junta I-TREATMENT médica I-TREATMENT interdisciplinaria, I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT Clindamicina I-TREATMENT 40 I-TREATMENT mg/kg/día I-TREATMENT y I-TREATMENT Ceftriaxone I-TREATMENT 100 I-TREATMENT mg/kg/día I-TREATMENT endovenoso I-TREATMENT durante I-TREATMENT 4 I-TREATMENT semanas I-TREATMENT y I-TREATMENT 2 I-TREATMENT semanas I-TREATMENT con I-TREATMENT Cefalexina I-TREATMENT 100 I-TREATMENT mg/kg/día I-TREATMENT vía I-TREATMENT oral. I-TREATMENT Para I-TREATMENT el I-TREATMENT manejo I-TREATMENT de I-TREATMENT dolor, I-TREATMENT recibió I-TREATMENT Naproxeno I-TREATMENT y I-TREATMENT se I-TREATMENT indicó I-TREATMENT rehabilitación I-TREATMENT física, I-TREATMENT hasta I-TREATMENT la I-TREATMENT resolución I-TREATMENT completa I-TREATMENT del I-TREATMENT cuadro I-TREATMENT clínico, I-TREATMENT evidenciado I-TREATMENT en I-TREATMENT ausencia I-TREATMENT de I-TREATMENT dolor, I-TREATMENT mejoría I-TREATMENT en I-TREATMENT bipedestación, I-TREATMENT marcha I-TREATMENT y I-TREATMENT normalización I-TREATMENT de I-TREATMENT los I-TREATMENT reactantes I-TREATMENT de I-TREATMENT fase I-TREATMENT aguda. I-TREATMENT I-TREATMENT Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS en I-PRESENT_ILLNESS controles I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS policlínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS broncopulmonar, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuadros I-PAST_MEDICAL_HISTORY bronquiales I-PAST_MEDICAL_HISTORY obstructivos I-PAST_MEDICAL_HISTORY frecuentes I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY infecciones I-PAST_MEDICAL_HISTORY respiratorias I-PAST_MEDICAL_HISTORY recurrentes, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY respuesta I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY convencional. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Por B-EXPLORATION referir I-EXPLORATION dolor I-EXPLORATION torácico I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION pesquisó I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION SP I-EXPLORATION intralobar. I-EXPLORATION Fue I-EXPLORATION evaluado I-EXPLORATION con I-EXPLORATION electrocardiograma I-EXPLORATION y I-EXPLORATION ecocardiograma I-EXPLORATION resultando I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION hemodinámico I-EXPLORATION para I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION usó I-EXPLORATION sedación I-EXPLORATION y I-EXPLORATION anestesia I-EXPLORATION local I-EXPLORATION con I-EXPLORATION lidocaína, I-EXPLORATION se I-EXPLORATION cateterizó I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION femoral I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION introductor I-EXPLORATION 5 I-EXPLORATION French. I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION aortografía I-EXPLORATION torácica I-EXPLORATION con I-EXPLORATION catéter I-EXPLORATION Pig I-EXPLORATION Tail I-EXPLORATION 5 I-EXPLORATION French I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION pesquisó, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION torácica, I-EXPLORATION un I-EXPLORATION vaso I-EXPLORATION aberrante I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION calibre I-EXPLORATION que I-EXPLORATION nacía I-EXPLORATION de I-EXPLORATION ésta I-EXPLORATION y I-EXPLORATION se I-EXPLORATION dirigía I-EXPLORATION al I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION pulmón I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION diámetro I-EXPLORATION mínimo I-EXPLORATION 2 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION máximo I-EXPLORATION 6 I-EXPLORATION mm. I-EXPLORATION I-EXPLORATION Posteriormente, B-TREATMENT con I-TREATMENT catéter I-TREATMENT multipropósito I-TREATMENT 5 I-TREATMENT French I-TREATMENT se I-TREATMENT canalizó I-TREATMENT el I-TREATMENT vaso I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT procedió I-TREATMENT al I-TREATMENT cambio I-TREATMENT de I-TREATMENT introductor I-TREATMENT N° I-TREATMENT 6 I-TREATMENT French I-TREATMENT y I-TREATMENT por I-TREATMENT medio I-TREATMENT de I-TREATMENT un I-TREATMENT catéter I-TREATMENT multipropósito I-TREATMENT se I-TREATMENT ubicó I-TREATMENT una I-TREATMENT guía I-TREATMENT de I-TREATMENT intercambio I-TREATMENT a I-TREATMENT distal I-TREATMENT de I-TREATMENT vasos I-TREATMENT que I-TREATMENT nutrían I-TREATMENT el I-TREATMENT secuestro I-TREATMENT por I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT introdujo I-TREATMENT catéter I-TREATMENT largo I-TREATMENT de I-TREATMENT 6 I-TREATMENT French I-TREATMENT y I-TREATMENT por I-TREATMENT medio I-TREATMENT de I-TREATMENT este I-TREATMENT se I-TREATMENT implantó I-TREATMENT un I-TREATMENT dispositivo I-TREATMENT AVP I-TREATMENT II I-TREATMENT (AmplatzerR) I-TREATMENT de I-TREATMENT dimensiones I-TREATMENT 4/6 I-TREATMENT mm, I-TREATMENT posterior I-TREATMENT a I-TREATMENT su I-TREATMENT ubicación I-TREATMENT y I-TREATMENT comprobando I-TREATMENT su I-TREATMENT estabilidad I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT su I-TREATMENT liberación, I-TREATMENT obteniendo I-TREATMENT oclusión I-TREATMENT total I-TREATMENT del I-TREATMENT vaso I-TREATMENT a I-TREATMENT la I-TREATMENT angiografía I-TREATMENT de I-TREATMENT control. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION controlado I-EVOLUTION con I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION tórax I-EVOLUTION en I-EVOLUTION la I-EVOLUTION que I-EVOLUTION se I-EVOLUTION evidenció I-EVOLUTION dispositivo I-EVOLUTION in I-EVOLUTION situ I-EVOLUTION y I-EVOLUTION campos I-EVOLUTION pulmonares I-EVOLUTION libres. I-EVOLUTION Fue I-EVOLUTION controlado I-EVOLUTION a I-EVOLUTION la I-EVOLUTION semana, I-EVOLUTION mes, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses, I-EVOLUTION al I-EVOLUTION año I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años, I-EVOLUTION encontrándose I-EVOLUTION en I-EVOLUTION todos I-EVOLUTION sus I-EVOLUTION controles I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION en I-EVOLUTION excelentes I-EVOLUTION condiciones. I-EVOLUTION I-EVOLUTION Recién B-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS hijo B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY primigesta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 36 I-PAST_MEDICAL_HISTORY semanas, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY prenatal I-PAST_MEDICAL_HISTORY irregular, I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY líquido I-PAST_MEDICAL_HISTORY amniótico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY meconio. I-PAST_MEDICAL_HISTORY Pesó I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacer I-PAST_MEDICAL_HISTORY 1.240 I-PAST_MEDICAL_HISTORY g I-PAST_MEDICAL_HISTORY (< I-PAST_MEDICAL_HISTORY p I-PAST_MEDICAL_HISTORY 3), I-PAST_MEDICAL_HISTORY midió I-PAST_MEDICAL_HISTORY 41 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY (< I-PAST_MEDICAL_HISTORY p I-PAST_MEDICAL_HISTORY 3), I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY apgar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 9. I-PAST_MEDICAL_HISTORY Presentó I-PAST_MEDICAL_HISTORY dificultad I-PAST_MEDICAL_HISTORY respiratoria I-PAST_MEDICAL_HISTORY temprana I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY requirió I-PAST_MEDICAL_HISTORY soporte I-PAST_MEDICAL_HISTORY ventilatorio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY surfactante I-PAST_MEDICAL_HISTORY pulmonar, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY adecuada I-PAST_MEDICAL_HISTORY respuesta. I-PAST_MEDICAL_HISTORY Se B-DERIVED_FROM/TO logró I-DERIVED_FROM/TO extubación I-DERIVED_FROM/TO a I-DERIVED_FROM/TO CPAP, I-DERIVED_FROM/TO pero I-DERIVED_FROM/TO presentó I-DERIVED_FROM/TO taquicardia I-DERIVED_FROM/TO y I-DERIVED_FROM/TO taquipnea I-DERIVED_FROM/TO persistente, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO cual I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realizó I-DERIVED_FROM/TO ecocardiograma I-DERIVED_FROM/TO sugestivo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO coartación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO aorta I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO un I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO mayor I-DERIVED_FROM/TO complejidad, I-DERIVED_FROM/TO a I-DERIVED_FROM/TO los I-DERIVED_FROM/TO 13 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vida. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION institución I-EXPLORATION se I-EXPLORATION tomó I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION en I-EXPLORATION cuatro I-EXPLORATION extremidades: I-EXPLORATION Miembros I-EXPLORATION superiores I-EXPLORATION derecho I-EXPLORATION e I-EXPLORATION izquierdo I-EXPLORATION 88/49 I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION media I-EXPLORATION (PAM) I-EXPLORATION 62 I-EXPLORATION y I-EXPLORATION 90/52 I-EXPLORATION PAM I-EXPLORATION 63, I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION derecho I-EXPLORATION e I-EXPLORATION izquierdo I-EXPLORATION 86/43 I-EXPLORATION PAM I-EXPLORATION 61, I-EXPLORATION 78/44 I-EXPLORATION PAM I-EXPLORATION 53, I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION 180 I-EXPLORATION y I-EXPLORATION respiratoria I-EXPLORATION 65 I-EXPLORATION x I-EXPLORATION min. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION segmentario I-EXPLORATION destacaba I-EXPLORATION hepatomegalia, I-EXPLORATION frialdad I-EXPLORATION distal, I-EXPLORATION taquicardia, I-EXPLORATION soplo I-EXPLORATION en I-EXPLORATION foco I-EXPLORATION pulmonar I-EXPLORATION II/VI, I-EXPLORATION pulsos I-EXPLORATION femorales I-EXPLORATION presentes, I-EXPLORATION retracción I-EXPLORATION subcostal, I-EXPLORATION temblor I-EXPLORATION distal I-EXPLORATION fino, I-EXPLORATION exoftalmo I-EXPLORATION marcado I-EXPLORATION y I-EXPLORATION precordio I-EXPLORATION hiperdinámico. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION Ecocardiograma I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION coartación I-EXPLORATION aórtica, I-EXPLORATION pero I-EXPLORATION mostró I-EXPLORATION disfunción I-EXPLORATION miocárdica I-EXPLORATION que I-EXPLORATION requirió I-EXPLORATION soporte I-EXPLORATION inotrópico. I-EXPLORATION Ecografía I-EXPLORATION transfontanelar I-EXPLORATION y I-EXPLORATION abdominal I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION iníciales I-EXPLORATION destacaron I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática, I-EXPLORATION bilirrubina I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 8 I-EXPLORATION mg% I-EXPLORATION (directa I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 3 I-EXPLORATION mg%). I-EXPLORATION I-EXPLORATION Al B-FAMILY_HISTORY evaluar I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY se I-FAMILY_HISTORY observó I-FAMILY_HISTORY fenotipo I-FAMILY_HISTORY sugestivo I-FAMILY_HISTORY de I-FAMILY_HISTORY hipertiroidismo, I-FAMILY_HISTORY con I-FAMILY_HISTORY delgadez I-FAMILY_HISTORY marcada I-FAMILY_HISTORY y I-FAMILY_HISTORY exoftalmo, I-FAMILY_HISTORY por I-FAMILY_HISTORY lo I-FAMILY_HISTORY que I-FAMILY_HISTORY se I-FAMILY_HISTORY sospechó I-FAMILY_HISTORY enfermedad I-FAMILY_HISTORY tiroidea I-FAMILY_HISTORY no I-FAMILY_HISTORY tratada. I-FAMILY_HISTORY Debido B-EXPLORATION a I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION hipertiroidismo I-EXPLORATION neonatal, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION perfil I-EXPLORATION tiroideo, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION TSH I-EXPLORATION 0, I-EXPLORATION 01 I-EXPLORATION uUI/ml I-EXPLORATION y I-EXPLORATION T4 I-EXPLORATION Libre I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 7 I-EXPLORATION (valores I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION 0, I-EXPLORATION 71-1, I-EXPLORATION 85 I-EXPLORATION ng/dl). I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION además I-EXPLORATION anticuerpos I-EXPLORATION antimicrosomales, I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION realizar I-EXPLORATION anticuerpos I-EXPLORATION estimulantes I-EXPLORATION del I-EXPLORATION receptor I-EXPLORATION de I-EXPLORATION tirotropina I-EXPLORATION (TRAab). I-EXPLORATION I-EXPLORATION Al I-EXPLORATION reevaluar I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION bocio I-EXPLORATION difuso I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION con I-EXPLORATION ecografía. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT metimazol I-TREATMENT 1 I-TREATMENT mg/kg/día I-TREATMENT dividido I-TREATMENT en I-TREATMENT 3 I-TREATMENT dosis, I-TREATMENT propanolol I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/kg/día I-TREATMENT dividido I-TREATMENT en I-TREATMENT 2 I-TREATMENT dosis, I-TREATMENT logrando I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT taquicardia. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION se I-EVOLUTION notó I-EVOLUTION poca I-EVOLUTION ganancia I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION en I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION días I-EVOLUTION de I-EVOLUTION manejo, I-EVOLUTION situación I-EVOLUTION revertida I-EVOLUTION después I-EVOLUTION de I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION Se B-TREATMENT logró I-TREATMENT retiro I-TREATMENT de I-TREATMENT oxígeno, I-TREATMENT resolución I-TREATMENT de I-TREATMENT hepatomegalia I-TREATMENT y B-EVOLUTION después I-EVOLUTION de I-EVOLUTION 1 I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION la I-EVOLUTION T4 I-EVOLUTION Libre I-EVOLUTION descendió I-EVOLUTION hasta I-EVOLUTION 3, I-EVOLUTION 1 I-EVOLUTION mg/dl, I-EVOLUTION persistiendo I-EVOLUTION con I-EVOLUTION supresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION TSH I-EVOLUTION (0, I-EVOLUTION 015 I-EVOLUTION uUI/ml) I-EVOLUTION al I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION su I-EVOLUTION egreso. I-EVOLUTION I-EVOLUTION En B-TREATMENT la I-TREATMENT semana I-TREATMENT 13 I-TREATMENT de I-TREATMENT evolución I-TREATMENT se I-TREATMENT normalizaron I-TREATMENT las I-TREATMENT pruebas I-TREATMENT de I-TREATMENT función I-TREATMENT tiroidea, I-TREATMENT retirándose I-TREATMENT la I-TREATMENT medicación I-TREATMENT antitiroidea. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION lactante I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION condición I-EVOLUTION eutiroidea, I-EVOLUTION sin I-EVOLUTION alteraciones I-EVOLUTION cardiovasculares I-EVOLUTION ni I-EVOLUTION del I-EVOLUTION neurodesarrollo. I-EVOLUTION La I-EVOLUTION madre I-EVOLUTION fue I-EVOLUTION referida I-EVOLUTION a I-EVOLUTION endocrinología I-EVOLUTION para I-EVOLUTION manejo I-EVOLUTION y I-EVOLUTION asesoría I-EVOLUTION para I-EVOLUTION futuros I-EVOLUTION embarazos. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO urgencias I-DERIVED_FROM/TO por I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO precordial I-DERIVED_FROM/TO intermitente I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 1 I-DERIVED_FROM/TO mes I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución, I-DERIVED_FROM/TO asociado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO alteración I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO electrocardiograma I-DERIVED_FROM/TO (ECG): I-DERIVED_FROM/TO atenuación I-DERIVED_FROM/TO del I-DERIVED_FROM/TO QRS I-DERIVED_FROM/TO e I-DERIVED_FROM/TO inversión I-DERIVED_FROM/TO de I-DERIVED_FROM/TO onda I-DERIVED_FROM/TO T I-DERIVED_FROM/TO en I-DERIVED_FROM/TO derivaciones I-DERIVED_FROM/TO precordiales. I-DERIVED_FROM/TO No B-PRESENT_ILLNESS refería I-PRESENT_ILLNESS palpitaciones, I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS vegetativos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS sincopales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presentaba I-EXPLORATION buen I-EXPLORATION aspecto I-EXPLORATION general, I-EXPLORATION manteniéndose I-EXPLORATION hemodinámicamente I-EXPLORATION estable, I-EXPLORATION destacando I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION torácica I-EXPLORATION izquierda I-EXPLORATION que I-EXPLORATION aumentaba I-EXPLORATION con I-EXPLORATION la I-EXPLORATION inspiración I-EXPLORATION y I-EXPLORATION la I-EXPLORATION movilización I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION superiores. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION cardíaca I-EXPLORATION se I-EXPLORATION escuchaba I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION ruidos I-EXPLORATION cardíacos I-EXPLORATION en I-EXPLORATION precordio I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION atenuados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Dado I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION del I-EXPLORATION dolor I-EXPLORATION y I-EXPLORATION la I-EXPLORATION alteración I-EXPLORATION electrocardiográfica I-EXPLORATION referida, I-EXPLORATION se I-EXPLORATION repitió I-EXPLORATION ECG, I-EXPLORATION persistiendo I-EXPLORATION eje I-EXPLORATION QRS I-EXPLORATION y I-EXPLORATION onda I-EXPLORATION P I-EXPLORATION de I-EXPLORATION +150°, I-EXPLORATION QRS I-EXPLORATION estrecho I-EXPLORATION de I-EXPLORATION voltaje I-EXPLORATION atenuado I-EXPLORATION en I-EXPLORATION precordiales I-EXPLORATION V3-V6 I-EXPLORATION y I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION negativas I-EXPLORATION en I-EXPLORATION V1-V4 I-EXPLORATION y I-EXPLORATION aVL. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION dextrocardia, I-EXPLORATION además I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION burbuja I-EXPLORATION gástrica I-EXPLORATION a I-EXPLORATION la I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION sombra I-EXPLORATION hepática I-EXPLORATION a I-EXPLORATION la I-EXPLORATION izquierda, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION situs I-EXPLORATION inversus, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION en I-EXPLORATION ecografía I-EXPLORATION abdominal. I-EXPLORATION I-EXPLORATION El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO Cardiología I-DERIVED_FROM/TO Infantil I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realizó I-DERIVED_FROM/TO ecocardiografía I-DERIVED_FROM/TO evidenciándose I-DERIVED_FROM/TO dextrocardia I-DERIVED_FROM/TO especular I-DERIVED_FROM/TO clásica I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO malformaciones I-DERIVED_FROM/TO cardíacas I-DERIVED_FROM/TO asociadas. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT etiología I-TREATMENT músculo-esquelética, I-TREATMENT el I-TREATMENT dolor I-TREATMENT torácico I-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT antiinflamatorios I-TREATMENT con B-EVOLUTION mejoría I-EVOLUTION progresiva, I-EVOLUTION encontrándose I-EVOLUTION asintomático I-EVOLUTION en I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION acudir I-EVOLUTION a I-EVOLUTION control. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses 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 tiroiditis I-PAST_MEDICAL_HISTORY autoinmune I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY pesquisada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY difuso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antecedente B-FAMILY_HISTORY familiar I-FAMILY_HISTORY de I-FAMILY_HISTORY carcinoma I-FAMILY_HISTORY papilar I-FAMILY_HISTORY en I-FAMILY_HISTORY primo, I-FAMILY_HISTORY abuela I-FAMILY_HISTORY y I-FAMILY_HISTORY bisabuela. I-FAMILY_HISTORY I-FAMILY_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en I-PRESENT_ILLNESS control I-PRESENT_ILLNESS ecográfico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS pesquisó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS nódulo I-PRESENT_ILLNESS tiroideo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1, I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bordes I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS limitados, I-PRESENT_ILLNESS heterogéneo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS calcificaciones I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS interior, I-PRESENT_ILLNESS se B-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION cuya I-EXPLORATION histología I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION carcinoma I-EXPLORATION papilar, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT tiroidectomia I-TREATMENT total I-TREATMENT con I-TREATMENT vaciamiento I-TREATMENT ganglionar I-TREATMENT cervical I-TREATMENT anterior. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION Carcinoma I-EXPLORATION papilar I-EXPLORATION de I-EXPLORATION tiroides I-EXPLORATION unifocal, I-EXPLORATION variedad I-EXPLORATION usual, I-EXPLORATION sin I-EXPLORATION infiltración I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION peritiroideo, I-EXPLORATION sin I-EXPLORATION permeaciones I-EXPLORATION linfovasculares I-EXPLORATION ni I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION los I-EXPLORATION linfonodos I-EXPLORATION evaluados, I-EXPLORATION bordes I-EXPLORATION quirúrgicos I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION tiroideo I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION tiroiditis I-EXPLORATION crónica I-EXPLORATION difusa. I-EXPLORATION De B-TREATMENT acuerdo I-TREATMENT a I-TREATMENT protocolo I-TREATMENT a I-TREATMENT continuación I-TREATMENT de I-TREATMENT la I-TREATMENT tiroidectomía I-TREATMENT se I-TREATMENT aplicó I-TREATMENT Radio I-TREATMENT yodo I-TREATMENT 100 I-TREATMENT mCi I-TREATMENT a I-TREATMENT los I-TREATMENT 25 I-TREATMENT días I-TREATMENT post I-TREATMENT cirugía I-TREATMENT con I-TREATMENT rastreo I-TREATMENT terapéutico I-TREATMENT posterior I-TREATMENT negativo. I-TREATMENT Permanece B-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION recidiva, I-EVOLUTION con I-EVOLUTION Tiroglobulinas I-EVOLUTION < I-EVOLUTION 0, I-EVOLUTION 2 I-EVOLUTION ng/ml I-EVOLUTION en I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION con I-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-FAMILY_HISTORY antecedente I-FAMILY_HISTORY familiar I-FAMILY_HISTORY de I-FAMILY_HISTORY madre I-FAMILY_HISTORY con I-FAMILY_HISTORY carcinoma I-FAMILY_HISTORY papilar I-FAMILY_HISTORY de I-FAMILY_HISTORY tiroides I-FAMILY_HISTORY operado. I-FAMILY_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS se I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS tiroídea I-PRESENT_ILLNESS por I-PRESENT_ILLNESS bocio I-PRESENT_ILLNESS que I-PRESENT_ILLNESS describe I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS sugerente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS neoplasia I-PRESENT_ILLNESS tiroídea I-PRESENT_ILLNESS extensa I-PRESENT_ILLNESS con I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS parte I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS glándula, I-PRESENT_ILLNESS nódulo I-PRESENT_ILLNESS dominante I-PRESENT_ILLNESS lóbulo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS supraclaviculares I-PRESENT_ILLNESS izquierdas. I-PRESENT_ILLNESS Teniendo B-TREATMENT en I-TREATMENT cuenta I-TREATMENT sus I-TREATMENT antecedentes I-TREATMENT familiares, I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT una I-TREATMENT tiroidectomía I-TREATMENT total I-TREATMENT sin I-TREATMENT punción I-TREATMENT tiroídea I-TREATMENT previa, I-TREATMENT cuya I-TREATMENT biopsia I-TREATMENT contemporánea I-TREATMENT y I-TREATMENT definitiva I-TREATMENT confirmaron I-TREATMENT carcinoma I-TREATMENT papilar I-TREATMENT de I-TREATMENT tiroides I-TREATMENT en I-TREATMENT lóbulo I-TREATMENT izquierdo, I-TREATMENT itsmo I-TREATMENT y I-TREATMENT lóbulo I-TREATMENT derecho, I-TREATMENT variante I-TREATMENT esclerosante I-TREATMENT difusa I-TREATMENT que I-TREATMENT infiltraba I-TREATMENT el I-TREATMENT tejido I-TREATMENT peritiroideo I-TREATMENT con I-TREATMENT múltiples I-TREATMENT permeaciones I-TREATMENT vasculares I-TREATMENT y I-TREATMENT compromiso I-TREATMENT ganglionar. I-TREATMENT I-TREATMENT A I-TREATMENT continuación I-TREATMENT de I-TREATMENT la I-TREATMENT Tiroidectomía I-TREATMENT se I-TREATMENT trató I-TREATMENT a I-TREATMENT los I-TREATMENT 30 I-TREATMENT días I-TREATMENT con I-TREATMENT radio I-TREATMENT yodo I-TREATMENT 150 I-TREATMENT mCi; I-TREATMENT el B-EXPLORATION rastreo I-EXPLORATION sistémico I-EXPLORATION terapéutico I-EXPLORATION mostró I-EXPLORATION sólo I-EXPLORATION tejido I-EXPLORATION captante I-EXPLORATION en I-EXPLORATION remanente I-EXPLORATION tiroideo. I-EXPLORATION Sin I-EXPLORATION embargo, I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 3 I-EXPLORATION meses I-EXPLORATION post I-EXPLORATION tiroidectomía I-EXPLORATION se I-EXPLORATION pesquisó I-EXPLORATION clínicamente I-EXPLORATION y I-EXPLORATION mediante I-EXPLORATION ecografía, I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION en I-EXPLORATION lecho I-EXPLORATION tiroideo I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION recidiva I-EXPLORATION ganglionar I-EXPLORATION cervical, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION mediante I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION papilar I-EXPLORATION en I-EXPLORATION ganglios I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION IIA, I-EXPLORATION II, I-EXPLORATION IV, I-EXPLORATION VD, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT reintervención I-TREATMENT quirúrgica. I-TREATMENT Evoluciona I-TREATMENT con I-TREATMENT persistencia I-TREATMENT imagenológica B-EVOLUTION de I-EVOLUTION lesión I-EVOLUTION ganglionar I-EVOLUTION cervical I-EVOLUTION sospechosa I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 9 I-EVOLUTION meses I-EVOLUTION postiroidectomia I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION aplicar I-EVOLUTION una I-EVOLUTION segunda I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION radio I-EVOLUTION yodo I-EVOLUTION 150 I-EVOLUTION mCi I-EVOLUTION con I-EVOLUTION exploración I-EVOLUTION sistémica I-EVOLUTION terapéutica I-EVOLUTION que I-EVOLUTION mostró I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION captación I-EVOLUTION en I-EVOLUTION región I-EVOLUTION cervical I-EVOLUTION anterior I-EVOLUTION compatible I-EVOLUTION con I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION nodular I-EVOLUTION visible I-EVOLUTION ecográficamente. I-EVOLUTION Esta I-EVOLUTION lesión I-EVOLUTION ha I-EVOLUTION disminuido I-EVOLUTION de I-EVOLUTION tamaño I-EVOLUTION en I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION con I-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION y B-TREATMENT persiste I-TREATMENT con I-TREATMENT Tiroglobulinas I-TREATMENT < I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT ng/ml. I-TREATMENT I-TREATMENT Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sana, I-PAST_MEDICAL_HISTORY tercera I-PAST_MEDICAL_HISTORY hija I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY matrimonio I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY consanguíneo, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY epilepsia I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY AE. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY ruido I-PAST_MEDICAL_HISTORY fuerte, I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY evento I-PAST_MEDICAL_HISTORY descrito I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY llanto I-PAST_MEDICAL_HISTORY intenso, I-PAST_MEDICAL_HISTORY persistente, I-PAST_MEDICAL_HISTORY apnea I-PAST_MEDICAL_HISTORY espiratoria, I-PAST_MEDICAL_HISTORY cianosis, I-PAST_MEDICAL_HISTORY desviación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mirada I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conciencia I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotonía. I-PAST_MEDICAL_HISTORY Remitió I-PAST_MEDICAL_HISTORY espontáneamente I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY segundos I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY vigilia I-PAST_MEDICAL_HISTORY normal I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY evento. I-PAST_MEDICAL_HISTORY Estos I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY continuaron I-PAST_MEDICAL_HISTORY haciéndose I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY frecuentes I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intensos, I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 3-5 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY seguidos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conciencia I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotonía, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY consultó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY neurología I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY EEG I-PAST_MEDICAL_HISTORY estándar I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY informado I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY normal. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY caída I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY piso, I-PAST_MEDICAL_HISTORY nuevamente I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY llanto, I-PAST_MEDICAL_HISTORY apnea I-PAST_MEDICAL_HISTORY espiratoria, I-PAST_MEDICAL_HISTORY cianosis I-PAST_MEDICAL_HISTORY seguida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conciencia, I-PAST_MEDICAL_HISTORY hipotonía I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY agregó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY tónico I-PAST_MEDICAL_HISTORY clónica I-PAST_MEDICAL_HISTORY generalizada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY min I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY duración. I-PAST_MEDICAL_HISTORY Ingresó B-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION lactante I-EXPLORATION vigil, I-EXPLORATION con I-EXPLORATION buen I-EXPLORATION desarrollo I-EXPLORATION psicomotor. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION hemograma I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION anemia, I-EXPLORATION sin I-EXPLORATION microcitosis, I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION cinética I-EXPLORATION de I-EXPLORATION fierro I-EXPLORATION normal, I-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION normal. I-EXPLORATION Se B-EVOLUTION dió I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION apnea I-EVOLUTION emotiva I-EVOLUTION cianótica I-EVOLUTION grave. I-EVOLUTION Se I-EVOLUTION solicitó I-EVOLUTION controles I-EVOLUTION ambulatorios. I-EVOLUTION I-EVOLUTION Posterior I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION persistió I-EVOLUTION con I-EVOLUTION AE I-EVOLUTION de I-EVOLUTION frecuencia I-EVOLUTION diaria, I-EVOLUTION con I-EVOLUTION intensidades I-EVOLUTION de I-EVOLUTION leves I-EVOLUTION a I-EVOLUTION graves. I-EVOLUTION El B-TREATMENT estudio I-TREATMENT de I-TREATMENT cinética I-TREATMENT de I-TREATMENT fierro I-TREATMENT fue I-TREATMENT normal, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT piracetam I-TREATMENT dosis I-TREATMENT 40 I-TREATMENT mg/kg I-TREATMENT día I-TREATMENT fraccionado I-TREATMENT en I-TREATMENT dos I-TREATMENT dosis I-TREATMENT por I-TREATMENT 4 I-TREATMENT meses. I-TREATMENT En B-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION verificar I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION frecuencia I-EVOLUTION e I-EVOLUTION intensidad I-EVOLUTION de I-EVOLUTION las I-EVOLUTION crisis, I-EVOLUTION con I-EVOLUTION sólo I-EVOLUTION 2 I-EVOLUTION apneas I-EVOLUTION emotivas I-EVOLUTION con I-EVOLUTION leve I-EVOLUTION cianosis I-EVOLUTION y I-EVOLUTION recuperación I-EVOLUTION espontánea. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY nacida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cesárea, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY fisiológico. I-PAST_MEDICAL_HISTORY Sus B-PRESENT_ILLNESS padres I-PRESENT_ILLNESS consultaron I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Ginecología I-PRESENT_ILLNESS Infantil I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS abertura I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vagina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ano I-PRESENT_ILLNESS detectada I-PRESENT_ILLNESS al I-PRESENT_ILLNESS nacimiento I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evolucionó I-PRESENT_ILLNESS asintomática. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION general I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION una I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION nutricional I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION dirigida I-EXPLORATION de I-EXPLORATION los I-EXPLORATION genitales I-EXPLORATION destacaron I-EXPLORATION los I-EXPLORATION labios I-EXPLORATION mayores I-EXPLORATION prominentes, I-EXPLORATION himen I-EXPLORATION rosado I-EXPLORATION redundante I-EXPLORATION y I-EXPLORATION permeable. I-EXPLORATION El I-EXPLORATION periné I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION lineal I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION horquilla I-EXPLORATION vulvar I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ano, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cortante I-EXPLORATION cubierta I-EXPLORATION por I-EXPLORATION mucosa I-EXPLORATION eritematosa I-EXPLORATION con I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION anal I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION y I-EXPLORATION posición I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION palpó I-EXPLORATION botón I-EXPLORATION mamario I-EXPLORATION sin I-EXPLORATION galactorrea I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION general I-EXPLORATION estaba I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT aseo I-TREATMENT con I-TREATMENT agua I-TREATMENT y I-TREATMENT lubricación I-TREATMENT con I-TREATMENT vaselina I-TREATMENT sólida I-TREATMENT en I-TREATMENT cada I-TREATMENT muda. I-TREATMENT En B-EVOLUTION el I-EVOLUTION control I-EVOLUTION de I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION la I-EVOLUTION madre I-EVOLUTION señaló I-EVOLUTION que I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION había I-EVOLUTION evolucionado I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y B-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION epitelización I-EXPLORATION del I-EXPLORATION surco I-EXPLORATION perineal. I-EXPLORATION I-EXPLORATION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ardor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS área I-PRESENT_ILLNESS genital I-PRESENT_ILLNESS y I-PRESENT_ILLNESS perineal I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS secreción I-PRESENT_ILLNESS blanca, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS olor, I-PRESENT_ILLNESS diariamente I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS aproximadamente. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fisura I-PAST_MEDICAL_HISTORY anogenital I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY lactante I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY mantuvo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY observación I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY breve I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY completar I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY alta. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY realizaba I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY aseo I-PAST_MEDICAL_HISTORY genital I-PAST_MEDICAL_HISTORY diariamente I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY agua I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY sangrado I-PAST_MEDICAL_HISTORY escaso I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY secar I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY perineal. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY urinaria, I-PAST_MEDICAL_HISTORY constipación, I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY desarrollo I-PAST_MEDICAL_HISTORY puberal. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION eutrófica, I-EXPLORATION con I-EXPLORATION mamas I-EXPLORATION y I-EXPLORATION vello I-EXPLORATION púbico I-EXPLORATION en I-EXPLORATION Tanner I-EXPLORATION I. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION genital I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION himen I-EXPLORATION redundante I-EXPLORATION permeable, I-EXPLORATION rojo, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION surco I-EXPLORATION mucoso I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION horquilla I-EXPLORATION vulvar I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION ano, I-EXPLORATION sensible I-EXPLORATION al I-EXPLORATION tacto. I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION un I-EXPLORATION surco I-EXPLORATION perineal I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION una I-EXPLORATION vulvovaginitis I-EXPLORATION inespecífica. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION cultivo I-EXPLORATION vaginal I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION arrojó I-EXPLORATION flora I-EXPLORATION comensal. I-EXPLORATION Se B-TREATMENT sugirió I-TREATMENT resección I-TREATMENT quirúrgica I-TREATMENT del I-TREATMENT surco, I-TREATMENT pero I-TREATMENT la I-TREATMENT familia I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT una I-TREATMENT prueba I-TREATMENT terapéutica I-TREATMENT con I-TREATMENT lubricantes I-TREATMENT tópicos, I-TREATMENT dado I-TREATMENT que I-TREATMENT entendió I-TREATMENT el I-TREATMENT carácter I-TREATMENT benigno I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT I-TREATMENT Recién B-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS cesárea I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS gestacional I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS cardiopatía I-PRESENT_ILLNESS compleja; I-PRESENT_ILLNESS peso B-EXPLORATION de I-EXPLORATION nacimiento I-EXPLORATION 2.860 I-EXPLORATION g I-EXPLORATION (p15), I-EXPLORATION longitud I-EXPLORATION 44 I-EXPLORATION cm I-EXPLORATION (p3), I-EXPLORATION perímetro I-EXPLORATION cefálico I-EXPLORATION 33 I-EXPLORATION cm I-EXPLORATION (p I-EXPLORATION 3). I-EXPLORATION Padres B-FAMILY_HISTORY no I-FAMILY_HISTORY consanguíneos I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY personales I-FAMILY_HISTORY ni I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY importancia, I-FAMILY_HISTORY madre I-FAMILY_HISTORY primigesta I-FAMILY_HISTORY de I-FAMILY_HISTORY 19 I-FAMILY_HISTORY años. I-FAMILY_HISTORY I-FAMILY_HISTORY A B-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontró I-PAST_MEDICAL_HISTORY translucencia I-PAST_MEDICAL_HISTORY nucal I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY p95, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cariotipo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vellosidades I-PAST_MEDICAL_HISTORY coriales I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY resultado I-PAST_MEDICAL_HISTORY 46, I-PAST_MEDICAL_HISTORY XY; I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY evidenció I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY compleja, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY canal I-PAST_MEDICAL_HISTORY aurículoventricular I-PAST_MEDICAL_HISTORY completo, I-PAST_MEDICAL_HISTORY mientras I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tercer I-PAST_MEDICAL_HISTORY trimestre I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY huesos I-PAST_MEDICAL_HISTORY largos I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraban I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY p5. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-DERIVED_FROM/TO nacimiento I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO hospitalizado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cuidados I-DERIVED_FROM/TO intensivos I-DERIVED_FROM/TO neonatal. I-DERIVED_FROM/TO Evaluado B-EXPLORATION por I-EXPLORATION genetista I-EXPLORATION clínico, I-EXPLORATION quien I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION dismorfológico I-EXPLORATION describió: I-EXPLORATION microcefalia, I-EXPLORATION orejas I-EXPLORATION de I-EXPLORATION implantación I-EXPLORATION baja I-EXPLORATION con I-EXPLORATION rotación I-EXPLORATION hacia I-EXPLORATION atrás, I-EXPLORATION puente I-EXPLORATION nasal I-EXPLORATION deprimido, I-EXPLORATION pliegue I-EXPLORATION epicántico I-EXPLORATION interno, I-EXPLORATION estrabismo I-EXPLORATION convergente, I-EXPLORATION en I-EXPLORATION boca I-EXPLORATION labio I-EXPLORATION superior I-EXPLORATION corto I-EXPLORATION unido I-EXPLORATION por I-EXPLORATION frenillos I-EXPLORATION al I-EXPLORATION reborde I-EXPLORATION alveolar, I-EXPLORATION extremidades I-EXPLORATION con I-EXPLORATION huesos I-EXPLORATION largos I-EXPLORATION cortos, I-EXPLORATION rizomelia, I-EXPLORATION manos I-EXPLORATION pequeñas, I-EXPLORATION braquidactilia, I-EXPLORATION pliegue I-EXPLORATION palmar I-EXPLORATION único, I-EXPLORATION polidactilia I-EXPLORATION post I-EXPLORATION axial I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION superiores, I-EXPLORATION polisindactilia I-EXPLORATION preaxial I-EXPLORATION bilateral I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION uñas I-EXPLORATION hipoplásicas. I-EXPLORATION I-EXPLORATION El I-EXPLORATION ecocardiograma I-EXPLORATION mostró I-EXPLORATION canal I-EXPLORATION aurículo-ventricular, I-EXPLORATION estenosis I-EXPLORATION aórtica, I-EXPLORATION hipoplasia I-EXPLORATION del I-EXPLORATION arco I-EXPLORATION aórtico, I-EXPLORATION ductus I-EXPLORATION arterioso I-EXPLORATION e I-EXPLORATION hipoplasia I-EXPLORATION leve I-EXPLORATION de I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION derecha, I-EXPLORATION también I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION transfontanelar I-EXPLORATION y I-EXPLORATION renal I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION normales; I-EXPLORATION radiografías I-EXPLORATION de I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION mostraron I-EXPLORATION fémur I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tibia I-EXPLORATION cortos I-EXPLORATION con I-EXPLORATION adecuada I-EXPLORATION osificación, I-EXPLORATION en I-EXPLORATION radiografía I-EXPLORATION toracoabdominal I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION tórax I-EXPLORATION estrecho I-EXPLORATION al I-EXPLORATION comparar I-EXPLORATION con I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION una I-EXPLORATION silueta I-EXPLORATION cardíaca I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION al I-EXPLORATION comparar I-EXPLORATION con I-EXPLORATION el I-EXPLORATION tórax I-EXPLORATION ; I-EXPLORATION en I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION alteraciones I-EXPLORATION vertebrales. I-EXPLORATION I-EXPLORATION La I-EXPLORATION suma I-EXPLORATION de I-EXPLORATION hallazgos I-EXPLORATION permitió I-EXPLORATION diagnosticar I-EXPLORATION el I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Ellis I-EXPLORATION Van I-EXPLORATION Creveld. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION desfavorable I-EVOLUTION falleciendo I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 8 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION nacido, I-EVOLUTION por I-EVOLUTION problemas I-EVOLUTION secundarios I-EVOLUTION a I-EVOLUTION su I-EVOLUTION cardiopatía I-EVOLUTION compleja. I-EVOLUTION I-EVOLUTION Primera B-PRESENT_ILLNESS hija I-PRESENT_ILLNESS de I-PRESENT_ILLNESS padres I-PRESENT_ILLNESS sanos I-PRESENT_ILLNESS no I-PRESENT_ILLNESS consanguíneos, I-PRESENT_ILLNESS sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY epilepsia I-FAMILY_HISTORY en I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY primer I-FAMILY_HISTORY grado, I-FAMILY_HISTORY debutó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS CF I-PRESENT_ILLNESS hemiclónica I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS min I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS paresia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Todd I-PRESENT_ILLNESS posterior. I-PRESENT_ILLNESS Las I-PRESENT_ILLNESS recurrencias I-PRESENT_ILLNESS fueron I-PRESENT_ILLNESS frecuentes, I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS focal I-PRESENT_ILLNESS compleja I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hemiclónicas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS min I-PRESENT_ILLNESS con I-PRESENT_ILLNESS al I-PRESENT_ILLNESS menos I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS SE I-PRESENT_ILLNESS febriles I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS mes, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS examen I-PRESENT_ILLNESS normal I-PRESENT_ILLNESS post I-PRESENT_ILLNESS crisis. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION RM I-EXPLORATION cerebral3 I-EXPLORATION fueron I-EXPLORATION normal, I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION múltiples I-EXPLORATION EEG I-EXPLORATION standard, I-EXPLORATION la I-EXPLORATION cuantificación I-EXPLORATION de I-EXPLORATION aminoácidos I-EXPLORATION en I-EXPLORATION sangre, I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo, I-EXPLORATION ácidos I-EXPLORATION orgánicos I-EXPLORATION y I-EXPLORATION ultramicroscopía I-EXPLORATION de I-EXPLORATION piel. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 6 I-EXPLORATION meses I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION SCN1A I-EXPLORATION confirmándose I-EXPLORATION mutación I-EXPLORATION c.5347G>A I-EXPLORATION (p.Ala1783Thr) I-EXPLORATION en I-EXPLORATION estado I-EXPLORATION heterocigoto I-EXPLORATION en I-EXPLORATION el I-EXPLORATION exón I-EXPLORATION 26 I-EXPLORATION del I-EXPLORATION gen. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION padres I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION El B-TREATMENT uso I-TREATMENT de I-TREATMENT fenobarbital, I-TREATMENT clobazam, I-TREATMENT levetiracetam I-TREATMENT y I-TREATMENT topiramato, I-TREATMENT no I-TREATMENT logró I-TREATMENT control I-TREATMENT de I-TREATMENT crisis. I-TREATMENT A I-TREATMENT los I-TREATMENT 9 I-TREATMENT meses I-TREATMENT se I-TREATMENT inició I-TREATMENT stiripentol I-TREATMENT dosis I-TREATMENT 50 I-TREATMENT mg I-TREATMENT kp I-TREATMENT día, I-TREATMENT asociado I-TREATMENT a I-TREATMENT topiramato I-TREATMENT y I-TREATMENT ácido I-TREATMENT valproico I-TREATMENT sin I-TREATMENT resultados. I-TREATMENT Entre B-EVOLUTION los I-EVOLUTION 12-18 I-EVOLUTION meses I-EVOLUTION los I-EVOLUTION múltiples I-EVOLUTION SE I-EVOLUTION y I-EVOLUTION crisis I-EVOLUTION frecuentes I-EVOLUTION deterioraron I-EVOLUTION su I-EVOLUTION desarrollo I-EVOLUTION perdiendo I-EVOLUTION marcha, I-EVOLUTION control I-EVOLUTION de I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION control I-EVOLUTION cefálico. I-EVOLUTION Se B-TREATMENT inició I-TREATMENT dieta I-TREATMENT cetogénica I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT asoció I-TREATMENT a I-TREATMENT una I-TREATMENT pancreatitis I-TREATMENT grave I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT discontinuó. I-TREATMENT I-TREATMENT La I-TREATMENT certificación I-TREATMENT de I-TREATMENT alteración I-TREATMENT deglución I-TREATMENT y I-TREATMENT cuadros I-TREATMENT respiratorios I-TREATMENT recurrentes I-TREATMENT febriles I-TREATMENT que I-TREATMENT precipitaban I-TREATMENT los I-TREATMENT SE I-TREATMENT plantearon I-TREATMENT gastrostomía I-TREATMENT lo I-TREATMENT que I-TREATMENT logró I-TREATMENT disminución I-TREATMENT de I-TREATMENT episodios I-TREATMENT febriles I-TREATMENT y I-TREATMENT mejor I-TREATMENT manejo I-TREATMENT de I-TREATMENT las I-TREATMENT crisis. I-TREATMENT I-TREATMENT Posterior I-TREATMENT a I-TREATMENT una I-TREATMENT serie I-TREATMENT de I-TREATMENT adecuaciones I-TREATMENT de I-TREATMENT fármacos I-TREATMENT antiepilépticos I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT triasociado I-TREATMENT con I-TREATMENT clobazam, I-TREATMENT topiramato I-TREATMENT y I-TREATMENT lacosamida I-TREATMENT permitió I-TREATMENT un I-TREATMENT control I-TREATMENT parcial I-TREATMENT de I-TREATMENT crisis, I-TREATMENT sin I-TREATMENT SE I-TREATMENT en I-TREATMENT 18 I-TREATMENT meses, I-TREATMENT con I-TREATMENT crisis I-TREATMENT de I-TREATMENT corta I-TREATMENT duración I-TREATMENT (segundos) I-TREATMENT 3-5 I-TREATMENT por I-TREATMENT semana I-TREATMENT que I-TREATMENT no I-TREATMENT requerían I-TREATMENT uso I-TREATMENT diazepam I-TREATMENT ni I-TREATMENT provocaban I-TREATMENT alteración I-TREATMENT en I-TREATMENT actividades I-TREATMENT de I-TREATMENT vida I-TREATMENT diaria. I-TREATMENT I-TREATMENT Tercera B-PRESENT_ILLNESS hija, I-PRESENT_ILLNESS embarazo B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY normal, I-PAST_MEDICAL_HISTORY sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY epilepsia I-FAMILY_HISTORY en I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY primer I-FAMILY_HISTORY grado. I-FAMILY_HISTORY Inició B-PRESENT_ILLNESS CF I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS prolongadas, I-PRESENT_ILLNESS focales, I-PRESENT_ILLNESS clonías I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hemicara I-PRESENT_ILLNESS y I-PRESENT_ILLNESS SE I-PRESENT_ILLNESS febriles I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mulitples I-PRESENT_ILLNESS EEG I-PRESENT_ILLNESS standard I-PRESENT_ILLNESS normales. I-PRESENT_ILLNESS A I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS agregan I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS afebriles I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS gatilladas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadros I-PRESENT_ILLNESS infecciosos. I-PRESENT_ILLNESS Posterior I-PRESENT_ILLNESS al I-PRESENT_ILLNESS año I-PRESENT_ILLNESS persistió I-PRESENT_ILLNESS con I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS afebriles I-PRESENT_ILLNESS hemigeneralizadas, I-PRESENT_ILLNESS mioclónicas, I-PRESENT_ILLNESS ausencias I-PRESENT_ILLNESS atípicas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tónicas I-PRESENT_ILLNESS clónicas I-PRESENT_ILLNESS generalizadas I-PRESENT_ILLNESS precipitadas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS foto I-PRESENT_ILLNESS estimulación. I-PRESENT_ILLNESS Entre I-PRESENT_ILLNESS el I-PRESENT_ILLNESS primer I-PRESENT_ILLNESS y I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS año I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS SE I-PRESENT_ILLNESS que I-PRESENT_ILLNESS requirieron I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuidados I-PRESENT_ILLNESS intensivos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS hospitalizaciones I-PRESENT_ILLNESS por I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS prolongadas. I-PRESENT_ILLNESS La B-TREATMENT triasociación I-TREATMENT de I-TREATMENT fenobarbital, I-TREATMENT ácido I-TREATMENT valproico I-TREATMENT y I-TREATMENT levetiracetam I-TREATMENT no I-TREATMENT logró I-TREATMENT control I-TREATMENT de I-TREATMENT crisis. I-TREATMENT La B-EXPLORATION RM I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION estudios I-EXPLORATION metabólicos I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION retraso I-EVOLUTION de I-EVOLUTION lenguaje, I-EVOLUTION compromiso I-EVOLUTION motor I-EVOLUTION de I-EVOLUTION menor I-EVOLUTION cuantía I-EVOLUTION y I-EVOLUTION microcefalia. I-EVOLUTION A B-EXPLORATION la I-EXPLORATION edad I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION años I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION SCN1A I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION c.3311C>A I-EXPLORATION (p.Ser1104X) I-EXPLORATION exón I-EXPLORATION 16 I-EXPLORATION en I-EXPLORATION estado I-EXPLORATION heterocigoto I-EXPLORATION para I-EXPLORATION el I-EXPLORATION gen. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION padres I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT topiramato, I-TREATMENT clobazam I-TREATMENT y I-TREATMENT Levetiracetam I-TREATMENT permitió I-TREATMENT controlar I-TREATMENT crisis I-TREATMENT prolongadas. I-TREATMENT Sin B-EVOLUTION SE I-EVOLUTION desde I-EVOLUTION 9 I-EVOLUTION meses I-EVOLUTION pero I-EVOLUTION ha I-EVOLUTION persistido I-EVOLUTION con I-EVOLUTION 5-7 I-EVOLUTION crisis I-EVOLUTION semanales I-EVOLUTION de I-EVOLUTION corta I-EVOLUTION duración I-EVOLUTION que I-EVOLUTION no I-EVOLUTION requieren I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION benzodiacepinas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS sano, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY controlado, I-PAST_MEDICAL_HISTORY nacido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY 38 I-PAST_MEDICAL_HISTORY semanas, I-PAST_MEDICAL_HISTORY pequeña I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional I-PAST_MEDICAL_HISTORY (2.670 I-PAST_MEDICAL_HISTORY kg). I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS coluria, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS buen I-PRESENT_ILLNESS incremento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS derivada I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS regional I-PRESENT_ILLNESS para I-PRESENT_ILLNESS estudio. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Exámenes B-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION colestásico, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION destacaba I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION (BT), I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bilirrubina I-EXPLORATION directa I-EXPLORATION (BD) I-EXPLORATION (12, I-EXPLORATION 75 I-EXPLORATION mg/dl-10, I-EXPLORATION 18 I-EXPLORATION mg/dl) I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION elevadas, I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION la I-EXPLORATION gamma I-EXPLORATION glutamil I-EXPLORATION transpeptidasa I-EXPLORATION (GGT) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION (FA). I-EXPLORATION I-EXPLORATION En I-EXPLORATION Hospital I-EXPLORATION regional I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION hepatitis I-EXPLORATION viral, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION tomó I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION negativas. I-EXPLORATION Evolucionó B-EVOLUTION favorablemente I-EVOLUTION pero I-EVOLUTION se I-EVOLUTION constataron I-EVOLUTION deposiciones I-EVOLUTION acólicas. I-EVOLUTION Se B-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO gastroenterología I-DERIVED_FROM/TO previos B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION control I-EXPLORATION que I-EXPLORATION mantenían I-EXPLORATION patrón I-EXPLORATION colestásico I-EXPLORATION con I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION BD I-EXPLORATION y I-EXPLORATION de I-EXPLORATION las I-EXPLORATION transaminasas: I-EXPLORATION BT I-EXPLORATION 10, I-EXPLORATION 58, I-EXPLORATION BD I-EXPLORATION 7, I-EXPLORATION 88, I-EXPLORATION GOT I-EXPLORATION 204, I-EXPLORATION GPT I-EXPLORATION 109, I-EXPLORATION GGT I-EXPLORATION 550. I-EXPLORATION I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 52 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION vida I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION dilatación I-EXPLORATION arrosariada I-EXPLORATION de I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION y I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION presente I-EXPLORATION pero I-EXPLORATION colapsada I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION del I-EXPLORATION ayuno. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION y I-EXPLORATION la I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION diferir I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colangio-resonancia. I-EXPLORATION Esta I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION hígado I-EXPLORATION normal I-EXPLORATION con I-EXPLORATION parénquima I-EXPLORATION conservado, I-EXPLORATION leve I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION ductos I-EXPLORATION biliares I-EXPLORATION intrahepáticos I-EXPLORATION hasta I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION su I-EXPLORATION confluencia, I-EXPLORATION hacia I-EXPLORATION distal I-EXPLORATION no I-EXPLORATION se I-EXPLORATION logró I-EXPLORATION visualizar I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT resultado I-TREATMENT de I-TREATMENT la I-TREATMENT colangio-resonancia I-TREATMENT se I-TREATMENT sospechó I-TREATMENT atresia I-TREATMENT de I-TREATMENT vía I-TREATMENT biliar I-TREATMENT y I-TREATMENT se I-TREATMENT decidió I-TREATMENT cirugía I-TREATMENT de I-TREATMENT derivación I-TREATMENT bilio-digestiva I-TREATMENT (Kasai). I-TREATMENT Llamaba B-EXPLORATION la I-EXPLORATION atención I-EXPLORATION que I-EXPLORATION en I-EXPLORATION exámenes I-EXPLORATION seriados I-EXPLORATION la I-EXPLORATION bilirrubina I-EXPLORATION había I-EXPLORATION ido I-EXPLORATION en I-EXPLORATION disminución I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION la I-EXPLORATION ictericia. I-EXPLORATION Por I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION deposiciones I-EXPLORATION acólicas I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION exploración I-EXPLORATION quirúrgica. I-EXPLORATION I-EXPLORATION Durante I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION superficie I-EXPLORATION hepática I-EXPLORATION lisa, I-EXPLORATION hígado I-EXPLORATION congestivo I-EXPLORATION (confirmado I-EXPLORATION por I-EXPLORATION biopsia), I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION presente, I-EXPLORATION con I-EXPLORATION lumen I-EXPLORATION y I-EXPLORATION bilis I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION colangiografía I-EXPLORATION intraoperatoria I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION estenótica I-EXPLORATION crítica I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION hepático I-EXPLORATION común I-EXPLORATION logrando I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION hacia I-EXPLORATION proximal I-EXPLORATION y I-EXPLORATION distal I-EXPLORATION (intra I-EXPLORATION y I-EXPLORATION extra I-EXPLORATION hepático), I-EXPLORATION con I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION dilatada. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT disección I-TREATMENT de I-TREATMENT conducto I-TREATMENT hepático I-TREATMENT común I-TREATMENT demostrando I-TREATMENT una I-TREATMENT estenosis I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT éste, I-TREATMENT causado I-TREATMENT por I-TREATMENT un I-TREATMENT anillo I-TREATMENT vascular I-TREATMENT proveniente I-TREATMENT de I-TREATMENT arteria I-TREATMENT hepática I-TREATMENT derecha. I-TREATMENT Se I-TREATMENT seccionó I-TREATMENT la I-TREATMENT vía I-TREATMENT biliar I-TREATMENT a I-TREATMENT nivel I-TREATMENT proximal I-TREATMENT de I-TREATMENT la I-TREATMENT estenosis I-TREATMENT realizando I-TREATMENT una I-TREATMENT hepático-duodeno I-TREATMENT anastomosis. I-TREATMENT Se I-TREATMENT dejó I-TREATMENT drenaje I-TREATMENT abdominal I-TREATMENT y I-TREATMENT sonda I-TREATMENT nasogástrica I-TREATMENT instalada. I-TREATMENT B-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION con I-EVOLUTION débito I-EVOLUTION en I-EVOLUTION disminución I-EVOLUTION por I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION retirándose I-EVOLUTION al I-EVOLUTION 6 I-EVOLUTION día I-EVOLUTION y I-EVOLUTION alimentándose I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION días. I-EVOLUTION Se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION días I-EVOLUTION post I-EVOLUTION operatorio I-EVOLUTION con I-EVOLUTION pruebas I-EVOLUTION hepáticas I-EVOLUTION en I-EVOLUTION disminución I-EVOLUTION (BT I-EVOLUTION 3, I-EVOLUTION 98, I-EVOLUTION BD I-EVOLUTION 3, I-EVOLUTION 46, I-EVOLUTION GOT I-EVOLUTION 266, I-EVOLUTION GPT I-EVOLUTION 134, I-EVOLUTION FA I-EVOLUTION 431, I-EVOLUTION GGT I-EVOLUTION 586). I-EVOLUTION En I-EVOLUTION controles I-EVOLUTION ambulatorios I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION asintomática, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION tolerancia I-EVOLUTION oral, I-EVOLUTION deposiciones I-EVOLUTION teñidas I-EVOLUTION y I-EVOLUTION exámenes I-EVOLUTION hepáticos I-EVOLUTION y I-EVOLUTION generales I-EVOLUTION normalizados. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS mejilla I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS asimetría I-PRESENT_ILLNESS facial, I-PRESENT_ILLNESS descenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS comisura I-PRESENT_ILLNESS oral I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS esqueletal, I-PRESENT_ILLNESS cuya I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS radiología I-PRESENT_ILLNESS era I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ML. I-PRESENT_ILLNESS La B-EXPLORATION ecografía I-EXPLORATION facial, I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 18 I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION edad, I-EXPLORATION realizada I-EXPLORATION con I-EXPLORATION transductor I-EXPLORATION lineal I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución, I-EXPLORATION mostraba I-EXPLORATION lesión I-EXPLORATION predominantemente I-EXPLORATION micro I-EXPLORATION quística, I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION quistes I-EXPLORATION que I-EXPLORATION superaban I-EXPLORATION los I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION I-EXPLORATION Se B-TREATMENT planificó I-TREATMENT realizar I-TREATMENT esclerosis I-TREATMENT seriada I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT para I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT utilizó I-TREATMENT en I-TREATMENT 2 I-TREATMENT ocasiones I-TREATMENT + I-TREATMENT OK-432 I-TREATMENT y I-TREATMENT en I-TREATMENT las I-TREATMENT 2 I-TREATMENT siguientes I-TREATMENT Bleomicina. I-TREATMENT Todas I-TREATMENT se I-TREATMENT realizaron I-TREATMENT con I-TREATMENT 6-8 I-TREATMENT semanas I-TREATMENT de I-TREATMENT intervalo I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general. I-TREATMENT El I-TREATMENT procedimiento I-TREATMENT consistió I-TREATMENT en I-TREATMENT el I-TREATMENT aspirado I-TREATMENT del I-TREATMENT contenido I-TREATMENT de I-TREATMENT los I-TREATMENT quistes I-TREATMENT de I-TREATMENT mayor I-TREATMENT tamaño I-TREATMENT e I-TREATMENT inyección I-TREATMENT de I-TREATMENT OK I-TREATMENT 432, I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 0, I-TREATMENT 1 I-TREATMENT mg I-TREATMENT disueltos I-TREATMENT en I-TREATMENT 10 I-TREATMENT cc I-TREATMENT de I-TREATMENT volumen I-TREATMENT total. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION primer I-EVOLUTION procedimiento, I-EVOLUTION al I-EVOLUTION 4° I-EVOLUTION día I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION importante I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION e I-EVOLUTION inició I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION escarlatina, I-EVOLUTION evolucionando I-EVOLUTION con I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION proyección I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mejilla I-EVOLUTION e I-EVOLUTION induración I-EVOLUTION local. I-EVOLUTION Similar B-TREATMENT procedimiento I-TREATMENT se I-TREATMENT realizó I-TREATMENT con I-TREATMENT la I-TREATMENT Bleomicina I-TREATMENT cuyas I-TREATMENT dosis I-TREATMENT no I-TREATMENT sobrepasaban I-TREATMENT 0, I-TREATMENT 3-1 I-TREATMENT mg/kg I-TREATMENT por I-TREATMENT sesión. I-TREATMENT En I-TREATMENT las I-TREATMENT posteriores I-TREATMENT infiltraciones, I-TREATMENT presentó I-TREATMENT aumento I-TREATMENT de I-TREATMENT volumen I-TREATMENT más I-TREATMENT discreto I-TREATMENT y I-TREATMENT con I-TREATMENT menor I-TREATMENT reacción I-TREATMENT local. I-TREATMENT I-TREATMENT A I-TREATMENT la I-TREATMENT edad I-TREATMENT de I-TREATMENT 2 I-TREATMENT años I-TREATMENT 4 I-TREATMENT meses, I-TREATMENT con I-TREATMENT la I-TREATMENT lesión I-TREATMENT más I-TREATMENT circunscrita, I-TREATMENT se I-TREATMENT consideró I-TREATMENT que I-TREATMENT no I-TREATMENT tenía I-TREATMENT mayor I-TREATMENT beneficio I-TREATMENT continuar I-TREATMENT con I-TREATMENT las I-TREATMENT esclerosis I-TREATMENT y I-TREATMENT se I-TREATMENT planificó I-TREATMENT extirpación I-TREATMENT quirúrgica I-TREATMENT intralesional. I-TREATMENT Se I-TREATMENT utilizó I-TREATMENT abordaje I-TREATMENT externo I-TREATMENT submandibular I-TREATMENT derecho, I-TREATMENT con I-TREATMENT resección I-TREATMENT parcial I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT la I-TREATMENT que I-TREATMENT comprometía I-TREATMENT espesor I-TREATMENT completo I-TREATMENT de I-TREATMENT la I-TREATMENT mejilla I-TREATMENT incluyendo I-TREATMENT musculatura I-TREATMENT facial I-TREATMENT y I-TREATMENT mucosa I-TREATMENT vestibular. I-TREATMENT A I-TREATMENT los I-TREATMENT 15 I-TREATMENT días I-TREATMENT post I-TREATMENT operatorio I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT compresivo I-TREATMENT elástico I-TREATMENT y I-TREATMENT masoterapia, I-TREATMENT intentándose I-TREATMENT compresión I-TREATMENT externa I-TREATMENT con I-TREATMENT máscara I-TREATMENT de I-TREATMENT acrílico I-TREATMENT pero I-TREATMENT que I-TREATMENT fue I-TREATMENT mal I-TREATMENT tolerada I-TREATMENT por I-TREATMENT la I-TREATMENT paciente. I-TREATMENT I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION ML I-EXPLORATION microquístico I-EXPLORATION con I-EXPLORATION intersticio I-EXPLORATION fibroso I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION inflamatoria I-EXPLORATION linfocitaria. I-EXPLORATION Seis B-TREATMENT meses I-TREATMENT después I-TREATMENT se I-TREATMENT planificó I-TREATMENT nueva I-TREATMENT resección I-TREATMENT utilizando I-TREATMENT el I-TREATMENT mismo I-TREATMENT abordaje I-TREATMENT y I-TREATMENT extirpando I-TREATMENT lesión I-TREATMENT remanente I-TREATMENT hacia I-TREATMENT cefálico. I-TREATMENT En B-EVOLUTION el I-EVOLUTION post I-EVOLUTION operatorio I-EVOLUTION se I-EVOLUTION mantuvieron I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION de I-EVOLUTION compresión I-EVOLUTION facial I-EVOLUTION previas I-EVOLUTION a I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Después I-EVOLUTION de I-EVOLUTION varios I-EVOLUTION años I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION molestias I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION lesiones I-EVOLUTION vesiculares I-EVOLUTION en I-EVOLUTION vestíbulo I-EVOLUTION oral I-EVOLUTION que I-EVOLUTION se I-EVOLUTION mordía I-EVOLUTION con I-EVOLUTION frecuencia, I-EVOLUTION siendo I-EVOLUTION interpretadas I-EVOLUTION como I-EVOLUTION recidiva I-EVOLUTION local I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ML. I-EVOLUTION A B-TREATMENT los I-TREATMENT 9 I-TREATMENT años I-TREATMENT de I-TREATMENT edad, I-TREATMENT se I-TREATMENT realizó I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT con I-TREATMENT abordaje I-TREATMENT intraoral, I-TREATMENT cuya I-TREATMENT biopsia I-TREATMENT mostraba I-TREATMENT ML I-TREATMENT con I-TREATMENT fibrosis I-TREATMENT difusa. I-TREATMENT Dado B-DERIVED_FROM/TO el I-DERIVED_FROM/TO difícil I-DERIVED_FROM/TO manejo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO cicatrización I-DERIVED_FROM/TO intraoral I-DERIVED_FROM/TO ya I-DERIVED_FROM/TO que I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO se I-DERIVED_FROM/TO mordía I-DERIVED_FROM/TO con I-DERIVED_FROM/TO frecuencia I-DERIVED_FROM/TO presentando I-DERIVED_FROM/TO sangramiento I-DERIVED_FROM/TO e I-DERIVED_FROM/TO inflamación I-DERIVED_FROM/TO local, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO ortodoncia I-DERIVED_FROM/TO para I-DERIVED_FROM/TO manejo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO su I-DERIVED_FROM/TO anomalía I-DERIVED_FROM/TO dentomaxilar I-DERIVED_FROM/TO y I-DERIVED_FROM/TO confección I-DERIVED_FROM/TO de I-DERIVED_FROM/TO un I-DERIVED_FROM/TO plano I-DERIVED_FROM/TO de I-DERIVED_FROM/TO apoyo I-DERIVED_FROM/TO intraoral. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-TREATMENT diseñó I-TREATMENT un I-TREATMENT aparato I-TREATMENT intraoral I-TREATMENT con I-TREATMENT prolongación I-TREATMENT vestibular I-TREATMENT completa I-TREATMENT que I-TREATMENT proporcionaba I-TREATMENT un I-TREATMENT buen I-TREATMENT plano I-TREATMENT de I-TREATMENT apoyo I-TREATMENT intraoral I-TREATMENT que I-TREATMENT potenciaba I-TREATMENT la I-TREATMENT compresión I-TREATMENT externa, I-TREATMENT Además I-TREATMENT se I-TREATMENT instaló I-TREATMENT aparatología I-TREATMENT ortodóncica I-TREATMENT fija I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT dentaria I-TREATMENT anterosuperior I-TREATMENT para I-TREATMENT alinear I-TREATMENT y I-TREATMENT nivelar I-TREATMENT el I-TREATMENT sector I-TREATMENT incisivo. I-TREATMENT La I-TREATMENT compresión I-TREATMENT interna/externa I-TREATMENT se I-TREATMENT indicó I-TREATMENT por I-TREATMENT 15 I-TREATMENT h I-TREATMENT diarias, I-TREATMENT con I-TREATMENT controles I-TREATMENT del I-TREATMENT aparato I-TREATMENT y I-TREATMENT rebasado I-TREATMENT de I-TREATMENT acrílico I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT al I-TREATMENT espacio I-TREATMENT que I-TREATMENT se I-TREATMENT iba I-TREATMENT produciendo I-TREATMENT en I-TREATMENT el I-TREATMENT vestíbulo. I-TREATMENT I-TREATMENT Dado I-TREATMENT que I-TREATMENT el I-TREATMENT seguimiento I-TREATMENT de I-TREATMENT los I-TREATMENT últimos I-TREATMENT 4 I-TREATMENT años I-TREATMENT no I-TREATMENT mostró I-TREATMENT recidiva I-TREATMENT local I-TREATMENT y I-TREATMENT la I-TREATMENT comisura I-TREATMENT oral I-TREATMENT derecha I-TREATMENT se I-TREATMENT encontraba I-TREATMENT descendida I-TREATMENT e I-TREATMENT inanimada, I-TREATMENT se I-TREATMENT programó I-TREATMENT una I-TREATMENT nueva I-TREATMENT cirugía I-TREATMENT para I-TREATMENT suspender I-TREATMENT la I-TREATMENT comisura I-TREATMENT derecha, I-TREATMENT ayudado I-TREATMENT por I-TREATMENT el I-TREATMENT soporte I-TREATMENT intraoral I-TREATMENT al I-TREATMENT que I-TREATMENT se I-TREATMENT le I-TREATMENT rebasa I-TREATMENT material I-TREATMENT semanalmente I-TREATMENT agregando I-TREATMENT una I-TREATMENT zona I-TREATMENT más I-TREATMENT alta I-TREATMENT que I-TREATMENT levanta I-TREATMENT y I-TREATMENT da I-TREATMENT soporte I-TREATMENT a I-TREATMENT la I-TREATMENT comisura. I-TREATMENT I-TREATMENT Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY proteína I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY leche I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vaca, I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY contrapruebas I-PAST_MEDICAL_HISTORY positivas, I-PAST_MEDICAL_HISTORY alimentada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lactancia I-PAST_MEDICAL_HISTORY materna I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dieta I-PAST_MEDICAL_HISTORY hipoalergénica. I-PAST_MEDICAL_HISTORY Tuvo I-PAST_MEDICAL_HISTORY adecuado I-PAST_MEDICAL_HISTORY incremento I-PAST_MEDICAL_HISTORY pondoestatural I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY (P/T I-PAST_MEDICAL_HISTORY –0, I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY DS I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY T/E I-PAST_MEDICAL_HISTORY –0, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY DS), I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY evolucionó I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY estacionario I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY caída I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY curva I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY talla I-PAST_MEDICAL_HISTORY (P/T I-PAST_MEDICAL_HISTORY –0, I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY DS I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY T/E I-PAST_MEDICAL_HISTORY –0, I-PAST_MEDICAL_HISTORY 8). I-PAST_MEDICAL_HISTORY Por B-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS modo I-PRESENT_ILLNESS intercurrente I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS alta I-PRESENT_ILLNESS se I-PRESENT_ILLNESS solicitaron I-PRESENT_ILLNESS exámenes I-PRESENT_ILLNESS generales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS orina, I-PRESENT_ILLNESS compatibles I-PRESENT_ILLNESS con I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tracto I-PRESENT_ILLNESS urinario. I-PRESENT_ILLNESS Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION mostraron I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION severa I-EXPLORATION de I-EXPLORATION las I-EXPLORATION FA I-EXPLORATION (4.552 I-EXPLORATION UI/l), I-EXPLORATION calcio, I-EXPLORATION fósforo I-EXPLORATION y I-EXPLORATION enzimas I-EXPLORATION hepáticas I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION isoenzimas I-EXPLORATION que I-EXPLORATION revelaron I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fracción I-EXPLORATION ósea I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION hepática I-EXPLORATION de I-EXPLORATION 96, I-EXPLORATION 3% I-EXPLORATION a I-EXPLORATION 3, I-EXPLORATION 7% I-EXPLORATION respectivamente. I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION FA I-EVOLUTION a I-EVOLUTION 269 I-EVOLUTION UI/l I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION y I-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION curva I-EVOLUTION pondoestatural. I-EVOLUTION I-EVOLUTION Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS sana, I-PRESENT_ILLNESS buen I-PRESENT_ILLNESS incremento I-PRESENT_ILLNESS pondoestatural I-PRESENT_ILLNESS (P/T I-PRESENT_ILLNESS –0, I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS DS I-PRESENT_ILLNESS y I-PRESENT_ILLNESS T/E I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS DS), I-PRESENT_ILLNESS que I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS curso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS prolongado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS inapetencia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS se B-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION elevación I-EXPLORATION severa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION FA I-EXPLORATION (5.553 I-EXPLORATION UI/l), I-EXPLORATION la I-EXPLORATION medición I-EXPLORATION de I-EXPLORATION isoenzimas I-EXPLORATION evidenció I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fracción I-EXPLORATION ósea I-EXPLORATION —75%— I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION hepática I-EXPLORATION —24%—. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteración I-EXPLORATION hepática, I-EXPLORATION ni I-EXPLORATION ósea, I-EXPLORATION con I-EXPLORATION hemograma, I-EXPLORATION VHS, I-EXPLORATION transaminasas, I-EXPLORATION calcio, I-EXPLORATION fósforo, I-EXPLORATION hormona I-EXPLORATION paratiroidea I-EXPLORATION (PTH), I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION 25-OH I-EXPLORATION vit. I-EXPLORATION D3 I-EXPLORATION y I-EXPLORATION cintigrafía I-EXPLORATION ósea I-EXPLORATION normales. I-EXPLORATION El B-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION FA I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION mostraron I-EVOLUTION un I-EVOLUTION leve I-EVOLUTION ascenso I-EVOLUTION con I-EVOLUTION respecto I-EVOLUTION al I-EVOLUTION valor I-EVOLUTION previo I-EVOLUTION (5.857 I-EVOLUTION UI/l), I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION recuperación I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION cuadro I-EVOLUTION febril I-EVOLUTION intercurrente; I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION disminuyeron I-EVOLUTION a I-EVOLUTION 631 I-EVOLUTION UI/l, I-EVOLUTION normalizándose I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION con I-EVOLUTION un I-EVOLUTION valor I-EVOLUTION de I-EVOLUTION 297 I-EVOLUTION U/l. I-EVOLUTION I-EVOLUTION Prees B-PAST_MEDICAL_HISTORY colar I-PAST_MEDICAL_HISTORY femenino B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS portador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cromosomopatia I-PAST_MEDICAL_HISTORY compleja I-PAST_MEDICAL_HISTORY 46XX I-PAST_MEDICAL_HISTORY add I-PAST_MEDICAL_HISTORY (8). I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS placas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ampollas I-PRESENT_ILLNESS localizadas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS mente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS extremidades, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS alta, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS antibiótico I-PRESENT_ILLNESS indicado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS sospecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS impetigo I-PRESENT_ILLNESS ampollar. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION placas I-EXPLORATION eritemato-violáceas, I-EXPLORATION con I-EXPLORATION centro I-EXPLORATION ampollar I-EXPLORATION en I-EXPLORATION dorso, I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores, I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION placas I-EXPLORATION y I-EXPLORATION nódulos I-EXPLORATION eritematosos I-EXPLORATION en I-EXPLORATION brazo I-EXPLORATION y I-EXPLORATION muslo I-EXPLORATION izquierdo. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacó I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (RAN I-EXPLORATION 45954/mm3) I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION elevada I-EXPLORATION (347 I-EXPLORATION mg/L). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION cutáneas I-EXPLORATION con I-EXPLORATION hallazgos I-EXPLORATION histopatológicos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION Síndrome I-EXPLORATION de I-EXPLORATION Sweet. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 1 I-TREATMENT mg/ I-TREATMENT kg/día, I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION presentaba I-EVOLUTION placas I-EVOLUTION costrosas I-EVOLUTION de I-EVOLUTION menor I-EVOLUTION tamaño, I-EVOLUTION sin I-EVOLUTION lesiones I-EVOLUTION ampollares. I-EVOLUTION I-EVOLUTION Recién B-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS gestacional, I-PRESENT_ILLNESS nacido B-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sepsis I-PAST_MEDICAL_HISTORY materna. I-PAST_MEDICAL_HISTORY Madre B-FAMILY_HISTORY de I-FAMILY_HISTORY 19 I-FAMILY_HISTORY años I-FAMILY_HISTORY de I-FAMILY_HISTORY edad I-FAMILY_HISTORY falleció I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY puerperio I-FAMILY_HISTORY inme I-FAMILY_HISTORY diato I-FAMILY_HISTORY por I-FAMILY_HISTORY sepsis I-FAMILY_HISTORY grave, I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY consanguinidad, I-FAMILY_HISTORY el B-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY controlado, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY reporte I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY ultrasonidos I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY signos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hidrops I-PAST_MEDICAL_HISTORY (derrame I-PAST_MEDICAL_HISTORY pleural, I-PAST_MEDICAL_HISTORY derrame I-PAST_MEDICAL_HISTORY pericárdico I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY asci I-PAST_MEDICAL_HISTORY tis). I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2090g, I-PAST_MEDICAL_HISTORY APGAR I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY minuto I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY minutos. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY examen I-PAST_MEDICAL_HISTORY clínico I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY fenotipo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY sugiera I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY genético. I-PAST_MEDICAL_HISTORY Dos B-PRESENT_ILLNESS horas I-PRESENT_ILLNESS después I-PRESENT_ILLNESS del I-PRESENT_ILLNESS nacimiento I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS taquipnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cianosis I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS grave. I-PRESENT_ILLNESS Fue B-TREATMENT tratado I-TREATMENT con I-TREATMENT surfactante I-TREATMENT exógeno I-TREATMENT de I-TREATMENT rescate I-TREATMENT por I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT signos I-TREATMENT y I-TREATMENT síntomas I-TREATMENT de I-TREATMENT síndrome I-TREATMENT de I-TREATMENT dificultad I-TREATMENT respiratoria, I-TREATMENT catecolaminas, I-TREATMENT antibióticos I-TREATMENT y I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT por I-TREATMENT 22 I-TREATMENT días; I-TREATMENT la I-TREATMENT ventilación I-TREATMENT convencional I-TREATMENT con I-TREATMENT presión I-TREATMENT media I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea I-TREATMENT máxima I-TREATMENT de I-TREATMENT 16 I-TREATMENT cm I-TREATMENT H2O, I-TREATMENT seguida I-TREATMENT de I-TREATMENT VAFO I-TREATMENT por I-TREATMENT acidosis I-TREATMENT respiratoria I-TREATMENT e I-TREATMENT hipoxemia I-TREATMENT refrac I-TREATMENT taria I-TREATMENT (pCO2 I-TREATMENT 75 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT pO2 I-TREATMENT 45 I-TREATMENT mmHg). I-TREATMENT I-TREATMENT La B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION infiltración I-EXPLORATION reticular I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION pulmones I-EXPLORATION y I-EXPLORATION sobre I-EXPLORATION distención I-EXPLORATION pulmonar I-EXPLORATION sin I-EXPLORATION consolidaciones. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION describió I-EXPLORATION cambios I-EXPLORATION reticulares I-EXPLORATION en I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION zonas, I-EXPLORATION engrosamiento I-EXPLORATION intersticial, I-EXPLORATION múltiples I-EXPLORATION bullas I-EXPLORATION y I-EXPLORATION atrapamiento I-EXPLORATION de I-EXPLORATION aire I-EXPLORATION en I-EXPLORATION pulmón I-EXPLORATION izquierdo, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION neumonía I-EXPLORATION derecha I-EXPLORATION (Fi I-EXPLORATION gura I-EXPLORATION 2). I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION linfangiectasia I-EXPLORATION en I-EXPLORATION otros I-EXPLORATION órganos I-EXPLORATION por I-EXPLORATION TAC I-EXPLORATION abdominal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION por I-EXPLORATION indicación I-EXPLORATION de I-EXPLORATION cirugía I-EXPLORATION pediátrica I-EXPLORATION lobectomía I-EXPLORATION inferior I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION dilatación I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION los I-EXPLORATION canales I-EXPLORATION linfáti I-EXPLORATION cos I-EXPLORATION broncovasculares,. I-EXPLORATION Por I-EXPLORATION ecocardiografía I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION comunicación I-EXPLORATION interauricular I-EXPLORATION (CIA) I-EXPLORATION y I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION conducto I-EXPLORATION arterioso I-EXPLORATION (PCA) I-EXPLORATION y I-EXPLORATION fueron I-EXPLORATION corregidas I-EXPLORATION quirúrgicamente I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 30 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION vida I-EXPLORATION extra I-EXPLORATION uterina. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION satisfactoria, I-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION pediátrico I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 19 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION edad I-EVOLUTION reportó I-EVOLUTION peso I-EVOLUTION y I-EVOLUTION talla I-EVOLUTION adecuados I-EVOLUTION para I-EVOLUTION su I-EVOLUTION edad, I-EVOLUTION desarrollo I-EVOLUTION psicomotor I-EVOLUTION nor I-EVOLUTION mal, I-EVOLUTION sin I-EVOLUTION cuadros I-EVOLUTION infecciosos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION vía I-EVOLUTION respiratoria I-EVOLUTION in I-EVOLUTION ferior, I-EVOLUTION no I-EVOLUTION requirió I-EVOLUTION oxigeno I-EVOLUTION suplementario; I-EVOLUTION la I-EVOLUTION TAC I-EVOLUTION de I-EVOLUTION tórax I-EVOLUTION de I-EVOLUTION control I-EVOLUTION informó I-EVOLUTION con I-EVOLUTION engrosamiento I-EVOLUTION intersti I-EVOLUTION cial, I-EVOLUTION bullas I-EVOLUTION enfisematosas I-EVOLUTION difusas I-EVOLUTION pequeñas I-EVOLUTION y I-EVOLUTION mejoría I-EVOLUTION con I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION TAC I-EVOLUTION inicial,. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS cursando B-PAST_MEDICAL_HISTORY escarlatina, I-PAST_MEDICAL_HISTORY quien B-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ictericia, I-PRESENT_ILLNESS coluria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS del I-PRESENT_ILLNESS apetito. I-PRESENT_ILLNESS Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION revelaron I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION transaminasas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION y I-EXPLORATION directa, I-EXPLORATION y I-EXPLORATION estudios I-EXPLORATION vira I-EXPLORATION les I-EXPLORATION negativos I-EXPLORATION para I-EXPLORATION Hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION Virus I-EXPLORATION de I-EXPLORATION Epstein I-EXPLORATION Barr, I-EXPLORATION Parvovirus I-EXPLORATION B19, I-EXPLORATION Citomegalovirus, I-EXPLORATION Virus I-EXPLORATION Herpes I-EXPLORATION 6 I-EXPLORATION y I-EXPLORATION Herpes I-EXPLORATION simplex I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2. I-EXPLORATION Ecografía I-EXPLORATION abdominal I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano. I-PAST_MEDICAL_HISTORY Comenzó B-PRESENT_ILLNESS con I-PRESENT_ILLNESS dermato I-PRESENT_ILLNESS sis I-PRESENT_ILLNESS generalizada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS máximo I-PRESENT_ILLNESS lesional I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS umbilical, I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS y I-PRESENT_ILLNESS genitales, I-PRESENT_ILLNESS caracterizada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ampollas, I-PRESENT_ILLNESS algunas I-PRESENT_ILLNESS denudadas I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sangrado I-PRESENT_ILLNESS fácil, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS mucoso I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Se B-TREATMENT diagnosticó I-TREATMENT impétigo I-TREATMENT bulloso I-TREATMENT y I-TREATMENT se I-TREATMENT indicó I-TREATMENT antibioticoterapia I-TREATMENT tópica I-TREATMENT y I-TREATMENT sistémica I-TREATMENT sin I-TREATMENT mejoría I-TREATMENT clínica. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION extensión I-EVOLUTION lesional, I-EVOLUTION con I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION mucosas I-EVOLUTION oral I-EVOLUTION y I-EVOLUTION anal. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION e I-EXPLORATION inmunohistoquí- I-EXPLORATION mico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION perilesional I-EXPLORATION confirmó I-EXPLORATION pénfigo I-EXPLORATION vulgar. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT corticoideo I-TREATMENT e I-TREATMENT inmunomodulador I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT I-TREATMENT Recién B-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS término I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS semanas, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS mascu I-PRESENT_ILLNESS lino, I-PRESENT_ILLNESS embarazo B-PAST_MEDICAL_HISTORY controlado, I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY eutócico, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY perinatales. I-PAST_MEDICAL_HISTORY Derivado B-DERIVED_FROM/TO a I-DERIVED_FROM/TO dermatología I-DERIVED_FROM/TO por I-DERIVED_FROM/TO placa I-DERIVED_FROM/TO eritematosa I-DERIVED_FROM/TO levemente I-DERIVED_FROM/TO infiltrada I-DERIVED_FROM/TO en I-DERIVED_FROM/TO región I-DERIVED_FROM/TO peri I-DERIVED_FROM/TO e I-DERIVED_FROM/TO infraumbilical I-DERIVED_FROM/TO presente I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO el I-DERIVED_FROM/TO nacimiento, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO bordes I-DERIVED_FROM/TO bien I-DERIVED_FROM/TO definidos I-DERIVED_FROM/TO y I-DERIVED_FROM/TO descamación I-DERIVED_FROM/TO amarillenta I-DERIVED_FROM/TO superficial I-DERIVED_FROM/TO adherente I-DERIVED_FROM/TO en I-DERIVED_FROM/TO polo I-DERIVED_FROM/TO inferior, I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO otros I-DERIVED_FROM/TO signos I-DERIVED_FROM/TO inflamatorios I-DERIVED_FROM/TO locales. I-DERIVED_FROM/TO Estudio B-EXPLORATION ecográfico I-EXPLORATION cutáneo I-EXPLORATION reveló I-EXPLORATION lesión I-EXPLORATION dermoepidérmica I-EXPLORATION hipoecogénica I-EXPLORATION homogénea, I-EXPLORATION con I-EXPLORATION extensión I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION tejido I-EXPLORATION subcutáneo I-EXPLORATION y I-EXPLORATION escasos I-EXPLORATION vasos I-EXPLORATION sinuosos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION segmento I-EXPLORATION más I-EXPLORATION profundo. I-EXPLORATION I-EXPLORATION Dado I-EXPLORATION las I-EXPLORATION características I-EXPLORATION clínicas, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION profunda I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION células I-EXPLORATION fusiformes I-EXPLORATION delgadas I-EXPLORATION en I-EXPLORATION dermis I-EXPLORATION e I-EXPLORATION hipodermis, I-EXPLORATION de I-EXPLORATION morfología I-EXPLORATION bifásica I-EXPLORATION con I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION dispuesto I-EXPLORATION en I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION arremolinado I-EXPLORATION infiltrante I-EXPLORATION y I-EXPLORATION otro I-EXPLORATION con I-EXPLORATION bandas I-EXPLORATION de I-EXPLORATION células I-EXPLORATION fusadas I-EXPLORATION con I-EXPLORATION hábitos I-EXPLORATION fibroblástico I-EXPLORATION y I-EXPLORATION miofibroblástico, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION Grenz. I-EXPLORATION En I-EXPLORATION profundidad, I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION componente I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION maduro, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION atipía. I-EXPLORATION Epidermis I-EXPLORATION madura, I-EXPLORATION parcialmente I-EXPLORATION atrófica. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION necrosis I-EXPLORATION ni I-EXPLORATION mitosis I-EXPLORATION atípicas. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION mos I-EXPLORATION tró I-EXPLORATION positividad I-EXPLORATION intensa I-EXPLORATION y I-EXPLORATION difusa I-EXPLORATION a I-EXPLORATION CD34 I-EXPLORATION y I-EXPLORATION focal I-EXPLORATION para I-EXPLORATION FXIIIa, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION inmunoreactividad I-EXPLORATION a I-EXPLORATION actina, I-EXPLORATION desmina, I-EXPLORATION MyoD1, I-EXPLORATION S100, I-EXPLORATION HMB45, I-EXPLORATION MelanA I-EXPLORATION y I-EXPLORATION EMA. I-EXPLORATION Índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION con I-EXPLORATION Ki67 I-EXPLORATION moderado, I-EXPLORATION con I-EXPLORATION positividad I-EXPLORATION en I-EXPLORATION aproximadamente I-EXPLORATION el I-EXPLORATION 20% I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células. I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION FISH I-EXPLORATION para I-EXPLORATION PDGF I-EXPLORATION beta I-EXPLORATION y I-EXPLORATION ETV6, I-EXPLORATION los I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION negativos, I-EXPLORATION excluyendo I-EXPLORATION los I-EXPLORATION diagnósticos I-EXPLORATION diferenciales I-EXPLORATION de I-EXPLORATION dermatofobrosarcoma I-EXPLORATION protuberans I-EXPLORATION congénito I-EXPLORATION y I-EXPLORATION fibrosarcoma I-EXPLORATION infantil, I-EXPLORATION respec I-EXPLORATION tivamente. I-EXPLORATION Estos I-EXPLORATION antecedentes, I-EXPLORATION sumados I-EXPLORATION a I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION histológicos, I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION HFI. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT extirpación I-TREATMENT quirúrgica I-TREATMENT por I-TREATMENT equipo I-TREATMENT de I-TREATMENT ci I-TREATMENT rugía I-TREATMENT pediátrica, I-TREATMENT con I-TREATMENT readecuación I-TREATMENT umbilical I-TREATMENT mediante I-TREATMENT colgajos I-TREATMENT de I-TREATMENT rotación I-TREATMENT laterales. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION e I-EXPLORATION inmunohistoquímico I-EXPLORATION sostuvo I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION descritos I-EXPLORATION previamente, I-EXPLORATION comprometiendo I-EXPLORATION márgenes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION quirúrgica. I-EXPLORATION Evolucionó B-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS joven I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS para I-PRESENT_ILLNESS lograr I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mejoría I-PRESENT_ILLNESS estético I-PRESENT_ILLNESS funcional I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS dedo I-PRESENT_ILLNESS pulgar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Había B-PAST_MEDICAL_HISTORY nacido I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY dedo I-PAST_MEDICAL_HISTORY pulgar I-PAST_MEDICAL_HISTORY pequeño I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY función, I-PAST_MEDICAL_HISTORY unido I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY resto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mano I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY través I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY pequeño I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY delgado I-PAST_MEDICAL_HISTORY tubo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY piel; I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY lactancia, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Hospital I-PAST_MEDICAL_HISTORY Infantil I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY habían I-PAST_MEDICAL_HISTORY únicamente I-PAST_MEDICAL_HISTORY extirpado I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY área I-PAST_MEDICAL_HISTORY cutánea I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY pequeño I-PAST_MEDICAL_HISTORY tubo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY unión I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY fin I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY lograr I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY implantación I-PAST_MEDICAL_HISTORY directa I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY apéndice I-PAST_MEDICAL_HISTORY pulgar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mano. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Cuando B-EXPLORATION acude I-EXPLORATION a I-EXPLORATION nuestra I-EXPLORATION consulta I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION pulgar I-EXPLORATION con I-EXPLORATION implantación I-EXPLORATION distal I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION metacarpofalangica I-EXPLORATION del I-EXPLORATION índice, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION primer I-EXPLORATION espacio I-EXPLORATION estrecho, I-EXPLORATION sin I-EXPLORATION capacidad I-EXPLORATION motora I-EXPLORATION de I-EXPLORATION oposición I-EXPLORATION ni I-EXPLORATION flexo-extensión, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION sensibilidad I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION bordes I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION eminencia I-EXPLORATION tenar I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION metacarpiano; I-EXPLORATION además I-EXPLORATION tenía I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION radial I-EXPLORATION pero I-EXPLORATION sí I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION adecuadamente I-EXPLORATION el I-EXPLORATION pulso I-EXPLORATION cubital. I-EXPLORATION La I-EXPLORATION parte I-EXPLORATION funcional I-EXPLORATION compensatoria I-EXPLORATION la I-EXPLORATION realizaba I-EXPLORATION con I-EXPLORATION alguna I-EXPLORATION dificultad I-EXPLORATION mediante I-EXPLORATION una I-EXPLORATION pinza I-EXPLORATION dígito-digital I-EXPLORATION lateral I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION índice I-EXPLORATION y I-EXPLORATION el I-EXPLORATION medio. I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION estudios I-EXPLORATION radiológicos I-EXPLORATION que I-EXPLORATION evidenciaron I-EXPLORATION hipoplasia I-EXPLORATION y I-EXPLORATION fusión I-EXPLORATION de I-EXPLORATION las I-EXPLORATION falanges, I-EXPLORATION agenesia I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION metacarpiano, I-EXPLORATION atrofia I-EXPLORATION del I-EXPLORATION trapecio I-EXPLORATION y I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION huesos I-EXPLORATION del I-EXPLORATION carpo, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION también I-EXPLORATION atrofia I-EXPLORATION del I-EXPLORATION radio; I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION doppler I-EXPLORATION color I-EXPLORATION revelo I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION radial I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION compensatoria I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION ulnar. I-EXPLORATION Con I-EXPLORATION este I-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION un I-EXPLORATION típico I-EXPLORATION pulgar I-EXPLORATION flotante I-EXPLORATION izquierdo I-EXPLORATION parcialmente I-EXPLORATION tratado. I-EXPLORATION I-EXPLORATION En I-EXPLORATION su I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION dominante I-EXPLORATION presentaba I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pulgar I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION anomalías: I-EXPLORATION primer I-EXPLORATION espacio I-EXPLORATION estrecho, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pliegues I-EXPLORATION de I-EXPLORATION flexión, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION eminencia I-EXPLORATION tenar, I-EXPLORATION imposibilidad I-EXPLORATION para I-EXPLORATION flexionar I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION metacarpofalángica I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION movilidad I-EXPLORATION pasiva I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma, I-EXPLORATION anquílosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION interfalángica; I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION esto I-EXPLORATION había I-EXPLORATION buena I-EXPLORATION función I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION y I-EXPLORATION con I-EXPLORATION doppler I-EXPLORATION color I-EXPLORATION no I-EXPLORATION evidenciaron I-EXPLORATION anomalías I-EXPLORATION óseas I-EXPLORATION o I-EXPLORATION vasculares. I-EXPLORATION Con I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION podríamos I-EXPLORATION clasificar I-EXPLORATION el I-EXPLORATION pulgar I-EXPLORATION derecho I-EXPLORATION en I-EXPLORATION el I-EXPLORATION grupo I-EXPLORATION I I-EXPLORATION de I-EXPLORATION Blauth. I-EXPLORATION I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectaron I-EXPLORATION otras I-EXPLORATION anomalías I-EXPLORATION corporales I-EXPLORATION congénitas. I-EXPLORATION I-EXPLORATION Tratamiento B-TREATMENT y I-TREATMENT resultados I-TREATMENT I-TREATMENT Al I-TREATMENT reconstruir I-TREATMENT un I-TREATMENT pulgar I-TREATMENT se I-TREATMENT deben I-TREATMENT tener I-TREATMENT bien I-TREATMENT claros I-TREATMENT algunos I-TREATMENT objetivos I-TREATMENT generales I-TREATMENT que I-TREATMENT ayudarán I-TREATMENT a I-TREATMENT la I-TREATMENT funcionabilidad I-TREATMENT del I-TREATMENT mismo, I-TREATMENT como I-TREATMENT son I-TREATMENT lograr I-TREATMENT estabilidad, I-TREATMENT oposición, I-TREATMENT sensibilidad, I-TREATMENT darle I-TREATMENT una I-TREATMENT longitud I-TREATMENT adecuada, I-TREATMENT darle I-TREATMENT movilidad I-TREATMENT en I-TREATMENT lo I-TREATMENT posible I-TREATMENT y I-TREATMENT un I-TREATMENT buen I-TREATMENT aspecto I-TREATMENT estético. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT de I-TREATMENT un I-TREATMENT pulgar I-TREATMENT flotante I-TREATMENT existen I-TREATMENT dos I-TREATMENT conductas I-TREATMENT básicamente I-TREATMENT opuestas, I-TREATMENT que I-TREATMENT deben I-TREATMENT discutirse I-TREATMENT ampliamente I-TREATMENT con I-TREATMENT los I-TREATMENT padres I-TREATMENT y I-TREATMENT con I-TREATMENT el I-TREATMENT paciente I-TREATMENT si I-TREATMENT éste I-TREATMENT se I-TREATMENT encuentra I-TREATMENT en I-TREATMENT una I-TREATMENT edad I-TREATMENT de I-TREATMENT comprender. I-TREATMENT I-TREATMENT Desde I-TREATMENT el I-TREATMENT punto I-TREATMENT de I-TREATMENT vista I-TREATMENT práctico I-TREATMENT se I-TREATMENT trata I-TREATMENT de I-TREATMENT decidir I-TREATMENT entre I-TREATMENT una I-TREATMENT de I-TREATMENT las I-TREATMENT siguientes I-TREATMENT actitudes I-TREATMENT terapéuticas: I-TREATMENT I-TREATMENT Amputación I-TREATMENT y I-TREATMENT reconstrucción: I-TREATMENT I-TREATMENT La I-TREATMENT amputación I-TREATMENT del I-TREATMENT pulgar I-TREATMENT flotante I-TREATMENT conducirá I-TREATMENT a I-TREATMENT una I-TREATMENT aplasia I-TREATMENT que I-TREATMENT necesitará I-TREATMENT una I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT técnicas I-TREATMENT microquirúrgicas I-TREATMENT tales I-TREATMENT como I-TREATMENT pulgarización I-TREATMENT del I-TREATMENT índice I-TREATMENT que I-TREATMENT se I-TREATMENT realiza I-TREATMENT con I-TREATMENT buenos I-TREATMENT resultados I-TREATMENT desde I-TREATMENT 1964 I-TREATMENT ( I-TREATMENT 3, I-TREATMENT 4), I-TREATMENT o I-TREATMENT la I-TREATMENT transferencia I-TREATMENT de I-TREATMENT un I-TREATMENT ortejo, I-TREATMENT técnica I-TREATMENT que I-TREATMENT conlleva I-TREATMENT muchos I-TREATMENT riesgos I-TREATMENT sobre I-TREATMENT todo I-TREATMENT cuando I-TREATMENT no I-TREATMENT se I-TREATMENT tiene I-TREATMENT un I-TREATMENT buen I-TREATMENT entrenamiento I-TREATMENT en I-TREATMENT microcirugía I-TREATMENT (5,6) I-TREATMENT o I-TREATMENT no I-TREATMENT se I-TREATMENT cuenta I-TREATMENT con I-TREATMENT la I-TREATMENT infraestructura I-TREATMENT idonea. I-TREATMENT En I-TREATMENT teoría, I-TREATMENT son I-TREATMENT las I-TREATMENT técnicas I-TREATMENT que I-TREATMENT mejor I-TREATMENT resultado I-TREATMENT estético-funcional I-TREATMENT producen. I-TREATMENT I-TREATMENT Conservación I-TREATMENT y I-TREATMENT estabilización: I-TREATMENT I-TREATMENT Son I-TREATMENT posibles I-TREATMENT tres I-TREATMENT tipos I-TREATMENT de I-TREATMENT conducta I-TREATMENT dependiendo I-TREATMENT del I-TREATMENT tipo I-TREATMENT de I-TREATMENT patología I-TREATMENT según I-TREATMENT la I-TREATMENT clasificación I-TREATMENT de I-TREATMENT Blauth I-TREATMENT I-TREATMENT -Estabilización I-TREATMENT de I-TREATMENT la I-TREATMENT articulación I-TREATMENT metacarpofalángica. I-TREATMENT -Estabilización I-TREATMENT de I-TREATMENT la I-TREATMENT metacarpofalángica I-TREATMENT más I-TREATMENT una I-TREATMENT transferencia I-TREATMENT de I-TREATMENT oposición. I-TREATMENT - I-TREATMENT Reconstrucción I-TREATMENT del I-TREATMENT metacarpiano I-TREATMENT con I-TREATMENT una I-TREATMENT transferencia I-TREATMENT ósea I-TREATMENT vascularizada I-TREATMENT o I-TREATMENT no. I-TREATMENT I-TREATMENT En I-TREATMENT nuestra I-TREATMENT paciente, I-TREATMENT una I-TREATMENT vez I-TREATMENT hecho I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT e I-TREATMENT identificados I-TREATMENT los I-TREATMENT problemas, I-TREATMENT se I-TREATMENT plantearon I-TREATMENT a I-TREATMENT la I-TREATMENT madre I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT las I-TREATMENT conductas I-TREATMENT quirúrgicas I-TREATMENT presentadas I-TREATMENT anteriormente, I-TREATMENT pero I-TREATMENT en I-TREATMENT definitiva I-TREATMENT fue I-TREATMENT sumamente I-TREATMENT difícil I-TREATMENT convencerlas I-TREATMENT de I-TREATMENT amputar I-TREATMENT el I-TREATMENT pulgar I-TREATMENT vestigial I-TREATMENT y I-TREATMENT reconstruirlo I-TREATMENT con I-TREATMENT una I-TREATMENT pulgarización I-TREATMENT del I-TREATMENT índice, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT tomó I-TREATMENT la I-TREATMENT decisión I-TREATMENT de I-TREATMENT reconstrucción I-TREATMENT y I-TREATMENT estabilización I-TREATMENT del I-TREATMENT metacarpiano. I-TREATMENT I-TREATMENT Debido I-TREATMENT a I-TREATMENT que I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT efectuar, I-TREATMENT por I-TREATMENT ejemplo, I-TREATMENT una I-TREATMENT transferencia I-TREATMENT con I-TREATMENT colgajo I-TREATMENT óseo I-TREATMENT del I-TREATMENT tercio I-TREATMENT distal I-TREATMENT del I-TREATMENT radio I-TREATMENT nutrido I-TREATMENT por I-TREATMENT la I-TREATMENT rama I-TREATMENT perforante I-TREATMENT superior I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT ínterósea I-TREATMENT anterior I-TREATMENT a I-TREATMENT flujo I-TREATMENT retrogrado I-TREATMENT (7), I-TREATMENT no I-TREATMENT era I-TREATMENT viable I-TREATMENT por I-TREATMENT las I-TREATMENT anomalías I-TREATMENT vasculares I-TREATMENT observadas I-TREATMENT con I-TREATMENT el I-TREATMENT doppler, I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT la I-TREATMENT toma I-TREATMENT de I-TREATMENT un I-TREATMENT injerto I-TREATMENT óseo I-TREATMENT convencional I-TREATMENT a I-TREATMENT pesar I-TREATMENT del I-TREATMENT riesgo I-TREATMENT de I-TREATMENT reabsorción I-TREATMENT que I-TREATMENT puede I-TREATMENT presentarse I-TREATMENT a I-TREATMENT largo I-TREATMENT plazo. I-TREATMENT Para I-TREATMENT no I-TREATMENT cambiar I-TREATMENT de I-TREATMENT campo I-TREATMENT operatorio I-TREATMENT se I-TREATMENT cosechó I-TREATMENT el I-TREATMENT injerto I-TREATMENT óseo I-TREATMENT del I-TREATMENT olécranon I-TREATMENT ipsilateral; I-TREATMENT después I-TREATMENT se I-TREATMENT estabilizó I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT trapecio I-TREATMENT vestigial I-TREATMENT con I-TREATMENT una I-TREATMENT miniplaca I-TREATMENT y I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT las I-TREATMENT falanges I-TREATMENT con I-TREATMENT alambre, I-TREATMENT logrando I-TREATMENT darle I-TREATMENT al I-TREATMENT neo-pulgar I-TREATMENT orientación I-TREATMENT en I-TREATMENT oposición. I-TREATMENT Para I-TREATMENT mantener I-TREATMENT estable I-TREATMENT esta I-TREATMENT posición I-TREATMENT y I-TREATMENT evitar I-TREATMENT futuros I-TREATMENT desplazamientos I-TREATMENT se I-TREATMENT decidió I-TREATMENT efectuar I-TREATMENT la I-TREATMENT transferencia I-TREATMENT del I-TREATMENT músculo I-TREATMENT abductor I-TREATMENT del I-TREATMENT meñique I-TREATMENT para I-TREATMENT fijarlo I-TREATMENT al I-TREATMENT neo-metacarpiano I-TREATMENT y I-TREATMENT reforzar I-TREATMENT o I-TREATMENT estabilizar I-TREATMENT la I-TREATMENT oposición I-TREATMENT del I-TREATMENT pulgar, I-TREATMENT así I-TREATMENT como I-TREATMENT para I-TREATMENT tratar I-TREATMENT de I-TREATMENT aumentar I-TREATMENT el I-TREATMENT volumen I-TREATMENT y I-TREATMENT por I-TREATMENT ende I-TREATMENT la I-TREATMENT estética I-TREATMENT del I-TREATMENT área I-TREATMENT tenar. I-TREATMENT La I-TREATMENT cirugía I-TREATMENT se I-TREATMENT efectuó I-TREATMENT con I-TREATMENT un I-TREATMENT bloqueo I-TREATMENT regional I-TREATMENT bajo I-TREATMENT torniquete I-TREATMENT neumático. I-TREATMENT I-TREATMENT No B-EVOLUTION se I-EVOLUTION presentaron I-EVOLUTION complicaciones I-EVOLUTION postoperatorias I-EVOLUTION I-EVOLUTION La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Fisioterapia I-DERIVED_FROM/TO para I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diseño I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO ortesis I-DERIVED_FROM/TO funcional I-DERIVED_FROM/TO y I-DERIVED_FROM/TO posteriormente, I-DERIVED_FROM/TO para I-DERIVED_FROM/TO el I-DERIVED_FROM/TO inicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO reeducación I-DERIVED_FROM/TO funcional. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Psicológicamente B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION respondido I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION positiva I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION ha I-EVOLUTION logrado I-EVOLUTION darle I-EVOLUTION utilidad I-EVOLUTION a I-EVOLUTION su I-EVOLUTION nuevo I-EVOLUTION pulgar I-EVOLUTION y I-EVOLUTION éste I-EVOLUTION ha I-EVOLUTION mejorado I-EVOLUTION en I-EVOLUTION su I-EVOLUTION aspecto I-EVOLUTION estético, I-EVOLUTION aunque I-EVOLUTION no I-EVOLUTION es I-EVOLUTION el I-EVOLUTION aspecto I-EVOLUTION que I-EVOLUTION sus I-EVOLUTION expectativas, I-EVOLUTION normales I-EVOLUTION o I-EVOLUTION no, I-EVOLUTION le I-EVOLUTION hicieron I-EVOLUTION desear. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 85 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS basocelular I-PRESENT_ILLNESS recidivado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pabellón I-PRESENT_ILLNESS auricular I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-TREATMENT tratamiento I-TREATMENT inicial, I-TREATMENT realizado I-TREATMENT en I-TREATMENT mayo I-TREATMENT de I-TREATMENT 2001, I-TREATMENT consistió I-TREATMENT en I-TREATMENT una I-TREATMENT extirpación I-TREATMENT local I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION siguió I-EVOLUTION revisiones I-EVOLUTION periódicas I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION recidiva I-EVOLUTION local I-EVOLUTION más I-EVOLUTION una I-EVOLUTION tumoración I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION submandibular I-EVOLUTION derecho. I-EVOLUTION Se B-EXPLORATION solicitó I-EXPLORATION citología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION mediante I-EXPLORATION punción I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION células I-EXPLORATION malignas, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION basocelular. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Tomografía I-EXPLORATION Axial I-EXPLORATION Computerizada I-EXPLORATION (TAC) I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tejidos I-EXPLORATION blandos I-EXPLORATION del I-EXPLORATION pabellón I-EXPLORATION auricular I-EXPLORATION derecho I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION antecedente I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION previa. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION de I-EXPLORATION 1.5 I-EXPLORATION cm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION situada I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION infraparotídeo, I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION central I-EXPLORATION y I-EXPLORATION que I-EXPLORATION impresiona I-EXPLORATION de I-EXPLORATION adenopatía I-EXPLORATION locoregional. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION En B-TREATMENT junio I-TREATMENT del I-TREATMENT 2003 I-TREATMENT se I-TREATMENT realizó I-TREATMENT resección I-TREATMENT parcial I-TREATMENT del I-TREATMENT lóbulo I-TREATMENT superficial I-TREATMENT de I-TREATMENT la I-TREATMENT parótida, I-TREATMENT un I-TREATMENT vaciamiento I-TREATMENT cervical I-TREATMENT derecho I-TREATMENT selectivo I-TREATMENT confinado I-TREATMENT a I-TREATMENT las I-TREATMENT zonas I-TREATMENT 2 I-TREATMENT y I-TREATMENT 3 I-TREATMENT y I-TREATMENT extirpación I-TREATMENT de I-TREATMENT la I-TREATMENT mitad I-TREATMENT inferior I-TREATMENT del I-TREATMENT pabellón I-TREATMENT auricular I-TREATMENT que I-TREATMENT incluía I-TREATMENT la I-TREATMENT recidiva I-TREATMENT local. I-TREATMENT I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION final I-EXPLORATION informó I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION como I-EXPLORATION una I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION basocelular I-EXPLORATION de I-EXPLORATION subtipo I-EXPLORATION infiltrante I-EXPLORATION que I-EXPLORATION afectaba I-EXPLORATION a I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION parótida I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION libres. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION del I-EXPLORATION vaciamiento I-EXPLORATION cervical, I-EXPLORATION de I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION ganglios I-EXPLORATION cervicales I-EXPLORATION aislados, I-EXPLORATION 2 I-EXPLORATION estaban I-EXPLORATION afectados. I-EXPLORATION I-EXPLORATION La I-EXPLORATION recidiva I-EXPLORATION local I-EXPLORATION del I-EXPLORATION pabellón I-EXPLORATION auricular I-EXPLORATION también I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION epitelioma I-EXPLORATION basocelular I-EXPLORATION infiltrante I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION libres. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT remitida I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT complementario I-TREATMENT con I-TREATMENT radioterapia, I-TREATMENT a I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT negó. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION publicación I-EVOLUTION no I-EVOLUTION existe I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION recurrencia I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION viva. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY reumatoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY corticoides I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS a I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS largo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS 2º I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 3er. I-PRESENT_ILLNESS radios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS punción I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS aguja I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS palma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION trayecto I-EXPLORATION flexor I-EXPLORATION del I-EXPLORATION 2º I-EXPLORATION y I-EXPLORATION 3er. I-EXPLORATION radios I-EXPLORATION y I-EXPLORATION una I-EXPLORATION actitud I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION en I-EXPLORATION hiperextensión, I-EXPLORATION por I-EXPLORATION probable I-EXPLORATION rotura I-EXPLORATION tendinosa. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION ecográficos I-EXPLORATION revelaron I-EXPLORATION un I-EXPLORATION área I-EXPLORATION hipoecogénica I-EXPLORATION rodeando I-EXPLORATION los I-EXPLORATION tendones I-EXPLORATION flexores I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION del I-EXPLORATION 2º I-EXPLORATION y I-EXPLORATION 3er. I-EXPLORATION radio I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION metacarpofalángica I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION distal, I-EXPLORATION una I-EXPLORATION desestructuración I-EXPLORATION del I-EXPLORATION flexor I-EXPLORATION profundo I-EXPLORATION y I-EXPLORATION una I-EXPLORATION sinovial I-EXPLORATION engrosada I-EXPLORATION hipervascularizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION doppler I-EXPLORATION color. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT drenaje I-TREATMENT abierto I-TREATMENT de I-TREATMENT gran I-TREATMENT cantidad I-TREATMENT de I-TREATMENT pus I-TREATMENT mediante I-TREATMENT incisiones I-TREATMENT volares I-TREATMENT tipo I-TREATMENT Brunner. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS cuyo I-PRESENT_ILLNESS aspecto I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS es I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS muestra I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Figura I-PRESENT_ILLNESS 1; I-PRESENT_ILLNESS además I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS dermatológicas, I-PRESENT_ILLNESS marcado I-PRESENT_ILLNESS plexo I-PRESENT_ILLNESS venoso I-PRESENT_ILLNESS subdérmico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS asimetría I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS físicas, I-PRESENT_ILLNESS psíquicas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dificultades I-PRESENT_ILLNESS para I-PRESENT_ILLNESS vestirse I-PRESENT_ILLNESS y I-PRESENT_ILLNESS para I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS ejercicios I-PRESENT_ILLNESS físicos, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS hacían I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS una I-PRESENT_ILLNESS situación I-PRESENT_ILLNESS insostenible I-PRESENT_ILLNESS para I-PRESENT_ILLNESS el I-PRESENT_ILLNESS desarrollo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS cotidiana. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION practicó I-EXPLORATION examen I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION biopsia I-EXPLORATION obtenida I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION aspiración, I-EXPLORATION encontrando I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION mamaria I-EXPLORATION tisular I-EXPLORATION tanto I-EXPLORATION del I-EXPLORATION estroma I-EXPLORATION como I-EXPLORATION del I-EXPLORATION epitelio, I-EXPLORATION con I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION diferenciarla I-EXPLORATION de I-EXPLORATION los I-EXPLORATION patrones I-EXPLORATION de I-EXPLORATION fibroadenoma I-EXPLORATION filoides I-EXPLORATION Las B-TREATMENT propuestas I-TREATMENT terapéuticas I-TREATMENT hormonales I-TREATMENT se I-TREATMENT excluyeron, I-TREATMENT como I-TREATMENT ya I-TREATMENT hemos I-TREATMENT explicado, I-TREATMENT por I-TREATMENT sus I-TREATMENT posibles I-TREATMENT efectos I-TREATMENT secundarios. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT realizado I-TREATMENT consistió I-TREATMENT en I-TREATMENT una I-TREATMENT mamoplastia I-TREATMENT reductora I-TREATMENT siguiendo I-TREATMENT el I-TREATMENT patrón I-TREATMENT de I-TREATMENT Wise I-TREATMENT en I-TREATMENT el I-TREATMENT marcaje I-TREATMENT dérmico; I-TREATMENT tallamos I-TREATMENT un I-TREATMENT amplio I-TREATMENT colgajo I-TREATMENT horizontal I-TREATMENT bipediculado I-TREATMENT cuya I-TREATMENT desepidermización I-TREATMENT se I-TREATMENT aprovechó I-TREATMENT para I-TREATMENT disminuir I-TREATMENT el I-TREATMENT tamaño I-TREATMENT de I-TREATMENT las I-TREATMENT areolas, I-TREATMENT que I-TREATMENT trasladamos I-TREATMENT a I-TREATMENT su I-TREATMENT nueva I-TREATMENT ubicación I-TREATMENT conservando I-TREATMENT la I-TREATMENT sensibilidad I-TREATMENT y I-TREATMENT evitando I-TREATMENT así I-TREATMENT el I-TREATMENT injerto I-TREATMENT libre I-TREATMENT tipo I-TREATMENT Thoreck. I-TREATMENT I-TREATMENT Empleamos I-TREATMENT el I-TREATMENT material I-TREATMENT autólogo I-TREATMENT de I-TREATMENT los I-TREATMENT colgajos I-TREATMENT a I-TREATMENT modo I-TREATMENT de I-TREATMENT relleno, I-TREATMENT evitando I-TREATMENT de I-TREATMENT esta I-TREATMENT manera I-TREATMENT también I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT prótesis. I-TREATMENT I-TREATMENT La I-TREATMENT resección I-TREATMENT en I-TREATMENT la I-TREATMENT mama I-TREATMENT derecha I-TREATMENT fue I-TREATMENT de I-TREATMENT 1.050 I-TREATMENT gr. I-TREATMENT de I-TREATMENT peso I-TREATMENT y I-TREATMENT en I-TREATMENT la I-TREATMENT izquierda I-TREATMENT llegó I-TREATMENT a I-TREATMENT los I-TREATMENT 1.800 I-TREATMENT gr. I-TREATMENT I-TREATMENT Colocamos I-TREATMENT drenajes I-TREATMENT en I-TREATMENT ambas I-TREATMENT mamas I-TREATMENT que I-TREATMENT fueron I-TREATMENT retirados I-TREATMENT a I-TREATMENT las I-TREATMENT 48h. I-TREATMENT y B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION con I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION evolución, I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION con I-EVOLUTION el I-EVOLUTION mismo I-EVOLUTION diagnóstico I-EVOLUTION anatomopatológico I-EVOLUTION de I-EVOLUTION hipertrofia I-EVOLUTION con I-EVOLUTION patrón I-EVOLUTION proliferativo I-EVOLUTION del I-EVOLUTION estroma I-EVOLUTION y I-EVOLUTION epitelio I-EVOLUTION a I-EVOLUTION modo I-EVOLUTION de I-EVOLUTION fibroadenoma I-EVOLUTION filoides. I-EVOLUTION I-EVOLUTION El I-EVOLUTION aspecto I-EVOLUTION del I-EVOLUTION resultado I-EVOLUTION reciente, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION pocos I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION podemos I-EVOLUTION verlo I-EVOLUTION en I-EVOLUTION las I-EVOLUTION Figuras I-EVOLUTION 3: I-EVOLUTION en I-EVOLUTION él I-EVOLUTION se I-EVOLUTION aprecian I-EVOLUTION unas I-EVOLUTION mamas I-EVOLUTION voluminosas I-EVOLUTION aun I-EVOLUTION para I-EVOLUTION el I-EVOLUTION tamaño I-EVOLUTION y I-EVOLUTION edad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION una I-EVOLUTION diferencia I-EVOLUTION notable I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION situación I-EVOLUTION previa. I-EVOLUTION I-EVOLUTION El I-EVOLUTION resultado I-EVOLUTION más I-EVOLUTION tardío, I-EVOLUTION ya I-EVOLUTION con I-EVOLUTION 17 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION edad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente, I-EVOLUTION presenta I-EVOLUTION un I-EVOLUTION tamaño I-EVOLUTION y I-EVOLUTION una I-EVOLUTION forma I-EVOLUTION de I-EVOLUTION las I-EVOLUTION mamas I-EVOLUTION más I-EVOLUTION proporcionados I-EVOLUTION a I-EVOLUTION la I-EVOLUTION edad I-EVOLUTION y I-EVOLUTION a I-EVOLUTION las I-EVOLUTION circunstancias I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente; I-EVOLUTION ha I-EVOLUTION mejorado I-EVOLUTION el I-EVOLUTION aspecto I-EVOLUTION dérmico I-EVOLUTION y I-EVOLUTION vascular I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION mamas I-EVOLUTION y I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION habido I-EVOLUTION recurrencia I-EVOLUTION del I-EVOLUTION cuadro, I-EVOLUTION mantiene I-EVOLUTION la I-EVOLUTION sensibilidad I-EVOLUTION de I-EVOLUTION los I-EVOLUTION complejos I-EVOLUTION areolares, I-EVOLUTION las I-EVOLUTION cicatrices I-EVOLUTION son I-EVOLUTION muy I-EVOLUTION aceptables I-EVOLUTION por I-EVOLUTION su I-EVOLUTION discreción I-EVOLUTION y I-EVOLUTION la I-EVOLUTION satisfacción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION le I-EVOLUTION lleva I-EVOLUTION a I-EVOLUTION rechazar I-EVOLUTION cualquier I-EVOLUTION retoque I-EVOLUTION de I-EVOLUTION mejora. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 35 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abuso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY patología I-PAST_MEDICAL_HISTORY asociada. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cirugía I-PRESENT_ILLNESS Plástica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Reparadora I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Carlos I-PRESENT_ILLNESS Haya I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Málaga I-PRESENT_ILLNESS (España) I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS masas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hombros, I-PRESENT_ILLNESS mamas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS flancos I-PRESENT_ILLNESS que I-PRESENT_ILLNESS habían I-PRESENT_ILLNESS aumentado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rápida I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS medio, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS dificultaban I-PRESENT_ILLNESS la I-PRESENT_ILLNESS movilidad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS por I-PRESENT_ILLNESS tanto I-PRESENT_ILLNESS su I-PRESENT_ILLNESS actividad I-PRESENT_ILLNESS laboral. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION reveló I-EXPLORATION masas I-EXPLORATION no I-EXPLORATION dolorosas I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION blanda, I-EXPLORATION sin I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION definidos, I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION hombros, I-EXPLORATION mamas, I-EXPLORATION fosas I-EXPLORATION lumbares I-EXPLORATION y I-EXPLORATION flancos I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION cervical I-EXPLORATION (Collar I-EXPLORATION de I-EXPLORATION Madelung). I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION mediante I-EXPLORATION secuencias I-EXPLORATION axiales I-EXPLORATION de I-EXPLORATION Tomografía I-EXPLORATION Axial I-EXPLORATION Computerizada I-EXPLORATION (TAC) I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION un I-EXPLORATION exceso I-EXPLORATION de I-EXPLORATION depósito I-EXPLORATION graso I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION homogénea I-EXPLORATION no I-EXPLORATION encapsulada I-EXPLORATION (difusa) I-EXPLORATION sobre I-EXPLORATION los I-EXPLORATION hombros, I-EXPLORATION mamas I-EXPLORATION y I-EXPLORATION cintura I-EXPLORATION abdominal, I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION estructuras I-EXPLORATION profundas. I-EXPLORATION Asimismo, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION depósitos I-EXPLORATION grasos I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION mesentérica I-EXPLORATION o I-EXPLORATION mediastínica, I-EXPLORATION ni I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cervical I-EXPLORATION anterior I-EXPLORATION o I-EXPLORATION posterior. I-EXPLORATION Dado I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION había I-EXPLORATION sido I-EXPLORATION intervenido I-EXPLORATION de I-EXPLORATION hernia I-EXPLORATION inguinal I-EXPLORATION y I-EXPLORATION eventración I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION Resonancia I-EXPLORATION Magnética I-EXPLORATION Nuclear I-EXPLORATION (RMN) I-EXPLORATION abdominal I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION integridad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION cortes I-EXPLORATION en I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION planos I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION con I-EXPLORATION secuencias I-EXPLORATION potenciadas I-EXPLORATION en I-EXPLORATION SE I-EXPLORATION T1, I-EXPLORATION TSE I-EXPLORATION T2 I-EXPLORATION y I-EXPLORATION Stir, I-EXPLORATION visualizándose I-EXPLORATION una I-EXPLORATION correcta I-EXPLORATION disposición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION abdominal, I-EXPLORATION un I-EXPLORATION importante I-EXPLORATION aumento I-EXPLORATION difuso I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION adiposo I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION grasa I-EXPLORATION intrabdominal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION depósitos I-EXPLORATION grasos I-EXPLORATION no I-EXPLORATION encapsulados I-EXPLORATION con I-EXPLORATION adipocitos I-EXPLORATION no I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION completar I-EXPLORATION estos I-EXPLORATION datos I-EXPLORATION con I-EXPLORATION la I-EXPLORATION anamnesis I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION Enfermedad I-EXPLORATION de I-EXPLORATION Madelung I-EXPLORATION o I-EXPLORATION Lipomatosis I-EXPLORATION Simétrica I-EXPLORATION Benigna I-EXPLORATION tipo I-EXPLORATION II. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT propuesto I-TREATMENT fue I-TREATMENT la I-TREATMENT liposucción I-TREATMENT de I-TREATMENT los I-TREATMENT cúmulos I-TREATMENT grasos I-TREATMENT localizados I-TREATMENT en I-TREATMENT abdomen, I-TREATMENT área I-TREATMENT lumbar I-TREATMENT y I-TREATMENT hombros I-TREATMENT y I-TREATMENT la I-TREATMENT dermolipectomía I-TREATMENT en I-TREATMENT ambas I-TREATMENT mamas. I-TREATMENT El I-TREATMENT paciente I-TREATMENT rehusó I-TREATMENT ambos I-TREATMENT procedimientos, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT le I-TREATMENT aconsejó I-TREATMENT entonces I-TREATMENT la I-TREATMENT pérdida I-TREATMENT de I-TREATMENT peso I-TREATMENT y I-TREATMENT la I-TREATMENT abstinencia I-TREATMENT alcohólica, I-TREATMENT aún I-TREATMENT conociendo I-TREATMENT sus I-TREATMENT limitados I-TREATMENT beneficios. I-TREATMENT I-TREATMENT 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 37 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO hospitalario I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO una I-DERIVED_FROM/TO pérdida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO sustancia I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO dorso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO mano I-DERIVED_FROM/TO izquierda I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO sufrir I-DERIVED_FROM/TO un I-DERIVED_FROM/TO accidente I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tráfico. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION pérdida I-EXPLORATION cutánea I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION muy I-EXPLORATION contundidos I-EXPLORATION y I-EXPLORATION que I-EXPLORATION sobrepasaba I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION metacarpofalangica I-EXPLORATION del I-EXPLORATION 2º I-EXPLORATION dedo. I-EXPLORATION Asimismo, I-EXPLORATION encontramos I-EXPLORATION una I-EXPLORATION exposición I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tendones I-EXPLORATION extensores I-EXPLORATION del I-EXPLORATION 2º I-EXPLORATION y I-EXPLORATION 3º I-EXPLORATION dedos I-EXPLORATION con I-EXPLORATION ruptura I-EXPLORATION del I-EXPLORATION extensor I-EXPLORATION del I-EXPLORATION 2º, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION exposición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION interósea I-EXPLORATION dorsal I-EXPLORATION de I-EXPLORATION 1º I-EXPLORATION y I-EXPLORATION 2º I-EXPLORATION dedos. I-EXPLORATION No I-EXPLORATION había I-EXPLORATION déficit I-EXPLORATION neurovascular I-EXPLORATION ni I-EXPLORATION fracturas I-EXPLORATION asociadas. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT una I-TREATMENT primera I-TREATMENT cura I-TREATMENT realizada I-TREATMENT a I-TREATMENT su I-TREATMENT ingreso, I-TREATMENT con I-TREATMENT retirada I-TREATMENT de I-TREATMENT tejidos I-TREATMENT desvitalizados I-TREATMENT y I-TREATMENT reparación I-TREATMENT del I-TREATMENT tendón I-TREATMENT extensor I-TREATMENT del I-TREATMENT 2º I-TREATMENT dedo, I-TREATMENT nos I-TREATMENT planteamos I-TREATMENT cómo I-TREATMENT realizar I-TREATMENT la I-TREATMENT cobertura I-TREATMENT del I-TREATMENT defecto, I-TREATMENT optando I-TREATMENT por I-TREATMENT una I-TREATMENT reconstrucción I-TREATMENT mediante I-TREATMENT un I-TREATMENT colgajo I-TREATMENT interóseo I-TREATMENT posterior I-TREATMENT de I-TREATMENT transferencia I-TREATMENT libre. I-TREATMENT Los I-TREATMENT motivos I-TREATMENT de I-TREATMENT esta I-TREATMENT elección I-TREATMENT los I-TREATMENT presentamos I-TREATMENT en I-TREATMENT el I-TREATMENT apartado I-TREATMENT de I-TREATMENT Discusión. I-TREATMENT I-TREATMENT 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 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS fumadora, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mielomelingocele I-PAST_MEDICAL_HISTORY congénito I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY paraplejia I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY nefrostomía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY operada I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY úlcera I-PAST_MEDICAL_HISTORY sacra, I-PAST_MEDICAL_HISTORY realizándose I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY colgajo I-PAST_MEDICAL_HISTORY glúteo. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY ninguna I-PAST_MEDICAL_HISTORY recidiva I-PAST_MEDICAL_HISTORY debido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY higiene I-PAST_MEDICAL_HISTORY postural I-PAST_MEDICAL_HISTORY domiciliaria. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Seis B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS acudir I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Servicio, I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS una I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fémur, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tuvo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS portar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS férula I-PRESENT_ILLNESS pelvi-pédica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS yeso. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS imposibilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS movilización I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS posturales I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS realizaba I-PRESENT_ILLNESS habitualmente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio, I-PRESENT_ILLNESS le I-PRESENT_ILLNESS ocasionaron I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS úlcera I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS sacra, I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS valoración. I-PRESENT_ILLNESS Presentaba B-EXPLORATION en I-EXPLORATION ese I-EXPLORATION momento I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION úlcera I-EXPLORATION isquiotroncantéreo-sacra I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 20 I-EXPLORATION x I-EXPLORATION 25 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION trayecto I-EXPLORATION fistuloso I-EXPLORATION hacia I-EXPLORATION pala I-EXPLORATION iliaca I-EXPLORATION y I-EXPLORATION que I-EXPLORATION en I-EXPLORATION algunas I-EXPLORATION zonas I-EXPLORATION profundizaba I-EXPLORATION hasta I-EXPLORATION plano I-EXPLORATION óseo I-EXPLORATION con I-EXPLORATION exposición I-EXPLORATION del I-EXPLORATION sacro. I-EXPLORATION Se B-EVOLUTION recomendó I-EVOLUTION ingreso I-EVOLUTION hospitalario I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION rechazó I-EVOLUTION por I-EVOLUTION motivos I-EVOLUTION personales, I-EVOLUTION acudiendo I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 3 I-EVOLUTION semanas, I-EVOLUTION momento I-EVOLUTION en I-EVOLUTION que I-EVOLUTION la I-EVOLUTION úlcera I-EVOLUTION medía I-EVOLUTION ya I-EVOLUTION 24 I-EVOLUTION x I-EVOLUTION 30 I-EVOLUTION cm. I-EVOLUTION I-EVOLUTION Durante B-TREATMENT el I-TREATMENT ingreso I-TREATMENT y I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT gran I-TREATMENT úlcera I-TREATMENT que I-TREATMENT presentaba I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT colostomía. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION tenía I-EVOLUTION un I-EVOLUTION mal I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION con I-EVOLUTION alteraciones I-EVOLUTION analíticas I-EVOLUTION importantes I-EVOLUTION tanto I-EVOLUTION en I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION hematocrito I-EVOLUTION como I-EVOLUTION en I-EVOLUTION las I-EVOLUTION de I-EVOLUTION proteínas I-EVOLUTION totales, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION tuvo I-EVOLUTION que I-EVOLUTION iniciar I-EVOLUTION nutrición I-EVOLUTION parenteral I-EVOLUTION para I-EVOLUTION remontar I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION general. I-EVOLUTION I-EVOLUTION Para B-TREATMENT cerrar I-TREATMENT el I-TREATMENT gran I-TREATMENT defecto I-TREATMENT que I-TREATMENT presentaba I-TREATMENT fue I-TREATMENT intervenida I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT un I-TREATMENT colgajo I-TREATMENT póstero-medial I-TREATMENT de I-TREATMENT muslo, I-TREATMENT para I-TREATMENT lo I-TREATMENT cual I-TREATMENT procedimos I-TREATMENT a I-TREATMENT desbridar I-TREATMENT la I-TREATMENT úlcera I-TREATMENT y I-TREATMENT cubrirla I-TREATMENT posteriormente I-TREATMENT mediante I-TREATMENT el I-TREATMENT colgajo I-TREATMENT anteriormente I-TREATMENT descrito I-TREATMENT como I-TREATMENT alternativa I-TREATMENT a I-TREATMENT la I-TREATMENT desarticulación I-TREATMENT de I-TREATMENT la I-TREATMENT cadera. I-TREATMENT I-TREATMENT La I-TREATMENT intervención I-TREATMENT duró I-TREATMENT unas I-TREATMENT 5 I-TREATMENT horas I-TREATMENT y I-TREATMENT se I-TREATMENT desarrolló I-TREATMENT sin I-TREATMENT contratiempos. I-TREATMENT La I-TREATMENT zona I-TREATMENT donante I-TREATMENT del I-TREATMENT colgajo I-TREATMENT se I-TREATMENT cerró I-TREATMENT directamente I-TREATMENT en I-TREATMENT su I-TREATMENT mayor I-TREATMENT parte, I-TREATMENT teniendo I-TREATMENT que I-TREATMENT cubrir I-TREATMENT solo I-TREATMENT la I-TREATMENT porción I-TREATMENT distal I-TREATMENT con I-TREATMENT un I-TREATMENT injerto I-TREATMENT de I-TREATMENT piel I-TREATMENT parcial I-TREATMENT tomado I-TREATMENT del I-TREATMENT muslo I-TREATMENT contralateral. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION 2 I-EVOLUTION días I-EVOLUTION para I-EVOLUTION control I-EVOLUTION de I-EVOLUTION su I-EVOLUTION situación I-EVOLUTION metabólica, I-EVOLUTION tras I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION trasladada I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION a I-EVOLUTION planta I-EVOLUTION hospitalaria. I-EVOLUTION I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días, I-EVOLUTION el I-EVOLUTION colgajo I-EVOLUTION presentaba I-EVOLUTION buen I-EVOLUTION estado, I-EVOLUTION con I-EVOLUTION adecuado I-EVOLUTION relleno I-EVOLUTION capilar. I-EVOLUTION A I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION ello, I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION empezó I-EVOLUTION a I-EVOLUTION deteriorarse. I-EVOLUTION Comenzó I-EVOLUTION con I-EVOLUTION una I-EVOLUTION insuficiencia I-EVOLUTION hepato-renal I-EVOLUTION progresiva I-EVOLUTION que I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION diagnóstico I-EVOLUTION exhaustivo I-EVOLUTION por I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Medicina I-EVOLUTION Interna I-EVOLUTION se I-EVOLUTION catalogó I-EVOLUTION como I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION alteraciones I-EVOLUTION biliopancreáticas I-EVOLUTION derivadas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION nutrición I-EVOLUTION parenteral. I-EVOLUTION Tras B-TREATMENT valoración I-TREATMENT por I-TREATMENT el I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Nefrología, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT diálisis, I-TREATMENT que I-TREATMENT mejoró I-TREATMENT las I-TREATMENT cifras I-TREATMENT de I-TREATMENT creatinina I-TREATMENT aunque I-TREATMENT se I-TREATMENT manifestó I-TREATMENT una I-TREATMENT hipoproteinemia I-TREATMENT severa I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT consiguió I-TREATMENT remontar. I-TREATMENT A B-EVOLUTION la I-EVOLUTION cuarta I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION postoperatorio, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION fiebre I-EVOLUTION alta I-EVOLUTION de I-EVOLUTION origen I-EVOLUTION desconocido I-EVOLUTION que I-EVOLUTION evolucionó I-EVOLUTION a I-EVOLUTION sepsis I-EVOLUTION y I-EVOLUTION fracaso I-EVOLUTION multiorgánico I-EVOLUTION que I-EVOLUTION provocaron I-EVOLUTION el I-EVOLUTION fallecimiento. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS tumoral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aspecto I-PRESENT_ILLNESS esclerodermiforme I-PRESENT_ILLNESS en I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS central I-PRESENT_ILLNESS del I-PRESENT_ILLNESS párpado I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS que I-PRESENT_ILLNESS deja I-PRESENT_ILLNESS libre I-PRESENT_ILLNESS el I-PRESENT_ILLNESS borde I-PRESENT_ILLNESS palpebral. I-PRESENT_ILLNESS Bajo B-TREATMENT anestesia I-TREATMENT local I-TREATMENT y I-TREATMENT sedación I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT exéresis I-TREATMENT amplia I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT cutánea I-TREATMENT respetando I-TREATMENT la I-TREATMENT lamela I-TREATMENT interna I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT mediante I-TREATMENT colgajo I-TREATMENT miocutáneo I-TREATMENT del I-TREATMENT músculo I-TREATMENT orbicular I-TREATMENT en I-TREATMENT isla I-TREATMENT con I-TREATMENT unas I-TREATMENT dimensiones I-TREATMENT de I-TREATMENT 25 I-TREATMENT x I-TREATMENT 17 I-TREATMENT mm. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION basocelular. I-EXPLORATION En B-EVOLUTION las I-EVOLUTION Fig. I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION 5 I-EVOLUTION presentamos I-EVOLUTION el I-EVOLUTION resultado I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Diez B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS indolora I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuarto I-PRESENT_ILLNESS dedo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS dio I-PRESENT_ILLNESS lugar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS déficit I-PRESENT_ILLNESS funcional, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS imposibilidad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS flexoextensión I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dedo I-PRESENT_ILLNESS afectado. I-PRESENT_ILLNESS El B-EXPLORATION estudio I-EXPLORATION radiográfico I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION definición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION anterior I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION proximal I-EXPLORATION del I-EXPLORATION cuarto I-EXPLORATION dedo, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION presentar I-EXPLORATION una I-EXPLORATION incipiente I-EXPLORATION calcificación I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION distalmente I-EXPLORATION por I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION palmar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION vio I-EXPLORATION lesión I-EXPLORATION intramedular. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION biopsia I-EXPLORATION incisional, I-EXPLORATION cuyo I-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION periostitis I-EXPLORATION reactiva I-EXPLORATION florida. I-EXPLORATION I-EXPLORATION El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO en I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO comprobó I-DERIVED_FROM/TO la I-DERIVED_FROM/TO existencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO masa I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO falange I-DERIVED_FROM/TO proximal I-DERIVED_FROM/TO del I-DERIVED_FROM/TO cuarto I-DERIVED_FROM/TO dedo I-DERIVED_FROM/TO con I-DERIVED_FROM/TO inflamación I-DERIVED_FROM/TO y I-DERIVED_FROM/TO tumefacción. I-DERIVED_FROM/TO No B-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION signos I-EXPLORATION locorregionales I-EXPLORATION de I-EXPLORATION infección. I-EXPLORATION La I-EXPLORATION movilidad I-EXPLORATION en I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION articulaciones I-EXPLORATION del I-EXPLORATION dedo I-EXPLORATION estaba I-EXPLORATION afectada, I-EXPLORATION existiendo I-EXPLORATION una I-EXPLORATION impotencia I-EXPLORATION funcional I-EXPLORATION absoluta. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION refería I-EXPLORATION dolor I-EXPLORATION con I-EXPLORATION parestesias I-EXPLORATION en I-EXPLORATION el I-EXPLORATION territorio I-EXPLORATION del I-EXPLORATION nervio I-EXPLORATION colateral I-EXPLORATION cubital. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiográfico I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION estadio I-EXPLORATION evolutivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION primer I-EXPLORATION estudio, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION la I-EXPLORATION calcificación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION palmar I-EXPLORATION de I-EXPLORATION falange I-EXPLORATION proximal I-EXPLORATION se I-EXPLORATION había I-EXPLORATION hecho I-EXPLORATION más I-EXPLORATION ostensible, I-EXPLORATION extendiéndose I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange. I-EXPLORATION Aparecía I-EXPLORATION una I-EXPLORATION clara I-EXPLORATION reacción I-EXPLORATION perióstica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION conectar I-EXPLORATION con I-EXPLORATION la I-EXPLORATION calcificación I-EXPLORATION pero I-EXPLORATION que I-EXPLORATION además, I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION al I-EXPLORATION lado I-EXPLORATION opuesto. I-EXPLORATION Es I-EXPLORATION interesante I-EXPLORATION señalar I-EXPLORATION también I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION reacción I-EXPLORATION perióstica I-EXPLORATION sólida I-EXPLORATION de I-EXPLORATION borde I-EXPLORATION irregular I-EXPLORATION en I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION radiográfico I-EXPLORATION preoperatorio I-EXPLORATION la I-EXPLORATION calcificación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION se I-EXPLORATION volvió I-EXPLORATION más I-EXPLORATION definida I-EXPLORATION y I-EXPLORATION grande, I-EXPLORATION abarcando I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION mediante I-EXPLORATION Resonancia I-EXPLORATION Magnética I-EXPLORATION (RM) I-EXPLORATION permitió I-EXPLORATION apreciar I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION que I-EXPLORATION englobaba I-EXPLORATION los I-EXPLORATION tendones I-EXPLORATION flexores I-EXPLORATION y I-EXPLORATION contactaba I-EXPLORATION con I-EXPLORATION el I-EXPLORATION periostio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION proximal. I-EXPLORATION Era I-EXPLORATION hipointensa I-EXPLORATION en I-EXPLORATION T1, I-EXPLORATION hiperintensa I-EXPLORATION en I-EXPLORATION T2 I-EXPLORATION y I-EXPLORATION realzaba I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION homogénea I-EXPLORATION con I-EXPLORATION Gadolinio. I-EXPLORATION En I-EXPLORATION su I-EXPLORATION margen I-EXPLORATION palmar I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION reborde I-EXPLORATION hipointenso I-EXPLORATION que I-EXPLORATION pudiera I-EXPLORATION representar I-EXPLORATION calcificación. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION vacíos I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION internos, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION calcificación I-EXPLORATION debería I-EXPLORATION ir I-EXPLORATION unido I-EXPLORATION a I-EXPLORATION una I-EXPLORATION matriz I-EXPLORATION celular I-EXPLORATION (lo I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION tumor I-EXPLORATION o I-EXPLORATION psedotumor). I-EXPLORATION En I-EXPLORATION los I-EXPLORATION márgenes I-EXPLORATION laterales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION levantamientos I-EXPLORATION periostios, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION componente I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION al I-EXPLORATION tendón I-EXPLORATION extensor. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION cortes I-EXPLORATION sagitales I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION que I-EXPLORATION la I-EXPLORATION medular I-EXPLORATION ósea I-EXPLORATION estaba I-EXPLORATION respetada I-EXPLORATION y I-EXPLORATION que I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION anterior I-EXPLORATION no I-EXPLORATION estaba I-EXPLORATION infiltrada I-EXPLORATION pero I-EXPLORATION si I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION ligero I-EXPLORATION festoneado I-EXPLORATION en I-EXPLORATION su I-EXPLORATION superficie I-EXPLORATION externa. I-EXPLORATION I-EXPLORATION La B-TREATMENT lesión I-TREATMENT fue I-TREATMENT extirpada I-TREATMENT realizando I-TREATMENT una I-TREATMENT amputación I-TREATMENT estética I-TREATMENT del I-TREATMENT 4º I-TREATMENT radio I-TREATMENT de I-TREATMENT la I-TREATMENT mano I-TREATMENT derecha I-TREATMENT por I-TREATMENT el I-TREATMENT déficit I-TREATMENT funcional I-TREATMENT del I-TREATMENT dedo. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION de I-EXPLORATION amputación I-EXPLORATION señaló I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION tendón I-EXPLORATION flexor I-EXPLORATION y I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION falange, I-EXPLORATION de I-EXPLORATION hueso I-EXPLORATION maduro I-EXPLORATION con I-EXPLORATION intensos I-EXPLORATION fenómenos I-EXPLORATION de I-EXPLORATION remodelación. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION centro I-EXPLORATION del I-EXPLORATION mencionado I-EXPLORATION hueso I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION fibroblástica I-EXPLORATION con I-EXPLORATION casi I-EXPLORATION total I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION mitosis, I-EXPLORATION que I-EXPLORATION diferenciaba I-EXPLORATION pequeñas I-EXPLORATION cantidades I-EXPLORATION de I-EXPLORATION osteoide. I-EXPLORATION Al I-EXPLORATION comparar I-EXPLORATION esta I-EXPLORATION biopsia I-EXPLORATION con I-EXPLORATION la I-EXPLORATION previa I-EXPLORATION o I-EXPLORATION diagnóstica, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION mayor I-EXPLORATION celularidad, I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION atipia I-EXPLORATION celular I-EXPLORATION y I-EXPLORATION mayor I-EXPLORATION actividad I-EXPLORATION mitótica. I-EXPLORATION B-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION satisfactoria I-EVOLUTION y I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION recidivado I-EVOLUTION tras I-EVOLUTION 8 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION conservando I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION función I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mano. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS basocelular I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS canto I-PRESENT_ILLNESS interno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS La B-TREATMENT resección I-TREATMENT se I-TREATMENT hizo I-TREATMENT con I-TREATMENT margen I-TREATMENT sano I-TREATMENT de I-TREATMENT 0.5 I-TREATMENT cm I-TREATMENT también I-TREATMENT confirmado I-TREATMENT mediante I-TREATMENT biopsia I-TREATMENT por I-TREATMENT congelación. I-TREATMENT Cobertura I-TREATMENT del I-TREATMENT defecto I-TREATMENT con I-TREATMENT la I-TREATMENT técnica I-TREATMENT descrita. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tumor I-PRESENT_ILLNESS parietal I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS costillas I-PRESENT_ILLNESS cuarta, I-PRESENT_ILLNESS quinta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sexta, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS línea I-PRESENT_ILLNESS media I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hemitórax I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS el I-PRESENT_ILLNESS margen I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS esternón I-PRESENT_ILLNESS por I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mama, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mastectomía I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS El B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Realizamos B-TREATMENT resección I-TREATMENT de I-TREATMENT las I-TREATMENT costillas I-TREATMENT afectadas I-TREATMENT con I-TREATMENT margen I-TREATMENT de I-TREATMENT seguridad I-TREATMENT de I-TREATMENT 4 I-TREATMENT cm. I-TREATMENT Realizamos I-TREATMENT la I-TREATMENT restitución I-TREATMENT parietal I-TREATMENT con I-TREATMENT una I-TREATMENT membrana I-TREATMENT de I-TREATMENT Gore-tex® I-TREATMENT sobre I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT repusieron I-TREATMENT dos I-TREATMENT arcos I-TREATMENT costales I-TREATMENT realizados I-TREATMENT son I-TREATMENT tubos I-TREATMENT de I-TREATMENT Gore-tex® I-TREATMENT rellenos I-TREATMENT de I-TREATMENT Craneoplastic® I-TREATMENT para I-TREATMENT reconstrucción I-TREATMENT costal. I-TREATMENT Finalmente I-TREATMENT efectuamos I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT un I-TREATMENT colgajo I-TREATMENT de I-TREATMENT músculo I-TREATMENT recto I-TREATMENT abdominal I-TREATMENT pediculado, I-TREATMENT contralateral. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION de I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION Permanece I-EVOLUTION asintomática I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION después, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 64 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS intervenida B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY centro I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sarcoma I-PAST_MEDICAL_HISTORY esternal; I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY esternectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY reconstrucción I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY placa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY metacrilato I-PAST_MEDICAL_HISTORY colocada I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY arcos I-PAST_MEDICAL_HISTORY costales I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY sutura I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY labrar I-PAST_MEDICAL_HISTORY orificios I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY bordes. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS La B-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TAC) I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION material I-EXPLORATION líquido I-EXPLORATION bajo I-EXPLORATION la I-EXPLORATION placa I-EXPLORATION de I-EXPLORATION metacrilato, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION empiema. I-EXPLORATION I-EXPLORATION Decidimos B-TREATMENT intervenir I-TREATMENT y I-TREATMENT retirar I-TREATMENT la I-TREATMENT placa I-TREATMENT de I-TREATMENT material I-TREATMENT aloplástico. I-TREATMENT Bajo I-TREATMENT la I-TREATMENT misma I-TREATMENT encontramos I-TREATMENT abundante I-TREATMENT material I-TREATMENT purulento, I-TREATMENT en I-TREATMENT cuyo I-TREATMENT cultivo I-TREATMENT se I-TREATMENT aisló I-TREATMENT un I-TREATMENT microorganismo I-TREATMENT anaerobio. I-TREATMENT La I-TREATMENT reconstrucción I-TREATMENT se I-TREATMENT efectuó I-TREATMENT con I-TREATMENT colgajo I-TREATMENT de I-TREATMENT epiplon I-TREATMENT basado I-TREATMENT en I-TREATMENT los I-TREATMENT vasos I-TREATMENT gastroepiploicos I-TREATMENT derecho I-TREATMENT e I-TREATMENT izquierdo I-TREATMENT cubierto I-TREATMENT con I-TREATMENT un I-TREATMENT injerto I-TREATMENT de I-TREATMENT piel I-TREATMENT mallada. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION No I-EVOLUTION hubo I-EVOLUTION recidiva I-EVOLUTION tumoral I-EVOLUTION local I-EVOLUTION y I-EVOLUTION las I-EVOLUTION biopsias I-EVOLUTION de I-EVOLUTION los I-EVOLUTION bordes I-EVOLUTION fueron I-EVOLUTION negativas. I-EVOLUTION Las I-EVOLUTION revisiones I-EVOLUTION son I-EVOLUTION satisfactorias I-EVOLUTION desde I-EVOLUTION entonces, I-EVOLUTION cumpliendo I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION en I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION redactar I-EVOLUTION este I-EVOLUTION trabajo. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS basocelular I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ceja I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS defecto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7x5 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS la I-PRESENT_ILLNESS resección I-PRESENT_ILLNESS tumoral. I-PRESENT_ILLNESS Realizamos B-TREATMENT un I-TREATMENT colgajo I-TREATMENT en I-TREATMENT isla I-TREATMENT de I-TREATMENT arteria I-TREATMENT temporal I-TREATMENT para I-TREATMENT reconstrucción I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT ceja I-TREATMENT con I-TREATMENT piel I-TREATMENT con I-TREATMENT pelo. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT realizó I-TREATMENT depilación I-TREATMENT con I-TREATMENT láser I-TREATMENT para I-TREATMENT lograr I-TREATMENT simetría I-TREATMENT con I-TREATMENT la I-TREATMENT ceja I-TREATMENT contralateral. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS abierta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tibia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS peroné I-PRESENT_ILLNESS tratada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS placa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fijador I-PRESENT_ILLNESS externo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sustancia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS exposición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS material I-PRESENT_ILLNESS de I-PRESENT_ILLNESS osteosíntesis. I-PRESENT_ILLNESS Se B-TREATMENT practica I-TREATMENT desbridamiento I-TREATMENT y I-TREATMENT limpieza I-TREATMENT y I-TREATMENT se I-TREATMENT coloca I-TREATMENT sistema I-TREATMENT Renasys® I-TREATMENT a-125 I-TREATMENT mm I-TREATMENT Hg. I-TREATMENT Tras B-EVOLUTION 12 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION su I-EVOLUTION aplicación, I-EVOLUTION se I-EVOLUTION consigue I-EVOLUTION un I-EVOLUTION lecho I-EVOLUTION limpio I-EVOLUTION con I-EVOLUTION tejido I-EVOLUTION de I-EVOLUTION granulación I-EVOLUTION sano. I-EVOLUTION Finalmente B-TREATMENT se I-TREATMENT realiza I-TREATMENT cobertura I-TREATMENT con I-TREATMENT colgajo I-TREATMENT anterolateral I-TREATMENT de I-TREATMENT muslo. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS afecto B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY leucemia I-PAST_MEDICAL_HISTORY linfática I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS epidermoide I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo. I-PRESENT_ILLNESS El B-TREATMENT tumor I-TREATMENT infiltra I-TREATMENT localmente I-TREATMENT sin I-TREATMENT llegar I-TREATMENT a I-TREATMENT afectar I-TREATMENT a I-TREATMENT la I-TREATMENT duramadre. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT y I-TREATMENT colgajo I-TREATMENT de I-TREATMENT periostio I-TREATMENT que I-TREATMENT se I-TREATMENT complica I-TREATMENT con I-TREATMENT necrosis. I-TREATMENT Se I-TREATMENT decide I-TREATMENT entonces I-TREATMENT colocar I-TREATMENT sistema I-TREATMENT de I-TREATMENT terapia I-TREATMENT Renasys® I-TREATMENT a I-TREATMENT -50 I-TREATMENT mm I-TREATMENT Hg. I-TREATMENT Tras I-TREATMENT 3 I-TREATMENT semanas I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT observa I-TREATMENT reducción I-TREATMENT del I-TREATMENT diámetro I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT y I-TREATMENT granulación I-TREATMENT sobre I-TREATMENT la I-TREATMENT duramadre. I-TREATMENT Posteriormente, I-TREATMENT se I-TREATMENT realiza I-TREATMENT cierre I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT con I-TREATMENT triple I-TREATMENT colgajo I-TREATMENT de I-TREATMENT Guillis. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 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 Cirugía I-PRESENT_ILLNESS Plástica I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Octubre I-PRESENT_ILLNESS (Madrid, I-PRESENT_ILLNESS España) I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS sufrido I-PRESENT_ILLNESS una I-PRESENT_ILLNESS penectomía I-PRESENT_ILLNESS subtotal I-PRESENT_ILLNESS por I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS epidermoide I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS precisó I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS oncológico I-PRESENT_ILLNESS coadyuvante I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS solicita I-PRESENT_ILLNESS reconstrucción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pene. I-PRESENT_ILLNESS Tras B-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION historia I-EXPLORATION clínica, I-EXPLORATION exploración I-EXPLORATION y I-EXPLORATION documentación I-EXPLORATION fotográfica I-EXPLORATION pertinentes I-EXPLORATION para I-EXPLORATION su I-EXPLORATION estudio, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION demorar I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION hasta I-EXPLORATION transcurridos I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION 6 I-EXPLORATION meses I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION extirpación I-EXPLORATION tumoral I-EXPLORATION para I-EXPLORATION confirmar I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION recurrencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION local. I-EXPLORATION Se I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION arcos I-EXPLORATION vasculares I-EXPLORATION palmares I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profundo I-EXPLORATION a I-EXPLORATION través I-EXPLORATION del I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Allen I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION con I-EXPLORATION sonda I-EXPLORATION doppler I-EXPLORATION de I-EXPLORATION 8Mhz, I-EXPLORATION que I-EXPLORATION permiten I-EXPLORATION la I-EXPLORATION elección I-EXPLORATION de I-EXPLORATION un I-EXPLORATION colgajo I-EXPLORATION libre I-EXPLORATION radial I-EXPLORATION para I-EXPLORATION la I-EXPLORATION reconstrucción I-EXPLORATION peneana, I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION vascular I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION superior I-EXPLORATION derecho. I-EXPLORATION El B-TREATMENT día I-TREATMENT previo I-TREATMENT a I-TREATMENT la I-TREATMENT intervención, I-TREATMENT se I-TREATMENT realiza I-TREATMENT una I-TREATMENT cistostomía I-TREATMENT suprapúbica. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 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 tumoración I-PAST_MEDICAL_HISTORY (osteosarcoma) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY rodilla I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY Tras B-TREATMENT recibir I-TREATMENT múltiples I-TREATMENT tratamientos I-TREATMENT de I-TREATMENT elongación I-TREATMENT ósea, I-TREATMENT fue I-TREATMENT necesario I-TREATMENT colocar I-TREATMENT una I-TREATMENT prótesis I-TREATMENT total I-TREATMENT de I-TREATMENT rodilla. I-TREATMENT Debido I-TREATMENT a I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT múltiples I-TREATMENT cicatrices, I-TREATMENT la I-TREATMENT piel I-TREATMENT se I-TREATMENT necrosó I-TREATMENT y I-TREATMENT la I-TREATMENT prótesis I-TREATMENT resultó I-TREATMENT expuesta, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT fue I-TREATMENT necesario I-TREATMENT cubrirla I-TREATMENT con I-TREATMENT 2 I-TREATMENT colgajos I-TREATMENT de I-TREATMENT gemelos I-TREATMENT según I-TREATMENT la I-TREATMENT técnica I-TREATMENT que I-TREATMENT hemos I-TREATMENT descrito. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS queja I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS aspecto I-PRESENT_ILLNESS inestético I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS que I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS notar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS social, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pareja. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-FAMILY_HISTORY historia I-FAMILY_HISTORY clínica I-FAMILY_HISTORY familiar I-FAMILY_HISTORY no I-FAMILY_HISTORY reveló I-FAMILY_HISTORY la I-FAMILY_HISTORY existencia I-FAMILY_HISTORY de I-FAMILY_HISTORY casos I-FAMILY_HISTORY semejantes. I-FAMILY_HISTORY I-FAMILY_HISTORY Presentaba B-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS pronunciado I-PRESENT_ILLNESS del I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS superior, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS mucho I-PRESENT_ILLNESS más I-PRESENT_ILLNESS evidente I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS sonreía, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS retracción I-PRESENT_ILLNESS central. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT realizó I-TREATMENT bajo I-TREATMENT bloqueo I-TREATMENT anestésico I-TREATMENT de I-TREATMENT ambos I-TREATMENT nervios I-TREATMENT infraorbitarios. I-TREATMENT Marcamos I-TREATMENT la I-TREATMENT zona I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT azul I-TREATMENT de I-TREATMENT metileno I-TREATMENT en I-TREATMENT forma I-TREATMENT de I-TREATMENT dos I-TREATMENT elipses I-TREATMENT tranversas I-TREATMENT con I-TREATMENT una I-TREATMENT "z" I-TREATMENT central. I-TREATMENT Resecamos I-TREATMENT el I-TREATMENT exceso I-TREATMENT de I-TREATMENT tejido I-TREATMENT mucoso I-TREATMENT y I-TREATMENT submucoso I-TREATMENT labial I-TREATMENT con I-TREATMENT excisiones I-TREATMENT elípticas I-TREATMENT y I-TREATMENT la I-TREATMENT brida I-TREATMENT central I-TREATMENT se I-TREATMENT corrigió I-TREATMENT con I-TREATMENT una I-TREATMENT z-plastia I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT con I-TREATMENT el I-TREATMENT marcaje I-TREATMENT realizado. I-TREATMENT La I-TREATMENT cirugía I-TREATMENT finalizó I-TREATMENT con I-TREATMENT el I-TREATMENT cierre I-TREATMENT mediante I-TREATMENT suturas I-TREATMENT simples I-TREATMENT con I-TREATMENT hilo I-TREATMENT sintético I-TREATMENT reabsorbible I-TREATMENT de I-TREATMENT poliglactin I-TREATMENT 6-0. I-TREATMENT I-TREATMENT La B-EVOLUTION herida I-EVOLUTION quirúrgica I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION edema I-EVOLUTION local I-EVOLUTION que I-EVOLUTION se I-EVOLUTION resolvió I-EVOLUTION al I-EVOLUTION final I-EVOLUTION de I-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION postoperatorio. I-EVOLUTION Dos I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION en I-EVOLUTION revisión I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION ambulatoria, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION plenamente I-EVOLUTION satisfecha I-EVOLUTION con I-EVOLUTION el I-EVOLUTION resultado I-EVOLUTION obtenido, I-EVOLUTION contando I-EVOLUTION incluso I-EVOLUTION que I-EVOLUTION había I-EVOLUTION vuelto I-EVOLUTION a I-EVOLUTION frecuentar I-EVOLUTION relaciones I-EVOLUTION sociales I-EVOLUTION en I-EVOLUTION compañía I-EVOLUTION de I-EVOLUTION su I-EVOLUTION pareja. I-EVOLUTION Tras I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION no I-EVOLUTION hay I-EVOLUTION señales I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION o I-EVOLUTION complicaciones I-EVOLUTION tardías. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS pediátrica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS púrpura I-PRESENT_ILLNESS fulminans I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS meningocóccica I-PRESENT_ILLNESS grave I-PRESENT_ILLNESS complicada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fallo I-PRESENT_ILLNESS multiorgánico, I-PRESENT_ILLNESS shock I-PRESENT_ILLNESS séptico, I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pulmón I-PRESENT_ILLNESS complicado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS neumonía I-PRESENT_ILLNESS nosocomial I-PRESENT_ILLNESS que I-PRESENT_ILLNESS requirió I-PRESENT_ILLNESS soporte I-PRESENT_ILLNESS ventilatorio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS grave I-PRESENT_ILLNESS necrosis I-PRESENT_ILLNESS isquémica I-PRESENT_ILLNESS por I-PRESENT_ILLNESS CID I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-DERIVED_FROM/TO los I-DERIVED_FROM/TO 4 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO su I-DERIVED_FROM/TO ingreso I-DERIVED_FROM/TO en I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cuidados I-DERIVED_FROM/TO Intensivos I-DERIVED_FROM/TO (UCI) I-DERIVED_FROM/TO pediátrica, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO pide I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO las I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO cutáneas. I-DERIVED_FROM/TO Apreciamos B-EXPLORATION flictenas I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sufrimiento I-EXPLORATION cutáneo I-EXPLORATION en I-EXPLORATION miembro I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION (MSD) I-EXPLORATION y I-EXPLORATION principalmente, I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION (MMII), I-EXPLORATION acompañados I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION purpúricas I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION irreversibles I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION pies. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT evolución I-TREATMENT tórpida I-TREATMENT y I-TREATMENT la I-TREATMENT extensión I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones, I-TREATMENT se I-TREATMENT decide I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT 17 I-TREATMENT días I-TREATMENT después. I-TREATMENT I-TREATMENT Realizamos I-TREATMENT desbridamiento I-TREATMENT superficial I-TREATMENT para I-TREATMENT demarcar I-TREATMENT la I-TREATMENT zona I-TREATMENT de I-TREATMENT necrosis I-TREATMENT profunda I-TREATMENT y I-TREATMENT colocamos I-TREATMENT Biobrane® I-TREATMENT (Biobrane, I-TREATMENT Smith I-TREATMENT & I-TREATMENT Nephew I-TREATMENT B.V., I-TREATMENT Barcelona, I-TREATMENT España). I-TREATMENT Las B-EVOLUTION zonas I-EVOLUTION intervenidas I-EVOLUTION se I-EVOLUTION curaron I-EVOLUTION con I-EVOLUTION sulfadiazina I-EVOLUTION argéntica I-EVOLUTION antes I-EVOLUTION y I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Ante B-DERIVED_FROM/TO la I-DERIVED_FROM/TO mala I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO de I-DERIVED_FROM/TO las I-DERIVED_FROM/TO heridas, I-DERIVED_FROM/TO contactamos I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Traumatología I-DERIVED_FROM/TO para I-DERIVED_FROM/TO nueva I-DERIVED_FROM/TO valoración. I-DERIVED_FROM/TO Se B-EXPLORATION realizaron I-EXPLORATION 2 I-EXPLORATION gammagrafías I-EXPLORATION óseas I-EXPLORATION en I-EXPLORATION un I-EXPLORATION intervalo I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION días I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION el I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION MMII I-EXPLORATION y I-EXPLORATION ambas I-EXPLORATION informaron I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION óseo I-EXPLORATION sin I-EXPLORATION captación I-EXPLORATION desde I-EXPLORATION aproximadamente I-EXPLORATION el I-EXPLORATION 1/3 I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tibia. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT gangrena I-TREATMENT establecida, I-TREATMENT con I-TREATMENT necrosis I-TREATMENT irreversible I-TREATMENT evidente I-TREATMENT y I-TREATMENT mal I-TREATMENT olor, I-TREATMENT los I-TREATMENT traumatólogos I-TREATMENT pediátricos I-TREATMENT deciden, I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT con I-TREATMENT la I-TREATMENT familia, I-TREATMENT proceder I-TREATMENT a I-TREATMENT practicar I-TREATMENT amputación I-TREATMENT infrarrotuliana I-TREATMENT bilateral I-TREATMENT para I-TREATMENT conservar I-TREATMENT la I-TREATMENT máxima I-TREATMENT movilidad I-TREATMENT ulterior I-TREATMENT de I-TREATMENT la I-TREATMENT paciente. I-TREATMENT I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION diferido I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION vascular I-EXPLORATION múltiple I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION abscesificante I-EXPLORATION en I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION tejidos I-EXPLORATION blandos. I-EXPLORATION I-EXPLORATION Durante B-EVOLUTION el I-EVOLUTION postoperatorio, I-EVOLUTION se I-EVOLUTION delimitó I-EVOLUTION aún I-EVOLUTION más I-EVOLUTION la I-EVOLUTION necrosis I-EVOLUTION de I-EVOLUTION tejidos I-EVOLUTION blandos I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION de I-EVOLUTION cobertura I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION muñones I-EVOLUTION de I-EVOLUTION amputación, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION produjo I-EVOLUTION una I-EVOLUTION exposición I-EVOLUTION de I-EVOLUTION los I-EVOLUTION segmentos I-EVOLUTION tibial I-EVOLUTION y I-EVOLUTION peroneo I-EVOLUTION de I-EVOLUTION ambas I-EVOLUTION extremidades. I-EVOLUTION Debido I-EVOLUTION a I-EVOLUTION la I-EVOLUTION corta I-EVOLUTION longitud I-EVOLUTION de I-EVOLUTION los I-EVOLUTION muñones, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION podía I-EVOLUTION proceder I-EVOLUTION a I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION amputación I-EVOLUTION de I-EVOLUTION los I-EVOLUTION segmentos I-EVOLUTION y I-EVOLUTION cobertura I-EVOLUTION con I-EVOLUTION tejido I-EVOLUTION proximal, I-EVOLUTION pues I-EVOLUTION no I-EVOLUTION garantizaría I-EVOLUTION la I-EVOLUTION posible I-EVOLUTION colocación I-EVOLUTION en I-EVOLUTION el I-EVOLUTION futuro I-EVOLUTION de I-EVOLUTION las I-EVOLUTION prótesis. I-EVOLUTION Por B-TREATMENT tanto, I-TREATMENT optamos I-TREATMENT por I-TREATMENT iniciar I-TREATMENT terapia I-TREATMENT de I-TREATMENT presión I-TREATMENT negativa I-TREATMENT con I-TREATMENT sistema I-TREATMENT VAC® I-TREATMENT para I-TREATMENT favorecer I-TREATMENT el I-TREATMENT crecimiento I-TREATMENT tisular I-TREATMENT y I-TREATMENT la I-TREATMENT eliminación I-TREATMENT del I-TREATMENT exudado I-TREATMENT de I-TREATMENT las I-TREATMENT heridas. I-TREATMENT I-TREATMENT Procedimos I-TREATMENT en I-TREATMENT primer I-TREATMENT lugar I-TREATMENT a I-TREATMENT lavar I-TREATMENT las I-TREATMENT extremidades I-TREATMENT con I-TREATMENT una I-TREATMENT solución I-TREATMENT de I-TREATMENT clorhexidina I-TREATMENT jabonosa I-TREATMENT al I-TREATMENT 0, I-TREATMENT 4% I-TREATMENT y I-TREATMENT suero I-TREATMENT fisiológico. I-TREATMENT Luego I-TREATMENT colocamos I-TREATMENT los I-TREATMENT apósitos I-TREATMENT VAC-Granufoam I-TREATMENT ® I-TREATMENT según I-TREATMENT la I-TREATMENT guía I-TREATMENT clínica I-TREATMENT de I-TREATMENT la I-TREATMENT terapia I-TREATMENT VAC®. I-TREATMENT Al I-TREATMENT principio I-TREATMENT utilizamos I-TREATMENT los I-TREATMENT apósitos I-TREATMENT medianos I-TREATMENT según I-TREATMENT el I-TREATMENT modelo I-TREATMENT Pitta-VAC® I-TREATMENT (10,11), I-TREATMENT dividiendo I-TREATMENT en I-TREATMENT dos I-TREATMENT mitades I-TREATMENT el I-TREATMENT apósito, I-TREATMENT de I-TREATMENT manera I-TREATMENT que I-TREATMENT cada I-TREATMENT una I-TREATMENT de I-TREATMENT ellas I-TREATMENT es I-TREATMENT separada I-TREATMENT parcialmente I-TREATMENT para I-TREATMENT ser I-TREATMENT colocada I-TREATMENT sobre I-TREATMENT la I-TREATMENT zona I-TREATMENT a I-TREATMENT tratar, I-TREATMENT como I-TREATMENT si I-TREATMENT fuera I-TREATMENT un I-TREATMENT guante. I-TREATMENT Esta B-EVOLUTION técnica I-EVOLUTION está I-EVOLUTION descrita I-EVOLUTION como I-EVOLUTION rápida I-EVOLUTION en I-EVOLUTION su I-EVOLUTION diseño I-EVOLUTION y I-EVOLUTION en I-EVOLUTION su I-EVOLUTION ejecución. I-EVOLUTION No I-EVOLUTION obstante, I-EVOLUTION en I-EVOLUTION zonas I-EVOLUTION en I-EVOLUTION las I-EVOLUTION que I-EVOLUTION la I-EVOLUTION necrosis I-EVOLUTION es I-EVOLUTION parcheada, I-EVOLUTION hemos I-EVOLUTION notado I-EVOLUTION que I-EVOLUTION este I-EVOLUTION sistema I-EVOLUTION macera I-EVOLUTION la I-EVOLUTION piel I-EVOLUTION sana I-EVOLUTION si I-EVOLUTION ésta I-EVOLUTION entra I-EVOLUTION en I-EVOLUTION contacto I-EVOLUTION directo I-EVOLUTION con I-EVOLUTION el I-EVOLUTION apósito I-EVOLUTION de I-EVOLUTION poliuretano I-EVOLUTION reticulado, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION es I-EVOLUTION necesario I-EVOLUTION colocar I-EVOLUTION apósitos I-EVOLUTION hidrocoloides I-EVOLUTION recortados I-EVOLUTION bajo I-EVOLUTION la I-EVOLUTION esponja I-EVOLUTION para I-EVOLUTION evitarlo, I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION hace I-EVOLUTION más I-EVOLUTION engorrosa I-EVOLUTION la I-EVOLUTION cura. I-EVOLUTION Decidimos B-TREATMENT por I-TREATMENT tanto I-TREATMENT volver I-TREATMENT a I-TREATMENT la I-TREATMENT colocación I-TREATMENT clásica I-TREATMENT de I-TREATMENT los I-TREATMENT apósitos: I-TREATMENT pequeños I-TREATMENT fragmentos I-TREATMENT recortados I-TREATMENT sobre I-TREATMENT las I-TREATMENT pérdidas I-TREATMENT de I-TREATMENT sustancia I-TREATMENT conectados I-TREATMENT entre I-TREATMENT sí I-TREATMENT mediante I-TREATMENT íntimo I-TREATMENT contacto I-TREATMENT en I-TREATMENT alguna I-TREATMENT de I-TREATMENT sus I-TREATMENT partes. I-TREATMENT La I-TREATMENT presión I-TREATMENT utilizada I-TREATMENT fue I-TREATMENT de I-TREATMENT -125 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT en I-TREATMENT modo I-TREATMENT continuo. I-TREATMENT La B-EVOLUTION granulación I-EVOLUTION en I-EVOLUTION el I-EVOLUTION lecho I-EVOLUTION y I-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION fueron I-EVOLUTION evidentes. I-EVOLUTION I-EVOLUTION Tras I-EVOLUTION 40 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION terapia, I-EVOLUTION conseguimos I-EVOLUTION el I-EVOLUTION recubrimiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION segmentos I-EVOLUTION óseos I-EVOLUTION expuestos I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION colocación I-EVOLUTION de I-EVOLUTION láminas I-EVOLUTION regeneradoras I-EVOLUTION dérmicas I-EVOLUTION Integra® I-EVOLUTION (Integra, I-EVOLUTION San I-EVOLUTION Priest, I-EVOLUTION Francia) I-EVOLUTION durante I-EVOLUTION 1 I-EVOLUTION mes, I-EVOLUTION logramos I-EVOLUTION la I-EVOLUTION cobertura I-EVOLUTION definitiva I-EVOLUTION mediante I-EVOLUTION injertos I-EVOLUTION de I-EVOLUTION piel I-EVOLUTION parcial I-EVOLUTION mallados I-EVOLUTION 1: I-EVOLUTION 1, I-EVOLUTION 5 I-EVOLUTION tomados I-EVOLUTION del I-EVOLUTION muslo I-EVOLUTION izquierdo. I-EVOLUTION I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION satisfactoria, I-EVOLUTION con I-EVOLUTION epitelización I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION los I-EVOLUTION muñones I-EVOLUTION de I-EVOLUTION amputación, I-EVOLUTION procediéndose I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION tras I-EVOLUTION exactamente I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION hospitalario. I-EVOLUTION Mantuvimos I-EVOLUTION seguimiento I-EVOLUTION ambulatorio I-EVOLUTION durante I-EVOLUTION 3 I-EVOLUTION semanas I-EVOLUTION más. I-EVOLUTION Tras I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION del I-EVOLUTION suceso, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION proceso I-EVOLUTION de I-EVOLUTION rehabilitación I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION secuelas I-EVOLUTION neurológicas, I-EVOLUTION control I-EVOLUTION del I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION adaptación I-EVOLUTION a I-EVOLUTION prótesis I-EVOLUTION infracondíleas. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS valorar I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS mamario I-PRESENT_ILLNESS bilateral. I-PRESENT_ILLNESS Presenta B-EXPLORATION atrofia I-EXPLORATION mamaria I-EXPLORATION moderada I-EXPLORATION con I-EXPLORATION ptosis I-EXPLORATION muy I-EXPLORATION leve. I-EXPLORATION La I-EXPLORATION piel I-EXPLORATION es I-EXPLORATION de I-EXPLORATION buena I-EXPLORATION calidad, I-EXPLORATION hidratada I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION estrías. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpan I-EXPLORATION nódulos I-EXPLORATION mamarios I-EXPLORATION y I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refiere I-EXPLORATION ningún I-EXPLORATION antecedente I-EXPLORATION patológico I-EXPLORATION mamario I-EXPLORATION de I-EXPLORATION relevancia. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION mamografías I-EXPLORATION recientes I-EXPLORATION no I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION ninguna I-EXPLORATION patología. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT la I-TREATMENT consulta I-TREATMENT y I-TREATMENT exploración I-TREATMENT clínica I-TREATMENT se I-TREATMENT decide I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT una I-TREATMENT cirugía I-TREATMENT de I-TREATMENT aumento I-TREATMENT mamario I-TREATMENT bilateral I-TREATMENT por I-TREATMENT vía I-TREATMENT periareolar I-TREATMENT inferior, I-TREATMENT con I-TREATMENT disección I-TREATMENT de I-TREATMENT bolsillo I-TREATMENT subpectoral I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT prótesis I-TREATMENT anatómicas I-TREATMENT de I-TREATMENT gel I-TREATMENT de I-TREATMENT silicona I-TREATMENT (McGhan® I-TREATMENT Style I-TREATMENT 140 I-TREATMENT MM I-TREATMENT de I-TREATMENT 320 I-TREATMENT cc.). I-TREATMENT I-TREATMENT La I-TREATMENT intervención I-TREATMENT se I-TREATMENT realizó I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT y I-TREATMENT transcurrió I-TREATMENT sin I-TREATMENT incidencias; I-TREATMENT la B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION día I-EVOLUTION siguiente. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION postoperatorio I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION bien, I-EVOLUTION el I-EVOLUTION aspecto I-EVOLUTION de I-EVOLUTION las I-EVOLUTION mamas I-EVOLUTION es I-EVOLUTION normal, I-EVOLUTION la I-EVOLUTION simetría I-EVOLUTION es I-EVOLUTION adecuada I-EVOLUTION y I-EVOLUTION las I-EVOLUTION molestias I-EVOLUTION son I-EVOLUTION de I-EVOLUTION escasa I-EVOLUTION relevancia. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION que I-EVOLUTION nota I-EVOLUTION tensión I-EVOLUTION en I-EVOLUTION las I-EVOLUTION mamas, I-EVOLUTION pero I-EVOLUTION sin I-EVOLUTION dolor I-EVOLUTION a I-EVOLUTION la I-EVOLUTION palpación. I-EVOLUTION La B-EXPLORATION cicatrización I-EXPLORATION es I-EXPLORATION correcta. I-EXPLORATION I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION postoperatorio I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION la I-EVOLUTION consulta I-EVOLUTION presentando I-EVOLUTION aumento I-EVOLUTION simétrico I-EVOLUTION del I-EVOLUTION volumen I-EVOLUTION mamario I-EVOLUTION y I-EVOLUTION drenaje I-EVOLUTION espontáneo I-EVOLUTION de I-EVOLUTION material I-EVOLUTION líquido I-EVOLUTION de I-EVOLUTION coloración I-EVOLUTION blanquecina I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION una I-EVOLUTION pequeña I-EVOLUTION dehiscencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION periareolar I-EVOLUTION derecha. I-EVOLUTION No B-EXPLORATION ha I-EXPLORATION presentado I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION las I-EXPLORATION mamas I-EXPLORATION no I-EXPLORATION muestran I-EXPLORATION signos I-EXPLORATION inflamatorios. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION margen I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cicatriz I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION pequeño I-EXPLORATION de I-EXPLORATION fecto I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION mm. I-EXPLORATION por I-EXPLORATION el I-EXPLORATION que I-EXPLORATION drena I-EXPLORATION material, I-EXPLORATION que I-EXPLORATION al I-EXPLORATION exprimir I-EXPLORATION la I-EXPLORATION mama I-EXPLORATION aumenta I-EXPLORATION su I-EXPLORATION caudal. I-EXPLORATION Sospechando B-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT un I-TREATMENT absceso I-TREATMENT retroareolar I-TREATMENT y I-TREATMENT decidimos I-TREATMENT dilatar I-TREATMENT dicho I-TREATMENT defecto I-TREATMENT usando I-TREATMENT una I-TREATMENT pinza I-TREATMENT de I-TREATMENT hemostasia, I-TREATMENT momento I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT produce I-TREATMENT el I-TREATMENT drenaje I-TREATMENT espontáneo I-TREATMENT de I-TREATMENT una I-TREATMENT gran I-TREATMENT cantidad I-TREATMENT del I-TREATMENT citado I-TREATMENT material. I-TREATMENT Al I-TREATMENT proceder I-TREATMENT a I-TREATMENT la I-TREATMENT expresión I-TREATMENT de I-TREATMENT la I-TREATMENT mama I-TREATMENT se I-TREATMENT aprecia I-TREATMENT igualmente I-TREATMENT que I-TREATMENT el I-TREATMENT material I-TREATMENT drena I-TREATMENT por I-TREATMENT el I-TREATMENT pezón I-TREATMENT y I-TREATMENT al I-TREATMENT hacer I-TREATMENT la I-TREATMENT misma I-TREATMENT maniobra I-TREATMENT en I-TREATMENT la I-TREATMENT mama I-TREATMENT izquierda, I-TREATMENT se I-TREATMENT aprecia I-TREATMENT también I-TREATMENT este I-TREATMENT drenaje I-TREATMENT por I-TREATMENT el I-TREATMENT pezón. I-TREATMENT Tomamos B-EXPLORATION muestra I-EXPLORATION para I-EXPLORATION cultivo, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION negativo. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION pensamos I-EXPLORATION que I-EXPLORATION la I-EXPLORATION tumefacción I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mamas I-EXPLORATION se I-EXPLORATION debe I-EXPLORATION a I-EXPLORATION la I-EXPLORATION producción I-EXPLORATION de I-EXPLORATION leche. I-EXPLORATION I-EXPLORATION Recomendamos I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION para I-EXPLORATION estudiar I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION prolactina I-EXPLORATION (PRL) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION consulta I-EXPLORATION con I-EXPLORATION Ginecología I-EXPLORATION que I-EXPLORATION recomienda I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION mamaria I-EXPLORATION bilateral, I-EXPLORATION TAC I-EXPLORATION craneal I-EXPLORATION y I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION hormonas I-EXPLORATION tiroideas I-EXPLORATION y I-EXPLORATION suprarrenales. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION todas I-EXPLORATION estas I-EXPLORATION pruebas I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION signos I-EXPLORATION patológicos. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION mamaria I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION densidad I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION mamario I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION líquido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION bolsillo I-EXPLORATION que I-EXPLORATION alojaba I-EXPLORATION la I-EXPLORATION prótesis. I-EXPLORATION Aún B-TREATMENT así I-TREATMENT se I-TREATMENT decide I-TREATMENT instaurar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT bromocriptina I-TREATMENT por I-TREATMENT vía I-TREATMENT oral I-TREATMENT de I-TREATMENT forma I-TREATMENT empírica, I-TREATMENT a I-TREATMENT una I-TREATMENT dosis I-TREATMENT inicial I-TREATMENT de I-TREATMENT 1, I-TREATMENT 25 I-TREATMENT mg., I-TREATMENT 3 I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT Después I-TREATMENT de I-TREATMENT una I-TREATMENT semana I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT al I-TREATMENT no I-TREATMENT obtener I-TREATMENT respuesta, I-TREATMENT se I-TREATMENT aumentó I-TREATMENT la I-TREATMENT dosis I-TREATMENT hasta I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT mg. I-TREATMENT 3 I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT mantendría I-TREATMENT hasta I-TREATMENT 2 I-TREATMENT semanas I-TREATMENT después I-TREATMENT del I-TREATMENT cese I-TREATMENT de I-TREATMENT la I-TREATMENT secreción. I-TREATMENT I-TREATMENT A B-EVOLUTION pesar I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION tórpida I-EVOLUTION y I-EVOLUTION el I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION galactorrea I-EVOLUTION no I-EVOLUTION cesó, I-EVOLUTION continuando I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION de I-EVOLUTION leche I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION derecha. I-EVOLUTION Ambas I-EVOLUTION mamas I-EVOLUTION continuaban I-EVOLUTION turgentes. I-EVOLUTION Se B-TREATMENT mantiene I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT con I-TREATMENT vendajes I-TREATMENT moderadamente I-TREATMENT compresivos I-TREATMENT considerando I-TREATMENT que I-TREATMENT el I-TREATMENT drenaje I-TREATMENT continuo I-TREATMENT de I-TREATMENT leche I-TREATMENT por I-TREATMENT la I-TREATMENT fístula I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT puede I-TREATMENT ser I-TREATMENT un I-TREATMENT estímulo I-TREATMENT mantenido I-TREATMENT para I-TREATMENT la I-TREATMENT lactancia, I-TREATMENT así I-TREATMENT como I-TREATMENT para I-TREATMENT sellar I-TREATMENT posibles I-TREATMENT espacios I-TREATMENT muertos I-TREATMENT en I-TREATMENT el I-TREATMENT bolsillo I-TREATMENT o I-TREATMENT en I-TREATMENT el I-TREATMENT tejido I-TREATMENT mamario. I-TREATMENT I-TREATMENT Al B-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION en I-EVOLUTION los I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION sometida I-EVOLUTION a I-EVOLUTION revisiones I-EVOLUTION y I-EVOLUTION curas I-EVOLUTION semanales, I-EVOLUTION el I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION galactorrea I-EVOLUTION cesó, I-EVOLUTION deteniéndose I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION de I-EVOLUTION leche I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION y I-EVOLUTION disminuyendo I-EVOLUTION la I-EVOLUTION turgencia I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION mamas. I-EVOLUTION I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION después I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION presentando I-EVOLUTION en I-EVOLUTION esta I-EVOLUTION ocasión I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION mamario I-EVOLUTION unilateral I-EVOLUTION derecho. I-EVOLUTION Se B-EXPLORATION realiza I-EXPLORATION nueva I-EXPLORATION ecografía I-EXPLORATION mamaria I-EXPLORATION que I-EXPLORATION revela I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION seroma I-EXPLORATION intracapsular I-EXPLORATION derecho. I-EXPLORATION Se B-TREATMENT procede I-TREATMENT al I-TREATMENT drenaje I-TREATMENT del I-TREATMENT mismo I-TREATMENT bajo I-TREATMENT condiciones I-TREATMENT de I-TREATMENT asepsia I-TREATMENT y I-TREATMENT éste I-TREATMENT se I-TREATMENT resuelve I-TREATMENT en I-TREATMENT 7 I-TREATMENT días; I-TREATMENT pero B-EVOLUTION la I-EVOLUTION morfología I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION comienza I-EVOLUTION a I-EVOLUTION verse I-EVOLUTION afectada I-EVOLUTION de I-EVOLUTION tal I-EVOLUTION forma I-EVOLUTION que I-EVOLUTION el I-EVOLUTION trayecto I-EVOLUTION a I-EVOLUTION través I-EVOLUTION del I-EVOLUTION cual I-EVOLUTION drenaba I-EVOLUTION la I-EVOLUTION leche I-EVOLUTION se I-EVOLUTION retrae I-EVOLUTION deformando I-EVOLUTION la I-EVOLUTION areola. I-EVOLUTION Se I-EVOLUTION constata I-EVOLUTION también I-EVOLUTION que I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION desarrolla I-EVOLUTION un I-EVOLUTION grado I-EVOLUTION incipiente I-EVOLUTION de I-EVOLUTION contractura I-EVOLUTION capsular. I-EVOLUTION Optamos B-TREATMENT por I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT revisión I-TREATMENT quirúrgica I-TREATMENT debido I-TREATMENT sobre I-TREATMENT todo I-TREATMENT a I-TREATMENT la I-TREATMENT deformidad I-TREATMENT provocada I-TREATMENT por I-TREATMENT la I-TREATMENT fístula I-TREATMENT areolar. I-TREATMENT I-TREATMENT La I-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenida I-TREATMENT procediendo I-TREATMENT a I-TREATMENT la I-TREATMENT revisión I-TREATMENT del I-TREATMENT bolsillo I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT aprecia I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT ninguna I-TREATMENT colección I-TREATMENT líquida, I-TREATMENT tan I-TREATMENT solo I-TREATMENT escasos I-TREATMENT depósitos I-TREATMENT blanquecinos I-TREATMENT que I-TREATMENT se I-TREATMENT analizan I-TREATMENT Practicamos I-TREATMENT capsulotomías, I-TREATMENT recolocación I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT que I-TREATMENT permanecía I-TREATMENT intacta I-TREATMENT y I-TREATMENT sin I-TREATMENT depósitos I-TREATMENT en I-TREATMENT su I-TREATMENT superficie I-TREATMENT y I-TREATMENT reparación I-TREATMENT de I-TREATMENT la I-TREATMENT retracción I-TREATMENT areolar. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION los I-EXPLORATION depósitos I-EXPLORATION blanquecinos I-EXPLORATION hallados I-EXPLORATION describe I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION hialinizada I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION crónica I-EXPLORATION granulomatosa I-EXPLORATION e I-EXPLORATION infiltrado I-EXPLORATION de I-EXPLORATION histiocitos. I-EXPLORATION I-EXPLORATION Durante B-EVOLUTION este I-EVOLUTION segundo I-EVOLUTION postoperatorio I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION desarrolla I-EVOLUTION galactorrea I-EVOLUTION y I-EVOLUTION se I-EVOLUTION recupera I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION después I-EVOLUTION de I-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION derecha I-EVOLUTION desarrolla I-EVOLUTION contractura I-EVOLUTION capsular I-EVOLUTION grado I-EVOLUTION III I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decide I-TREATMENT reintervenir I-TREATMENT nuevamente, I-TREATMENT realizando I-TREATMENT capsulectomía I-TREATMENT parcial I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT los I-TREATMENT tegumentos I-TREATMENT se I-TREATMENT han I-TREATMENT adelgazado I-TREATMENT y I-TREATMENT se I-TREATMENT considera I-TREATMENT el I-TREATMENT riesgo I-TREATMENT de I-TREATMENT afectar I-TREATMENT la I-TREATMENT integridad I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT durante I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT capsulectomia I-TREATMENT total, I-TREATMENT y I-TREATMENT capsulorrafia I-TREATMENT medial I-TREATMENT por I-TREATMENT ser I-TREATMENT esta I-TREATMENT la I-TREATMENT zona I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT el I-TREATMENT adelgazamiento I-TREATMENT de I-TREATMENT los I-TREATMENT tejidos I-TREATMENT es I-TREATMENT mayor. I-TREATMENT Cambiamos I-TREATMENT la I-TREATMENT prótesis I-TREATMENT por I-TREATMENT otra I-TREATMENT de I-TREATMENT idénticas I-TREATMENT carácterísticas. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION nueva I-EVOLUTION intervención I-EVOLUTION detectamos I-EVOLUTION como I-EVOLUTION única I-EVOLUTION complicación I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Mondor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION derecha. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION postoperatorio I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION nuevamente I-EVOLUTION signos I-EVOLUTION compatibles I-EVOLUTION con I-EVOLUTION contractura I-EVOLUTION capsular I-EVOLUTION recidivada I-EVOLUTION en I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION derecha, I-EVOLUTION con I-EVOLUTION notable I-EVOLUTION afectación I-EVOLUTION estética I-EVOLUTION y I-EVOLUTION de I-EVOLUTION aparición I-EVOLUTION más I-EVOLUTION lenta I-EVOLUTION en I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION izquierda. I-EVOLUTION El B-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT que I-TREATMENT podría I-TREATMENT plantearse I-TREATMENT en I-TREATMENT esta I-TREATMENT ocasión I-TREATMENT sería: I-TREATMENT en I-TREATMENT la I-TREATMENT mama I-TREATMENT derecha I-TREATMENT nueva I-TREATMENT capsulectomía, I-TREATMENT si I-TREATMENT los I-TREATMENT tegumentos I-TREATMENT lo I-TREATMENT permiten, I-TREATMENT pudiendo I-TREATMENT precisar I-TREATMENT de I-TREATMENT refuerzo I-TREATMENT mediante I-TREATMENT malla I-TREATMENT de I-TREATMENT material I-TREATMENT sintético I-TREATMENT o I-TREATMENT biológico I-TREATMENT en I-TREATMENT la I-TREATMENT región I-TREATMENT ínferomedial, I-TREATMENT y I-TREATMENT en I-TREATMENT la I-TREATMENT mama I-TREATMENT izquierda I-TREATMENT capsulectomía I-TREATMENT y I-TREATMENT recambio I-TREATMENT de I-TREATMENT prótesis. I-TREATMENT No I-TREATMENT se I-TREATMENT descarta I-TREATMENT la I-TREATMENT necesidad I-TREATMENT de I-TREATMENT añadir I-TREATMENT procedimientos I-TREATMENT de I-TREATMENT mastopexia I-TREATMENT para I-TREATMENT corregir I-TREATMENT la I-TREATMENT posición I-TREATMENT del I-TREATMENT complejo I-TREATMENT teloareolar. I-TREATMENT I-TREATMENT Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS región I-PRESENT_ILLNESS maseterina I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS el I-PRESENT_ILLNESS músculo I-PRESENT_ILLNESS masetero I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS motivó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY estar I-PAST_MEDICAL_HISTORY asintomático, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY patologías I-PAST_MEDICAL_HISTORY agregadas, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY malos I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY dietéticos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bruxismo I-PAST_MEDICAL_HISTORY diurno I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY nocturno. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION en I-EXPLORATION marzo I-EXPLORATION del I-EXPLORATION 2008 I-EXPLORATION mediante I-EXPLORATION Tomografía I-EXPLORATION Axial I-EXPLORATION Computerizada I-EXPLORATION (TAC) I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION contrastada I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION patología I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos I-EXPLORATION y I-EXPLORATION duros I-EXPLORATION tipo I-EXPLORATION neoplasia, I-EXPLORATION proceso I-EXPLORATION infeccioso I-EXPLORATION crónico I-EXPLORATION o I-EXPLORATION crecimiento I-EXPLORATION óseo. I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION finalmente I-EXPLORATION como I-EXPLORATION hipertrofia I-EXPLORATION del I-EXPLORATION músculo I-EXPLORATION masetero I-EXPLORATION bilateral, I-EXPLORATION mayor I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Tomamos I-EXPLORATION medidas I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION maseteros I-EXPLORATION en I-EXPLORATION los I-EXPLORATION cortes I-EXPLORATION tomográficos, I-EXPLORATION de I-EXPLORATION anterior I-EXPLORATION a I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION músculos I-EXPLORATION maseteros I-EXPLORATION y I-EXPLORATION en I-EXPLORATION su I-EXPLORATION diámetro I-EXPLORATION transverso I-EXPLORATION con I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION resultados: I-EXPLORATION 1.40 I-EXPLORATION cm, I-EXPLORATION 1.60 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION 0.95 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION masetero I-EXPLORATION derecho; I-EXPLORATION 1.83 I-EXPLORATION cm, I-EXPLORATION 1.53 I-EXPLORATION y I-EXPLORATION 1.13 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION músculo I-EXPLORATION masetero I-EXPLORATION izquierdo, I-EXPLORATION ambos I-EXPLORATION mayores I-EXPLORATION de I-EXPLORATION lo I-EXPLORATION normal. I-EXPLORATION Iniciamos B-TREATMENT tratamiento I-TREATMENT a I-TREATMENT base I-TREATMENT de I-TREATMENT guarda I-TREATMENT oclusal I-TREATMENT nocturna I-TREATMENT y I-TREATMENT aplicación I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT en I-TREATMENT noviembre I-TREATMENT del I-TREATMENT 2009, I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT al I-TREATMENT protocolo I-TREATMENT seleccionado. I-TREATMENT I-TREATMENT Se I-TREATMENT propuso I-TREATMENT la I-TREATMENT aplicación I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica. I-TREATMENT La I-TREATMENT Primera I-TREATMENT aplicación I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 50 I-TREATMENT U, I-TREATMENT 25 I-TREATMENT de I-TREATMENT las I-TREATMENT cuales I-TREATMENT se I-TREATMENT aplicaron I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT de I-TREATMENT mayor I-TREATMENT hipertrofia I-TREATMENT (zona I-TREATMENT IV I-TREATMENT descrita I-TREATMENT por I-TREATMENT Da-Hye I-TREATMENT Kim), I-TREATMENT 15 I-TREATMENT U I-TREATMENT en I-TREATMENT dirección I-TREATMENT al I-TREATMENT borde I-TREATMENT inferior I-TREATMENT mandibular I-TREATMENT y I-TREATMENT 10 I-TREATMENT U I-TREATMENT por I-TREATMENT encima I-TREATMENT de I-TREATMENT la I-TREATMENT aplicación I-TREATMENT previa I-TREATMENT (correspondiente I-TREATMENT a I-TREATMENT zona I-TREATMENT V I-TREATMENT de I-TREATMENT Da-Hye I-TREATMENT Kim). I-TREATMENT Con I-TREATMENT esta I-TREATMENT distribución I-TREATMENT de I-TREATMENT aplicación I-TREATMENT en I-TREATMENT los I-TREATMENT puntos I-TREATMENT propuestos I-TREATMENT por I-TREATMENT Nam-Ho I-TREATMENT Kim I-TREATMENT que I-TREATMENT mejoran I-TREATMENT el I-TREATMENT contorno I-TREATMENT mandibular, I-TREATMENT se I-TREATMENT realizó I-TREATMENT marcaje I-TREATMENT sobre I-TREATMENT la I-TREATMENT piel I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT ambos I-TREATMENT músculos I-TREATMENT maseteros I-TREATMENT (5). I-TREATMENT Para I-TREATMENT la I-TREATMENT preparación I-TREATMENT del I-TREATMENT producto I-TREATMENT se I-TREATMENT utilizó I-TREATMENT una I-TREATMENT aguja I-TREATMENT gruesa I-TREATMENT (18G) I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT evitar I-TREATMENT la I-TREATMENT formación I-TREATMENT de I-TREATMENT turbulencias. I-TREATMENT El I-TREATMENT alcohol, I-TREATMENT usado I-TREATMENT ya I-TREATMENT sea I-TREATMENT en I-TREATMENT el I-TREATMENT tapón I-TREATMENT del I-TREATMENT vial I-TREATMENT o I-TREATMENT bien I-TREATMENT en I-TREATMENT la I-TREATMENT piel I-TREATMENT del I-TREATMENT paciente, I-TREATMENT debe I-TREATMENT evaporarse I-TREATMENT completamente I-TREATMENT antes I-TREATMENT de I-TREATMENT aplicar I-TREATMENT la I-TREATMENT toxina I-TREATMENT dado I-TREATMENT que I-TREATMENT también I-TREATMENT puede I-TREATMENT inactivarla. I-TREATMENT A I-TREATMENT pesar I-TREATMENT de I-TREATMENT que I-TREATMENT el I-TREATMENT vial I-TREATMENT puede I-TREATMENT reconstituirse I-TREATMENT a I-TREATMENT una I-TREATMENT dilución I-TREATMENT de I-TREATMENT 8 I-TREATMENT cc/100 I-TREATMENT U, I-TREATMENT preferimos I-TREATMENT la I-TREATMENT dilución I-TREATMENT en I-TREATMENT 4 I-TREATMENT cc. I-TREATMENT a I-TREATMENT fin I-TREATMENT de I-TREATMENT conseguir I-TREATMENT una I-TREATMENT dosificación I-TREATMENT de I-TREATMENT 2.5 I-TREATMENT U/0.1 I-TREATMENT cc. I-TREATMENT El I-TREATMENT obtener I-TREATMENT de I-TREATMENT esta I-TREATMENT forma I-TREATMENT un I-TREATMENT volumen I-TREATMENT menor, I-TREATMENT limitará I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT que I-TREATMENT la I-TREATMENT toxina I-TREATMENT difunda I-TREATMENT hacia I-TREATMENT las I-TREATMENT zonas I-TREATMENT adyacentes. I-TREATMENT Es I-TREATMENT importante I-TREATMENT recordar I-TREATMENT que I-TREATMENT una I-TREATMENT vez I-TREATMENT realizada I-TREATMENT la I-TREATMENT reconstitución, I-TREATMENT el I-TREATMENT producto I-TREATMENT deberá I-TREATMENT utilizarse I-TREATMENT en I-TREATMENT el I-TREATMENT plazo I-TREATMENT de I-TREATMENT las I-TREATMENT 4 I-TREATMENT horas I-TREATMENT siguientes I-TREATMENT para I-TREATMENT evitar I-TREATMENT pérdida I-TREATMENT de I-TREATMENT eficacia, I-TREATMENT aunque I-TREATMENT algunos I-TREATMENT autores I-TREATMENT señalan I-TREATMENT que I-TREATMENT se I-TREATMENT puede I-TREATMENT utilizar I-TREATMENT sin I-TREATMENT disminuir I-TREATMENT su I-TREATMENT eficacia I-TREATMENT dentro I-TREATMENT de I-TREATMENT los I-TREATMENT 3 I-TREATMENT a I-TREATMENT 7 I-TREATMENT días I-TREATMENT posteriores. I-TREATMENT I-TREATMENT Para I-TREATMENT disminuir I-TREATMENT las I-TREATMENT molestias I-TREATMENT y I-TREATMENT que I-TREATMENT la I-TREATMENT aplicación I-TREATMENT sea I-TREATMENT segura I-TREATMENT utilizamos I-TREATMENT una I-TREATMENT aguja I-TREATMENT fina I-TREATMENT (30G). I-TREATMENT Es I-TREATMENT importante I-TREATMENT insistir I-TREATMENT en I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT no I-TREATMENT debe I-TREATMENT tomar I-TREATMENT medicamentos I-TREATMENT que I-TREATMENT interfieran I-TREATMENT con I-TREATMENT la I-TREATMENT coagulación I-TREATMENT de I-TREATMENT 10 I-TREATMENT a I-TREATMENT 14 I-TREATMENT días I-TREATMENT antes I-TREATMENT de I-TREATMENT la I-TREATMENT inyección I-TREATMENT para I-TREATMENT evitar I-TREATMENT equímosis. I-TREATMENT También I-TREATMENT solicitamos I-TREATMENT al I-TREATMENT paciente I-TREATMENT la I-TREATMENT correspondiente I-TREATMENT autorización I-TREATMENT para I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT mediante I-TREATMENT un I-TREATMENT consentimiento I-TREATMENT informado I-TREATMENT específico, I-TREATMENT tal I-TREATMENT y I-TREATMENT como I-TREATMENT habitualmente I-TREATMENT hacemos I-TREATMENT con I-TREATMENT cualquier I-TREATMENT procedimiento I-TREATMENT invasivo. I-TREATMENT I-TREATMENT Para I-TREATMENT las I-TREATMENT aplicaciones I-TREATMENT posteriores I-TREATMENT citamos I-TREATMENT al I-TREATMENT paciente I-TREATMENT cada I-TREATMENT 12 I-TREATMENT semanas I-TREATMENT (3 I-TREATMENT meses), I-TREATMENT utilizando I-TREATMENT la I-TREATMENT misma I-TREATMENT técnica I-TREATMENT y I-TREATMENT completando I-TREATMENT hasta I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 4 I-TREATMENT aplicaciones. I-TREATMENT Se I-TREATMENT sabe I-TREATMENT que I-TREATMENT al I-TREATMENT utilizar I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT de I-TREATMENT forma I-TREATMENT repetitiva I-TREATMENT se I-TREATMENT causa I-TREATMENT atrofia I-TREATMENT en I-TREATMENT los I-TREATMENT grupos I-TREATMENT musculares I-TREATMENT infiltrados, I-TREATMENT lo I-TREATMENT que I-TREATMENT hace I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT presente I-TREATMENT mejoría I-TREATMENT clínica. I-TREATMENT También I-TREATMENT se I-TREATMENT indicó I-TREATMENT continuar I-TREATMENT con I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT la I-TREATMENT guarda I-TREATMENT oclusal I-TREATMENT nocturna I-TREATMENT para I-TREATMENT controlar I-TREATMENT el I-TREATMENT bruxismo. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS sufre I-PRESENT_ILLNESS herida I-PRESENT_ILLNESS traumática I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS quedar I-PRESENT_ILLNESS atrapada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS cinta I-PRESENT_ILLNESS transportadora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS empresa I-PRESENT_ILLNESS cárnica, I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS y I-PRESENT_ILLNESS arrancamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS tendones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS músculo I-PRESENT_ILLNESS extensor I-PRESENT_ILLNESS común I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS su I-PRESENT_ILLNESS unión I-PRESENT_ILLNESS miotendinosa. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-TREATMENT un I-TREATMENT primer I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT urgencia I-TREATMENT se I-TREATMENT realizó I-TREATMENT limpieza I-TREATMENT exhaustiva, I-TREATMENT cierre I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT y I-TREATMENT cobertura I-TREATMENT antibiótica, I-TREATMENT postponiendo I-TREATMENT la I-TREATMENT cirugía I-TREATMENT reconstructiva I-TREATMENT dado I-TREATMENT el I-TREATMENT alto I-TREATMENT riesgo I-TREATMENT de I-TREATMENT infección. I-TREATMENT Tras B-EVOLUTION una I-EVOLUTION semana I-EVOLUTION y I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION profilácticas, I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION sufrió I-EVOLUTION una I-EVOLUTION infección I-EVOLUTION por I-EVOLUTION microorganismos I-EVOLUTION anaerobios I-EVOLUTION que B-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT desbridamiento I-TREATMENT quirúrgico, I-TREATMENT antibiotepia I-TREATMENT y I-TREATMENT cámara I-TREATMENT hiperbárica I-TREATMENT durante I-TREATMENT 3 I-TREATMENT semanas. I-TREATMENT Una I-TREATMENT vez I-TREATMENT resuelta I-TREATMENT la I-TREATMENT infección I-TREATMENT se I-TREATMENT programó I-TREATMENT para I-TREATMENT transferencia I-TREATMENT tendinosa, I-TREATMENT pero I-TREATMENT en I-TREATMENT el I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT encontró I-TREATMENT necrosis I-TREATMENT de I-TREATMENT los I-TREATMENT tendones I-TREATMENT extensores I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT resecar I-TREATMENT hasta I-TREATMENT tejido I-TREATMENT viable I-TREATMENT y I-TREATMENT utilizar I-TREATMENT varillas I-TREATMENT de I-TREATMENT silicona I-TREATMENT en I-TREATMENT un I-TREATMENT primer I-TREATMENT tiempo I-TREATMENT con I-TREATMENT vistas I-TREATMENT a I-TREATMENT un I-TREATMENT posterior I-TREATMENT injerto I-TREATMENT tendinoso. I-TREATMENT I-TREATMENT Al B-EVOLUTION mes I-EVOLUTION de I-EVOLUTION la I-EVOLUTION implantación I-EVOLUTION de I-EVOLUTION las I-EVOLUTION varillas, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentaba I-EVOLUTION una I-EVOLUTION severa I-EVOLUTION limitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION movilidad I-EVOLUTION que I-EVOLUTION contraindicaba I-EVOLUTION el I-EVOLUTION injerto I-EVOLUTION tendinoso, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT tras I-TREATMENT confirmar I-TREATMENT mediante I-TREATMENT doppler I-TREATMENT la I-TREATMENT permeabilidad I-TREATMENT tanto I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT tibial I-TREATMENT posterior I-TREATMENT como I-TREATMENT de I-TREATMENT la I-TREATMENT tibial I-TREATMENT anterior, I-TREATMENT se I-TREATMENT decidió I-TREATMENT utilizar I-TREATMENT el I-TREATMENT colgajo I-TREATMENT vascularizado I-TREATMENT de I-TREATMENT dorsalis I-TREATMENT pedis I-TREATMENT para I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT funcional I-TREATMENT completa. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT anastomosis I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT dorsal I-TREATMENT del I-TREATMENT pie I-TREATMENT a I-TREATMENT la I-TREATMENT radial, I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT safena I-TREATMENT a I-TREATMENT una I-TREATMENT vena I-TREATMENT superficial I-TREATMENT del I-TREATMENT antebrazo, I-TREATMENT y I-TREATMENT la I-TREATMENT correspondiente I-TREATMENT sutura I-TREATMENT tendinosa. I-TREATMENT I-TREATMENT Se I-TREATMENT inmovilizó I-TREATMENT la I-TREATMENT zona I-TREATMENT donante I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días I-TREATMENT con I-TREATMENT férula I-TREATMENT de I-TREATMENT yeso, I-TREATMENT lo I-TREATMENT suficiente I-TREATMENT para I-TREATMENT que I-TREATMENT el I-TREATMENT injerto I-TREATMENT prendiera. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION comenzó I-EVOLUTION entonces I-EVOLUTION a I-EVOLUTION deambular I-EVOLUTION libremente I-EVOLUTION con I-EVOLUTION un I-EVOLUTION vendaje I-EVOLUTION simple I-EVOLUTION del I-EVOLUTION área I-EVOLUTION y I-EVOLUTION no I-EVOLUTION sufrió I-EVOLUTION complicaciones. I-EVOLUTION Tras I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION postoperatorio, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refería I-EVOLUTION anestesia I-EVOLUTION exclusivamente I-EVOLUTION en I-EVOLUTION el I-EVOLUTION área I-EVOLUTION donante I-EVOLUTION del I-EVOLUTION colgajo. I-EVOLUTION I-EVOLUTION La B-TREATMENT mano I-TREATMENT se I-TREATMENT inmovilizó I-TREATMENT durante I-TREATMENT 4 I-TREATMENT semanas I-TREATMENT y I-TREATMENT se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT rehabilitación I-TREATMENT con I-TREATMENT ejercicios I-TREATMENT activos I-TREATMENT protegidos I-TREATMENT durante I-TREATMENT 8 I-TREATMENT semanas, I-TREATMENT obteniendo I-TREATMENT un I-TREATMENT resultado I-TREATMENT funcional I-TREATMENT satisfactorio I-TREATMENT y B-EVOLUTION reincorporación I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION al I-EVOLUTION trabajo I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de B-PRESENT_ILLNESS interés, I-PRESENT_ILLNESS remitido I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS compartimento I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS dolorosa I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor, I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS velocidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento, I-PRESENT_ILLNESS impotencia I-PRESENT_ILLNESS funcional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS parestesias. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pierna I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 15 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION con I-EXPLORATION distensión I-EXPLORATION de I-EXPLORATION los I-EXPLORATION compartimentos I-EXPLORATION posteriores I-EXPLORATION y I-EXPLORATION laterales. I-EXPLORATION Asimismo, I-EXPLORATION refería I-EXPLORATION parestesias I-EXPLORATION discontinuas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION afecta I-EXPLORATION e I-EXPLORATION hiperestesia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pulpejo I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION dedo I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION peronea. I-EXPLORATION La I-EXPLORATION vascularización I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION estaba I-EXPLORATION indemne, I-EXPLORATION presentando I-EXPLORATION pulsos I-EXPLORATION poplíteos, I-EXPLORATION tibial I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION pedio I-EXPLORATION conservados. I-EXPLORATION No I-EXPLORATION obstante, I-EXPLORATION constatamos I-EXPLORATION una I-EXPLORATION mayor I-EXPLORATION frialdad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION contralateral. I-EXPLORATION I-EXPLORATION Realizamos I-EXPLORATION Trucut I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION sarcoma I-EXPLORATION fusocelular I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado I-EXPLORATION (sarcoma I-EXPLORATION sinovial). I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pierna I-EXPLORATION izquierda I-EXPLORATION que I-EXPLORATION afectaba I-EXPLORATION a I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION músculo I-EXPLORATION sóleo, I-EXPLORATION marcadamente I-EXPLORATION heterogénea, I-EXPLORATION multinodular I-EXPLORATION y I-EXPLORATION polilobulada, I-EXPLORATION de I-EXPLORATION 14x10x7 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION reciente. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION posterior, I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION comprime I-EXPLORATION y I-EXPLORATION desplaza I-EXPLORATION los I-EXPLORATION vientres I-EXPLORATION musculares I-EXPLORATION de I-EXPLORATION los I-EXPLORATION gemelos I-EXPLORATION interno I-EXPLORATION y I-EXPLORATION externo, I-EXPLORATION con I-EXPLORATION los I-EXPLORATION que I-EXPLORATION contacta I-EXPLORATION sin I-EXPLORATION planos I-EXPLORATION grasos, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION anterior I-EXPLORATION con I-EXPLORATION el I-EXPLORATION poplíteo, I-EXPLORATION tibial I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION flexor I-EXPLORATION común I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dedos. I-EXPLORATION Anterocaudalmente, I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION infiltra I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION flexor I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION dedo. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION las I-EXPLORATION estructuras I-EXPLORATION óseas I-EXPLORATION observamos I-EXPLORATION una I-EXPLORATION estrecha I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION la I-EXPLORATION diáfisis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tibia I-EXPLORATION y, I-EXPLORATION aunque I-EXPLORATION se I-EXPLORATION mantienen I-EXPLORATION los I-EXPLORATION planos I-EXPLORATION grasos, I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION interpuesto I-EXPLORATION entre I-EXPLORATION ambas I-EXPLORATION estructuras I-EXPLORATION es I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION 1cm. I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION al I-EXPLORATION peroné, I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION lo I-EXPLORATION engloba I-EXPLORATION semicircularmente I-EXPLORATION en I-EXPLORATION una I-EXPLORATION extensión I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 12 I-EXPLORATION cm. I-EXPLORATION A I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION estrecha I-EXPLORATION relación I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION con I-EXPLORATION la I-EXPLORATION tibia I-EXPLORATION y I-EXPLORATION el I-EXPLORATION peroné, I-EXPLORATION no I-EXPLORATION observamos I-EXPLORATION signos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION ósea. I-EXPLORATION En I-EXPLORATION relación I-EXPLORATION a I-EXPLORATION las I-EXPLORATION estructuras I-EXPLORATION vasculares, I-EXPLORATION apreciamos I-EXPLORATION cómo I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION llega I-EXPLORATION a I-EXPLORATION contactar I-EXPLORATION con I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION su I-EXPLORATION bifurcación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION tibial I-EXPLORATION anterior, I-EXPLORATION pasando I-EXPLORATION a I-EXPLORATION englobar I-EXPLORATION distalmente I-EXPLORATION al I-EXPLORATION tronco I-EXPLORATION tibio-peroneo I-EXPLORATION con I-EXPLORATION repermeabilización I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION peroneos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION resumen, I-EXPLORATION se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION sólea I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 14 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION sarcoma I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION vascular I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION adyacente. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT intervenido I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT y I-TREATMENT la I-TREATMENT intervención I-TREATMENT fue I-TREATMENT realizada I-TREATMENT por I-TREATMENT un I-TREATMENT único I-TREATMENT equipo I-TREATMENT quirúrgico I-TREATMENT que I-TREATMENT practicó I-TREATMENT tanto I-TREATMENT la I-TREATMENT resección I-TREATMENT tumoral I-TREATMENT como I-TREATMENT la I-TREATMENT posterior I-TREATMENT reconstrucción. I-TREATMENT I-TREATMENT Comenzamos I-TREATMENT con I-TREATMENT el I-TREATMENT colgajo I-TREATMENT plantar I-TREATMENT disecando I-TREATMENT un I-TREATMENT colgajo I-TREATMENT fileteado I-TREATMENT B3 I-TREATMENT de I-TREATMENT Künstcher I-TREATMENT (6) I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT con I-TREATMENT la I-TREATMENT amputación I-TREATMENT infracondilea I-TREATMENT incluyendo I-TREATMENT la I-TREATMENT cortical I-TREATMENT posterior I-TREATMENT de I-TREATMENT la I-TREATMENT tibia. I-TREATMENT Realizamos I-TREATMENT anastomosis I-TREATMENT términoterminales I-TREATMENT (T-T) I-TREATMENT a I-TREATMENT la I-TREATMENT arteria I-TREATMENT poplítea I-TREATMENT y I-TREATMENT a I-TREATMENT ambas I-TREATMENT safenas I-TREATMENT y I-TREATMENT neurorrafia I-TREATMENT entre I-TREATMENT ciático I-TREATMENT poplíteo I-TREATMENT externo I-TREATMENT y I-TREATMENT tibial I-TREATMENT posterior. I-TREATMENT B-EVOLUTION En I-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION alteración I-EVOLUTION hemodinámica I-EVOLUTION alguna I-EVOLUTION y I-EVOLUTION el I-EVOLUTION colgajo I-EVOLUTION evolucionó I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION favorable I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION revisión I-EVOLUTION microquirúrgica I-EVOLUTION del I-EVOLUTION mismo I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION a I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION El B-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION extirpada I-EXPLORATION resultó I-EXPLORATION ser I-EXPLORATION de I-EXPLORATION sarcoma I-EXPLORATION sinovial I-EXPLORATION bifásico I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION muscular, I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION quirúrgicos I-EXPLORATION respetados I-EXPLORATION (tumor I-EXPLORATION a I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION borde I-EXPLORATION quirúrgico I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION infiltración I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION óseo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION siguió I-EVOLUTION un I-EVOLUTION postoperatorio I-EVOLUTION favorable, I-EVOLUTION siendo I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION su I-EVOLUTION domicilio I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 30 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION Llevamos B-TREATMENT a I-TREATMENT cabo I-TREATMENT un I-TREATMENT seguimiento I-TREATMENT semanal I-TREATMENT del I-TREATMENT mismo I-TREATMENT hasta I-TREATMENT obtener I-TREATMENT una I-TREATMENT cicatrización I-TREATMENT óptima I-TREATMENT para I-TREATMENT comenzar I-TREATMENT con I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT ortopédico. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 60 I-EVOLUTION días I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION deambulaba I-EVOLUTION con I-EVOLUTION prótesis I-EVOLUTION transtibial I-EVOLUTION tipo I-EVOLUTION PTB I-EVOLUTION (patellartendon-bearing I-EVOLUTION prosthesis) I-EVOLUTION con I-EVOLUTION sistema I-EVOLUTION endoesquelético I-EVOLUTION y I-EVOLUTION pie I-EVOLUTION dinámico I-EVOLUTION con I-EVOLUTION sensibilidad I-EVOLUTION completa I-EVOLUTION en I-EVOLUTION el I-EVOLUTION muñón I-EVOLUTION de I-EVOLUTION amputación. I-EVOLUTION El I-EVOLUTION seguimiento I-EVOLUTION total I-EVOLUTION por I-EVOLUTION nuestra I-EVOLUTION parte I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 7 I-EVOLUTION meses I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION Dos B-TREATMENT años I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT intervención, I-TREATMENT continúa I-TREATMENT en I-TREATMENT seguimiento I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT los I-TREATMENT Servicios I-TREATMENT de I-TREATMENT Oncología I-TREATMENT y I-TREATMENT Rehabilitación I-TREATMENT de I-TREATMENT nuestro I-TREATMENT hospital, I-TREATMENT que I-TREATMENT procederán I-TREATMENT al I-TREATMENT recambio I-TREATMENT protésico I-TREATMENT según I-TREATMENT su I-TREATMENT protocolo I-TREATMENT cada I-TREATMENT 2 I-TREATMENT años. I-TREATMENT Hasta B-EVOLUTION la I-EVOLUTION fecha, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION han I-EVOLUTION encontrado I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION recurrencia I-EVOLUTION local. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY acude I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infiltración I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY material I-PAST_MEDICAL_HISTORY desconocido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ambas I-PAST_MEDICAL_HISTORY mamas I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 200 I-PAST_MEDICAL_HISTORY cc I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY lado, I-PAST_MEDICAL_HISTORY presentando B-PRESENT_ILLNESS dolor, I-PRESENT_ILLNESS deformidad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS tróficos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS afectada. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION pétrea I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION retroareolar I-EXPLORATION que I-EXPLORATION involucra I-EXPLORATION prácticamente I-EXPLORATION al I-EXPLORATION 80 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION mamaria. I-EXPLORATION Se B-TREATMENT decide I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT a I-TREATMENT base I-TREATMENT de I-TREATMENT esteroides, I-TREATMENT metrotexate I-TREATMENT y I-TREATMENT antiinflamatorios I-TREATMENT no I-TREATMENT esteroideos I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Reumatología I-TREATMENT de I-TREATMENT nuestro I-TREATMENT hospital I-TREATMENT y I-TREATMENT se I-TREATMENT programa I-TREATMENT para I-TREATMENT mastectomía I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT mediante I-TREATMENT colgajo I-TREATMENT TRAM I-TREATMENT pediculado I-TREATMENT bilateral, I-TREATMENT procedimiento I-TREATMENT que I-TREATMENT se I-TREATMENT realiza I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT ni I-TREATMENT incidentes. I-TREATMENT Queda I-TREATMENT pendiente I-TREATMENT de I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT bilateral I-TREATMENT del I-TREATMENT complejo I-TREATMENT pezón-areola. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia, I-PAST_MEDICAL_HISTORY remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO por I-DERIVED_FROM/TO una I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO premaxilar I-DERIVED_FROM/TO izquierda, I-DERIVED_FROM/TO blanda, I-DERIVED_FROM/TO móvil I-DERIVED_FROM/TO y I-DERIVED_FROM/TO no I-DERIVED_FROM/TO adherida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO planos I-DERIVED_FROM/TO profundos I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO exploración, I-DERIVED_FROM/TO de I-DERIVED_FROM/TO unos I-DERIVED_FROM/TO 4cm. I-DERIVED_FROM/TO de I-DERIVED_FROM/TO diámetro I-DERIVED_FROM/TO y I-DERIVED_FROM/TO 6 I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución, I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO otra I-DERIVED_FROM/TO sintomatología I-DERIVED_FROM/TO asociada, I-DERIVED_FROM/TO y I-DERIVED_FROM/TO que I-DERIVED_FROM/TO ha I-DERIVED_FROM/TO presentado I-DERIVED_FROM/TO crecimiento I-DERIVED_FROM/TO lento I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO este I-DERIVED_FROM/TO tiempo. I-DERIVED_FROM/TO A B-EXPLORATION simple I-EXPLORATION vista I-EXPLORATION impresiona I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION o I-EXPLORATION lipoma, I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION su I-EXPLORATION localización I-EXPLORATION y I-EXPLORATION su I-EXPLORATION consistencia I-EXPLORATION blanda, I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION móvil I-EXPLORATION hacen I-EXPLORATION sospechar I-EXPLORATION que I-EXPLORATION pueda I-EXPLORATION tratarse I-EXPLORATION de I-EXPLORATION otro I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION lesión. I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION aporta I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION otro I-EXPLORATION centro, I-EXPLORATION con I-EXPLORATION informe I-EXPLORATION de I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 25mm. I-EXPLORATION en I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION hueso I-EXPLORATION maxilar I-EXPLORATION y I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION inespecífica, I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION fibroso I-EXPLORATION o I-EXPLORATION hematoma, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION no I-EXPLORATION existir I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION traumatismo I-EXPLORATION facial. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION esta I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION programamos I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION para I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION biopsia I-EXPLORATION en I-EXPLORATION quirófano, I-EXPLORATION bajo I-EXPLORATION anestesia I-EXPLORATION local, I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION encontramos I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION friabilidad I-EXPLORATION y I-EXPLORATION sangrado I-EXPLORATION en I-EXPLORATION sábana I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION que I-EXPLORATION impresiona I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION vascular, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION posteriormente I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION con I-EXPLORATION el I-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION que I-EXPLORATION refiere: I-EXPLORATION tumoración I-EXPLORATION mesenquimal I-EXPLORATION vascular I-EXPLORATION cuya I-EXPLORATION morfología I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION inmunohistoquímico I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION patrón I-EXPLORATION observado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemangiopericitoma. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION resultado: I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION CD99 I-EXPLORATION (difuso), I-EXPLORATION BCL2, I-EXPLORATION Betacatenina I-EXPLORATION (focal I-EXPLORATION intracitoplasmática) I-EXPLORATION y I-EXPLORATION CD34 I-EXPLORATION (focal I-EXPLORATION citoplasmática), I-EXPLORATION y I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION S100, I-EXPLORATION GLUT-1, I-EXPLORATION WT1, I-EXPLORATION AE1, I-EXPLORATION CD31 I-EXPLORATION y I-EXPLORATION Factor I-EXPLORATION VIII. I-EXPLORATION El I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION celular I-EXPLORATION Ki I-EXPLORATION 67 I-EXPLORATION es I-EXPLORATION de I-EXPLORATION un I-EXPLORATION 5%. I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION confirmación I-EXPLORATION diagnóstica I-EXPLORATION y I-EXPLORATION al I-EXPLORATION haberse I-EXPLORATION realizado I-EXPLORATION la I-EXPLORATION RMN I-EXPLORATION inicial I-EXPLORATION en I-EXPLORATION otro I-EXPLORATION centro, I-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Radiología I-EXPLORATION de I-EXPLORATION nuestro I-EXPLORATION hospital I-EXPLORATION nos I-EXPLORATION recomienda I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION adicional I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION certeza I-EXPLORATION la I-EXPLORATION afectación I-EXPLORATION ósea I-EXPLORATION de I-EXPLORATION cara I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía; I-EXPLORATION este I-EXPLORATION estudio I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION hipervascular I-EXPLORATION en I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION premaxilar I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION y I-EXPLORATION extensión I-EXPLORATION en I-EXPLORATION profundidad I-EXPLORATION hacia I-EXPLORATION planos I-EXPLORATION musculares, I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION óseas I-EXPLORATION vecinas.. I-EXPLORATION I-EXPLORATION Bajo B-TREATMENT ese I-TREATMENT diagnóstico I-TREATMENT final, I-TREATMENT intervenimos I-TREATMENT quirúrgicamente I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT empleando I-TREATMENT visión I-TREATMENT de I-TREATMENT aumento I-TREATMENT con I-TREATMENT gafas I-TREATMENT lupa I-TREATMENT (x4.3); I-TREATMENT realizamos I-TREATMENT extirpación I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT en I-TREATMENT bloque I-TREATMENT con I-TREATMENT margen I-TREATMENT de I-TREATMENT seguridad I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 2, I-TREATMENT 5cm. I-TREATMENT e I-TREATMENT incluyendo I-TREATMENT la I-TREATMENT musculatura I-TREATMENT afectada: I-TREATMENT porción I-TREATMENT orbitaria I-TREATMENT del I-TREATMENT músculo I-TREATMENT orbicular I-TREATMENT mayor I-TREATMENT inferior I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT parcialmente I-TREATMENT el I-TREATMENT músculo I-TREATMENT cigomático I-TREATMENT menor I-TREATMENT y I-TREATMENT el I-TREATMENT elevador I-TREATMENT del I-TREATMENT labio I-TREATMENT superior, I-TREATMENT incluidos I-TREATMENT en I-TREATMENT el I-TREATMENT tumor. I-TREATMENT Identificamos I-TREATMENT la I-TREATMENT rama I-TREATMENT angular I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT facial, I-TREATMENT que I-TREATMENT se I-TREATMENT introduce I-TREATMENT en I-TREATMENT el I-TREATMENT seno I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración, I-TREATMENT y I-TREATMENT que I-TREATMENT ligamos, I-TREATMENT así I-TREATMENT como I-TREATMENT las I-TREATMENT ramas I-TREATMENT cigomáticas I-TREATMENT del I-TREATMENT nervio I-TREATMENT facial I-TREATMENT que I-TREATMENT quedan I-TREATMENT en I-TREATMENT el I-TREATMENT lecho I-TREATMENT quirúrgico I-TREATMENT y I-TREATMENT que I-TREATMENT se I-TREATMENT preservan I-TREATMENT en I-TREATMENT su I-TREATMENT totalidad. I-TREATMENT I-TREATMENT Realizamos I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT del I-TREATMENT defecto I-TREATMENT quirúrgico I-TREATMENT con I-TREATMENT un I-TREATMENT colgajo I-TREATMENT de I-TREATMENT avance I-TREATMENT de I-TREATMENT mejilla I-TREATMENT de I-TREATMENT base I-TREATMENT ínfero-lateral. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION final I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION hemangiopericitoma I-EXPLORATION que I-EXPLORATION respeta I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION quirúrgicos I-EXPLORATION de I-EXPLORATION resección, I-EXPLORATION con I-EXPLORATION inflamación I-EXPLORATION gigantocelular I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION extraño I-EXPLORATION acompañante. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION definitivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION CD34 I-EXPLORATION difuso, I-EXPLORATION CD99 I-EXPLORATION focal, I-EXPLORATION y I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION S-100, I-EXPLORATION CD31 I-EXPLORATION y I-EXPLORATION factor I-EXPLORATION VIII, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION celular I-EXPLORATION Ki-67 I-EXPLORATION del I-EXPLORATION 5%. I-EXPLORATION I-EXPLORATION Presentamos B-TREATMENT el I-TREATMENT caso I-TREATMENT en I-TREATMENT el I-TREATMENT Comité I-TREATMENT de I-TREATMENT Tumores I-TREATMENT del I-TREATMENT hospital, I-TREATMENT donde I-TREATMENT en I-TREATMENT función I-TREATMENT de I-TREATMENT los I-TREATMENT resultados I-TREATMENT postoperatorios, I-TREATMENT se I-TREATMENT decidió I-TREATMENT que I-TREATMENT no I-TREATMENT era I-TREATMENT necesario I-TREATMENT realizar I-TREATMENT ningún I-TREATMENT tratamiento I-TREATMENT complementario, I-TREATMENT solo I-TREATMENT un I-TREATMENT seguimiento I-TREATMENT periódico I-TREATMENT del I-TREATMENT paciente. I-TREATMENT Tras B-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION postoperatorio, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION buen I-EVOLUTION resultado I-EVOLUTION estético I-EVOLUTION y I-EVOLUTION funcional, I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION datos I-EVOLUTION de I-EVOLUTION recurrencia I-EVOLUTION ni I-EVOLUTION clínica I-EVOLUTION ni I-EVOLUTION radiológica I-EVOLUTION en I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION postoperatorios I-EVOLUTION realizados I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION fecha. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS traída I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS deformidad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS 2o I-PRESENT_ILLNESS dedo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS La B-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY sufrió I-PAST_MEDICAL_HISTORY caída I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY altura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cm. I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aplastamiento I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cariotipo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY resultado I-PAST_MEDICAL_HISTORY normal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY contexto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alteraciones I-PAST_MEDICAL_HISTORY electroencefalográficas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY plagiocefalia I-PAST_MEDICAL_HISTORY parietooccipital I-PAST_MEDICAL_HISTORY resueltas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION Urgencias I-EXPLORATION observamos I-EXPLORATION ensanchamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION del I-EXPLORATION 2o I-EXPLORATION dedo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION interfalángica I-EXPLORATION proximal, I-EXPLORATION que I-EXPLORATION alcanza I-EXPLORATION los I-EXPLORATION 50 I-EXPLORATION grados I-EXPLORATION de I-EXPLORATION flexión I-EXPLORATION máxima. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION neurovascular I-EXPLORATION no I-EXPLORATION determinó I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION Efectuamos I-EXPLORATION también I-EXPLORATION exploraciones I-EXPLORATION radiológicas I-EXPLORATION del I-EXPLORATION 2o I-EXPLORATION dedo I-EXPLORATION en I-EXPLORATION proyecciones I-EXPLORATION anteroposterior I-EXPLORATION y I-EXPLORATION de I-EXPLORATION perfil, I-EXPLORATION que I-EXPLORATION determinan I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION de I-EXPLORATION dicho I-EXPLORATION dedo I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION volar. I-EXPLORATION I-EXPLORATION La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO diagnosticada I-DERIVED_FROM/TO de I-DERIVED_FROM/TO subluxación I-DERIVED_FROM/TO y I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO consultas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Traumatología I-DERIVED_FROM/TO Infantil I-DERIVED_FROM/TO con I-DERIVED_FROM/TO control I-DERIVED_FROM/TO radiográfico. I-DERIVED_FROM/TO Allí B-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION macroscópico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION del I-EXPLORATION 2o I-EXPLORATION dedo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha, I-EXPLORATION y I-EXPLORATION limitación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION interfalángica I-EXPLORATION proximal, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION máximo I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION grados. I-EXPLORATION Acude I-EXPLORATION con I-EXPLORATION radiografía I-EXPLORATION control. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION palmar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION con I-EXPLORATION borramiento I-EXPLORATION del I-EXPLORATION cartílago I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION a I-EXPLORATION ese I-EXPLORATION nivel; I-EXPLORATION en I-EXPLORATION la I-EXPLORATION proyección I-EXPLORATION anteroposterior I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION superposición I-EXPLORATION ósea. I-EXPLORATION Se I-EXPLORATION postula I-EXPLORATION como I-EXPLORATION posible I-EXPLORATION diagnóstico I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION fractura I-EXPLORATION antigua I-EXPLORATION de I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION con I-EXPLORATION callo I-EXPLORATION de I-EXPLORATION fractura I-EXPLORATION prominente I-EXPLORATION y I-EXPLORATION epifisiodesis. I-EXPLORATION La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO mano I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Plástica I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Reparadora I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO secuela I-DERIVED_FROM/TO de I-DERIVED_FROM/TO fractura. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION primera I-EXPLORATION consulta I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Cirugía I-EXPLORATION Plástica I-EXPLORATION y I-EXPLORATION Reparadora I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION los I-EXPLORATION descritos I-EXPLORATION por I-EXPLORATION Traumatología I-EXPLORATION Infantil. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION aporta I-EXPLORATION las I-EXPLORATION radiografías I-EXPLORATION que I-EXPLORATION le I-EXPLORATION habían I-EXPLORATION sido I-EXPLORATION entregadas I-EXPLORATION en I-EXPLORATION mano I-EXPLORATION en I-EXPLORATION Urgencias I-EXPLORATION y I-EXPLORATION Traumatología I-EXPLORATION Infantil I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION cita I-EXPLORATION nuevamente I-EXPLORATION para I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION y I-EXPLORATION se I-EXPLORATION insiste I-EXPLORATION en I-EXPLORATION la I-EXPLORATION necesidad I-EXPLORATION de I-EXPLORATION que I-EXPLORATION aporte I-EXPLORATION las I-EXPLORATION radiografías I-EXPLORATION previas. I-EXPLORATION Osteocondroma I-EXPLORATION gigante I-EXPLORATION de I-EXPLORATION falange I-EXPLORATION en I-EXPLORATION paciente I-EXPLORATION pediátrico I-EXPLORATION Cirugía I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION la I-EVOLUTION cita I-EVOLUTION en I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION siguientes. I-EVOLUTION Pasado I-EVOLUTION este I-EVOLUTION tiempo, I-EVOLUTION solicita I-EVOLUTION nuevamente I-EVOLUTION cita I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION de I-EVOLUTION Cirugía I-EVOLUTION Plástica I-EVOLUTION y I-EVOLUTION Reparadora I-EVOLUTION por I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION deformidad I-EVOLUTION del I-EVOLUTION dedo. I-EVOLUTION A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION notable I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION del I-EXPLORATION 2o I-EXPLORATION dedo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION (macrodactilia). I-EXPLORATION La I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION es I-EXPLORATION mayor, I-EXPLORATION alcanzando I-EXPLORATION los I-EXPLORATION 20 I-EXPLORATION grados I-EXPLORATION de I-EXPLORATION flexión I-EXPLORATION máxima. I-EXPLORATION Solicitamos I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION control. I-EXPLORATION I-EXPLORATION Observamos I-EXPLORATION en I-EXPLORATION las I-EXPLORATION radiografías, I-EXPLORATION en I-EXPLORATION proyección I-EXPLORATION de I-EXPLORATION perfil, I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION lobulado, I-EXPLORATION con I-EXPLORATION distintas I-EXPLORATION densidades, I-EXPLORATION que I-EXPLORATION parece I-EXPLORATION provenir I-EXPLORATION del I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION del I-EXPLORATION 2o I-EXPLORATION dedo. I-EXPLORATION La I-EXPLORATION masa I-EXPLORATION alcanza I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION proximal. I-EXPLORATION Asimismo I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION muesca I-EXPLORATION en I-EXPLORATION su I-EXPLORATION porción I-EXPLORATION superior. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION proyección I-EXPLORATION anteroposterior I-EXPLORATION apreciamos I-EXPLORATION que I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION sobrepasa I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION de I-EXPLORATION anchura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION segunda I-EXPLORATION falange. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION osteocondroma/encondroma I-EXPLORATION solicitamos I-EXPLORATION RM I-EXPLORATION que I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION exóstosis I-EXPLORATION lobulada I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION espesor, I-EXPLORATION con I-EXPLORATION base I-EXPLORATION de I-EXPLORATION 20x20 I-EXPLORATION mm, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION proximalmente I-EXPLORATION afectando I-EXPLORATION a I-EXPLORATION la I-EXPLORATION placa I-EXPLORATION volar I-EXPLORATION de I-EXPLORATION inserción I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION flexor I-EXPLORATION superficial, I-EXPLORATION con I-EXPLORATION desplazamiento I-EXPLORATION del I-EXPLORATION tendón I-EXPLORATION flexor I-EXPLORATION profundo I-EXPLORATION y I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION de I-EXPLORATION anclaje I-EXPLORATION de I-EXPLORATION poleas, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION osteocondroma. I-EXPLORATION I-EXPLORATION Estadiamos I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION empleando I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION de I-EXPLORATION Enneking I-EXPLORATION y I-EXPLORATION determinamos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION un I-EXPLORATION estadio I-EXPLORATION III, I-EXPLORATION lesión I-EXPLORATION benigna I-EXPLORATION agresiva: I-EXPLORATION lesión I-EXPLORATION benigna I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION agresividad I-EXPLORATION (G0), I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inserción I-EXPLORATION perióstica I-EXPLORATION del I-EXPLORATION extensor I-EXPLORATION superficial I-EXPLORATION (extracompartimental) I-EXPLORATION (T2) I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION metástasis I-EXPLORATION (M0). I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT alteración I-TREATMENT funcional I-TREATMENT que I-TREATMENT presentaba I-TREATMENT la I-TREATMENT paciente I-TREATMENT y I-TREATMENT el I-TREATMENT tamaño I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT tumoral, I-TREATMENT decidimos I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT cirugía I-TREATMENT efectuamos I-TREATMENT acceso I-TREATMENT a I-TREATMENT la I-TREATMENT lesión I-TREATMENT mediante I-TREATMENT técnica I-TREATMENT de I-TREATMENT Brunner I-TREATMENT en I-TREATMENT zig-zag I-TREATMENT evitando I-TREATMENT así I-TREATMENT la I-TREATMENT sección I-TREATMENT transversal I-TREATMENT de I-TREATMENT los I-TREATMENT pliegues I-TREATMENT palmares I-TREATMENT que I-TREATMENT pudiera I-TREATMENT generar I-TREATMENT futuras I-TREATMENT retracciones. I-TREATMENT Localizamos I-TREATMENT el I-TREATMENT tendón I-TREATMENT flexor I-TREATMENT superficial I-TREATMENT y I-TREATMENT colocamos I-TREATMENT la I-TREATMENT articulación I-TREATMENT metacarpofalángica I-TREATMENT del I-TREATMENT 2o I-TREATMENT dedo, I-TREATMENT así I-TREATMENT como I-TREATMENT la I-TREATMENT muñeca, I-TREATMENT en I-TREATMENT flexión I-TREATMENT máxima I-TREATMENT para I-TREATMENT alcanzar I-TREATMENT la I-TREATMENT porción I-TREATMENT más I-TREATMENT proximal I-TREATMENT del I-TREATMENT tendón I-TREATMENT flexor I-TREATMENT superficial. I-TREATMENT Lo I-TREATMENT seccionamos, I-TREATMENT elegiendo I-TREATMENT realizar I-TREATMENT dicha I-TREATMENT sección I-TREATMENT a I-TREATMENT nivel I-TREATMENT proximal I-TREATMENT para I-TREATMENT prevenir I-TREATMENT la I-TREATMENT aparición I-TREATMENT del I-TREATMENT fenómeno I-TREATMENT conocido I-TREATMENT como I-TREATMENT Cuádriga I-TREATMENT de I-TREATMENT Verdán, I-TREATMENT entendido I-TREATMENT como I-TREATMENT alteración I-TREATMENT de I-TREATMENT la I-TREATMENT flexión I-TREATMENT de I-TREATMENT la I-TREATMENT articulación I-TREATMENT metacarpofalángica I-TREATMENT por I-TREATMENT adhesión I-TREATMENT en I-TREATMENT una I-TREATMENT articulación I-TREATMENT del I-TREATMENT cabo I-TREATMENT proximal I-TREATMENT de I-TREATMENT un I-TREATMENT tendón I-TREATMENT tras I-TREATMENT su I-TREATMENT sección. I-TREATMENT Mediante I-TREATMENT escoplo, I-TREATMENT escindimos I-TREATMENT la I-TREATMENT porción I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT que I-TREATMENT sobresalía I-TREATMENT de I-TREATMENT la I-TREATMENT falange I-TREATMENT sana I-TREATMENT y I-TREATMENT una I-TREATMENT porción I-TREATMENT de I-TREATMENT la I-TREATMENT cortical I-TREATMENT adyacente. I-TREATMENT Seguidamente I-TREATMENT practicamos I-TREATMENT curetaje I-TREATMENT mediante I-TREATMENT cucharilla I-TREATMENT de I-TREATMENT la I-TREATMENT médula I-TREATMENT y I-TREATMENT del I-TREATMENT tejido I-TREATMENT óseo I-TREATMENT de I-TREATMENT la I-TREATMENT superficie I-TREATMENT dorsal. I-TREATMENT I-TREATMENT Para I-TREATMENT la I-TREATMENT reconstrucción: I-TREATMENT de I-TREATMENT la I-TREATMENT cavidad I-TREATMENT generada I-TREATMENT empleamos I-TREATMENT material I-TREATMENT osteoconductor I-TREATMENT (Actifuse I-TREATMENT Abx I-TREATMENT Silicated I-TREATMENT Calcium I-TREATMENT Phosphate®, I-TREATMENT BioSurgery, I-TREATMENT EE. I-TREATMENT UU). I-TREATMENT Efectuamos I-TREATMENT inmovilización I-TREATMENT mediante I-TREATMENT férula I-TREATMENT dorsal I-TREATMENT de I-TREATMENT yeso I-TREATMENT desde I-TREATMENT tercio I-TREATMENT proximal I-TREATMENT del I-TREATMENT antebrazo I-TREATMENT hasta I-TREATMENT final I-TREATMENT de I-TREATMENT los I-TREATMENT dedos, I-TREATMENT con I-TREATMENT muñeca I-TREATMENT en I-TREATMENT 40o I-TREATMENT de I-TREATMENT flexión I-TREATMENT palmar, I-TREATMENT articulaciones I-TREATMENT metacarpofalángicas I-TREATMENT en I-TREATMENT 90o I-TREATMENT y I-TREATMENT articulaciones I-TREATMENT interfalángicas I-TREATMENT en I-TREATMENT extensión. I-TREATMENT Mantuvimos B-EVOLUTION la I-EVOLUTION inmovilización I-EVOLUTION durante I-EVOLUTION 3 I-EVOLUTION semanas, I-EVOLUTION tras I-EVOLUTION las I-EVOLUTION cuales I-EVOLUTION no I-EVOLUTION fue I-EVOLUTION necesaria I-EVOLUTION la I-EVOLUTION rehabilitación I-EVOLUTION dada I-EVOLUTION la I-EVOLUTION edad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION la I-EVOLUTION buena I-EVOLUTION movilidad I-EVOLUTION postoperatoria I-EVOLUTION que I-EVOLUTION presentaba. I-EVOLUTION I-EVOLUTION Practicamos I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION control I-EVOLUTION anual I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION y I-EVOLUTION con I-EVOLUTION movilidad I-EVOLUTION completa I-EVOLUTION tras I-EVOLUTION 3 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial. I-PAST_MEDICAL_HISTORY En B-TREATMENT revisión I-TREATMENT ginecológica I-TREATMENT periódica I-TREATMENT se I-TREATMENT le I-TREATMENT diagnostica I-TREATMENT carcinoma I-TREATMENT ductal I-TREATMENT infiltrante I-TREATMENT de I-TREATMENT mama I-TREATMENT izquierda I-TREATMENT y I-TREATMENT es I-TREATMENT sometida I-TREATMENT a I-TREATMENT mastectomía I-TREATMENT radical I-TREATMENT modificada I-TREATMENT con I-TREATMENT vaciamiento I-TREATMENT axilar I-TREATMENT por I-TREATMENT el I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Cirugía I-TREATMENT General, I-TREATMENT recibiendo I-TREATMENT tratamiento I-TREATMENT adyuvante I-TREATMENT con I-TREATMENT radioterapia I-TREATMENT y I-TREATMENT quimioterapia. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION resultó I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION adenopatías I-EXPLORATION locorregionales I-EXPLORATION y I-EXPLORATION metástasis I-EXPLORATION a I-EXPLORATION distancia I-EXPLORATION (pT3pN0M0). I-EXPLORATION Al B-DERIVED_FROM/TO finalizar I-DERIVED_FROM/TO el I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO solicita I-DERIVED_FROM/TO reconstrucción I-DERIVED_FROM/TO mamaria, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Plástica. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-TREATMENT los I-TREATMENT 4 I-TREATMENT años I-TREATMENT de I-TREATMENT la I-TREATMENT mastectomía I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT mamaria I-TREATMENT con I-TREATMENT diversos I-TREATMENT procedimientos I-TREATMENT que I-TREATMENT describimos I-TREATMENT a I-TREATMENT continuación. I-TREATMENT En I-TREATMENT primer I-TREATMENT lugar I-TREATMENT reconstrucción I-TREATMENT de I-TREATMENT mama I-TREATMENT izquierda I-TREATMENT con I-TREATMENT colgajo I-TREATMENT miocutáneo I-TREATMENT de I-TREATMENT recto I-TREATMENT abdominal I-TREATMENT transverso I-TREATMENT (TRAM), I-TREATMENT sufriendo I-TREATMENT pérdida I-TREATMENT parcial I-TREATMENT del I-TREATMENT mismo I-TREATMENT que I-TREATMENT se I-TREATMENT resolvió I-TREATMENT con I-TREATMENT desbridamiento I-TREATMENT y I-TREATMENT cierre I-TREATMENT directo. I-TREATMENT Dos I-TREATMENT años I-TREATMENT después I-TREATMENT se I-TREATMENT colocó I-TREATMENT prótesis I-TREATMENT expansora I-TREATMENT de I-TREATMENT Becker I-TREATMENT subTRAM I-TREATMENT y I-TREATMENT finalmente, I-TREATMENT se I-TREATMENT realizó I-TREATMENT recambio I-TREATMENT del I-TREATMENT expansor I-TREATMENT por I-TREATMENT prótesis I-TREATMENT mamaria I-TREATMENT definitiva I-TREATMENT y I-TREATMENT mastopexia I-TREATMENT simetrizadora I-TREATMENT de I-TREATMENT mama I-TREATMENT contralateral, I-TREATMENT quedando I-TREATMENT pendiente I-TREATMENT de I-TREATMENT completar I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT del I-TREATMENT complejo I-TREATMENT areola I-TREATMENT pezón I-TREATMENT (CAP). I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION última I-EVOLUTION intervención I-EVOLUTION comienza I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION periareolar I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION derecha I-EVOLUTION y I-EVOLUTION en I-EVOLUTION el I-EVOLUTION centro I-EVOLUTION del I-EVOLUTION colgajo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION izquierda I-EVOLUTION de I-EVOLUTION pequeñas I-EVOLUTION lesiones I-EVOLUTION pustulosas I-EVOLUTION con I-EVOLUTION posterior I-EVOLUTION desarrollo I-EVOLUTION de I-EVOLUTION úlceras I-EVOLUTION dolorosas I-EVOLUTION de I-EVOLUTION borde I-EVOLUTION violáceo I-EVOLUTION y I-EVOLUTION fondo I-EVOLUTION con I-EVOLUTION tejido I-EVOLUTION de I-EVOLUTION granulación,. I-EVOLUTION I-EVOLUTION Con B-EXPLORATION el I-EXPLORATION presunto I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION dehiscencia I-EXPLORATION de I-EXPLORATION herida I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION biopsia I-EXPLORATION que I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION granulación, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT es I-TREATMENT sometida I-TREATMENT a I-TREATMENT curas I-TREATMENT con I-TREATMENT desbridamiento I-TREATMENT durante I-TREATMENT más I-TREATMENT de I-TREATMENT 12 I-TREATMENT meses. I-TREATMENT Dada B-DERIVED_FROM/TO la I-DERIVED_FROM/TO mala I-DERIVED_FROM/TO evolución, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO interconsulta I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Dermatología, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO ante I-DERIVED_FROM/TO la I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO inicial I-DERIVED_FROM/TO de I-DERIVED_FROM/TO pioderma I-DERIVED_FROM/TO gangrenoso, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realiza I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO exhaustivo I-DERIVED_FROM/TO para I-DERIVED_FROM/TO descartar I-DERIVED_FROM/TO otros I-DERIVED_FROM/TO procesos. I-DERIVED_FROM/TO Se B-EXPLORATION solicitaron I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION pruebas: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Analítica, I-EXPLORATION incluyendo I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION autoinmunidad I-EXPLORATION (ANAs I-EXPLORATION y I-EXPLORATION ENAs) I-EXPLORATION y I-EXPLORATION proteinograma: I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION patológicas. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Serología I-EXPLORATION luética, I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION VIH: I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Mantoux: I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION engrosamiento I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION bronquiales; I-EXPLORATION cambios I-EXPLORATION quirúrgicos I-EXPLORATION en I-EXPLORATION mama I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION grapas I-EXPLORATION en I-EXPLORATION región I-EXPLORATION axilar. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Biopsia I-EXPLORATION con I-EXPLORATION técnicas I-EXPLORATION de I-EXPLORATION PAS, I-EXPLORATION Grocott I-EXPLORATION y I-EXPLORATION Ziehl- I-EXPLORATION Neelsen: I-EXPLORATION ulceración I-EXPLORATION epidérmica I-EXPLORATION focal I-EXPLORATION con I-EXPLORATION abscesificación I-EXPLORATION dérmica I-EXPLORATION y I-EXPLORATION folicular, I-EXPLORATION inflamación I-EXPLORATION crónica I-EXPLORATION linfohistiocitaria I-EXPLORATION y I-EXPLORATION plasmocitaria I-EXPLORATION adyacente I-EXPLORATION y I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION perivascular I-EXPLORATION en I-EXPLORATION dermis I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profunda. I-EXPLORATION Hallazgos I-EXPLORATION histopatológicos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION pioderma I-EXPLORATION gangrenoso I-EXPLORATION clásico I-EXPLORATION o I-EXPLORATION ulcerado. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Cultivo I-EXPLORATION biopsia I-EXPLORATION (aerobio, I-EXPLORATION anaerobio, I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION micobacterias): I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT exclusión I-TREATMENT de I-TREATMENT pioderma I-TREATMENT gangrenoso I-TREATMENT clásico, I-TREATMENT iniciamos I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona I-TREATMENT oral I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 60 I-TREATMENT mg/día I-TREATMENT asociando I-TREATMENT propionato I-TREATMENT de I-TREATMENT clobetasol I-TREATMENT 0, I-TREATMENT 05% I-TREATMENT tópico I-TREATMENT durante I-TREATMENT 3 I-TREATMENT meses. I-TREATMENT Al I-TREATMENT reducir I-TREATMENT la I-TREATMENT pauta I-TREATMENT esteroidea I-TREATMENT a I-TREATMENT 30 I-TREATMENT mg/día I-TREATMENT la I-TREATMENT paciente I-TREATMENT comenzó I-TREATMENT con I-TREATMENT un I-TREATMENT rebrote I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT decidimos I-TREATMENT asociar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ciclosporina I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 4 I-TREATMENT mg/Kg I-TREATMENT de I-TREATMENT peso, I-TREATMENT sustituir I-TREATMENT los I-TREATMENT corticoides I-TREATMENT tópicos I-TREATMENT por I-TREATMENT tacrolimus I-TREATMENT 0, I-TREATMENT 1% I-TREATMENT tópico I-TREATMENT y I-TREATMENT reducir I-TREATMENT también I-TREATMENT paulatinamente I-TREATMENT la I-TREATMENT prednisona I-TREATMENT hasta I-TREATMENT su I-TREATMENT suspensión I-TREATMENT durante I-TREATMENT un I-TREATMENT periodo I-TREATMENT de I-TREATMENT mes I-TREATMENT y I-TREATMENT medio. I-TREATMENT I-TREATMENT Inicialmente, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION experimenta I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable I-EVOLUTION salvo I-EVOLUTION hipertensión I-EVOLUTION controlada I-EVOLUTION con I-EVOLUTION un I-EVOLUTION diurético I-EVOLUTION tiazídico I-EVOLUTION y I-EVOLUTION se I-EVOLUTION consigue I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION reepitelización I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones; I-EVOLUTION pero I-EVOLUTION tras I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION ciclosporina I-EVOLUTION comienza I-EVOLUTION con I-EVOLUTION efectos I-EVOLUTION secundarios I-EVOLUTION muy I-EVOLUTION molestos: I-EVOLUTION hiperplasia I-EVOLUTION gingival, I-EVOLUTION hipertricosis, I-EVOLUTION hirsutismo I-EVOLUTION y I-EVOLUTION disestesias I-EVOLUTION que I-EVOLUTION nos I-EVOLUTION obligan I-EVOLUTION a I-EVOLUTION la I-EVOLUTION reducción I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION este I-EVOLUTION tratamiento, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION tiene I-EVOLUTION como I-EVOLUTION consecuencia I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION rebrote I-EVOLUTION de I-EVOLUTION pequeñas I-EVOLUTION lesiones I-EVOLUTION pustulosas I-EVOLUTION que B-TREATMENT infiltramos I-TREATMENT con I-TREATMENT triamcinolona I-TREATMENT a I-TREATMENT la I-TREATMENT vez I-TREATMENT que I-TREATMENT retiramos I-TREATMENT el I-TREATMENT tacrolimus I-TREATMENT tópico. I-TREATMENT La I-TREATMENT intolerancia I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT a I-TREATMENT los I-TREATMENT efectos I-TREATMENT secundarios I-TREATMENT de I-TREATMENT la I-TREATMENT ciclosporina, I-TREATMENT nos I-TREATMENT obligó I-TREATMENT a I-TREATMENT su I-TREATMENT suspensión I-TREATMENT completa I-TREATMENT tras I-TREATMENT 4 I-TREATMENT meses I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT I-TREATMENT Finalmente, I-TREATMENT ante I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT nuevas I-TREATMENT lesiones I-TREATMENT y I-TREATMENT la I-TREATMENT mala I-TREATMENT tolerancia I-TREATMENT a I-TREATMENT los I-TREATMENT tratamientos I-TREATMENT previos, I-TREATMENT optamos I-TREATMENT por I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT infliximab I-TREATMENT (agente I-TREATMENT anti-TNF), I-TREATMENT comenzando I-TREATMENT con I-TREATMENT una I-TREATMENT terapia I-TREATMENT de I-TREATMENT inducción I-TREATMENT de I-TREATMENT 5 I-TREATMENT mg/kg I-TREATMENT a I-TREATMENT las I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT y I-TREATMENT 6 I-TREATMENT semanas I-TREATMENT similar I-TREATMENT a I-TREATMENT la I-TREATMENT empleada I-TREATMENT en I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT inflamatoria I-TREATMENT intestinal I-TREATMENT o I-TREATMENT en I-TREATMENT la I-TREATMENT psoriasis, I-TREATMENT continuando I-TREATMENT con I-TREATMENT infusiones I-TREATMENT de I-TREATMENT mantenimiento I-TREATMENT cada I-TREATMENT 8 I-TREATMENT semanas. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION satisfactoria I-EVOLUTION con I-EVOLUTION reepitelización I-EVOLUTION completa I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION nuevo I-EVOLUTION tratamiento, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT decidimos I-TREATMENT mantener I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT forma I-TREATMENT similar I-TREATMENT al I-TREATMENT de I-TREATMENT otras I-TREATMENT dermatosis I-TREATMENT inflamatorias I-TREATMENT hasta I-TREATMENT objetivar I-TREATMENT estabilización I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad, I-TREATMENT tras I-TREATMENT lo I-TREATMENT cual I-TREATMENT nos I-TREATMENT plantearemos I-TREATMENT reducir, I-TREATMENT con I-TREATMENT espaciamiento I-TREATMENT progresivo I-TREATMENT de I-TREATMENT las I-TREATMENT dosis. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS neonato I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS que I-PRESENT_ILLNESS sufre I-PRESENT_ILLNESS cefalohematoma I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS parto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fórceps. I-PRESENT_ILLNESS La B-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Neonatología I-DERIVED_FROM/TO de I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO hospitalario I-DERIVED_FROM/TO solicita I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO a I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Plástica. I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION observamos I-EXPLORATION tejido I-EXPLORATION necrótico I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 3x4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION occipital. I-EXPLORATION I-EXPLORATION Procedimos B-TREATMENT a I-TREATMENT desbridamientos I-TREATMENT seriados I-TREATMENT que I-TREATMENT se I-TREATMENT llevaron I-TREATMENT a I-TREATMENT cabo I-TREATMENT a I-TREATMENT los I-TREATMENT 8 I-TREATMENT y I-TREATMENT 15 I-TREATMENT días I-TREATMENT de I-TREATMENT vida I-TREATMENT de I-TREATMENT la I-TREATMENT paciente. I-TREATMENT En I-TREATMENT esa I-TREATMENT segunda I-TREATMENT intervención, I-TREATMENT optamos I-TREATMENT por I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT sistema I-TREATMENT de I-TREATMENT terapia I-TREATMENT de I-TREATMENT vacío I-TREATMENT (Renasys®, I-TREATMENT Smith&Nephew®, I-TREATMENT Londres, I-TREATMENT Reino I-TREATMENT Unido) I-TREATMENT de I-TREATMENT modo I-TREATMENT continuo, I-TREATMENT a I-TREATMENT 120 I-TREATMENT mmHg I-TREATMENT durante I-TREATMENT 20 I-TREATMENT días, I-TREATMENT con I-TREATMENT cambios I-TREATMENT de I-TREATMENT apósitos I-TREATMENT cada I-TREATMENT 72 I-TREATMENT horas. I-TREATMENT Con I-TREATMENT este I-TREATMENT tratamiento I-TREATMENT observamos I-TREATMENT contracción I-TREATMENT del I-TREATMENT defecto I-TREATMENT original, I-TREATMENT procediendo I-TREATMENT a I-TREATMENT realizar I-TREATMENT colgajos I-TREATMENT rotacionales I-TREATMENT para I-TREATMENT el I-TREATMENT cierre I-TREATMENT definitivo I-TREATMENT de I-TREATMENT la I-TREATMENT herida. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION el I-EVOLUTION 4o I-EVOLUTION día I-EVOLUTION de I-EVOLUTION postoperatorio, I-EVOLUTION sin I-EVOLUTION mayores I-EVOLUTION incidencias. I-EVOLUTION La I-EVOLUTION última I-EVOLUTION valoración I-EVOLUTION fue I-EVOLUTION realizada I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION postoperatorio, I-EVOLUTION observando I-EVOLUTION solo I-EVOLUTION una I-EVOLUTION pequeña I-EVOLUTION zona I-EVOLUTION de I-EVOLUTION alopecia I-EVOLUTION cicatricial I-EVOLUTION así I-EVOLUTION como I-EVOLUTION una I-EVOLUTION brida I-EVOLUTION en I-EVOLUTION la I-EVOLUTION región I-EVOLUTION de I-EVOLUTION la I-EVOLUTION nuca, I-EVOLUTION susceptibles I-EVOLUTION de I-EVOLUTION nuevas I-EVOLUTION intervenciones I-EVOLUTION quirúrgicas I-EVOLUTION en I-EVOLUTION el I-EVOLUTION futuro I-EVOLUTION si I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION o I-EVOLUTION la I-EVOLUTION familia I-EVOLUTION lo I-EVOLUTION requieren. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS recién I-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gestación, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO Pediatría I-DERIVED_FROM/TO de I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO malformación I-DERIVED_FROM/TO linfática I-DERIVED_FROM/TO microquística I-DERIVED_FROM/TO cérvicoescápulo- I-DERIVED_FROM/TO humeral. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-TREATMENT los I-TREATMENT 7 I-TREATMENT días I-TREATMENT de I-TREATMENT vida I-TREATMENT se I-TREATMENT le I-TREATMENT realiza I-TREATMENT la I-TREATMENT punción I-TREATMENT y I-TREATMENT evacuación I-TREATMENT del I-TREATMENT linfangioma I-TREATMENT con I-TREATMENT posterior I-TREATMENT instilación I-TREATMENT de I-TREATMENT polidocanol I-TREATMENT y I-TREATMENT etanol. I-TREATMENT Se I-TREATMENT repitió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT 5 I-TREATMENT días I-TREATMENT después. I-TREATMENT De I-TREATMENT los I-TREATMENT 7 I-TREATMENT drenajes I-TREATMENT colocados, I-TREATMENT 1 I-TREATMENT de I-TREATMENT localización I-TREATMENT axilar I-TREATMENT fue I-TREATMENT retirado I-TREATMENT a I-TREATMENT los I-TREATMENT 3 I-TREATMENT días I-TREATMENT por I-TREATMENT aparente I-TREATMENT sufrimiento I-TREATMENT cutáneo. I-TREATMENT I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION infiltración I-EVOLUTION observamos I-EVOLUTION herida I-EVOLUTION superficial I-EVOLUTION de I-EVOLUTION 3x10 I-EVOLUTION cm I-EVOLUTION de I-EVOLUTION diámetro, I-EVOLUTION que I-EVOLUTION afecta I-EVOLUTION a I-EVOLUTION la I-EVOLUTION región I-EVOLUTION humeral I-EVOLUTION y I-EVOLUTION a I-EVOLUTION la I-EVOLUTION superficie I-EVOLUTION anterior I-EVOLUTION del I-EVOLUTION tórax, I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION extravasación I-EVOLUTION por I-EVOLUTION punta I-EVOLUTION del I-EVOLUTION catéter I-EVOLUTION de I-EVOLUTION instilación I-EVOLUTION de I-EVOLUTION polidocanol. I-EVOLUTION La B-TREATMENT lesión I-TREATMENT fue I-TREATMENT tratada I-TREATMENT con I-TREATMENT curas I-TREATMENT con I-TREATMENT apósitos I-TREATMENT de I-TREATMENT hidrocoloide. I-TREATMENT Una I-TREATMENT semana I-TREATMENT después, I-TREATMENT procedimos I-TREATMENT a I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT sistema I-TREATMENT de I-TREATMENT terapia I-TREATMENT de I-TREATMENT vacío I-TREATMENT (Renasys®, I-TREATMENT Smith&Nephew®, I-TREATMENT Londres, I-TREATMENT Reino I-TREATMENT Unido) I-TREATMENT a I-TREATMENT 100 I-TREATMENT mmHg, I-TREATMENT en I-TREATMENT modo I-TREATMENT continuo, I-TREATMENT con I-TREATMENT la I-TREATMENT finalidad I-TREATMENT de I-TREATMENT acelerar I-TREATMENT el I-TREATMENT cierre I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT y I-TREATMENT controlar I-TREATMENT la I-TREATMENT linforrea. I-TREATMENT Los I-TREATMENT cambios I-TREATMENT de I-TREATMENT apósitos I-TREATMENT se I-TREATMENT realizaron I-TREATMENT cada I-TREATMENT 72 I-TREATMENT horas I-TREATMENT y I-TREATMENT la I-TREATMENT terapia I-TREATMENT de I-TREATMENT vacío I-TREATMENT se I-TREATMENT utilizó I-TREATMENT durante I-TREATMENT 21 I-TREATMENT días. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION hospitalizado I-EVOLUTION hasta I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT curas I-TREATMENT domiciliarias I-TREATMENT con I-TREATMENT Aquacel® I-TREATMENT Ag I-TREATMENT (ConvaTec®, I-TREATMENT Reino I-TREATMENT Unido), I-TREATMENT hasta I-TREATMENT lograr I-TREATMENT el I-TREATMENT cierre I-TREATMENT total I-TREATMENT y I-TREATMENT estable I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT de I-TREATMENT manera I-TREATMENT ambulatoria. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 11 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION masa I-EVOLUTION persistente, I-EVOLUTION fundamentalmente I-EVOLUTION a I-EVOLUTION expensas I-EVOLUTION de I-EVOLUTION hipertrofia I-EVOLUTION del I-EVOLUTION tejido I-EVOLUTION celular I-EVOLUTION subcutáneo, I-EVOLUTION con I-EVOLUTION lesiones I-EVOLUTION quísticas I-EVOLUTION residuales I-EVOLUTION de I-EVOLUTION predominio I-EVOLUTION microquístico I-EVOLUTION en I-EVOLUTION la I-EVOLUTION superficie I-EVOLUTION medial I-EVOLUTION del I-EVOLUTION brazo I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pared I-EVOLUTION torácica. I-EVOLUTION Dado B-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT está I-TREATMENT asintomático, I-TREATMENT tras I-TREATMENT consultar I-TREATMENT con I-TREATMENT la I-TREATMENT familia I-TREATMENT decidimos I-TREATMENT mantener I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT conservador I-TREATMENT y I-TREATMENT valorar I-TREATMENT su I-TREATMENT evolución I-TREATMENT con I-TREATMENT la I-TREATMENT edad. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS resección I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS paredes I-PRESENT_ILLNESS laterales I-PRESENT_ILLNESS nasales I-PRESENT_ILLNESS por I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS basocelular I-PRESENT_ILLNESS en I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS focos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS nasal. I-PRESENT_ILLNESS Reconstrucción B-TREATMENT con I-TREATMENT colgajo I-TREATMENT frontal I-TREATMENT paramediano I-TREATMENT con I-TREATMENT base I-TREATMENT estrecha I-TREATMENT después I-TREATMENT de I-TREATMENT conocer I-TREATMENT los I-TREATMENT límites I-TREATMENT quirúrgicos I-TREATMENT negativos I-TREATMENT de I-TREATMENT la I-TREATMENT biopsia I-TREATMENT por I-TREATMENT congelación. I-TREATMENT Autonomización B-EVOLUTION del I-EVOLUTION colgajo I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 3 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Dermatología I-DERIVED_FROM/TO por I-DERIVED_FROM/TO carcinoma I-DERIVED_FROM/TO basocelular I-DERIVED_FROM/TO en I-DERIVED_FROM/TO columela I-DERIVED_FROM/TO nasal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO años I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución. I-DERIVED_FROM/TO Tras B-TREATMENT resección I-TREATMENT tumoral I-TREATMENT con I-TREATMENT límites I-TREATMENT negativos I-TREATMENT en I-TREATMENT la I-TREATMENT biopsia I-TREATMENT por I-TREATMENT congelación, I-TREATMENT se I-TREATMENT hizo I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT colgajo I-TREATMENT frontal I-TREATMENT paramediano I-TREATMENT izquierdo I-TREATMENT de I-TREATMENT base I-TREATMENT estrecha I-TREATMENT prolongado I-TREATMENT hacia I-TREATMENT el I-TREATMENT mismo I-TREATMENT lado. I-TREATMENT I-TREATMENT El B-EVOLUTION colgajo I-EVOLUTION quedó I-EVOLUTION con I-EVOLUTION una I-EVOLUTION ligera I-EVOLUTION tensión, I-EVOLUTION pero I-EVOLUTION esto I-EVOLUTION no I-EVOLUTION produjo I-EVOLUTION ningún I-EVOLUTION sufrimiento I-EVOLUTION ni I-EVOLUTION necrosis I-EVOLUTION del I-EVOLUTION mismo. I-EVOLUTION Se I-EVOLUTION autonomizó I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 3 I-EVOLUTION semanas I-EVOLUTION y I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION quedar I-EVOLUTION un I-EVOLUTION poco I-EVOLUTION redundante, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mostró I-EVOLUTION satisfecha I-EVOLUTION y I-EVOLUTION no I-EVOLUTION quiso I-EVOLUTION otro I-EVOLUTION procedimiento. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY elefantiasis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY extremidad I-PAST_MEDICAL_HISTORY inferior I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY linfedema I-PAST_MEDICAL_HISTORY congénito I-PAST_MEDICAL_HISTORY primario I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY agenesia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vasos I-PAST_MEDICAL_HISTORY linfáticos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY hemicuerpo I-PAST_MEDICAL_HISTORY izquierdo. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY diagnostica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY primera I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY raíz I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY observación I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY perímetro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY extremidad I-PAST_MEDICAL_HISTORY respecto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY contralateral, I-PAST_MEDICAL_HISTORY iniciándose I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY medidas I-PAST_MEDICAL_HISTORY físicas I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY local I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY patología. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ya I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pubertad, I-PAST_MEDICAL_HISTORY evoluciona I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY elefantiasis I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY importante I-PAST_MEDICAL_HISTORY limitación I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY imposibilita I-PAST_MEDICAL_HISTORY deambular, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY preciso I-PAST_MEDICAL_HISTORY iniciar I-PAST_MEDICAL_HISTORY tandas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antibioticoterapia I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY menos I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY vez I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cuadros I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY linfangitis. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS un I-PRESENT_ILLNESS periodo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS llega I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sufrir I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 102 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS llegando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS año I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 180 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS constata I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS frecuencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS linfangitis I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS como I-PRESENT_ILLNESS mínimo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS mensual, I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS finalmente I-PRESENT_ILLNESS obliga I-PRESENT_ILLNESS a I-PRESENT_ILLNESS replantear I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION evaluación I-EXPLORATION radiológica I-EXPLORATION mediante I-EXPLORATION linfografía I-EXPLORATION demuestra I-EXPLORATION ausencia I-EXPLORATION total I-EXPLORATION de I-EXPLORATION drenaje I-EXPLORATION linfático I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION el I-EXPLORATION drenaje I-EXPLORATION linfático I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION superior I-EXPLORATION izquierda. I-EXPLORATION La I-EXPLORATION tomografia I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION muestra I-EXPLORATION hipertrofia I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION subcutáneo. I-EXPLORATION I-EXPLORATION Una B-TREATMENT vez I-TREATMENT constatado I-TREATMENT el I-TREATMENT avanzado I-TREATMENT estado I-TREATMENT clínico I-TREATMENT y I-TREATMENT radiológico I-TREATMENT de I-TREATMENT la I-TREATMENT patología I-TREATMENT y I-TREATMENT ante I-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT respuesta I-TREATMENT clínica I-TREATMENT a I-TREATMENT las I-TREATMENT medidas I-TREATMENT conservadoras, I-TREATMENT se I-TREATMENT propone I-TREATMENT practicar I-TREATMENT cirugía I-TREATMENT escisional I-TREATMENT según I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT Charles. I-TREATMENT I-TREATMENT En I-TREATMENT un I-TREATMENT primer I-TREATMENT tiempo I-TREATMENT quirúrgico I-TREATMENT realizamos I-TREATMENT una I-TREATMENT escisión I-TREATMENT completa I-TREATMENT de I-TREATMENT piel I-TREATMENT y I-TREATMENT tejido I-TREATMENT celular I-TREATMENT subcutáneo I-TREATMENT en I-TREATMENT todo I-TREATMENT su I-TREATMENT espesor, I-TREATMENT respetando I-TREATMENT la I-TREATMENT fascia I-TREATMENT muscular, I-TREATMENT desde I-TREATMENT el I-TREATMENT tobillo I-TREATMENT hasta I-TREATMENT la I-TREATMENT raíz I-TREATMENT del I-TREATMENT muslo I-TREATMENT y I-TREATMENT cobertura I-TREATMENT mediante I-TREATMENT autoinjertos I-TREATMENT de I-TREATMENT espesor I-TREATMENT parcial I-TREATMENT mallados I-TREATMENT 1: I-TREATMENT 1.5 I-TREATMENT aprovechando I-TREATMENT la I-TREATMENT piel I-TREATMENT del I-TREATMENT mismo I-TREATMENT muslo I-TREATMENT izquierdo. I-TREATMENT Tras I-TREATMENT 20 I-TREATMENT días I-TREATMENT de I-TREATMENT ingreso I-TREATMENT hospitalario I-TREATMENT y I-TREATMENT curas, I-TREATMENT realizamos I-TREATMENT una I-TREATMENT segunda I-TREATMENT intervención I-TREATMENT para I-TREATMENT cubrir I-TREATMENT las I-TREATMENT zonas I-TREATMENT cruentas I-TREATMENT dispersas I-TREATMENT residuales I-TREATMENT en I-TREATMENT el I-TREATMENT 3% I-TREATMENT de I-TREATMENT superficie I-TREATMENT corporal I-TREATMENT total. I-TREATMENT Obtuvimos I-TREATMENT los I-TREATMENT injertos I-TREATMENT del I-TREATMENT muslo I-TREATMENT derecho, I-TREATMENT que I-TREATMENT se I-TREATMENT aplicaron I-TREATMENT mallados I-TREATMENT 1: I-TREATMENT 1.5. I-TREATMENT En B-EVOLUTION una I-EVOLUTION semana, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 31 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION los I-EVOLUTION injertos I-EVOLUTION prendidos I-EVOLUTION en I-EVOLUTION su I-EVOLUTION mayoría, I-EVOLUTION quedando I-EVOLUTION aun I-EVOLUTION así I-EVOLUTION zonas I-EVOLUTION residuales I-EVOLUTION dispersas I-EVOLUTION en I-EVOLUTION una I-EVOLUTION superficie I-EVOLUTION inferior I-EVOLUTION al I-EVOLUTION 0.5%. I-EVOLUTION I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION área I-EVOLUTION tratada I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION fue I-EVOLUTION muy I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION las I-EVOLUTION zonas I-EVOLUTION cruentas I-EVOLUTION residuales I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION semanas. I-EVOLUTION Iniciamos B-TREATMENT presoterapia I-TREATMENT un I-TREATMENT mes I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT en I-TREATMENT todo I-TREATMENT momento I-TREATMENT la I-TREATMENT fisioterapia. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION observamos I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION progresivo I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION en I-EVOLUTION el I-EVOLUTION dorso I-EVOLUTION del I-EVOLUTION pie I-EVOLUTION izquierdo, I-EVOLUTION además I-EVOLUTION de I-EVOLUTION pequeñas I-EVOLUTION erosiones I-EVOLUTION cutáneas I-EVOLUTION debidas I-EVOLUTION a I-EVOLUTION la I-EVOLUTION fricción I-EVOLUTION de I-EVOLUTION las I-EVOLUTION prendas I-EVOLUTION de I-EVOLUTION presoterapia, I-EVOLUTION que I-EVOLUTION evolucionaron I-EVOLUTION favorablemente I-EVOLUTION con B-TREATMENT curas I-TREATMENT tópicas. I-TREATMENT I-TREATMENT A I-TREATMENT los I-TREATMENT 7 I-TREATMENT meses I-TREATMENT de I-TREATMENT la I-TREATMENT primera I-TREATMENT cirugía I-TREATMENT procedimos I-TREATMENT a I-TREATMENT intervenir I-TREATMENT quirúrgicamente I-TREATMENT de I-TREATMENT nuevo I-TREATMENT para I-TREATMENT tratar I-TREATMENT el I-TREATMENT linfedema I-TREATMENT residual I-TREATMENT del I-TREATMENT dorso I-TREATMENT del I-TREATMENT pie. I-TREATMENT De I-TREATMENT igual I-TREATMENT modo, I-TREATMENT llevaremos I-TREATMENT a I-TREATMENT cabo I-TREATMENT según I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT Charles I-TREATMENT escisión I-TREATMENT completa I-TREATMENT de I-TREATMENT piel I-TREATMENT y I-TREATMENT tejido I-TREATMENT subcutáneo I-TREATMENT del I-TREATMENT dorso I-TREATMENT del I-TREATMENT pie I-TREATMENT izquierdo, I-TREATMENT preservando I-TREATMENT la I-TREATMENT fascia I-TREATMENT profunda, I-TREATMENT y I-TREATMENT cobertura I-TREATMENT del I-TREATMENT área I-TREATMENT cruenta I-TREATMENT mediante I-TREATMENT autoinjertos I-TREATMENT de I-TREATMENT espesor I-TREATMENT parcial I-TREATMENT mallados I-TREATMENT 1: I-TREATMENT 1.5 I-TREATMENT obtenidos I-TREATMENT del I-TREATMENT muslo I-TREATMENT derecho. I-TREATMENT En B-EVOLUTION 6 I-EVOLUTION días I-EVOLUTION los I-EVOLUTION injertos I-EVOLUTION estaban I-EVOLUTION prendidos I-EVOLUTION y I-EVOLUTION estables I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION recibió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION hospitalaria. I-EVOLUTION I-EVOLUTION Pasados I-EVOLUTION 3 I-EVOLUTION años I-EVOLUTION con I-EVOLUTION controles I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION ambulatoria I-EVOLUTION en I-EVOLUTION intervalos I-EVOLUTION de I-EVOLUTION aproximadamente I-EVOLUTION 2 I-EVOLUTION meses, I-EVOLUTION persiste I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION errática I-EVOLUTION de I-EVOLUTION áreas I-EVOLUTION cruentas I-EVOLUTION irritativas I-EVOLUTION con I-EVOLUTION exudado I-EVOLUTION no I-EVOLUTION purulento I-EVOLUTION que B-TREATMENT se I-TREATMENT van I-TREATMENT controlando I-TREATMENT con I-TREATMENT curas I-TREATMENT tópicas I-TREATMENT en I-TREATMENT las I-TREATMENT que I-TREATMENT se I-TREATMENT alterna I-TREATMENT sulfadiazina I-TREATMENT argéntica, I-TREATMENT nitrofurazona I-TREATMENT y I-TREATMENT solución I-TREATMENT yodada. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION extremidad I-EVOLUTION funcional I-EVOLUTION con I-EVOLUTION dimensiones I-EVOLUTION muy I-EVOLUTION cercanas I-EVOLUTION a I-EVOLUTION la I-EVOLUTION contralateral I-EVOLUTION sana I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION linfangitis I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION fecha. I-EVOLUTION Sigue B-TREATMENT realizando I-TREATMENT presoterapia, I-TREATMENT rehabilitación I-TREATMENT y I-TREATMENT medidas I-TREATMENT higiénicas. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION aspecto I-EVOLUTION es I-EVOLUTION muy I-EVOLUTION bueno, I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION afectada I-EVOLUTION mantiene I-EVOLUTION un I-EVOLUTION diámetro I-EVOLUTION igual I-EVOLUTION o I-EVOLUTION incluso I-EVOLUTION menor I-EVOLUTION que I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION sana; I-EVOLUTION con I-EVOLUTION una I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION los I-EVOLUTION injertos I-EVOLUTION aceptable, I-EVOLUTION con I-EVOLUTION tejido I-EVOLUTION fibrótico I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pierna, I-EVOLUTION y I-EVOLUTION con I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION linforrea I-EVOLUTION ocasional I-EVOLUTION que I-EVOLUTION causa I-EVOLUTION procesos I-EVOLUTION de I-EVOLUTION irritación I-EVOLUTION cutánea I-EVOLUTION que I-EVOLUTION generan I-EVOLUTION un I-EVOLUTION proceso I-EVOLUTION crónico I-EVOLUTION de I-EVOLUTION fibrosis. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION muslo I-EVOLUTION no I-EVOLUTION aparece I-EVOLUTION linforrea, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION injertada I-EVOLUTION del I-EVOLUTION mismo I-EVOLUTION presenta I-EVOLUTION mejor I-EVOLUTION aspecto I-EVOLUTION que I-EVOLUTION los I-EVOLUTION injertos I-EVOLUTION de I-EVOLUTION la I-EVOLUTION pierna. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY personales I-FAMILY_HISTORY de I-FAMILY_HISTORY linfocitosis I-FAMILY_HISTORY diagnosticada I-FAMILY_HISTORY hace I-FAMILY_HISTORY 10 I-FAMILY_HISTORY años, I-FAMILY_HISTORY no I-FAMILY_HISTORY habiendo I-FAMILY_HISTORY precisado I-FAMILY_HISTORY ningún I-FAMILY_HISTORY tratamiento; I-FAMILY_HISTORY hipertensión B-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY medicamentoso. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tres B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS denotó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS axilar I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS progresivamente I-PRESENT_ILLNESS aumentando I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Se B-TREATMENT decidió I-TREATMENT realizar I-TREATMENT extirpación I-TREATMENT quirúrgica. I-TREATMENT En I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT apreció I-TREATMENT una I-TREATMENT masa I-TREATMENT tumoral I-TREATMENT de I-TREATMENT 10x10x5 I-TREATMENT centímetros, I-TREATMENT que I-TREATMENT afectaba I-TREATMENT a I-TREATMENT la I-TREATMENT axila, I-TREATMENT pectorales I-TREATMENT e I-TREATMENT infiltraba I-TREATMENT la I-TREATMENT vena I-TREATMENT axilar, I-TREATMENT el I-TREATMENT plexo I-TREATMENT nervioso I-TREATMENT y I-TREATMENT la I-TREATMENT pared I-TREATMENT costal I-TREATMENT por I-TREATMENT debajo I-TREATMENT del I-TREATMENT músculo I-TREATMENT dorsal I-TREATMENT ancho. I-TREATMENT Se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION infiltración I-EXPLORATION difusa I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION escaso I-EXPLORATION citoplasma, I-EXPLORATION abundantes I-EXPLORATION mitosis I-EXPLORATION e I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION apoptosis. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION eran I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION cromogranina, I-EXPLORATION NSE, I-EXPLORATION sinaptofisina I-EXPLORATION y I-EXPLORATION mostraban I-EXPLORATION positividad I-EXPLORATION débil I-EXPLORATION para I-EXPLORATION AE1 I-EXPLORATION y I-EXPLORATION AE3, I-EXPLORATION siendo I-EXPLORATION negativas I-EXPLORATION para I-EXPLORATION CD I-EXPLORATION 45, I-EXPLORATION Actina I-EXPLORATION ML, I-EXPLORATION Actina I-EXPLORATION Me, I-EXPLORATION S100, I-EXPLORATION Vimentina, I-EXPLORATION EMA, I-EXPLORATION CEA, I-EXPLORATION CD I-EXPLORATION 57, I-EXPLORATION CD I-EXPLORATION 34, I-EXPLORATION CD I-EXPLORATION 38, I-EXPLORATION CD I-EXPLORATION 15, I-EXPLORATION proteína I-EXPLORATION básica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mielina, I-EXPLORATION tiroglobulina, I-EXPLORATION CK I-EXPLORATION 7, I-EXPLORATION CK I-EXPLORATION 20, I-EXPLORATION HMB I-EXPLORATION 45 I-EXPLORATION y I-EXPLORATION GCD I-EXPLORATION FP I-EXPLORATION 15. I-EXPLORATION Fue I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION primario I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION (carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION Merkel). I-EXPLORATION Se I-EXPLORATION recomendó I-EXPLORATION descartar I-EXPLORATION afectación I-EXPLORATION primaria I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION gastrointestinal I-EXPLORATION y I-EXPLORATION pulmón. I-EXPLORATION I-EXPLORATION Otros I-EXPLORATION estudios I-EXPLORATION realizados: I-EXPLORATION hemograma, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION normales I-EXPLORATION excepto I-EXPLORATION LDH I-EXPLORATION de I-EXPLORATION 1088 I-EXPLORATION U/l, I-EXPLORATION CEA I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 65 I-EXPLORATION U/l, I-EXPLORATION Ca I-EXPLORATION 125 I-EXPLORATION y I-EXPLORATION Ca I-EXPLORATION 15.3, I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION gastroscopia I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION divertículos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION sigma I-EXPLORATION y I-EXPLORATION un I-EXPLORATION pólipo I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 2 I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION a I-EXPLORATION 30 I-EXPLORATION centímetros I-EXPLORATION del I-EXPLORATION ano, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION biopsiado, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION histología I-EXPLORATION de I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION velloso I-EXPLORATION con I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION displasia I-EXPLORATION severa. I-EXPLORATION Se I-EXPLORATION envió I-EXPLORATION posteriormente I-EXPLORATION a I-EXPLORATION realizar I-EXPLORATION polipectomía. I-EXPLORATION I-EXPLORATION TAC I-EXPLORATION toraco-abdominal: I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Posteriormente B-TREATMENT se I-TREATMENT completó I-TREATMENT el I-TREATMENT tratamiento, I-TREATMENT efectuándose I-TREATMENT radioterapia I-TREATMENT loco-regional. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS junio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1995 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION constata I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION distendido, I-EXPLORATION con I-EXPLORATION semiología I-EXPLORATION de I-EXPLORATION ascitis, I-EXPLORATION no I-EXPLORATION a I-EXPLORATION tensión. I-EXPLORATION No I-EXPLORATION hay I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION ni I-EXPLORATION insuficiencia I-EXPLORATION cardíaca. I-EXPLORATION Las I-EXPLORATION exploraciones I-EXPLORATION complementarias I-EXPLORATION muestran I-EXPLORATION una I-EXPLORATION bioquímica I-EXPLORATION básica I-EXPLORATION y I-EXPLORATION hemograma I-EXPLORATION sin I-EXPLORATION alteraciones, I-EXPLORATION unos I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION con I-EXPLORATION un I-EXPLORATION Ca I-EXPLORATION 125: I-EXPLORATION 35 I-EXPLORATION Ul/ml, I-EXPLORATION Ca I-EXPLORATION 19.9: I-EXPLORATION 37 I-EXPLORATION Ul/ml I-EXPLORATION y I-EXPLORATION CEA: I-EXPLORATION 8 I-EXPLORATION Ul/ml. I-EXPLORATION Se I-EXPLORATION intenta I-EXPLORATION realizar I-EXPLORATION paracentesis I-EXPLORATION diagnóstica, I-EXPLORATION pero I-EXPLORATION es I-EXPLORATION infructuosa I-EXPLORATION en I-EXPLORATION varios I-EXPLORATION intentos. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION hablan I-EXPLORATION de I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION abdomino-pélvica I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION ascitis, I-EXPLORATION con I-EXPLORATION adenopatías I-EXPLORATION y I-EXPLORATION varios I-EXPLORATION nódulos I-EXPLORATION peritoneales; I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION ginecológica I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Finalmente I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION somete I-EXPLORATION a I-EXPLORATION laparotomía I-EXPLORATION exploradora I-EXPLORATION encontrándose I-EXPLORATION una I-EXPLORATION cantidad I-EXPLORATION moderada I-EXPLORATION de I-EXPLORATION ascitis I-EXPLORATION con I-EXPLORATION abundante I-EXPLORATION moco, I-EXPLORATION múltiples I-EXPLORATION adherencias I-EXPLORATION a I-EXPLORATION intestino I-EXPLORATION y I-EXPLORATION anejos I-EXPLORATION ginecológicos, I-EXPLORATION numerosos I-EXPLORATION implantes I-EXPLORATION en I-EXPLORATION omento, I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION peritoneo I-EXPLORATION y, I-EXPLORATION un I-EXPLORATION apéndice I-EXPLORATION abierto I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION mucoso. I-EXPLORATION Se B-TREATMENT practica I-TREATMENT un I-TREATMENT histerectomía I-TREATMENT con I-TREATMENT doble I-TREATMENT anexectomía, I-TREATMENT linfadenectomía I-TREATMENT pélvica, I-TREATMENT apendicectomía I-TREATMENT y I-TREATMENT hemicolectomía I-TREATMENT derecha. I-TREATMENT La I-TREATMENT cirugía I-TREATMENT no I-TREATMENT es I-TREATMENT radical, I-TREATMENT permaneciendo I-TREATMENT enfermedad I-TREATMENT residual I-TREATMENT superior I-TREATMENT a I-TREATMENT 2 I-TREATMENT cms. I-TREATMENT El B-EXPLORATION análisis I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION piezas I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION una I-EXPLORATION carcinomatosis I-EXPLORATION peritoneal I-EXPLORATION por I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION apéndice; I-EXPLORATION colon I-EXPLORATION y I-EXPLORATION ovario I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION postcirugía I-EXPLORATION muestra I-EXPLORATION nódulos I-EXPLORATION tumorales I-EXPLORATION en I-EXPLORATION epiplón I-EXPLORATION y I-EXPLORATION peritoneo. I-EXPLORATION Los I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION habían I-EXPLORATION descendido I-EXPLORATION a I-EXPLORATION niveles I-EXPLORATION normales I-EXPLORATION (CEA: I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION Ul/ml; I-EXPLORATION Ca I-EXPLORATION 19.9: I-EXPLORATION 27 I-EXPLORATION Ul/ I-EXPLORATION ml). I-EXPLORATION I-EXPLORATION Se B-TREATMENT decide I-TREATMENT administrar I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT esquema I-TREATMENT de I-TREATMENT la I-TREATMENT Clínica I-TREATMENT Mayo I-TREATMENT (5FU-FA). I-TREATMENT La I-TREATMENT paciente I-TREATMENT recibe I-TREATMENT tratamiento I-TREATMENT durante I-TREATMENT un I-TREATMENT año I-TREATMENT con I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 12 I-TREATMENT ciclos, I-TREATMENT desapareciendo I-TREATMENT las I-TREATMENT imágenes I-TREATMENT de I-TREATMENT TAC I-TREATMENT y I-TREATMENT con I-TREATMENT normalización I-TREATMENT de I-TREATMENT marcadores. I-TREATMENT Desde I-TREATMENT febrero I-TREATMENT de I-TREATMENT 1997 I-TREATMENT permanece I-TREATMENT en I-TREATMENT control I-TREATMENT por I-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT oncología I-TREATMENT médica. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION seguimiento, I-EVOLUTION se I-EVOLUTION aprecian I-EVOLUTION nódulos I-EVOLUTION peritoneales I-EVOLUTION de I-EVOLUTION lento I-EVOLUTION crecimiento, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION ascenso I-EVOLUTION progresivo I-EVOLUTION de I-EVOLUTION marcadores I-EVOLUTION tumorales. I-EVOLUTION Se B-TREATMENT opta I-TREATMENT por I-TREATMENT la I-TREATMENT abstención I-TREATMENT terapéutica, I-TREATMENT dado I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT permanece I-TREATMENT asintomática. I-TREATMENT Cuando B-EXPLORATION el I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nódulos I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION manifiesto, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION punción I-EXPLORATION biopsia, I-EXPLORATION en I-EXPLORATION junio I-EXPLORATION de I-EXPLORATION 2001, I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION recaída I-EXPLORATION peritoneal I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION apendicular. I-EXPLORATION En B-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT decide I-TREATMENT retratar I-TREATMENT con I-TREATMENT esquema I-TREATMENT Clínica I-TREATMENT Mayo I-TREATMENT hasta I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 8 I-TREATMENT ciclos, I-TREATMENT alcanzando I-TREATMENT criterios I-TREATMENT de I-TREATMENT enfermedad I-TREATMENT estable. I-TREATMENT Se I-TREATMENT decide I-TREATMENT continuar I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT de I-TREATMENT tercera I-TREATMENT línea I-TREATMENT con I-TREATMENT Tomudex-Oxaliplatino I-TREATMENT (6 I-TREATMENT ciclos). I-TREATMENT La B-EVOLUTION respuesta, I-EVOLUTION en I-EVOLUTION agosto I-EVOLUTION de I-EVOLUTION 2002, I-EVOLUTION fue I-EVOLUTION nuevamente I-EVOLUTION de I-EVOLUTION estabilización. I-EVOLUTION Desde I-EVOLUTION entonces I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION oligoasintomática I-EVOLUTION con I-EVOLUTION vida I-EVOLUTION activa, I-EVOLUTION y I-EVOLUTION con I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION múltiples I-EVOLUTION nódulos I-EVOLUTION peritoneales I-EVOLUTION que I-EVOLUTION forman I-EVOLUTION una I-EVOLUTION coraza I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pared I-EVOLUTION abdominal. I-EVOLUTION En I-EVOLUTION diciembre I-EVOLUTION de I-EVOLUTION 2003, I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION progresa I-EVOLUTION produciéndose I-EVOLUTION compresión I-EVOLUTION de I-EVOLUTION cola I-EVOLUTION de I-EVOLUTION caballo I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION masa I-EVOLUTION presacra. I-EVOLUTION Recibe B-TREATMENT radioterapia I-TREATMENT paliativa, I-TREATMENT aliviándose I-TREATMENT el I-TREATMENT dolor I-TREATMENT y I-TREATMENT sin I-TREATMENT producirse I-TREATMENT déficit I-TREATMENT neurológico. I-TREATMENT La B-EVOLUTION situación I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION a I-EVOLUTION octubre I-EVOLUTION de I-EVOLUTION 2004, I-EVOLUTION es I-EVOLUTION la I-EVOLUTION de I-EVOLUTION lento I-EVOLUTION deterioro I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION por I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION enfermedad, I-EVOLUTION con I-EVOLUTION anemia I-EVOLUTION y I-EVOLUTION desnutrición I-EVOLUTION por I-EVOLUTION dificultad I-EVOLUTION en I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION cuadros I-EVOLUTION suboclusivos. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 37 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años/paquete, I-PAST_MEDICAL_HISTORY consumidor I-PAST_MEDICAL_HISTORY habitual I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cocaína I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY drogas I-PAST_MEDICAL_HISTORY sintéticas I-PAST_MEDICAL_HISTORY (anfetaminas, I-PAST_MEDICAL_HISTORY speed, I-PAST_MEDICAL_HISTORY ...) I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY enolismo I-PAST_MEDICAL_HISTORY < I-PAST_MEDICAL_HISTORY 80 I-PAST_MEDICAL_HISTORY gr. I-PAST_MEDICAL_HISTORY etanol/día. I-PAST_MEDICAL_HISTORY Homosexual I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY SIDA I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Noviembre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2001 I-PAST_MEDICAL_HISTORY (estadio I-PAST_MEDICAL_HISTORY C3), I-PAST_MEDICAL_HISTORY según I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY criterios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY CDC I-PAST_MEDICAL_HISTORY (neumonía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY P. I-PAST_MEDICAL_HISTORY carinni I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY recuento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY linfocitos I-PAST_MEDICAL_HISTORY <200 I-PAST_MEDICAL_HISTORY CD4/µL). I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY subpoblaciones I-PAST_MEDICAL_HISTORY linfoides I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY sangre I-PAST_MEDICAL_HISTORY periférica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY aquella I-PAST_MEDICAL_HISTORY fecha I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY siguientes I-PAST_MEDICAL_HISTORY resultados I-PAST_MEDICAL_HISTORY CD4: I-PAST_MEDICAL_HISTORY 4, I-PAST_MEDICAL_HISTORY 5% I-PAST_MEDICAL_HISTORY (81), I-PAST_MEDICAL_HISTORY CD8: I-PAST_MEDICAL_HISTORY 71, I-PAST_MEDICAL_HISTORY 7% I-PAST_MEDICAL_HISTORY (1290) I-PAST_MEDICAL_HISTORY CD4/CD8: I-PAST_MEDICAL_HISTORY 0, I-PAST_MEDICAL_HISTORY 06 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY carga I-PAST_MEDICAL_HISTORY viral I-PAST_MEDICAL_HISTORY HIV: I-PAST_MEDICAL_HISTORY 19.200 I-PAST_MEDICAL_HISTORY copias I-PAST_MEDICAL_HISTORY RNA/ml. I-PAST_MEDICAL_HISTORY Con I-PAST_MEDICAL_HISTORY estos I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY Tratamiento I-PAST_MEDICAL_HISTORY Antiretroviral I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Alta I-PAST_MEDICAL_HISTORY Eficacia I-PAST_MEDICAL_HISTORY (HAART), I-PAST_MEDICAL_HISTORY utilizando I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY inhibidores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY transcriptasa I-PAST_MEDICAL_HISTORY inversa, I-PAST_MEDICAL_HISTORY zidovudina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY lamivudina, I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY inhibidor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY proteasa, I-PAST_MEDICAL_HISTORY abacavir, I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY ido I-PAST_MEDICAL_HISTORY cambiando I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY combinando I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY fármacos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY misma I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY (efavirenz, I-PAST_MEDICAL_HISTORY estavudina, I-PAST_MEDICAL_HISTORY ritonavir). I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS Diciembre I-PRESENT_ILLNESS 2001 I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS disfonía I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS a B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION ORL I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION rinitis I-EXPLORATION seca-costrosa I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION bilateral I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION rinitis I-EXPLORATION por I-EXPLORATION inhalación I-EXPLORATION de I-EXPLORATION cocaína, I-EXPLORATION candidiasis I-EXPLORATION oral I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION laringoscopia I-EXPLORATION indirecta, I-EXPLORATION lesión I-EXPLORATION violácea I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION banda I-EXPLORATION ventricular I-EXPLORATION y I-EXPLORATION repliegue I-EXPLORATION aritenoepiglótico I-EXPLORATION izdo., I-EXPLORATION movilidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cuerda I-EXPLORATION vocal I-EXPLORATION y I-EXPLORATION aritenoides I-EXPLORATION izdo. I-EXPLORATION disminuida. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION sarcoma I-EXPLORATION de I-EXPLORATION Kaposi, I-EXPLORATION y I-EXPLORATION dada I-EXPLORATION las I-EXPLORATION posibles I-EXPLORATION complicaciones I-EXPLORATION no I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión, I-EXPLORATION no I-EXPLORATION obstante, I-EXPLORATION se I-EXPLORATION practicaron I-EXPLORATION broncoscopia I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION laríngeo I-EXPLORATION de I-EXPLORATION placas I-EXPLORATION de I-EXPLORATION color I-EXPLORATION rojo I-EXPLORATION intenso I-EXPLORATION que I-EXPLORATION también I-EXPLORATION estaban I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION más I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION traquea I-EXPLORATION y I-EXPLORATION que I-EXPLORATION igualmente I-EXPLORATION eran I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION sarcoma I-EXPLORATION de I-EXPLORATION Kaposi I-EXPLORATION a I-EXPLORATION dicho I-EXPLORATION nivel; I-EXPLORATION gastroscopia I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION la I-EXPLORATION no I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION colonoscopia I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION hemorroides I-EXPLORATION grado I-EXPLORATION II/IV I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION estenosis I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION anal. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT clínico I-TREATMENT de I-TREATMENT sarcoma I-TREATMENT de I-TREATMENT Kaposi I-TREATMENT laringeo I-TREATMENT el I-TREATMENT paciente, I-TREATMENT y I-TREATMENT ante I-TREATMENT el I-TREATMENT riesgo I-TREATMENT de I-TREATMENT obstrucción I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea, I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT radiaciones I-TREATMENT ionizantes I-TREATMENT sobre I-TREATMENT PTV-región I-TREATMENT laringea, I-TREATMENT mediante I-TREATMENT dos I-TREATMENT campos I-TREATMENT laterales I-TREATMENT y I-TREATMENT opuestos, I-TREATMENT utilizando I-TREATMENT mascara I-TREATMENT termolábil I-TREATMENT de I-TREATMENT inmovilización I-TREATMENT y I-TREATMENT planificación I-TREATMENT mediante I-TREATMENT TAC I-TREATMENT se I-TREATMENT alcanzó I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT 15 I-TREATMENT Gy I-TREATMENT a I-TREATMENT la I-TREATMENT isodosis I-TREATMENT del I-TREATMENT 95% I-TREATMENT a I-TREATMENT un I-TREATMENT fraccionamiento I-TREATMENT de I-TREATMENT 150 I-TREATMENT cGy I-TREATMENT /día I-TREATMENT en I-TREATMENT 10 I-TREATMENT fracciones I-TREATMENT y I-TREATMENT en I-TREATMENT 2 I-TREATMENT semanas. I-TREATMENT Una I-TREATMENT semana I-TREATMENT previa I-TREATMENT al I-TREATMENT inicio I-TREATMENT del I-TREATMENT tratamiento, I-TREATMENT durante I-TREATMENT y I-TREATMENT una I-TREATMENT semana I-TREATMENT después I-TREATMENT de I-TREATMENT haber I-TREATMENT finalizado I-TREATMENT la I-TREATMENT radioterapia I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT medicado I-TREATMENT con I-TREATMENT fluconazol I-TREATMENT 50 I-TREATMENT mg. I-TREATMENT V.O./24h. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION finalizado I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION había I-EVOLUTION recuperado I-EVOLUTION de I-EVOLUTION su I-EVOLUTION disfonía I-EVOLUTION sin I-EVOLUTION haber I-EVOLUTION presentado I-EVOLUTION toxicidad I-EVOLUTION mucosa I-EVOLUTION aguda I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION 36 I-EVOLUTION meses, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION haya I-EVOLUTION en I-EVOLUTION remisión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION su I-EVOLUTION sarcoma I-EVOLUTION de I-EVOLUTION Kaposi I-EVOLUTION laringeo, I-EVOLUTION con I-EVOLUTION controles I-EVOLUTION periódicos. I-EVOLUTION No I-EVOLUTION obstante, I-EVOLUTION en I-EVOLUTION Febrero I-EVOLUTION de I-EVOLUTION 2002 I-EVOLUTION fue I-EVOLUTION diagnosticado I-EVOLUTION de I-EVOLUTION una I-EVOLUTION Giardiasis I-EVOLUTION intestinal, I-EVOLUTION que B-TREATMENT se I-TREATMENT resolvió I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT y I-TREATMENT de I-TREATMENT un I-TREATMENT Ameboma I-TREATMENT rectal I-TREATMENT que I-TREATMENT requirió I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT que B-EVOLUTION ha I-EVOLUTION dejado I-EVOLUTION como I-EVOLUTION secuelas I-EVOLUTION una I-EVOLUTION incontinencia I-EVOLUTION anorrectal I-EVOLUTION grado I-EVOLUTION IV I-EVOLUTION de I-EVOLUTION caracter I-EVOLUTION irreversible. I-EVOLUTION También I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION diagnosticado I-EVOLUTION en I-EVOLUTION Abril I-EVOLUTION 2002 I-EVOLUTION de I-EVOLUTION Condilomas I-EVOLUTION acuminados I-EVOLUTION perianales, I-EVOLUTION habiendo B-TREATMENT sido I-TREATMENT intervenido I-TREATMENT en I-TREATMENT dos I-TREATMENT ocasiones, I-TREATMENT en I-TREATMENT Junio I-TREATMENT 2002 I-TREATMENT y I-TREATMENT Abril I-TREATMENT 2004. I-TREATMENT Así B-EVOLUTION mismo I-EVOLUTION en I-EVOLUTION Enero I-EVOLUTION 2003 I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION diagnosticado I-EVOLUTION de I-EVOLUTION una I-EVOLUTION Hepatopatía I-EVOLUTION crónica I-EVOLUTION por I-EVOLUTION virus I-EVOLUTION C I-EVOLUTION (informe I-EVOLUTION AP: I-EVOLUTION hepatitis I-EVOLUTION crónica I-EVOLUTION C I-EVOLUTION de I-EVOLUTION actividad I-EVOLUTION leve, I-EVOLUTION estadio I-EVOLUTION 1 I-EVOLUTION (fibrosis I-EVOLUTION portal); I-EVOLUTION siderosis I-EVOLUTION focal I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION células I-EVOLUTION de I-EVOLUTION Kupffer); I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION VHC I-EVOLUTION (virus I-EVOLUTION hepatitis I-EVOLUTION C) I-EVOLUTION 2.443.750 I-EVOLUTION UI/ml I-EVOLUTION genotipo I-EVOLUTION 1, I-EVOLUTION subtipo I-EVOLUTION B. I-EVOLUTION El B-EXPLORATION último I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION subpoblaciones I-EXPLORATION linfoides I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION en I-EXPLORATION Enero I-EXPLORATION 2005 I-EXPLORATION muestra I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION resultados I-EXPLORATION CD4: I-EXPLORATION 10, I-EXPLORATION 3% I-EXPLORATION (504,7), I-EXPLORATION CD8: I-EXPLORATION 60, I-EXPLORATION 7% I-EXPLORATION (2.974,3), I-EXPLORATION CD3: I-EXPLORATION 76, I-EXPLORATION 3, I-EXPLORATION CD4/CD8: I-EXPLORATION 0, I-EXPLORATION 17 I-EXPLORATION y I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION HIV: I-EXPLORATION 304 I-EXPLORATION copias I-EXPLORATION RNA/ml. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION no I-EXPLORATION revela I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION (hematológico I-EXPLORATION y I-EXPLORATION bioquímico) I-EXPLORATION no I-EXPLORATION presenta I-EXPLORATION alteraciones. I-EXPLORATION La I-EXPLORATION radiología I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION revela I-EXPLORATION pequeñas I-EXPLORATION imágenes I-EXPLORATION radiopacas I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION cálcica I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION hepática, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION corresponden I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION con I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION hipoecoicas I-EXPLORATION e I-EXPLORATION hipodensas I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION hepáticos, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION comprendido I-EXPLORATION entre I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION y I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION interpretadas I-EXPLORATION como I-EXPLORATION metástasis. I-EXPLORATION Las I-EXPLORATION exploraciones I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION primario I-EXPLORATION mamario I-EXPLORATION y I-EXPLORATION gastrointestinal I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION somete I-EXPLORATION a I-EXPLORATION una I-EXPLORATION laparotomia I-EXPLORATION exploradora I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION visualizan I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION blanquecinas I-EXPLORATION que I-EXPLORATION protuyen I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION hepáticos, I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION lisa, I-EXPLORATION de I-EXPLORATION las I-EXPLORATION que I-EXPLORATION se I-EXPLORATION toman I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION anatomopatológico. I-EXPLORATION I-EXPLORATION Estudio I-EXPLORATION anatomopatológico I-EXPLORATION I-EXPLORATION Las I-EXPLORATION muestras I-EXPLORATION corresponden I-EXPLORATION a I-EXPLORATION dos I-EXPLORATION fragmentos I-EXPLORATION cuneiformes I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION y I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION dimensiones I-EXPLORATION máximas, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blanquecino I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION central I-EXPLORATION y I-EXPLORATION marrón I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia. I-EXPLORATION Al I-EXPLORATION corte I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION dos I-EXPLORATION lesiones I-EXPLORATION blanquecinas, I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION definidos I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION rodeadas I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION color I-EXPLORATION marrón. I-EXPLORATION Las I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION seleccionadas I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION fueron I-EXPLORATION fijadas I-EXPLORATION en I-EXPLORATION formol I-EXPLORATION acuoso I-EXPLORATION al I-EXPLORATION 10% I-EXPLORATION durante I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION e I-EXPLORATION incluidas I-EXPLORATION en I-EXPLORATION parafina. I-EXPLORATION Se I-EXPLORATION obtuvieron I-EXPLORATION cortes I-EXPLORATION histológicos I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION micras I-EXPLORATION de I-EXPLORATION espesor I-EXPLORATION que I-EXPLORATION se I-EXPLORATION tiñeron I-EXPLORATION con I-EXPLORATION hematoxilina-eosina. I-EXPLORATION Otros I-EXPLORATION cortes I-EXPLORATION se I-EXPLORATION montaron I-EXPLORATION sobre I-EXPLORATION portas I-EXPLORATION cargados I-EXPLORATION eléctricamente I-EXPLORATION y I-EXPLORATION se I-EXPLORATION destinaron I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION automatizada I-EXPLORATION en I-EXPLORATION un I-EXPLORATION aparato I-EXPLORATION tipo I-EXPLORATION ventana. I-EXPLORATION I-EXPLORATION Microscópicamente I-EXPLORATION se I-EXPLORATION advierte I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION neoplásica I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION sólido I-EXPLORATION y I-EXPLORATION márgenes I-EXPLORATION infiltrativos I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION parcial I-EXPLORATION o I-EXPLORATION totalmente I-EXPLORATION las I-EXPLORATION luces I-EXPLORATION venulares I-EXPLORATION y I-EXPLORATION sinusoidales, I-EXPLORATION respetando I-EXPLORATION los I-EXPLORATION espacios I-EXPLORATION porta I-EXPLORATION y I-EXPLORATION en I-EXPLORATION cierta I-EXPLORATION medida I-EXPLORATION las I-EXPLORATION trabéculas I-EXPLORATION hepáticas I-EXPLORATION y I-EXPLORATION conductillos I-EXPLORATION biliares. I-EXPLORATION Alternan I-EXPLORATION áreas I-EXPLORATION celulares I-EXPLORATION con I-EXPLORATION otras I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fibroso. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION neoplásicas I-EXPLORATION dominantes I-EXPLORATION exhiben I-EXPLORATION citoplasmas I-EXPLORATION amplios I-EXPLORATION y I-EXPLORATION densos, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION definidos, I-EXPLORATION a I-EXPLORATION veces I-EXPLORATION con I-EXPLORATION vacuolas I-EXPLORATION únicas I-EXPLORATION o I-EXPLORATION múltiples, I-EXPLORATION ocasionalmente I-EXPLORATION ocupadas I-EXPLORATION por I-EXPLORATION hematíes I-EXPLORATION y I-EXPLORATION núcleos I-EXPLORATION vesiculares I-EXPLORATION con I-EXPLORATION nucleolos I-EXPLORATION evidentes I-EXPLORATION y I-EXPLORATION aisladas I-EXPLORATION mitosis. I-EXPLORATION La I-EXPLORATION mayoría I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION expresan I-EXPLORATION inmunopositividad I-EXPLORATION fuerte I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION los I-EXPLORATION marcadores I-EXPLORATION vasculares I-EXPLORATION FVIII, I-EXPLORATION CD I-EXPLORATION 31 I-EXPLORATION y I-EXPLORATION CD I-EXPLORATION 34 I-EXPLORATION y I-EXPLORATION ocasionalmente I-EXPLORATION frente I-EXPLORATION al I-EXPLORATION anticuerpo I-EXPLORATION citoqueratina. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT no I-TREATMENT ha I-TREATMENT recibido I-TREATMENT tratamiento I-TREATMENT y B-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION han I-EVOLUTION permanecido I-EVOLUTION estables I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION actual, I-EVOLUTION año I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION después I-EVOLUTION del I-EVOLUTION diagnóstico. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS transcurso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS exploración I-PRESENT_ILLNESS ginecológica I-PRESENT_ILLNESS rutinaria I-PRESENT_ILLNESS se I-PRESENT_ILLNESS descubre I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS máximo I-PRESENT_ILLNESS sonodensa, I-PRESENT_ILLNESS homogénea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS definida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS contornos I-PRESENT_ILLNESS posteriores I-PRESENT_ILLNESS ya I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS existe I-PRESENT_ILLNESS interfase I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tejido I-PRESENT_ILLNESS graso I-PRESENT_ILLNESS circundante, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS localización I-PRESENT_ILLNESS presacra, I-PRESENT_ILLNESS detrás I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS imagen I-PRESENT_ILLNESS del I-PRESENT_ILLNESS recto-sigma. I-PRESENT_ILLNESS Dicha B-EXPLORATION masa I-EXPLORATION fue I-EXPLORATION confirmada I-EXPLORATION por I-EXPLORATION TAC I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION redondeada, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION coeficientes I-EXPLORATION de I-EXPLORATION absorción I-EXPLORATION predominantemente I-EXPLORATION grasos I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION heterogeneidad, I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION posible I-EXPLORATION tumor I-EXPLORATION dermoide I-EXPLORATION presacro. I-EXPLORATION Dicha I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION unas I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 38% I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION hematológicas I-EXPLORATION acompañantes. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION visceromegalias. I-EXPLORATION I-EXPLORATION Macroscópicamente I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION irregular I-EXPLORATION bien I-EXPLORATION delimitada I-EXPLORATION de I-EXPLORATION 7x5x3 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION estar I-EXPLORATION constituida I-EXPLORATION fundamentalmente I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION adiposo, I-EXPLORATION observándose I-EXPLORATION un I-EXPLORATION área I-EXPLORATION central I-EXPLORATION hemorrágica I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia, I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION áreas I-EXPLORATION blanquecinas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fibroso I-EXPLORATION así I-EXPLORATION como I-EXPLORATION otras I-EXPLORATION edematosas. I-EXPLORATION I-EXPLORATION Histológicamente I-EXPLORATION la I-EXPLORATION neoplasia I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION relativamente I-EXPLORATION bien I-EXPLORATION circunscrita I-EXPLORATION y I-EXPLORATION estaba I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION maduro, I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION laxo I-EXPLORATION y I-EXPLORATION celularidad I-EXPLORATION hematopoyética I-EXPLORATION mixta. I-EXPLORATION Este I-EXPLORATION último I-EXPLORATION componente I-EXPLORATION predominaba I-EXPLORATION en I-EXPLORATION las I-EXPLORATION áreas I-EXPLORATION centrales I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION se I-EXPLORATION hallaba I-EXPLORATION representado I-EXPLORATION por I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION series I-EXPLORATION hematopoyéticas I-EXPLORATION (megacariocítica, I-EXPLORATION serie I-EXPLORATION roja I-EXPLORATION y I-EXPLORATION serie I-EXPLORATION blanca), I-EXPLORATION con I-EXPLORATION diferentes I-EXPLORATION proporciones I-EXPLORATION según I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION estudiada I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION eritromieloide I-EXPLORATION que I-EXPLORATION oscilaba I-EXPLORATION entre I-EXPLORATION 1: I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2: I-EXPLORATION 1. I-EXPLORATION Los I-EXPLORATION megacariocíticos I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION con I-EXPLORATION facilidad I-EXPLORATION y I-EXPLORATION aunque I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION ocasionales I-EXPLORATION formas I-EXPLORATION inmaduras I-EXPLORATION de I-EXPLORATION los I-EXPLORATION mismos, I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION rasgos I-EXPLORATION displásicos. I-EXPLORATION El I-EXPLORATION estroma I-EXPLORATION de I-EXPLORATION las I-EXPLORATION áreas I-EXPLORATION hematopoyéticas I-EXPLORATION era I-EXPLORATION casi I-EXPLORATION exclusivamente I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION adiposo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION más I-EXPLORATION periférica I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION predominaba I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION maduro I-EXPLORATION con I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION y I-EXPLORATION abundantes I-EXPLORATION hemosiderinófagos. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION lipoblastos I-EXPLORATION ni I-EXPLORATION células I-EXPLORATION mesenquimales I-EXPLORATION bizarras I-EXPLORATION y I-EXPLORATION existía I-EXPLORATION cierto I-EXPLORATION componente I-EXPLORATION inflamatorio I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION linfocitario, I-EXPLORATION ocasionalmente I-EXPLORATION dispuesto I-EXPLORATION en I-EXPLORATION agregados I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION aleatoria I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION las I-EXPLORATION zonas I-EXPLORATION hematopoyéticas I-EXPLORATION como I-EXPLORATION en I-EXPLORATION las I-EXPLORATION adiposas. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en B-PAST_MEDICAL_HISTORY 1997, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY tumoración I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY mama I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY adenopatía I-PAST_MEDICAL_HISTORY palpable. I-PAST_MEDICAL_HISTORY Estudio I-PAST_MEDICAL_HISTORY radiológico I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY carcinoma. I-PAST_MEDICAL_HISTORY Es I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY mastectomía I-PAST_MEDICAL_HISTORY radical I-PAST_MEDICAL_HISTORY modificada I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY Madden I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY intraoperatoria I-PAST_MEDICAL_HISTORY positiva I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY carcinoma. I-PAST_MEDICAL_HISTORY Informe I-PAST_MEDICAL_HISTORY anatomopatológico: I-PAST_MEDICAL_HISTORY Carcinoma I-PAST_MEDICAL_HISTORY ductal I-PAST_MEDICAL_HISTORY infiltrante I-PAST_MEDICAL_HISTORY mucinoso I-PAST_MEDICAL_HISTORY (coloide) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3.2 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY eje I-PAST_MEDICAL_HISTORY máximo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY adenopatía I-PAST_MEDICAL_HISTORY positiva I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 22 I-PAST_MEDICAL_HISTORY ganglios I-PAST_MEDICAL_HISTORY axilares I-PAST_MEDICAL_HISTORY aislados. I-PAST_MEDICAL_HISTORY Recibe I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY complementario I-PAST_MEDICAL_HISTORY tamoxifeno I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY diarios. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY realizan I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rastreo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY resultan I-PAST_MEDICAL_HISTORY negativos. I-PAST_MEDICAL_HISTORY Así I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizan I-PAST_MEDICAL_HISTORY ecografías I-PAST_MEDICAL_HISTORY ginecológicas I-PAST_MEDICAL_HISTORY anuales I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY son I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS Mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2001 I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS metrorragia I-PRESENT_ILLNESS postmenopáusica. I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION vaginal I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION ser I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION "pólipo I-EXPLORATION endometrial" I-EXPLORATION de I-EXPLORATION 19*16 I-EXPLORATION mm. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION Histeroscopia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION excrecente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION vagina I-EXPLORATION que I-EXPLORATION es I-EXPLORATION biopsiada I-EXPLORATION y I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION intrauterino I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION polipoidea I-EXPLORATION con I-EXPLORATION vasos I-EXPLORATION anómalos, I-EXPLORATION altamente I-EXPLORATION sospechosa I-EXPLORATION que I-EXPLORATION es I-EXPLORATION igualmente I-EXPLORATION biopsiada. I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION en I-EXPLORATION vagina I-EXPLORATION se I-EXPLORATION informa I-EXPLORATION como I-EXPLORATION carcinoma I-EXPLORATION pobremente I-EXPLORATION diferenciado I-EXPLORATION y I-EXPLORATION la I-EXPLORATION formación I-EXPLORATION polipoidea I-EXPLORATION como I-EXPLORATION atipia I-EXPLORATION celular I-EXPLORATION no I-EXPLORATION filiada. I-EXPLORATION B-TREATMENT Se I-TREATMENT realiza I-TREATMENT una I-TREATMENT histerectomía I-TREATMENT total I-TREATMENT con I-TREATMENT doble I-TREATMENT anexectomía, I-TREATMENT manguito I-TREATMENT vaginal I-TREATMENT y I-TREATMENT linfadenectomía. I-TREATMENT Informe B-EXPLORATION anatomopatológico: I-EXPLORATION Lavado I-EXPLORATION peritoneal I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION células I-EXPLORATION malignas. I-EXPLORATION Tumor I-EXPLORATION intracavitario I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION Tumor I-EXPLORATION Mülleriano I-EXPLORATION Mixto I-EXPLORATION Maligno I-EXPLORATION Heterólogo I-EXPLORATION con I-EXPLORATION extensa I-EXPLORATION permeación I-EXPLORATION vascular I-EXPLORATION linfática. I-EXPLORATION Metástasis I-EXPLORATION múltiples I-EXPLORATION en I-EXPLORATION miometrio, I-EXPLORATION trompa I-EXPLORATION y I-EXPLORATION ovarios I-EXPLORATION y I-EXPLORATION metástasis I-EXPLORATION ganglionares. I-EXPLORATION La I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION vagina I-EXPLORATION es I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION pobremente I-EXPLORATION diferenciado I-EXPLORATION probablemente I-EXPLORATION metástasis I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION Mülleriano I-EXPLORATION mixto I-EXPLORATION descrito I-EXPLORATION (Estadio I-EXPLORATION III). I-EXPLORATION Realiza B-TREATMENT tratamiento I-TREATMENT complementario I-TREATMENT con I-TREATMENT Taxol, I-TREATMENT que I-TREATMENT tolera I-TREATMENT mal, I-TREATMENT y I-TREATMENT radioterapia, I-TREATMENT falleciendo I-TREATMENT al I-TREATMENT año I-TREATMENT de I-TREATMENT este I-TREATMENT proceso. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-FAMILY_HISTORY historia I-FAMILY_HISTORY familiar I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY y B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY intervención I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estrabismo I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ex-fumadora I-PAST_MEDICAL_HISTORY (10 I-PAST_MEDICAL_HISTORY cigarrillos/día). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Inicia B-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS otorrinolaringólogo I-PRESENT_ILLNESS (ORL) I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS gusto, I-PRESENT_ILLNESS anosmia, I-PRESENT_ILLNESS epístaxis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS epífora I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS ocasional, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS intensa I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS para I-PRESENT_ILLNESS iniciar I-PRESENT_ILLNESS estudio. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION ORL I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION derecha I-EXPLORATION e I-EXPLORATION impide I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio I-EXPLORATION con I-EXPLORATION desplazamiento I-EXPLORATION septal I-EXPLORATION a I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION indiferenciado. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectan I-EXPLORATION adenopatías I-EXPLORATION palpables. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION analítica I-EXPLORATION y I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitan I-EXPLORATION Tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION (TAC) I-EXPLORATION y I-EXPLORATION Resonancia I-EXPLORATION nuclear I-EXPLORATION magnética I-EXPLORATION (RNM) I-EXPLORATION craneofacial I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION desplaza I-EXPLORATION el I-EXPLORATION septum I-EXPLORATION y I-EXPLORATION afecta I-EXPLORATION celdillas I-EXPLORATION etmoidales I-EXPLORATION y I-EXPLORATION coanas I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION lado. I-EXPLORATION I-EXPLORATION Es B-TREATMENT intervenida I-TREATMENT quirúrgicamente I-TREATMENT mediante I-TREATMENT resección I-TREATMENT craneofacial I-TREATMENT de I-TREATMENT etmoides I-TREATMENT y I-TREATMENT translocación I-TREATMENT facial I-TREATMENT medial, I-TREATMENT que I-TREATMENT permite I-TREATMENT apreciar I-TREATMENT que I-TREATMENT la I-TREATMENT tumoración I-TREATMENT ocupaba I-TREATMENT todo I-TREATMENT el I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT derecho I-TREATMENT y I-TREATMENT celdas I-TREATMENT etmoidales, I-TREATMENT a I-TREATMENT las I-TREATMENT cuales I-TREATMENT desplaza I-TREATMENT por I-TREATMENT compresión, I-TREATMENT con I-TREATMENT disrupción I-TREATMENT de I-TREATMENT partes I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT ósea I-TREATMENT posterior I-TREATMENT y I-TREATMENT medial I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar. I-TREATMENT El I-TREATMENT tumor I-TREATMENT rellenaba I-TREATMENT submucosamente I-TREATMENT toda I-TREATMENT la I-TREATMENT fosa I-TREATMENT nasal I-TREATMENT derecha I-TREATMENT y I-TREATMENT parte I-TREATMENT del I-TREATMENT seno I-TREATMENT esfenoidal. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION Anatomo-patológico I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION Neuroestesioblastoma, I-EXPLORATION estadio I-EXPLORATION B I-EXPLORATION de I-EXPLORATION Kádish. I-EXPLORATION En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION sufrió I-EVOLUTION una I-EVOLUTION meningitis I-EVOLUTION bacteriana I-EVOLUTION con I-EVOLUTION evolución I-EVOLUTION satisfactoria. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION RNM I-EXPLORATION posquirúrgica I-EXPLORATION solo I-EXPLORATION se I-EXPLORATION visualizan I-EXPLORATION cambios I-EXPLORATION postcirugía. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT valoración I-TREATMENT en I-TREATMENT Subcomité I-TREATMENT de I-TREATMENT tumores I-TREATMENT de I-TREATMENT cabeza I-TREATMENT y I-TREATMENT cuello I-TREATMENT se I-TREATMENT decidió I-TREATMENT Radioterapia I-TREATMENT postoperatoria, I-TREATMENT recibiendo I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT sobre I-TREATMENT lecho I-TREATMENT tumoral I-TREATMENT de I-TREATMENT 60 I-TREATMENT Gy I-TREATMENT con I-TREATMENT técnica I-TREATMENT de I-TREATMENT simulación I-TREATMENT virtual I-TREATMENT y I-TREATMENT planificación I-TREATMENT tridimensional I-TREATMENT (3D) I-TREATMENT sobre I-TREATMENT tomografía I-TREATMENT computarizada I-TREATMENT (TC) I-TREATMENT helicoidal I-TREATMENT individualizada I-TREATMENT (cortes I-TREATMENT cada I-TREATMENT 5 I-TREATMENT mm), I-TREATMENT con I-TREATMENT protección I-TREATMENT plomada I-TREATMENT personalizada I-TREATMENT de I-TREATMENT órganos I-TREATMENT sanos, I-TREATMENT fraccionamiento I-TREATMENT de I-TREATMENT 2 I-TREATMENT Gy/fracción, I-TREATMENT 5 I-TREATMENT fracciones I-TREATMENT semana I-TREATMENT mediante I-TREATMENT fotones I-TREATMENT de I-TREATMENT 6 I-TREATMENT Megavoltios I-TREATMENT (MV) I-TREATMENT procedentes I-TREATMENT de I-TREATMENT Acelerador I-TREATMENT Lineal. I-TREATMENT Se I-TREATMENT emplea I-TREATMENT sistema I-TREATMENT de I-TREATMENT homogeneización I-TREATMENT de I-TREATMENT dosis I-TREATMENT con I-TREATMENT cuñas I-TREATMENT de I-TREATMENT compensación I-TREATMENT tisular, I-TREATMENT e I-TREATMENT inmovilización I-TREATMENT con I-TREATMENT máscara I-TREATMENT termoplástica I-TREATMENT facial I-TREATMENT para I-TREATMENT una I-TREATMENT adecuada I-TREATMENT reproductibilidad I-TREATMENT a I-TREATMENT lo I-TREATMENT largo I-TREATMENT del I-TREATMENT tratamiento. I-TREATMENT La B-EVOLUTION tolerancia I-EVOLUTION es I-EVOLUTION buena, I-EVOLUTION con I-EVOLUTION toxicidad I-EVOLUTION aguda I-EVOLUTION dérmica I-EVOLUTION grado I-EVOLUTION 1 I-EVOLUTION (G1), I-EVOLUTION y I-EVOLUTION en I-EVOLUTION mucosa I-EVOLUTION grado I-EVOLUTION 2 I-EVOLUTION (G2). I-EVOLUTION A B-TREATMENT las I-TREATMENT 4 I-TREATMENT semanas I-TREATMENT de I-TREATMENT finalizada I-TREATMENT la I-TREATMENT irradiación I-TREATMENT es I-TREATMENT reintervenida I-TREATMENT por I-TREATMENT fístula I-TREATMENT oroantral I-TREATMENT en I-TREATMENT el I-TREATMENT surco I-TREATMENT gingival I-TREATMENT derecho I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT primer I-TREATMENT molar. I-TREATMENT Siete I-TREATMENT meses I-TREATMENT después, I-TREATMENT es I-TREATMENT reintervenida I-TREATMENT con I-TREATMENT abordaje I-TREATMENT craneofacial I-TREATMENT por I-TREATMENT granuloma I-TREATMENT a I-TREATMENT cuerpo I-TREATMENT extraño I-TREATMENT en I-TREATMENT cavidad I-TREATMENT frontal I-TREATMENT izquierda I-TREATMENT sin I-TREATMENT datos I-TREATMENT histológicos I-TREATMENT de I-TREATMENT recidiva. I-TREATMENT I-TREATMENT En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION tras I-EVOLUTION 26 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION intervención, I-EVOLUTION no I-EVOLUTION existe I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION local, I-EVOLUTION hallándose I-EVOLUTION en I-EVOLUTION remisión I-EVOLUTION completa, I-EVOLUTION realizando I-EVOLUTION vida I-EVOLUTION normal I-EVOLUTION activa. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS homosexual I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tuberculosis I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY estreptomicina, I-PAST_MEDICAL_HISTORY esfinterotomía I-PAST_MEDICAL_HISTORY lateral I-PAST_MEDICAL_HISTORY interna I-PAST_MEDICAL_HISTORY reciente I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY fisura I-PAST_MEDICAL_HISTORY anal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY centinela, I-PAST_MEDICAL_HISTORY serología I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY positiva I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY enero I-PAST_MEDICAL_HISTORY 2003, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY C3 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY neumonía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Pneumocystis I-PAST_MEDICAL_HISTORY carinii. I-PAST_MEDICAL_HISTORY Último I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY CD I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 2.220.000 I-PAST_MEDICAL_HISTORY copias I-PAST_MEDICAL_HISTORY virales. I-PAST_MEDICAL_HISTORY Inicia B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT lamivudina-zidovudina-ritonavir-lopinavir. I-TREATMENT Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS postpandrial I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS pirosis. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION lesiones I-EXPLORATION sobreelevadas I-EXPLORATION rojovioláceas I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION laterocervical I-EXPLORATION izquierda I-EXPLORATION e I-EXPLORATION inguinal I-EXPLORATION derecha, I-EXPLORATION la I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION endoscopia I-EXPLORATION oral, I-EXPLORATION apreciándose I-EXPLORATION lesiones I-EXPLORATION eritematosas I-EXPLORATION en I-EXPLORATION estómago I-EXPLORATION y I-EXPLORATION primeras I-EXPLORATION porciones I-EXPLORATION duodenales, I-EXPLORATION alguna I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION ulceradas I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION sarcoma I-EXPLORATION de I-EXPLORATION Kaposi. I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION negativo, I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION toracabdominal I-EXPLORATION normal. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT sarcoma I-TREATMENT de I-TREATMENT kaposi I-TREATMENT con I-TREATMENT afectación I-TREATMENT visceral I-TREATMENT y I-TREATMENT cutánea I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT adriamicina I-TREATMENT liposomal I-TREATMENT 20 I-TREATMENT mg/m2 I-TREATMENT cada I-TREATMENT 3 I-TREATMENT semanas. I-TREATMENT Desde B-EVOLUTION el I-EVOLUTION primer I-EVOLUTION de I-EVOLUTION ciclo I-EVOLUTION de I-EVOLUTION tratamiento, I-EVOLUTION se I-EVOLUTION produce I-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION afectación I-EVOLUTION cutánea I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION queda I-EVOLUTION asintomático, I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION ciclo I-EVOLUTION se I-EVOLUTION repite I-EVOLUTION endoscopia I-EVOLUTION oral, I-EVOLUTION mostrando I-EVOLUTION una I-EVOLUTION resolución I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesiones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés I-FAMILY_HISTORY oncológico I-FAMILY_HISTORY y B-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY túnel I-PAST_MEDICAL_HISTORY carpiano I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mano I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY nódulos I-PAST_MEDICAL_HISTORY mamarios I-PAST_MEDICAL_HISTORY benignos. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY diagnostico I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY suplementos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY calcitonina I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY osteoporosis. I-PAST_MEDICAL_HISTORY Desde B-PRESENT_ILLNESS noviembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1999 I-PRESENT_ILLNESS notaba I-PRESENT_ILLNESS perdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS ocular I-PRESENT_ILLNESS ocasional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS conjuntivitis I-PRESENT_ILLNESS bilateral. I-PRESENT_ILLNESS Vista B-EXPLORATION por I-EXPLORATION oftalmología I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION "edema I-EXPLORATION de I-EXPLORATION papila" I-EXPLORATION unilateral I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION izquierdo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION los I-EXPLORATION movimientos I-EXPLORATION oculares I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION órbitas. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION exploraciones I-EXPLORATION complementarias. I-EXPLORATION I-EXPLORATION - I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION órbita: I-EXPLORATION en I-EXPLORATION vértice I-EXPLORATION de I-EXPLORATION órbita I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION en I-EXPLORATION íntimo I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION nervio I-EXPLORATION óptico, I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION intraconal I-EXPLORATION que I-EXPLORATION captaba I-EXPLORATION contraste I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION intensa I-EXPLORATION y I-EXPLORATION homogénea, I-EXPLORATION observándose I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vaina I-EXPLORATION del I-EXPLORATION nervio I-EXPLORATION óptico I-EXPLORATION formando I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION en I-EXPLORATION "railes I-EXPLORATION de I-EXPLORATION tranvía". I-EXPLORATION No I-EXPLORATION había I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION agrandamiento I-EXPLORATION del I-EXPLORATION agujero I-EXPLORATION óptico I-EXPLORATION ni I-EXPLORATION invasión I-EXPLORATION intracraneal; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION erosiones I-EXPLORATION óseas. I-EXPLORATION I-EXPLORATION - I-EXPLORATION RMN I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION de I-EXPLORATION órbita: I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION isointensa I-EXPLORATION con I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION cerebral I-EXPLORATION en I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION secuencias I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION el I-EXPLORATION agujero I-EXPLORATION óptico I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION captación I-EXPLORATION intensa I-EXPLORATION y I-EXPLORATION homogénea I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION englobaba I-EXPLORATION el I-EXPLORATION nervio I-EXPLORATION óptico I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION discretamente I-EXPLORATION comprimido. I-EXPLORATION El I-EXPLORATION tamaño I-EXPLORATION aproximado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 2x1x1 I-EXPLORATION cm. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION radiológicos I-EXPLORATION sugerían I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION meningioma I-EXPLORATION aunque I-EXPLORATION no I-EXPLORATION se I-EXPLORATION podían I-EXPLORATION descartar I-EXPLORATION otras I-EXPLORATION posibilidades I-EXPLORATION como I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vaina I-EXPLORATION nerviosa. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Estudio I-EXPLORATION oftalmológico: I-EXPLORATION mostró I-EXPLORATION en I-EXPLORATION la I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION una I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION visión I-EXPLORATION a I-EXPLORATION 1/10 I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION campimétrico I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION déficit I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION conservando I-EXPLORATION parcialmente I-EXPLORATION la I-EXPLORATION visión I-EXPLORATION en I-EXPLORATION cuadrante I-EXPLORATION superior I-EXPLORATION interno. I-EXPLORATION I-EXPLORATION Valorado B-TREATMENT por I-TREATMENT el I-TREATMENT Comité I-TREATMENT de I-TREATMENT Radiocirugía I-TREATMENT (RC) I-TREATMENT se I-TREATMENT aceptó I-TREATMENT el I-TREATMENT caso I-TREATMENT para I-TREATMENT RTEF, I-TREATMENT siendo I-TREATMENT irradiado I-TREATMENT con I-TREATMENT un I-TREATMENT Acelerador I-TREATMENT Lineal I-TREATMENT con I-TREATMENT fotones I-TREATMENT de I-TREATMENT 6 I-TREATMENT Mv, I-TREATMENT con I-TREATMENT colimadores I-TREATMENT cónicos I-TREATMENT de I-TREATMENT 10 I-TREATMENT y I-TREATMENT 25 I-TREATMENT mm, I-TREATMENT con I-TREATMENT 2 I-TREATMENT isocentros, I-TREATMENT administrándose I-TREATMENT 8 I-TREATMENT arcos I-TREATMENT esterotáxicos I-TREATMENT y I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT de I-TREATMENT 52, I-TREATMENT 2 I-TREATMENT Gy I-TREATMENT en I-TREATMENT fracciones I-TREATMENT de I-TREATMENT 1, I-TREATMENT 8 I-TREATMENT Gy, I-TREATMENT hasta I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 29 I-TREATMENT fracciones. I-TREATMENT Se I-TREATMENT eligió I-TREATMENT como I-TREATMENT referencia I-TREATMENT la I-TREATMENT Isodosis I-TREATMENT de I-TREATMENT Cubrimiento I-TREATMENT del I-TREATMENT 80%. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION respondió I-EVOLUTION clínicamente I-EVOLUTION con I-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION dolorosa I-EVOLUTION orbitaria I-EVOLUTION y I-EVOLUTION el I-EVOLUTION exoftalmos I-EVOLUTION ya I-EVOLUTION en I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION control I-EVOLUTION semestral. I-EVOLUTION Las I-EVOLUTION exploraciones I-EVOLUTION con I-EVOLUTION RMN I-EVOLUTION confirmaron I-EVOLUTION en I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION control I-EVOLUTION a I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION significativa I-EVOLUTION del I-EVOLUTION tamaño I-EVOLUTION tumoral, I-EVOLUTION quedando I-EVOLUTION zonas I-EVOLUTION de I-EVOLUTION captación I-EVOLUTION alrededor I-EVOLUTION del I-EVOLUTION agujero I-EVOLUTION óptico, I-EVOLUTION sugestivas I-EVOLUTION de I-EVOLUTION restos I-EVOLUTION tumorales I-EVOLUTION de I-EVOLUTION meningioma I-EVOLUTION que I-EVOLUTION han I-EVOLUTION permanecido I-EVOLUTION estables I-EVOLUTION en I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION posteriores. I-EVOLUTION Los I-EVOLUTION estudios I-EVOLUTION oftalmológicos I-EVOLUTION demostraron I-EVOLUTION mejora I-EVOLUTION de I-EVOLUTION cierto I-EVOLUTION grado I-EVOLUTION de I-EVOLUTION visión, I-EVOLUTION situación I-EVOLUTION que I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION con I-EVOLUTION el I-EVOLUTION paso I-EVOLUTION del I-EVOLUTION tiempo. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION etiquetada I-EVOLUTION en I-EVOLUTION remisión I-EVOLUTION clínica I-EVOLUTION parcial/completa. I-EVOLUTION No I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION toxicidad I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION vía I-EVOLUTION óptica I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION actual. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos, I-PRESENT_ILLNESS escasa I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS que I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS a I-PRESENT_ILLNESS máximos I-PRESENT_ILLNESS esfuerzos I-PRESENT_ILLNESS se I-PRESENT_ILLNESS hizo I-PRESENT_ILLNESS a I-PRESENT_ILLNESS moderados I-PRESENT_ILLNESS esfuerzos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY exfumador I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY (1.5 I-PAST_MEDICAL_HISTORY paq/día), I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY ocular, I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fémur I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tibia I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 13 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY complicada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY osteomielitis, I-PAST_MEDICAL_HISTORY herniorrafia I-PAST_MEDICAL_HISTORY umbilical I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY apendicitis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Exploración B-EXPLORATION física: I-EXPLORATION no I-EXPLORATION fiebre, I-EXPLORATION no I-EXPLORATION dolor I-EXPLORATION torácico, I-EXPLORATION eupneico I-EXPLORATION en I-EXPLORATION reposo, I-EXPLORATION no I-EXPLORATION síndrome I-EXPLORATION constitucional, I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ventilación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemitórax I-EXPLORATION izquierdo. I-EXPLORATION Peso=73, I-EXPLORATION 4 I-EXPLORATION Kg, I-EXPLORATION altura=1, I-EXPLORATION 69 I-EXPLORATION m. I-EXPLORATION I-EXPLORATION Analítica: I-EXPLORATION leucocitosis I-EXPLORATION leve I-EXPLORATION (11.3x10^9/l) I-EXPLORATION y I-EXPLORATION ligera I-EXPLORATION neutrofilia I-EXPLORATION (74.7%), I-EXPLORATION bioquímica I-EXPLORATION y I-EXPLORATION coagulación: I-EXPLORATION normales. I-EXPLORATION Gasometría I-EXPLORATION arterial: I-EXPLORATION pH=7.41, I-EXPLORATION pO2=74.0 I-EXPLORATION mmHg, I-EXPLORATION pCO2=36.3 I-EXPLORATION mmHg. I-EXPLORATION Rx-TC: I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION regulares I-EXPLORATION de I-EXPLORATION 10.8 I-EXPLORATION x I-EXPLORATION 8.4 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mediastino I-EXPLORATION anterior I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION extensión I-EXPLORATION al I-EXPLORATION hilio I-EXPLORATION ipsilateral I-EXPLORATION comprimiéndolo, I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION izquierdo I-EXPLORATION moderado. I-EXPLORATION Fibrobroncoscopia: I-EXPLORATION no I-EXPLORATION tumoración I-EXPLORATION endobronquial, I-EXPLORATION hiperemia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION difusa. I-EXPLORATION Pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION respiratoria: I-EXPLORATION FEV1=2010 I-EXPLORATION l. I-EXPLORATION (59%), I-EXPLORATION FVC=2290 I-EXPLORATION l. I-EXPLORATION (54.8%), I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION Tiffenau=87.8%. I-EXPLORATION PAAF: I-EXPLORATION células I-EXPLORATION epiteliales I-EXPLORATION con I-EXPLORATION discreto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION atipia I-EXPLORATION y I-EXPLORATION abundantes I-EXPLORATION linfocitos, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION histiocitos, I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION multinucleadas I-EXPLORATION y I-EXPLORATION eosinófilos, I-EXPLORATION algunas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION (citología I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION timoma). I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION fue I-EXPLORATION sometido I-EXPLORATION a I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION toracoscopia: I-EXPLORATION nódulos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pleura I-EXPLORATION parietal I-EXPLORATION y I-EXPLORATION diafragmática, I-EXPLORATION nódulos I-EXPLORATION pulmonares I-EXPLORATION en I-EXPLORATION LII I-EXPLORATION (informe I-EXPLORATION de I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION intraoperatoria I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION linfoide I-EXPLORATION y I-EXPLORATION material I-EXPLORATION fibrohemorrágico), I-EXPLORATION evacuación I-EXPLORATION de I-EXPLORATION 2000 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION y I-EXPLORATION observación I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION tumoral I-EXPLORATION en I-EXPLORATION mediastino I-EXPLORATION anterior. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION anatomopatológicos I-EXPLORATION definitivos I-EXPLORATION fueron: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Citología I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION pleural: I-EXPLORATION hiperplasia I-EXPLORATION mesotelial I-EXPLORATION reactiva I-EXPLORATION I-EXPLORATION - I-EXPLORATION Biopsia I-EXPLORATION de I-EXPLORATION pleura I-EXPLORATION parietal I-EXPLORATION y I-EXPLORATION diafragmática: I-EXPLORATION tejido I-EXPLORATION fibroso I-EXPLORATION hialinizado, I-EXPLORATION tejido I-EXPLORATION fibroso I-EXPLORATION y I-EXPLORATION muscular I-EXPLORATION I-EXPLORATION - I-EXPLORATION Biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION mediastínica: I-EXPLORATION células I-EXPLORATION epiteliales I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION citoqueratina I-EXPLORATION y I-EXPLORATION CAM I-EXPLORATION 5.2, I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION CD-3 I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION timoma I-EXPLORATION cortical. I-EXPLORATION I-EXPLORATION Por B-TREATMENT tratarse I-TREATMENT de I-TREATMENT un I-TREATMENT timoma I-TREATMENT invasor I-TREATMENT (estadío-III I-TREATMENT de I-TREATMENT Massaoka), I-TREATMENT se I-TREATMENT planeó I-TREATMENT una I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Qt I-TREATMENT neoadyuvante, I-TREATMENT cirugía I-TREATMENT y I-TREATMENT posterior I-TREATMENT radioterapia. I-TREATMENT I-TREATMENT La I-TREATMENT Qt I-TREATMENT consistió I-TREATMENT en: I-TREATMENT adriamicina I-TREATMENT 50 I-TREATMENT mg/m I-TREATMENT 2 I-TREATMENT y I-TREATMENT CDDP I-TREATMENT 100 I-TREATMENT mg/m2 I-TREATMENT en I-TREATMENT tres I-TREATMENT ciclos I-TREATMENT con I-TREATMENT intervalo I-TREATMENT de I-TREATMENT 21 I-TREATMENT días. I-TREATMENT En I-TREATMENT el I-TREATMENT segundo I-TREATMENT y I-TREATMENT tercer I-TREATMENT ciclos I-TREATMENT se I-TREATMENT disminuyó I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT CDDP I-TREATMENT a I-TREATMENT 75 I-TREATMENT mg/m2 I-TREATMENT por I-TREATMENT vómitos I-TREATMENT y I-TREATMENT somnolencia. I-TREATMENT I-TREATMENT En B-EVOLUTION la I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION Qt I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION del I-EVOLUTION tamaño I-EVOLUTION aproximadamente I-EVOLUTION en I-EVOLUTION un I-EVOLUTION 25% I-EVOLUTION a I-EVOLUTION expensas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION porción I-EVOLUTION periférica I-EVOLUTION manteniendo I-EVOLUTION la I-EVOLUTION prolongación I-EVOLUTION hacia I-EVOLUTION el I-EVOLUTION hilio I-EVOLUTION pulmonar: I-EVOLUTION 7.9 I-EVOLUTION x I-EVOLUTION 6.3 I-EVOLUTION cm I-EVOLUTION infiltrando I-EVOLUTION la I-EVOLUTION pleura I-EVOLUTION mediastínica I-EVOLUTION y I-EVOLUTION contactando I-EVOLUTION con I-EVOLUTION la I-EVOLUTION arteria I-EVOLUTION pulmonar I-EVOLUTION izquierda. I-EVOLUTION I-EVOLUTION En B-TREATMENT la I-TREATMENT cirugía I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT extirpación I-TREATMENT en I-TREATMENT bloque I-TREATMENT del I-TREATMENT timoma I-TREATMENT junto I-TREATMENT a I-TREATMENT una I-TREATMENT neumonectomía I-TREATMENT izquierda I-TREATMENT y I-TREATMENT linfadenectomía I-TREATMENT mediastínica I-TREATMENT englobando I-TREATMENT los I-TREATMENT ganglios I-TREATMENT de I-TREATMENT las I-TREATMENT áreas I-TREATMENT 5, I-TREATMENT 6, I-TREATMENT 7, I-TREATMENT 8 I-TREATMENT y I-TREATMENT 9. I-TREATMENT Los I-TREATMENT nervios I-TREATMENT frénico I-TREATMENT y I-TREATMENT vago I-TREATMENT izquierdos I-TREATMENT fueron I-TREATMENT seccionados I-TREATMENT por I-TREATMENT invasión I-TREATMENT tumoral. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION anemia I-EVOLUTION bien I-EVOLUTION tolerada I-EVOLUTION sin I-EVOLUTION precisar I-EVOLUTION transfusión I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Los B-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION fueron: I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION adenopatías I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION tumor, I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION previo I-EXPLORATION de I-EXPLORATION timoma I-EXPLORATION y I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION tumoral I-EXPLORATION del I-EXPLORATION 20%. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY paquetes/año, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buen I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY farmacológico, I-PAST_MEDICAL_HISTORY miopía I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY catarata I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY destacables. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS oftalmología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital, I-PRESENT_ILLNESS consistió I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS escotoma I-PRESENT_ILLNESS no I-PRESENT_ILLNESS central I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS respiratorios, I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS constitucional. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmoscópica I-EXPLORATION se I-EXPLORATION identificaba I-EXPLORATION en I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION más I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION papila, I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION despigmentación, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION pigmentadas I-EXPLORATION anaranjadas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION centro, I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION 4-5 I-EXPLORATION diámetros I-EXPLORATION papilares I-EXPLORATION y I-EXPLORATION levantamiento I-EXPLORATION exudativo I-EXPLORATION de I-EXPLORATION los I-EXPLORATION bordes. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION angiografía I-EXPLORATION fluoresceínica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION reconoce I-EXPLORATION de I-EXPLORATION nuevo I-EXPLORATION esta I-EXPLORATION misma I-EXPLORATION lesión I-EXPLORATION descrita I-EXPLORATION en I-EXPLORATION la I-EXPLORATION retinografía, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION de I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION o I-EXPLORATION hemangioma. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION orbitaria I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 3 I-EXPLORATION milímetros I-EXPLORATION (mm) I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION mm. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION mínimo I-EXPLORATION engrosamiento I-EXPLORATION focal I-EXPLORATION retiniano I-EXPLORATION inmediatamente I-EXPLORATION adyacente I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION a I-EXPLORATION la I-EXPLORATION papila, I-EXPLORATION sin I-EXPLORATION hiperseñal I-EXPLORATION ni I-EXPLORATION realce I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION Un I-EXPLORATION mes I-EXPLORATION después I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION retinografía I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION orbitaria, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION claro I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION retiniana, I-EXPLORATION llegando I-EXPLORATION a I-EXPLORATION una I-EXPLORATION dimensión I-EXPLORATION de I-EXPLORATION 9, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 9 I-EXPLORATION mm. I-EXPLORATION La I-EXPLORATION aproximación I-EXPLORATION diagnóstica I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION retiniano, I-EXPLORATION posiblemente I-EXPLORATION metastásico. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION general I-EXPLORATION de I-EXPLORATION búsqueda I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION primario, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION toracoabdominopélvica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION engloba I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION del I-EXPLORATION bronquio I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION superior, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION adenopatías I-EXPLORATION mediastínicas I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION superior I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION centímetros I-EXPLORATION (cm) I-EXPLORATION prevasculares, I-EXPLORATION pretraqueales I-EXPLORATION derechas, I-EXPLORATION ventana I-EXPLORATION aortopulmonar I-EXPLORATION y I-EXPLORATION subcarinales. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION abdominal I-EXPLORATION destacan I-EXPLORATION nódulos I-EXPLORATION suprarrenales I-EXPLORATION bilaterales I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION Tomografía I-EXPLORATION por I-EXPLORATION emisión I-EXPLORATION de I-EXPLORATION positrones I-EXPLORATION (PET) I-EXPLORATION mostraba I-EXPLORATION múltiples I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION elevada I-EXPLORATION actividad I-EXPLORATION metabólica I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION paratraqueal I-EXPLORATION derecho, I-EXPLORATION mediastínico I-EXPLORATION y I-EXPLORATION región I-EXPLORATION hiliar I-EXPLORATION y I-EXPLORATION parahiliar I-EXPLORATION izquierdo, I-EXPLORATION región I-EXPLORATION suprarrenal I-EXPLORATION derecha, I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION tumoral I-EXPLORATION maligna. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION mediastinoscopia I-EXPLORATION para I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION paratraqueal I-EXPLORATION derecha, I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION fue I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION adenocarcinoma. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT metástasis I-TREATMENT retiniana I-TREATMENT derecha I-TREATMENT y I-TREATMENT suprarrenal I-TREATMENT de I-TREATMENT adenocarcinoma I-TREATMENT de I-TREATMENT pulmón, I-TREATMENT comienza I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT con I-TREATMENT esquema I-TREATMENT docetaxel I-TREATMENT y I-TREATMENT cisplatino, I-TREATMENT mostrando I-TREATMENT tras I-TREATMENT dos I-TREATMENT ciclos I-TREATMENT una I-TREATMENT respuesta I-TREATMENT parcial I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT medible I-TREATMENT y I-TREATMENT una I-TREATMENT aparente I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT formación I-TREATMENT retiniana, I-TREATMENT aunque I-TREATMENT posteriormente, I-TREATMENT se I-TREATMENT complicó I-TREATMENT con I-TREATMENT un I-TREATMENT desprendimiento I-TREATMENT de I-TREATMENT retina I-TREATMENT leve I-TREATMENT y I-TREATMENT tuvo I-TREATMENT que I-TREATMENT ser I-TREATMENT tratado I-TREATMENT con I-TREATMENT radioterapia. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS visto I-PRESENT_ILLNESS por I-PRESENT_ILLNESS vez I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestras I-PRESENT_ILLNESS consultas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS marzo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2003. I-PRESENT_ILLNESS Fue B-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Nefrología I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO diagnosticarse I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tumor I-DERIVED_FROM/TO de I-DERIVED_FROM/TO músculo I-DERIVED_FROM/TO liso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO potencial I-DERIVED_FROM/TO maligno I-DERIVED_FROM/TO incierto. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY cólico I-PAST_MEDICAL_HISTORY nefrítico I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY estudiado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dicho I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY haberse I-PAST_MEDICAL_HISTORY detectado I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION se I-EXPLORATION describió I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION abdominal I-EXPLORATION polilobulada I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION realzaba I-EXPLORATION en I-EXPLORATION parte I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION y I-EXPLORATION presentaba I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION y I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION espacio I-EXPLORATION subfrénico I-EXPLORATION hasta I-EXPLORATION hilio I-EXPLORATION esplénico I-EXPLORATION y I-EXPLORATION cola I-EXPLORATION pancreática. I-EXPLORATION I-EXPLORATION El I-EXPLORATION 13-2-03 I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecoendoscopia: I-EXPLORATION gran I-EXPLORATION tumoración I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION probable I-EXPLORATION localización I-EXPLORATION en I-EXPLORATION retroperitoneo, I-EXPLORATION independiente I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION del I-EXPLORATION páncreas I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION bazo I-EXPLORATION del I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION podía I-EXPLORATION independizar. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION adenopatías. I-EXPLORATION Se B-TREATMENT intervino I-TREATMENT el I-TREATMENT 6-3-03 I-TREATMENT encontrándose I-TREATMENT tumoración I-TREATMENT multilobulada I-TREATMENT entre I-TREATMENT fornix I-TREATMENT e I-TREATMENT hilio I-TREATMENT esplénico, I-TREATMENT realizándose I-TREATMENT extirpación I-TREATMENT total I-TREATMENT junto I-TREATMENT a I-TREATMENT bazo I-TREATMENT y I-TREATMENT pared I-TREATMENT gástrica I-TREATMENT a I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT adhiere. I-TREATMENT I-TREATMENT Anatomía B-EXPLORATION Patológica I-EXPLORATION : I-EXPLORATION Macroscópicamente I-EXPLORATION y I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION esplénico I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION multinodular I-EXPLORATION de I-EXPLORATION 11x9x6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION y I-EXPLORATION coloración I-EXPLORATION pardusca I-EXPLORATION que I-EXPLORATION al I-EXPLORATION corte I-EXPLORATION presenta I-EXPLORATION frecuentes I-EXPLORATION áreas I-EXPLORATION hemorrágicas. I-EXPLORATION Microscópicamente, I-EXPLORATION el I-EXPLORATION bazo I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION infiltración I-EXPLORATION tumoral. I-EXPLORATION Fragmento I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION gástrica I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION El I-EXPLORATION tumor I-EXPLORATION descrito I-EXPLORATION previamente I-EXPLORATION está I-EXPLORATION bien I-EXPLORATION delimitado I-EXPLORATION por I-EXPLORATION una I-EXPLORATION delgada I-EXPLORATION cápsula I-EXPLORATION fibrosa I-EXPLORATION y I-EXPLORATION está I-EXPLORATION constituido I-EXPLORATION por I-EXPLORATION células I-EXPLORATION fusiformes I-EXPLORATION isomorfas, I-EXPLORATION sin I-EXPLORATION atipia I-EXPLORATION ni I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION necrosis, I-EXPLORATION presentado I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION mitótico I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION mitosis I-EXPLORATION por I-EXPLORATION 10 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION aumento. I-EXPLORATION La I-EXPLORATION inmunohistoquímica I-EXPLORATION (IMH) I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION actina I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION liso I-EXPLORATION y I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION desmina, I-EXPLORATION S-100, I-EXPLORATION CD I-EXPLORATION 57, I-EXPLORATION EMA, I-EXPLORATION CD68 I-EXPLORATION y I-EXPLORATION neurofilamentos. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION fue I-EXPLORATION "Tumor I-EXPLORATION de I-EXPLORATION musculo I-EXPLORATION liso I-EXPLORATION de I-EXPLORATION potencial I-EXPLORATION maligno I-EXPLORATION incierto" I-EXPLORATION (11 I-EXPLORATION cm). I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION negativo, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION revisión I-EXPLORATION del I-EXPLORATION caso I-EXPLORATION para I-EXPLORATION catalogación I-EXPLORATION definitiva I-EXPLORATION mediante I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION IMH I-EXPLORATION que I-EXPLORATION en I-EXPLORATION esta I-EXPLORATION ocasión I-EXPLORATION incluyera I-EXPLORATION CD I-EXPLORATION 117; I-EXPLORATION ésta I-EXPLORATION fue I-EXPLORATION intensamente I-EXPLORATION positiva. I-EXPLORATION I-EXPLORATION Resultados: I-EXPLORATION Actina I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION liso I-EXPLORATION y I-EXPLORATION Actina I-EXPLORATION muscular I-EXPLORATION específica: I-EXPLORATION inmunotinción I-EXPLORATION débil I-EXPLORATION y I-EXPLORATION focal; I-EXPLORATION CD34 I-EXPLORATION y I-EXPLORATION c-kit I-EXPLORATION (CD I-EXPLORATION 117): I-EXPLORATION inmunotinción I-EXPLORATION intensa I-EXPLORATION con I-EXPLORATION control I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION CD I-EXPLORATION 117; I-EXPLORATION S-100 I-EXPLORATION y I-EXPLORATION desmina: I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION inmunotinción; I-EXPLORATION Ki67: I-EXPLORATION 10%. I-EXPLORATION I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION tumor I-EXPLORATION estromal I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION en I-EXPLORATION retroperitoneo I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS entre B-PAST_MEDICAL_HISTORY cuyos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY I, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY únicamente I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY medidas I-PAST_MEDICAL_HISTORY dietéticas, I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY beta-talasemia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY dermatitis I-PAST_MEDICAL_HISTORY atópica. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hábito I-PAST_MEDICAL_HISTORY tabáquico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY paquetes/año I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS estudiada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS vascular I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2003 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS raiz I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS úlceras I-PRESENT_ILLNESS profundas, I-PRESENT_ILLNESS dolorosas, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ellas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS mejoría I-PRESENT_ILLNESS con I-PRESENT_ILLNESS los I-PRESENT_ILLNESS tratamientos I-PRESENT_ILLNESS administrados I-PRESENT_ILLNESS y I-PRESENT_ILLNESS llegándose I-PRESENT_ILLNESS finalmente I-PRESENT_ILLNESS al I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pioderma I-PRESENT_ILLNESS gangrenoso I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS la I-PRESENT_ILLNESS realización I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS biopsia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión. I-PRESENT_ILLNESS Ante B-DERIVED_FROM/TO dicho I-DERIVED_FROM/TO hallazgo, I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO medicina I-DERIVED_FROM/TO interna I-DERIVED_FROM/TO en I-DERIVED_FROM/TO mayo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2004 I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO sometida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO diversas I-DERIVED_FROM/TO pruebas I-DERIVED_FROM/TO diagnósticas, I-DERIVED_FROM/TO destacando I-DERIVED_FROM/TO la I-DERIVED_FROM/TO normalidad I-DERIVED_FROM/TO en I-DERIVED_FROM/TO las I-DERIVED_FROM/TO pruebas I-DERIVED_FROM/TO realizadas, I-DERIVED_FROM/TO tanto I-DERIVED_FROM/TO en I-DERIVED_FROM/TO pruebas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO imagen, I-DERIVED_FROM/TO como I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO inmunológico. I-DERIVED_FROM/TO Así I-DERIVED_FROM/TO mismo I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO negaba I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO digestiva I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cualquier I-DERIVED_FROM/TO índole. I-DERIVED_FROM/TO Se B-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT corticoides I-TREATMENT y I-TREATMENT ciclosporina I-TREATMENT A I-TREATMENT con I-TREATMENT muy I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT sigue I-TREATMENT este I-TREATMENT tratamiento I-TREATMENT hasta I-TREATMENT noviembre I-TREATMENT de I-TREATMENT 2004 I-TREATMENT así I-TREATMENT como I-TREATMENT curas I-TREATMENT locales I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT ulcerosas, I-TREATMENT aunque I-TREATMENT con I-TREATMENT persistencia I-TREATMENT de I-TREATMENT dichas I-TREATMENT lesiones. I-TREATMENT B-EVOLUTION En I-EVOLUTION noviembre I-EVOLUTION de I-EVOLUTION 2004 I-EVOLUTION comienza I-EVOLUTION con I-EVOLUTION clínica I-EVOLUTION digestiva I-EVOLUTION inespecífica I-EVOLUTION consistente I-EVOLUTION en I-EVOLUTION molestias I-EVOLUTION abdominales I-EVOLUTION difusas I-EVOLUTION y I-EVOLUTION alteración I-EVOLUTION del I-EVOLUTION ritmo I-EVOLUTION intestinal, I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION la I-EXPLORATION anemia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION (en I-EXPLORATION principio I-EXPLORATION atribuida I-EXPLORATION a I-EXPLORATION la I-EXPLORATION beta-talasemia) I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION y I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION baja, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION en I-EXPLORATION recto I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION inmediatamente I-EXPLORATION al I-EXPLORATION pasar I-EXPLORATION el I-EXPLORATION esfinter, I-EXPLORATION de I-EXPLORATION tacto I-EXPLORATION dura, I-EXPLORATION mamelonada I-EXPLORATION y I-EXPLORATION muy I-EXPLORATION friable, I-EXPLORATION región I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION toman I-EXPLORATION biopsias. I-EXPLORATION I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION mucosecretor I-EXPLORATION tipo I-EXPLORATION coloide. I-EXPLORATION Ante B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT referido I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT intervención I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT realizándose I-TREATMENT una I-TREATMENT amputación I-TREATMENT abdomino-perineal I-TREATMENT y I-TREATMENT una I-TREATMENT colostomía I-TREATMENT terminal I-TREATMENT izquierda I-TREATMENT a I-TREATMENT fecha I-TREATMENT de I-TREATMENT enero I-TREATMENT de I-TREATMENT 2005. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION mucosecretor I-EXPLORATION moderadamente I-EXPLORATION diferenciado I-EXPLORATION con I-EXPLORATION extensas I-EXPLORATION necrosis I-EXPLORATION que I-EXPLORATION infiltraba I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared. I-EXPLORATION Afectación I-EXPLORATION por I-EXPLORATION adenocarcinoma I-EXPLORATION en I-EXPLORATION cinco I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nueve I-EXPLORATION ganglios I-EXPLORATION aislados. I-EXPLORATION Márgenes I-EXPLORATION libres. I-EXPLORATION I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION realizada I-EXPLORATION la I-EXPLORATION cirugía, I-EXPLORATION se I-EXPLORATION somete I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión, I-EXPLORATION que I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION pulmonares I-EXPLORATION múltiples, I-EXPLORATION y I-EXPLORATION afectación I-EXPLORATION adenopática I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION mesentérico, I-EXPLORATION retroperitoneal, I-EXPLORATION y I-EXPLORATION pélvico. I-EXPLORATION Con B-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT adenocarcinoma I-TREATMENT de I-TREATMENT recto I-TREATMENT estadio-IV I-TREATMENT decidimos I-TREATMENT iniciar I-TREATMENT quimioterapia I-TREATMENT paliativa I-TREATMENT en I-TREATMENT régimen I-TREATMENT FOLFOX-6, I-TREATMENT tratamiento I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT inició I-TREATMENT a I-TREATMENT finales I-TREATMENT de I-TREATMENT febrero I-TREATMENT de I-TREATMENT 2005. I-TREATMENT La B-EVOLUTION respuesta I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION quimioterápico I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION respuesta I-EVOLUTION parcial I-EVOLUTION de I-EVOLUTION las I-EVOLUTION metástasis I-EVOLUTION pulmonares I-EVOLUTION y I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION afectación I-EVOLUTION adenopática, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION los I-EVOLUTION marcadores I-EVOLUTION tumorales. I-EVOLUTION En I-EVOLUTION cuanto I-EVOLUTION al I-EVOLUTION pioderma I-EVOLUTION gangrenoso I-EVOLUTION y I-EVOLUTION ya I-EVOLUTION sin I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION que I-EVOLUTION seguía I-EVOLUTION previamente I-EVOLUTION para I-EVOLUTION éste, I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION completa I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION piernas, I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION ningún I-EVOLUTION tipo I-EVOLUTION de I-EVOLUTION sintomatología I-EVOLUTION añadida. I-EVOLUTION I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION curso I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION (finalizado I-EVOLUTION el I-EVOLUTION 4º I-EVOLUTION ciclo) I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION por I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION febril I-EVOLUTION de I-EVOLUTION 39º, I-EVOLUTION náuseas, I-EVOLUTION vómitos I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION derecho, I-EVOLUTION destacando I-EVOLUTION en I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION complementarias I-EVOLUTION una I-EVOLUTION neutropenia I-EVOLUTION grado I-EVOLUTION IV, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION un I-EVOLUTION patrón I-EVOLUTION de I-EVOLUTION citólisis I-EVOLUTION hepática, I-EVOLUTION colestasis I-EVOLUTION e I-EVOLUTION insuficiencia I-EVOLUTION renal. I-EVOLUTION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT shock I-TREATMENT séptico I-TREATMENT secundario I-TREATMENT a I-TREATMENT una I-TREATMENT colangitis, I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT su I-TREATMENT ingreso I-TREATMENT en I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Cuidados I-TREATMENT Intensivos, I-TREATMENT donde I-TREATMENT se I-TREATMENT instauraron I-TREATMENT las I-TREATMENT medidas I-TREATMENT antibióticas I-TREATMENT necesarias, I-TREATMENT así I-TREATMENT como I-TREATMENT drogas I-TREATMENT vasoactivas, I-TREATMENT sin B-EVOLUTION conseguir I-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION y I-EVOLUTION produciéndose I-EVOLUTION el I-EVOLUTION éxitus I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY trabaja I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY auxiliar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermería I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 38 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY encontramos: I-PAST_MEDICAL_HISTORY alérgica I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY Paracetamol, I-PAST_MEDICAL_HISTORY hipotiroidismo, I-PAST_MEDICAL_HISTORY microapneas. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY quirúrgicos I-PAST_MEDICAL_HISTORY CIN3 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY MMII. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY cardiovascular I-PAST_MEDICAL_HISTORY destacan: I-PAST_MEDICAL_HISTORY Hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento, I-PAST_MEDICAL_HISTORY dislipemia, I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY paroxística I-PAST_MEDICAL_HISTORY revertida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2012. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Existe I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conflicto I-PAST_MEDICAL_HISTORY laboral I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY compañera, I-PAST_MEDICAL_HISTORY conocido I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY valorado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Prevención I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2005. I-PAST_MEDICAL_HISTORY Entonces I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY recomendó I-PAST_MEDICAL_HISTORY separar I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY partes I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY conflicto I-PAST_MEDICAL_HISTORY si I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY podían I-PAST_MEDICAL_HISTORY garantizar I-PAST_MEDICAL_HISTORY unas I-PAST_MEDICAL_HISTORY condiciones I-PAST_MEDICAL_HISTORY óptimas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trabajo. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY ofertó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cambio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY puesto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trabajo, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY rechazado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY trabajadora. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Prevención I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Riesgos I-PAST_MEDICAL_HISTORY Laborales I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY ofreció I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY comenzar I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY trabajar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY técnicas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY afrontamiento I-PAST_MEDICAL_HISTORY asertivo I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY manejo I-PAST_MEDICAL_HISTORY adaptativo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY situación. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY julio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2012, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY produce I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY nueva I-PAST_MEDICAL_HISTORY situación I-PAST_MEDICAL_HISTORY estresante I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY compañera I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY mantenía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY conflicto. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS precordial, I-PRESENT_ILLNESS llanto I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS produce I-PRESENT_ILLNESS al I-PRESENT_ILLNESS relatar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS compañeras, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS situación I-PRESENT_ILLNESS vital I-PRESENT_ILLNESS estresante I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acababa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocurrirle, I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS conflicto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS compañera. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Exploración B-EXPLORATION física I-EXPLORATION a I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION urgencia: I-EXPLORATION TA: I-EXPLORATION 160/110 I-EXPLORATION mmHg. I-EXPLORATION Disneica. I-EXPLORATION Crepitantes I-EXPLORATION bibasales, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION gasometría, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION insuficiencia I-EXPLORATION respiratoria I-EXPLORATION aguda, I-EXPLORATION con I-EXPLORATION saturación I-EXPLORATION del I-EXPLORATION 82%, I-EXPLORATION PO2 I-EXPLORATION de I-EXPLORATION 40 I-EXPLORATION e I-EXPLORATION hiperlactacidemia I-EXPLORATION de I-EXPLORATION 3. I-EXPLORATION Se B-TREATMENT administran I-TREATMENT dos I-TREATMENT ampollas I-TREATMENT de I-TREATMENT Furosemida I-TREATMENT intravenosa, I-TREATMENT se I-TREATMENT inicia I-TREATMENT perfusión I-TREATMENT de I-TREATMENT nitroglicerina I-TREATMENT intravenosa I-TREATMENT y I-TREATMENT ventilación I-TREATMENT con I-TREATMENT mascarilla I-TREATMENT reservorio, I-TREATMENT con B-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION control I-EVOLUTION de I-EVOLUTION cifras I-EVOLUTION tensionales. I-EVOLUTION I-EVOLUTION ECG B-EXPLORATION realizado I-EXPLORATION al I-EXPLORATION ingreso: I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION a I-EXPLORATION 92 I-EXPLORATION lpm, I-EXPLORATION eje I-EXPLORATION desviado I-EXPLORATION a I-EXPLORATION la I-EXPLORATION izquierda, I-EXPLORATION PR I-EXPLORATION 200 I-EXPLORATION mseg, I-EXPLORATION HBAI; I-EXPLORATION pobre I-EXPLORATION progresión I-EXPLORATION de I-EXPLORATION derivaciones I-EXPLORATION en I-EXPLORATION V1-V3 I-EXPLORATION y I-EXPLORATION dudosa I-EXPLORATION supradesnivelación I-EXPLORATION de I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION V1-V2, I-EXPLORATION T I-EXPLORATION picuda I-EXPLORATION en I-EXPLORATION V3-V6 I-EXPLORATION y I-EXPLORATION negativa I-EXPLORATION en I-EXPLORATION I I-EXPLORATION y I-EXPLORATION AVL I-EXPLORATION (ECG, I-EXPLORATION figuras I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2, I-EXPLORATION una I-EXPLORATION vez I-EXPLORATION desaparece I-EXPLORATION el I-EXPLORATION dolor). I-EXPLORATION I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION insuficiencia I-EXPLORATION cardíaca. I-EXPLORATION I-EXPLORATION Ecocardiografía I-EXPLORATION transtorácica: I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION esférico I-EXPLORATION con I-EXPLORATION acinesia I-EXPLORATION septal, I-EXPLORATION hipocinesia I-EXPLORATION de I-EXPLORATION segmento I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION cara I-EXPLORATION inferior I-EXPLORATION y I-EXPLORATION FEVI I-EXPLORATION estimada I-EXPLORATION en I-EXPLORATION torno I-EXPLORATION al I-EXPLORATION 20-25% I-EXPLORATION e I-EXPLORATION IM I-EXPLORATION leve. I-EXPLORATION Con B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT Sd. I-TREATMENT De I-TREATMENT takotsubo, I-TREATMENT discinesia I-TREATMENT apical I-TREATMENT transitoria I-TREATMENT sin I-TREATMENT aumento I-TREATMENT del I-TREATMENT valor I-TREATMENT enzimático, I-TREATMENT se I-TREATMENT administran I-TREATMENT 300 I-TREATMENT mg I-TREATMENT de I-TREATMENT AAS I-TREATMENT y I-TREATMENT 600 I-TREATMENT de I-TREATMENT clopidogrel I-TREATMENT y B-EXPLORATION se I-EXPLORATION traslada I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sala I-EXPLORATION de I-EXPLORATION hemodinámica I-EXPLORATION para I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION coronariografía. I-EXPLORATION Esta I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION vía I-EXPLORATION femoral I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION evidencian I-EXPLORATION lesiones I-EXPLORATION angiográficamente I-EXPLORATION significativas, I-EXPLORATION aunque I-EXPLORATION la I-EXPLORATION DA I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION flujo I-EXPLORATION TIMI I-EXPLORATION I. I-EXPLORATION La I-EXPLORATION ventriculografía I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION VI I-EXPLORATION ovoide I-EXPLORATION con I-EXPLORATION FEVI I-EXPLORATION del I-EXPLORATION 25% I-EXPLORATION y I-EXPLORATION acinesia I-EXPLORATION en I-EXPLORATION banda I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION medial, I-EXPLORATION hipocinesia I-EXPLORATION leve I-EXPLORATION de I-EXPLORATION segmento I-EXPLORATION basal I-EXPLORATION y I-EXPLORATION ápex. I-EXPLORATION I-EXPLORATION Permanece B-EVOLUTION durante I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION ingresada, I-EVOLUTION en I-EVOLUTION UCOR I-EVOLUTION (Unidad I-EVOLUTION Coronaria), I-EVOLUTION hemodinámicamente I-EVOLUTION estable I-EVOLUTION y I-EVOLUTION asintomática. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION último I-EXPLORATION ecocardiograma I-EXPLORATION realizado I-EXPLORATION durante I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION obtiene I-EXPLORATION un I-EXPLORATION FEVI I-EXPLORATION 75%, I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION realizadas I-EXPLORATION son I-EXPLORATION normales, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION procede I-EXPLORATION al I-EXPLORATION alta I-EXPLORATION hospitalaria. I-EXPLORATION I-EXPLORATION El B-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Prevención I-EVOLUTION confirma I-EVOLUTION los I-EVOLUTION desencadenantes I-EVOLUTION emocionales I-EVOLUTION de I-EVOLUTION origen I-EVOLUTION laboral I-EVOLUTION y I-EVOLUTION descarta I-EVOLUTION otros I-EVOLUTION factores I-EVOLUTION extralaborales. I-EVOLUTION Valorada I-EVOLUTION la I-EVOLUTION determinación I-EVOLUTION de I-EVOLUTION contingencia I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION este I-EVOLUTION se I-EVOLUTION reconocería I-EVOLUTION finalmente I-EVOLUTION como I-EVOLUTION accidente I-EVOLUTION de I-EVOLUTION trabajo. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS desplazado B-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Haití I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY octubre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2013 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY motivos I-PAST_MEDICAL_HISTORY laborales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY baja I-PAST_MEDICAL_HISTORY laboral I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY contingencia I-PAST_MEDICAL_HISTORY común I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY febrero I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2014 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dengue I-PAST_MEDICAL_HISTORY confirmada, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY recuperación I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY reincorporación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY puesto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trabajo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mayo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2014, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY sufrir I-PAST_MEDICAL_HISTORY abundantes I-PAST_MEDICAL_HISTORY picaduras I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mosquito, I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY brusca I-PAST_MEDICAL_HISTORY fiebre I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY odinofagia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY rash I-PAST_MEDICAL_HISTORY cutáneo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY poliartralgias. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY descartó I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY dengue. I-PAST_MEDICAL_HISTORY Regresó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS España, I-PRESENT_ILLNESS causó I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS laboral I-PRESENT_ILLNESS por I-PRESENT_ILLNESS contingencia I-PRESENT_ILLNESS común I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS estudiado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Enfermedades I-PRESENT_ILLNESS Tropicales I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Clínic I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Barcelona. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION hiperemia I-EXPLORATION orofaringea I-EXPLORATION y I-EXPLORATION rash I-EXPLORATION cutáneo I-EXPLORATION que I-EXPLORATION evolucionaron I-EXPLORATION favorablemente I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION la I-EXPLORATION fiebre; I-EXPLORATION persistiendo I-EXPLORATION las I-EXPLORATION poliartralgias I-EXPLORATION acompañadas I-EXPLORATION de I-EXPLORATION astenia I-EXPLORATION intensa. I-EXPLORATION I-EXPLORATION A I-EXPLORATION destacar I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION exploraciones I-EXPLORATION complementarias I-EXPLORATION practicadas I-EXPLORATION leve I-EXPLORATION leucopenia, I-EXPLORATION serología I-EXPLORATION Chikungunya I-EXPLORATION IgM I-EXPLORATION e I-EXPLORATION IgG I-EXPLORATION y I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION ARN I-EXPLORATION viral I-EXPLORATION por I-EXPLORATION RT-PCR I-EXPLORATION positivas. I-EXPLORATION PCR I-EXPLORATION dengue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION de I-EXPLORATION Fiebre I-EXPLORATION por I-EXPLORATION virus I-EXPLORATION Chikungunya I-EXPLORATION no I-EXPLORATION complicada I-EXPLORATION adquirida I-EXPLORATION en I-EXPLORATION Haití I-EXPLORATION y I-EXPLORATION artralgias I-EXPLORATION reactivas I-EXPLORATION al I-EXPLORATION proceso I-EXPLORATION infeccioso, I-EXPLORATION al I-EXPLORATION cumplir I-EXPLORATION criterios I-EXPLORATION epidemiológicos, I-EXPLORATION clínicos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION laboratorio. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION siguió I-EVOLUTION control I-EVOLUTION médico I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION Público I-EVOLUTION de I-EVOLUTION Salud I-EVOLUTION y I-EVOLUTION desde I-EVOLUTION julio I-EVOLUTION de I-EVOLUTION 2014 I-EVOLUTION con I-EVOLUTION Mutua I-EVOLUTION FREMAP, I-EVOLUTION al I-EVOLUTION tener I-EVOLUTION la I-EVOLUTION empresa I-EVOLUTION concertada I-EVOLUTION la I-EVOLUTION cobertura I-EVOLUTION de I-EVOLUTION la I-EVOLUTION contingencia I-EVOLUTION común I-EVOLUTION con I-EVOLUTION esta I-EVOLUTION entidad10. I-EVOLUTION El I-EVOLUTION 16 I-EVOLUTION de I-EVOLUTION octubre I-EVOLUTION aportó I-EVOLUTION a I-EVOLUTION los I-EVOLUTION Servicios I-EVOLUTION Médicos I-EVOLUTION de I-EVOLUTION FREMAP I-EVOLUTION una I-EVOLUTION solicitud I-EVOLUTION de I-EVOLUTION determinación I-EVOLUTION de I-EVOLUTION contingencia I-EVOLUTION indicando I-EVOLUTION le I-EVOLUTION fuera I-EVOLUTION reconocida I-EVOLUTION dicha I-EVOLUTION baja I-EVOLUTION como I-EVOLUTION laboral. I-EVOLUTION Tras I-EVOLUTION la I-EVOLUTION valoración I-EVOLUTION global I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION epidemiológico, I-EVOLUTION médico I-EVOLUTION y I-EVOLUTION laboral I-EVOLUTION se I-EVOLUTION aceptó I-EVOLUTION el I-EVOLUTION cambio I-EVOLUTION de I-EVOLUTION contingencia I-EVOLUTION a I-EVOLUTION Accidente I-EVOLUTION de I-EVOLUTION Trabajo. I-EVOLUTION I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION lenta I-EVOLUTION y I-EVOLUTION fluctuante, I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION astenia I-EVOLUTION y I-EVOLUTION poliartralgias I-EVOLUTION limitantes, I-EVOLUTION de I-EVOLUTION predominio I-EVOLUTION en I-EVOLUTION carpo I-EVOLUTION y I-EVOLUTION manos. I-EVOLUTION Descartada B-TREATMENT artritis I-TREATMENT siguió I-TREATMENT tratamiento I-TREATMENT sintomático. I-TREATMENT En B-EVOLUTION marzo I-EVOLUTION de I-EVOLUTION 2015 I-EVOLUTION manifestó I-EVOLUTION una I-EVOLUTION franca I-EVOLUTION mejoría I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION el I-EVOLUTION cambio I-EVOLUTION estacional. I-EVOLUTION Se B-EXPLORATION solicitó I-EXPLORATION control I-EXPLORATION analítico I-EXPLORATION con I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION bioquímica I-EXPLORATION incluyendo I-EXPLORATION VSG, I-EXPLORATION PCR I-EXPLORATION e I-EXPLORATION interleucina I-EXPLORATION 6, I-EXPLORATION sin I-EXPLORATION mostrar I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION I-EXPLORATION El B-EVOLUTION 14 I-EVOLUTION de I-EVOLUTION abril I-EVOLUTION de I-EVOLUTION 2015 I-EVOLUTION se I-EVOLUTION extendió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION laboral I-EVOLUTION y I-EVOLUTION en I-EVOLUTION julio I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION control I-EVOLUTION ratificando I-EVOLUTION la I-EVOLUTION recuperación I-EVOLUTION clínica. I-EVOLUTION Hasta I-EVOLUTION la I-EVOLUTION fecha I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION solicitado I-EVOLUTION nueva I-EVOLUTION visita. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS residente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Chimbarongo, I-PAST_MEDICAL_HISTORY VI I-PAST_MEDICAL_HISTORY Región. I-PAST_MEDICAL_HISTORY Tenía I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY padecer I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY epilepsia, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fenobarbital. I-PAST_MEDICAL_HISTORY Ingresó B-EXPLORATION a I-EXPLORATION la I-EXPLORATION UCI I-EXPLORATION del I-EXPLORATION Hospital I-EXPLORATION Barros I-EXPLORATION Luco I-EXPLORATION Trudeau I-EXPLORATION (HBLT) I-EXPLORATION el I-EXPLORATION día I-EXPLORATION cuarto I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION con I-EXPLORATION una I-EXPLORATION historia I-EXPLORATION de I-EXPLORATION tos, I-EXPLORATION expectoración I-EXPLORATION hemoptoica, I-EXPLORATION apremio I-EXPLORATION respiratorio I-EXPLORATION y I-EXPLORATION epistaxis I-EXPLORATION anterior. I-EXPLORATION La I-EXPLORATION anamnesis I-EXPLORATION describía I-EXPLORATION los I-EXPLORATION primeros I-EXPLORATION días I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION caracterizado I-EXPLORATION por I-EXPLORATION fiebre, I-EXPLORATION compromiso I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION mialgia, I-EXPLORATION cefalea, I-EXPLORATION vómitos I-EXPLORATION y I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION conciencia. I-EXPLORATION Al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION se I-EXPLORATION había I-EXPLORATION agregado I-EXPLORATION ictericia I-EXPLORATION intensa, I-EXPLORATION coluria I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION abdominal. I-EXPLORATION Consultó B-DERIVED_FROM/TO inicialmente I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Emergencia I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Chimbarongo, I-DERIVED_FROM/TO siendo I-DERIVED_FROM/TO referido I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hepatitis I-DERIVED_FROM/TO aguda I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO San I-DERIVED_FROM/TO Fernando, I-DERIVED_FROM/TO en I-DERIVED_FROM/TO estado I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hipotensión I-DERIVED_FROM/TO arterial, I-DERIVED_FROM/TO taquicárdico, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO epistaxis I-DERIVED_FROM/TO y I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO abdominal I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hipocondrio I-DERIVED_FROM/TO derecho; I-DERIVED_FROM/TO allí B-TREATMENT fue I-TREATMENT asistido I-TREATMENT con I-TREATMENT infusión I-TREATMENT de I-TREATMENT solución I-TREATMENT salina I-TREATMENT al I-TREATMENT 9‰ I-TREATMENT y I-TREATMENT dopamina I-TREATMENT y B-DERIVED_FROM/TO finalmente I-DERIVED_FROM/TO enviado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO HBLT I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO ingresó I-DERIVED_FROM/TO vigil, I-DERIVED_FROM/TO orientado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO tiempo I-DERIVED_FROM/TO y I-DERIVED_FROM/TO espacio, I-DERIVED_FROM/TO cooperando. I-DERIVED_FROM/TO Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaban I-EXPLORATION intensa I-EXPLORATION ictericia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION escleras, I-EXPLORATION taquicardia, I-EXPLORATION taquipnea, I-EXPLORATION normotensión I-EXPLORATION y I-EXPLORATION fiebre I-EXPLORATION (38° I-EXPLORATION C I-EXPLORATION axilar), I-EXPLORATION murmullo I-EXPLORATION pulmonar I-EXPLORATION disminuido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemicampo I-EXPLORATION inferior I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION presente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION derecho. I-EXPLORATION Aproximadamente B-TREATMENT 50 I-TREATMENT minutos I-TREATMENT más I-TREATMENT tarde I-TREATMENT se I-TREATMENT describió I-TREATMENT en I-TREATMENT estado I-TREATMENT de I-TREATMENT shock I-TREATMENT séptico, I-TREATMENT debiendo I-TREATMENT ser I-TREATMENT intubado, I-TREATMENT maniobra I-TREATMENT durante I-TREATMENT la I-TREATMENT cual I-TREATMENT eliminó I-TREATMENT sangre I-TREATMENT rutilante I-TREATMENT por I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea, I-TREATMENT y I-TREATMENT fue I-TREATMENT trasladado I-TREATMENT a I-TREATMENT UCI. I-TREATMENT De I-TREATMENT allí I-TREATMENT en I-TREATMENT adelante I-TREATMENT evolucionó I-TREATMENT con I-TREATMENT escasa I-TREATMENT respiración I-TREATMENT espontánea I-TREATMENT debió I-TREATMENT ser I-TREATMENT asistido I-TREATMENT manualmente, I-TREATMENT presentaba I-TREATMENT sangramiento I-TREATMENT por I-TREATMENT el I-TREATMENT tubo I-TREATMENT orotraqueal, I-TREATMENT ictericia I-TREATMENT e I-TREATMENT isocoria I-TREATMENT reactiva. I-TREATMENT Se I-TREATMENT conectó I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT por I-TREATMENT una I-TREATMENT desaturación I-TREATMENT de I-TREATMENT 65%, I-TREATMENT mientras I-TREATMENT estaba I-TREATMENT taquicárdico I-TREATMENT pero I-TREATMENT con I-TREATMENT normotensión. I-TREATMENT Fue I-TREATMENT ingresado I-TREATMENT con I-TREATMENT los I-TREATMENT diagnósticos I-TREATMENT de: I-TREATMENT shock I-TREATMENT séptico, I-TREATMENT síndrome I-TREATMENT de I-TREATMENT distrés I-TREATMENT respiratorio I-TREATMENT del I-TREATMENT adulto I-TREATMENT y I-TREATMENT la I-TREATMENT hipótesis I-TREATMENT de I-TREATMENT una I-TREATMENT leptospirosis. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION PA I-EVOLUTION 0/0 I-EVOLUTION mm/Hg I-EVOLUTION y I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION la I-EVOLUTION hora I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION ingresado I-EVOLUTION en I-EVOLUTION UCI, I-EVOLUTION pese I-EVOLUTION a I-EVOLUTION maniobras I-EVOLUTION de I-EVOLUTION reanimación I-EVOLUTION avanzada. I-EVOLUTION I-EVOLUTION Anatomía B-EXPLORATION patológica I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION morfológicos I-EXPLORATION están I-EXPLORATION relacionados I-EXPLORATION con I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION microcirculación, I-EXPLORATION caracterizadas I-EXPLORATION por I-EXPLORATION una I-EXPLORATION panvasculitis I-EXPLORATION venulocapilar I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION órganos I-EXPLORATION y I-EXPLORATION sistemas9. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION pulmón I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION macroscópicamente I-EXPLORATION extensas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION parenquimatosa I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION microscopia I-EXPLORATION necrosis I-EXPLORATION alveolar. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION hepático I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION extensas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION hepatocelular I-EXPLORATION e I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION linfoplasmocitario I-EXPLORATION portal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION miocardio I-EXPLORATION exhibía I-EXPLORATION degeneración I-EXPLORATION miofibrilar I-EXPLORATION focal I-EXPLORATION y I-EXPLORATION extenso I-EXPLORATION infiltrado I-EXPLORATION linfoplasmocitario I-EXPLORATION intersticial. I-EXPLORATION I-EXPLORATION El I-EXPLORATION parénquima I-EXPLORATION renal I-EXPLORATION presentaba I-EXPLORATION congestión I-EXPLORATION vascular, I-EXPLORATION vasculitis I-EXPLORATION linfoplasmocitaria I-EXPLORATION y I-EXPLORATION extensa I-EXPLORATION necrosis I-EXPLORATION tubular I-EXPLORATION aguda. I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION coloración I-EXPLORATION argéntica I-EXPLORATION de I-EXPLORATION Warthin-Starry I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION formaciones I-EXPLORATION espirilares I-EXPLORATION adosadas I-EXPLORATION al I-EXPLORATION epitelio I-EXPLORATION tubular I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION coma, I-EXPLORATION características I-EXPLORATION de I-EXPLORATION leptospira. I-EXPLORATION Por I-EXPLORATION métodos I-EXPLORATION morfométricos I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION una I-EXPLORATION longitud I-EXPLORATION promedio I-EXPLORATION de I-EXPLORATION 13 I-EXPLORATION mµ. I-EXPLORATION I-EXPLORATION Diagnósticos I-EXPLORATION anátomo-patológicos: I-EXPLORATION I-EXPLORATION · I-EXPLORATION Enfermedad I-EXPLORATION de I-EXPLORATION Weil I-EXPLORATION (leptospirosis) I-EXPLORATION con: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Hemorragia I-EXPLORATION pulmonar I-EXPLORATION parenquimatosa- I-EXPLORATION alveolitis I-EXPLORATION necrosante. I-EXPLORATION - I-EXPLORATION Panvasculitis I-EXPLORATION vénulo-capilar. I-EXPLORATION - I-EXPLORATION Necrosis I-EXPLORATION tubular I-EXPLORATION aguda-nefritis I-EXPLORATION intersticial I-EXPLORATION linfo-plasmocitaria. I-EXPLORATION - I-EXPLORATION Hepatitis I-EXPLORATION aguda. I-EXPLORATION - I-EXPLORATION Miocarditis I-EXPLORATION y I-EXPLORATION pericarditis I-EXPLORATION linfo-plasmocitaria. I-EXPLORATION - I-EXPLORATION Meningitis I-EXPLORATION linfo-plasmocitaria. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en B-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY prednisona I-PAST_MEDICAL_HISTORY 12, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY metotrexato I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY semanales I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hidroxicloroquina I-PAST_MEDICAL_HISTORY 200 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lupus I-PAST_MEDICAL_HISTORY eritematoso I-PAST_MEDICAL_HISTORY sistémico I-PAST_MEDICAL_HISTORY (LES) I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY manifestado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY poliartritis, I-PAST_MEDICAL_HISTORY leucopenia, I-PAST_MEDICAL_HISTORY linfopenia, I-PAST_MEDICAL_HISTORY VHS I-PAST_MEDICAL_HISTORY elevada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY serología I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY (anti-DNA I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ANA I-PAST_MEDICAL_HISTORY positivos, I-PAST_MEDICAL_HISTORY C3 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY C4 I-PAST_MEDICAL_HISTORY bajos). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Con B-PRESENT_ILLNESS un I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS insidioso, I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS escasamente I-PRESENT_ILLNESS productiva, I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS mucopurulenta, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hemitórax I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tope I-PRESENT_ILLNESS inspiratorio, I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ~10%. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS este I-PRESENT_ILLNESS período. I-PRESENT_ILLNESS Inicialmente I-PRESENT_ILLNESS recibió I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS claritromicina I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS días, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS buena I-PRESENT_ILLNESS respuesta, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS hospitalizada I-PRESENT_ILLNESS para I-PRESENT_ILLNESS estudio. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION atelectasias I-EXPLORATION bibasales I-EXPLORATION y I-EXPLORATION una I-EXPLORATION escasa I-EXPLORATION efusión I-EXPLORATION pleural I-EXPLORATION derecha I-EXPLORATION (no I-EXPLORATION puncionable), I-EXPLORATION sin I-EXPLORATION consolidaciones I-EXPLORATION ni I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION sustitución. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION asociación I-EXPLORATION con I-EXPLORATION poliartralgias I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION LES I-EXPLORATION positiva I-EXPLORATION (anti I-EXPLORATION ADN I-EXPLORATION Farr I-EXPLORATION 975 I-EXPLORATION U) I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION fueron I-EXPLORATION interpretados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION actividad I-EXPLORATION lúpica I-EXPLORATION y B-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT metotrexato I-TREATMENT por I-TREATMENT azatioprina I-TREATMENT 75 I-TREATMENT mg/día. I-TREATMENT Durante B-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION meses I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION afebril, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION tos I-EVOLUTION persistente I-EVOLUTION y I-EVOLUTION ocasionalmente I-EVOLUTION expectoración I-EVOLUTION hemoptoica-purulenta, I-EVOLUTION recibiendo B-TREATMENT levofloxacina I-TREATMENT 500 I-TREATMENT mg/día I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días, I-TREATMENT con B-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION disminuyó I-EVOLUTION parcialmente I-EVOLUTION la I-EVOLUTION sintomatología. I-EVOLUTION A B-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION carecer I-EXPLORATION de I-EXPLORATION factores I-EXPLORATION de I-EXPLORATION riesgo I-EXPLORATION para I-EXPLORATION adquirir I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION VIH I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION serológico I-EXPLORATION de I-EXPLORATION VIH-1 I-EXPLORATION y I-EXPLORATION VIH-2 I-EXPLORATION (ELISA) I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION séptimo I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION nuevamente I-EVOLUTION hospitalizada I-EVOLUTION por I-EVOLUTION reagudización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología, I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION fiebre I-EVOLUTION hasta I-EVOLUTION 38º I-EVOLUTION C. I-EVOLUTION La B-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION evidenció I-EXPLORATION esta I-EXPLORATION vez I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION consolidación I-EXPLORATION bilaterales, I-EXPLORATION nódulos I-EXPLORATION excavados, I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION mediastínicas. I-EXPLORATION Laboratorio: I-EXPLORATION PCR I-EXPLORATION 20, I-EXPLORATION 1 I-EXPLORATION mg/dL I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1, I-EXPLORATION 0 I-EXPLORATION mg/dL) I-EXPLORATION y I-EXPLORATION VHS I-EXPLORATION 118 I-EXPLORATION mm/h. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION fibrobroncoscopia I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION inflamación I-EXPLORATION traqueo-bronquial I-EXPLORATION proximal I-EXPLORATION con I-EXPLORATION deformación I-EXPLORATION del I-EXPLORATION bronquio I-EXPLORATION segmentario I-EXPLORATION apical I-EXPLORATION derecho, I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION que I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION biopsia. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION un I-EXPLORATION lavado I-EXPLORATION bronco-alveolar I-EXPLORATION (LBA) I-EXPLORATION resultó I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION bacterias I-EXPLORATION incluyendo I-EXPLORATION micobacterias I-EXPLORATION y I-EXPLORATION hongos I-EXPLORATION incluyendo I-EXPLORATION Pneumocystis I-EXPLORATION jiroveci. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION bronquial I-EXPLORATION demostró I-EXPLORATION exudado I-EXPLORATION fibrinoleucocitario I-EXPLORATION con I-EXPLORATION tejido I-EXPLORATION necrótico. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT cefotaxima+clindamicina I-TREATMENT que I-TREATMENT recibió I-TREATMENT durante I-TREATMENT siete I-TREATMENT días I-TREATMENT bajo I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT neumonía I-TREATMENT cavitada I-TREATMENT de I-TREATMENT etiología I-TREATMENT no I-TREATMENT precisada. I-TREATMENT Dada B-EVOLUTION la I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION se I-EVOLUTION le I-EVOLUTION dio I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION para B-TREATMENT completar I-TREATMENT tres I-TREATMENT semanas I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amoxicilina/ácido I-TREATMENT clavulánico, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT azatioprina I-TREATMENT y I-TREATMENT mantuvo I-TREATMENT con I-TREATMENT prednisona I-TREATMENT e I-TREATMENT hidroxicloroquina. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION en I-EVOLUTION las I-EVOLUTION semanas I-EVOLUTION siguientes I-EVOLUTION se I-EVOLUTION reagudizó I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION internada I-EVOLUTION nuevamente. I-EVOLUTION La B-EXPLORATION evaluación I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION demostró I-EXPLORATION esta I-EXPLORATION vez I-EXPLORATION leucopenia I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda, I-EXPLORATION VHS I-EXPLORATION 119 I-EXPLORATION mm/h I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION 35 I-EXPLORATION mg/dL. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION absceso I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION nódulos I-EXPLORATION cavitados I-EXPLORATION y I-EXPLORATION consolidaciones I-EXPLORATION masiformes. I-EXPLORATION Se I-EXPLORATION repitieron I-EXPLORATION baciloscopias I-EXPLORATION y I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Kinyoun I-EXPLORATION en I-EXPLORATION expectoración I-EXPLORATION resultando I-EXPLORATION negativas. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION fibrobroncoscopia I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION lesiones I-EXPLORATION blanquecinas I-EXPLORATION solevantadas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION traqueal, I-EXPLORATION obteniéndose I-EXPLORATION biopsia I-EXPLORATION para I-EXPLORATION estudios I-EXPLORATION microbiológico I-EXPLORATION e I-EXPLORATION histológico. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION pulmonar I-EXPLORATION percutánea I-EXPLORATION bajo I-EXPLORATION TAC, I-EXPLORATION cuya I-EXPLORATION histología I-EXPLORATION evidenció I-EXPLORATION gran I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION bacilos I-EXPLORATION grampositivos I-EXPLORATION intra-macrófagos. I-EXPLORATION Tanto I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION corriente I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION recuperado I-EXPLORATION por I-EXPLORATION biopsia I-EXPLORATION bajo I-EXPLORATION TAC I-EXPLORATION como I-EXPLORATION en I-EXPLORATION el I-EXPLORATION obtenido I-EXPLORATION por I-EXPLORATION fibrobroncoscopia I-EXPLORATION hubo I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION bacilos I-EXPLORATION grampositivos, I-EXPLORATION diagnosticados I-EXPLORATION como I-EXPLORATION Rhodococcus I-EXPLORATION sp. I-EXPLORATION La I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION género I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Microbiología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Red I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION UC I-EXPLORATION mediante I-EXPLORATION una I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Kinyoun I-EXPLORATION positiva I-EXPLORATION (ácido-alcohol I-EXPLORATION resistencia I-EXPLORATION parcial), I-EXPLORATION con I-EXPLORATION una I-EXPLORATION morfología I-EXPLORATION bifásica I-EXPLORATION característica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION al I-EXPLORATION incubar I-EXPLORATION la I-EXPLORATION colonia I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION BHI I-EXPLORATION (infusión I-EXPLORATION cerebro I-EXPLORATION corazón): I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 6 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION incubación I-EXPLORATION aeróbica I-EXPLORATION a I-EXPLORATION 35º I-EXPLORATION C I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION elementos I-EXPLORATION bacilares I-EXPLORATION al I-EXPLORATION Gram I-EXPLORATION y I-EXPLORATION al I-EXPLORATION continuar I-EXPLORATION la I-EXPLORATION incubación I-EXPLORATION hasta I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION elementos I-EXPLORATION cocoideos. I-EXPLORATION El I-EXPLORATION desarrollo I-EXPLORATION en I-EXPLORATION placas I-EXPLORATION de I-EXPLORATION agar I-EXPLORATION sangre I-EXPLORATION de I-EXPLORATION cordero I-EXPLORATION mostró I-EXPLORATION a I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION días I-EXPLORATION de I-EXPLORATION incubación I-EXPLORATION colonias I-EXPLORATION mucoideas I-EXPLORATION de I-EXPLORATION color I-EXPLORATION coral. I-EXPLORATION Con I-EXPLORATION estas I-EXPLORATION pruebas I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION de I-EXPLORATION Chile I-EXPLORATION (Laboratorio I-EXPLORATION de I-EXPLORATION Referencia) I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION de I-EXPLORATION Rhodococcus I-EXPLORATION sp, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION morfología I-EXPLORATION típica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION y I-EXPLORATION las I-EXPLORATION características I-EXPLORATION macroscópicas I-EXPLORATION de I-EXPLORATION las I-EXPLORATION colonias. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION bioquímicas I-EXPLORATION en I-EXPLORATION una I-EXPLORATION galería I-EXPLORATION API I-EXPLORATION Coryne® I-EXPLORATION (Biomerieux) I-EXPLORATION con I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION resultados: I-EXPLORATION reducción I-EXPLORATION de I-EXPLORATION nitratos I-EXPLORATION negativa, I-EXPLORATION pirazinamidasa I-EXPLORATION negativa, I-EXPLORATION pirrolidanil I-EXPLORATION arilamidasa I-EXPLORATION (PYR) I-EXPLORATION negativa, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION (PAL) I-EXPLORATION positiva, I-EXPLORATION b-glucuronidasa I-EXPLORATION (bGUR) I-EXPLORATION negativa, I-EXPLORATION b-galactosidasa I-EXPLORATION ((bGAL) I-EXPLORATION negativa, I-EXPLORATION a-glucosidasa I-EXPLORATION (aGLU) I-EXPLORATION positiva, I-EXPLORATION n-acetil-b-glucosaminidasa I-EXPLORATION (bNAG) I-EXPLORATION negativa, I-EXPLORATION esculina I-EXPLORATION positiva, I-EXPLORATION ureasa I-EXPLORATION negativa, I-EXPLORATION hidrólisis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION gelatina I-EXPLORATION negativa, I-EXPLORATION fermentación I-EXPLORATION de I-EXPLORATION ornitina, I-EXPLORATION glucosa, I-EXPLORATION ribosa, I-EXPLORATION xilosa, I-EXPLORATION manitol, I-EXPLORATION maltosa, I-EXPLORATION lactosa, I-EXPLORATION sacarosa I-EXPLORATION y I-EXPLORATION glicógeno I-EXPLORATION negativas I-EXPLORATION y I-EXPLORATION catalasa I-EXPLORATION positiva. I-EXPLORATION Por I-EXPLORATION estas I-EXPLORATION pruebas I-EXPLORATION bioquímicas I-EXPLORATION y I-EXPLORATION por I-EXPLORATION las I-EXPLORATION características I-EXPLORATION macroscópicas I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION Rhodococcus I-EXPLORATION equi I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT 2 I-TREATMENT gr/día I-TREATMENT y I-TREATMENT rifampicina I-TREATMENT 600 I-TREATMENT mg/día, I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT inicial. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 6 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION terapia I-EVOLUTION desarrolló I-EVOLUTION un I-EVOLUTION rash I-EVOLUTION pruriginoso I-EVOLUTION intenso I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION necesario I-EVOLUTION cambiar I-EVOLUTION el I-EVOLUTION esquema. I-EVOLUTION Para B-EXPLORATION definir I-EXPLORATION la I-EXPLORATION siguiente I-EXPLORATION terapia I-EXPLORATION antimicrobiana I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION in I-EXPLORATION vitro I-EXPLORATION mediante I-EXPLORATION dilución I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION y I-EXPLORATION epsilometría I-EXPLORATION (E-test®). I-EXPLORATION Si I-EXPLORATION bien I-EXPLORATION no I-EXPLORATION están I-EXPLORATION descritos I-EXPLORATION los I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION de I-EXPLORATION los I-EXPLORATION antimicrobianos I-EXPLORATION para I-EXPLORATION este I-EXPLORATION microorganismo2, I-EXPLORATION se I-EXPLORATION midieron I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION CIM I-EXPLORATION > I-EXPLORATION 32 I-EXPLORATION µg/mL I-EXPLORATION a I-EXPLORATION cefotaxima, I-EXPLORATION > I-EXPLORATION 40 I-EXPLORATION µg/mL I-EXPLORATION a I-EXPLORATION cotrimoxazol I-EXPLORATION y I-EXPLORATION < I-EXPLORATION 2µg/mL I-EXPLORATION para I-EXPLORATION ciprofloxacina, I-EXPLORATION imipenem I-EXPLORATION y I-EXPLORATION gentamicina3. I-EXPLORATION Con B-TREATMENT esta I-TREATMENT información I-TREATMENT el I-TREATMENT esquema I-TREATMENT fue I-TREATMENT cambiado I-TREATMENT a I-TREATMENT ciprofloxacina+amikacina I-TREATMENT y I-TREATMENT luego I-TREATMENT ciprofloxacina+ I-TREATMENT claritromicina I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 24 I-TREATMENT semanas I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION con I-EVOLUTION lenta I-EVOLUTION y I-EVOLUTION progresiva I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION hasta I-EVOLUTION desaparecer, I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios I-EVOLUTION en I-EVOLUTION los I-EVOLUTION exámenes I-EVOLUTION de I-EVOLUTION laboratorio I-EVOLUTION hasta I-EVOLUTION su I-EVOLUTION normalización, I-EVOLUTION y I-EVOLUTION regresión I-EVOLUTION de I-EVOLUTION las I-EVOLUTION imágenes I-EVOLUTION de I-EVOLUTION consolidación I-EVOLUTION pulmonar I-EVOLUTION en I-EVOLUTION la I-EVOLUTION TAC I-EVOLUTION de I-EVOLUTION tórax. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS meses 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 de I-PAST_MEDICAL_HISTORY importancia. I-PAST_MEDICAL_HISTORY Presentaba B-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS periorbitario I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS hospitalizó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS TAC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS senos I-PRESENT_ILLNESS paranasales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS órbita I-PRESENT_ILLNESS que I-PRESENT_ILLNESS demostró I-PRESENT_ILLNESS una I-PRESENT_ILLNESS pansinusitis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sospecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS absceso I-PRESENT_ILLNESS orbitario I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS iniciándose I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS antimicrobiano I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ceftriaxona I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cloxacilina. I-PRESENT_ILLNESS A B-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION horas I-EXPLORATION del I-EXPLORATION ingreso, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION cursó I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION confusional I-EXPLORATION agudo I-EXPLORATION y I-EXPLORATION crisis I-EXPLORATION de I-EXPLORATION agitación I-EXPLORATION psicomotora I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION meníngea, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION obteniéndose I-EXPLORATION LCR I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION meningitis I-EXPLORATION (490 I-EXPLORATION células/mm3 I-EXPLORATION 60% I-EXPLORATION PMN, I-EXPLORATION glucorraquia I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION normales), I-EXPLORATION pero I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION y I-EXPLORATION sangre I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION con I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION evidenció I-EXPLORATION edema I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION subdural I-EXPLORATION bilateral I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trasladó I-EXPLORATION a I-EXPLORATION nuestro I-EXPLORATION centro I-EXPLORATION para I-EXPLORATION evaluación I-EXPLORATION neuro-quirúrgica I-EXPLORATION con I-EXPLORATION los I-EXPLORATION diagnósticos I-EXPLORATION de I-EXPLORATION pansinusitis, I-EXPLORATION meningitis I-EXPLORATION aguda I-EXPLORATION secundaria I-EXPLORATION y I-EXPLORATION colección I-EXPLORATION subdural. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION ingreso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION unidad I-EXPLORATION de I-EXPLORATION cuidados I-EXPLORATION intensivos I-EXPLORATION pediátricos I-EXPLORATION destacaba I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico: I-EXPLORATION T° I-EXPLORATION axilar I-EXPLORATION 38, I-EXPLORATION 3 I-EXPLORATION °C, I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION de I-EXPLORATION 65 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION 140/90 I-EXPLORATION mm I-EXPLORATION Hg, I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION Glasgow: I-EXPLORATION 6, I-EXPLORATION hiperreflexia, I-EXPLORATION anisocoria I-EXPLORATION midriática I-EXPLORATION a I-EXPLORATION derecha, I-EXPLORATION rigidez I-EXPLORATION de I-EXPLORATION nuca, I-EXPLORATION edema I-EXPLORATION bipalpebral I-EXPLORATION y I-EXPLORATION quemosis, I-EXPLORATION clonus I-EXPLORATION bilateral I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION derecha. I-EXPLORATION La I-EXPLORATION PCR I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 215 I-EXPLORATION mg/L, I-EXPLORATION el I-EXPLORATION recuento I-EXPLORATION leucocitario I-EXPLORATION de I-EXPLORATION 15.800/mm3, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT hipertensión I-TREATMENT endocraneana I-TREATMENT con I-TREATMENT intubación I-TREATMENT endotraqueal I-TREATMENT y I-TREATMENT conexión I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT asociada I-TREATMENT a I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT manitol, I-TREATMENT sedoanalgesia I-TREATMENT con I-TREATMENT midazolam-fentanilo I-TREATMENT y I-TREATMENT soporte I-TREATMENT inotrópico I-TREATMENT con I-TREATMENT dopamina. I-TREATMENT Se I-TREATMENT instauró I-TREATMENT terapia I-TREATMENT anticonvulsivante I-TREATMENT con I-TREATMENT fenitoína I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT triasociado I-TREATMENT con I-TREATMENT ceftriaxona, I-TREATMENT metronidazol I-TREATMENT y I-TREATMENT vancomicina. I-TREATMENT Una B-EXPLORATION nueva I-EXPLORATION TAC I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION contraste I-EXPLORATION mostró I-EXPLORATION edema I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION progresión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION colección I-EXPLORATION subdural I-EXPLORATION planteándose I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION empiema I-EXPLORATION subdural I-EXPLORATION con I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION inicial. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION fue I-EXPLORATION evaluado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION otorrinolaringología I-EXPLORATION y I-EXPLORATION neurocirugía I-EXPLORATION realizándose I-EXPLORATION exploración I-EXPLORATION del I-EXPLORATION meato I-EXPLORATION medio I-EXPLORATION y B-TREATMENT drenaje I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT derecho I-TREATMENT por I-TREATMENT vía I-TREATMENT endoscópica I-TREATMENT y I-TREATMENT en I-TREATMENT las I-TREATMENT horas I-TREATMENT siguientes I-TREATMENT etmoidectomía I-TREATMENT derecha, I-TREATMENT drenaje I-TREATMENT de I-TREATMENT un I-TREATMENT absceso I-TREATMENT orbitario I-TREATMENT derecho I-TREATMENT y I-TREATMENT drenaje I-TREATMENT de I-TREATMENT un I-TREATMENT empiema I-TREATMENT subdural I-TREATMENT izquierdo I-TREATMENT desde I-TREATMENT donde I-TREATMENT se I-TREATMENT retiró I-TREATMENT abundante I-TREATMENT material I-TREATMENT purulento. I-TREATMENT El B-EXPLORATION cultivo I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION estas I-EXPLORATION zonas I-EXPLORATION para I-EXPLORATION aerobios I-EXPLORATION y I-EXPLORATION anaerobios I-EXPLORATION estrictos, I-EXPLORATION procesado I-EXPLORATION en I-EXPLORATION sistema I-EXPLORATION BACTEC/ALERT® I-EXPLORATION FN I-EXPLORATION con I-EXPLORATION bajo I-EXPLORATION potencial I-EXPLORATION de I-EXPLORATION oxido I-EXPLORATION reducción I-EXPLORATION y I-EXPLORATION carbón I-EXPLORATION activado, I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION ventilación I-EVOLUTION asistida I-EVOLUTION durante I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION y I-EVOLUTION cursó I-EVOLUTION con I-EVOLUTION regresión I-EVOLUTION de I-EVOLUTION los I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION hipertensión I-EVOLUTION endocraneana I-EVOLUTION y I-EVOLUTION recuperación I-EVOLUTION progresiva I-EVOLUTION en I-EVOLUTION la I-EVOLUTION escala I-EVOLUTION de I-EVOLUTION Glasgow. I-EVOLUTION Tras B-EXPLORATION tres I-EXPLORATION semanas I-EXPLORATION de I-EXPLORATION antibioterapia I-EXPLORATION triasociada, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION nueva I-EXPLORATION TAC I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION dos I-EXPLORATION colecciones I-EXPLORATION encefálicas I-EXPLORATION frontales I-EXPLORATION derechas, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT debió I-TREATMENT realizarse I-TREATMENT una I-TREATMENT nueva I-TREATMENT intervención I-TREATMENT quirúrgica: I-TREATMENT cranectomía I-TREATMENT con I-TREATMENT vaciamiento I-TREATMENT frontal I-TREATMENT derecho, I-TREATMENT drenaje I-TREATMENT de I-TREATMENT empiema I-TREATMENT con I-TREATMENT dos I-TREATMENT agujeros I-TREATMENT de I-TREATMENT trépano I-TREATMENT y I-TREATMENT durotomía I-TREATMENT que I-TREATMENT dio I-TREATMENT salida I-TREATMENT a I-TREATMENT pus I-TREATMENT abundante. I-TREATMENT Los B-EXPLORATION cultivos I-EXPLORATION nuevamente I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION evolución I-EXPLORATION posterior I-EXPLORATION fue I-EXPLORATION favorable, I-EXPLORATION completando I-EXPLORATION 5 I-EXPLORATION semanas I-EXPLORATION de I-EXPLORATION antibioterapia I-EXPLORATION y I-EXPLORATION el I-EXPLORATION seguimiento I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION nuevas I-EXPLORATION colecciones. I-EXPLORATION En B-EVOLUTION los I-EVOLUTION controles I-EVOLUTION clínicos I-EVOLUTION post I-EVOLUTION egreso I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentaba I-EVOLUTION una I-EVOLUTION afasia I-EVOLUTION de I-EVOLUTION expresión, I-EVOLUTION logrando I-EVOLUTION comunicación I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION escrita I-EVOLUTION y I-EVOLUTION una I-EVOLUTION hemiparesia I-EVOLUTION derecha I-EVOLUTION actualmente I-EVOLUTION en I-EVOLUTION regresión. I-EVOLUTION I-EVOLUTION Recién B-PRESENT_ILLNESS nacida I-PRESENT_ILLNESS (RN) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS término, I-PRESENT_ILLNESS segunda B-PAST_MEDICAL_HISTORY hija I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 19 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY sana I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY controlado. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Parto I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY espontáneo, I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY minuto I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY minutos, I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nacimiento: I-PAST_MEDICAL_HISTORY 3.370 I-PAST_MEDICAL_HISTORY g. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS las I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS °C, I-PRESENT_ILLNESS quejido I-PRESENT_ILLNESS respiratorio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS decidió I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Neonatología I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Parroquial I-PRESENT_ILLNESS San I-PRESENT_ILLNESS Bernardo. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaban I-EXPLORATION su I-EXPLORATION hipoactividad, I-EXPLORATION mala I-EXPLORATION perfusión I-EXPLORATION periférica, I-EXPLORATION ictericia I-EXPLORATION moderada I-EXPLORATION y I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION distendido I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION resistencia I-EXPLORATION muscular. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraban I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 5.300/mm3 I-EXPLORATION sin I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda, I-EXPLORATION PCR: I-EXPLORATION 204 I-EXPLORATION mg/l I-EXPLORATION y I-EXPLORATION gases I-EXPLORATION sanguíneos I-EXPLORATION con I-EXPLORATION acidosis I-EXPLORATION metabólica. I-EXPLORATION Orina I-EXPLORATION completa I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION dio I-EXPLORATION un I-EXPLORATION LCR I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION turbio. I-EXPLORATION Citoquímico I-EXPLORATION del I-EXPLORATION LCR: I-EXPLORATION glucosa I-EXPLORATION 49 I-EXPLORATION mg/dl, I-EXPLORATION proteínas I-EXPLORATION 266 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION leucocitos: I-EXPLORATION 950/mm3 I-EXPLORATION con I-EXPLORATION 70% I-EXPLORATION PMN, I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram: I-EXPLORATION cocáceas I-EXPLORATION grampositivas I-EXPLORATION en I-EXPLORATION pares I-EXPLORATION (diplo). I-EXPLORATION Los I-EXPLORATION látex I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION LCR I-EXPLORATION para I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION antígeno I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION agalactiae I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ampicilina I-TREATMENT y I-TREATMENT cefotaxima. I-TREATMENT Los B-EXPLORATION hemocultivos I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION hicieron I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 7, I-EXPLORATION 3 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION incubación, I-EXPLORATION informándose I-EXPLORATION cocáceas I-EXPLORATION grampositivas I-EXPLORATION en I-EXPLORATION cadena. I-EXPLORATION I-EXPLORATION La I-EXPLORATION RN I-EXPLORATION persistió I-EXPLORATION febril, I-EXPLORATION hipoactiva I-EXPLORATION y I-EXPLORATION hemodinámicamente I-EXPLORATION estable. I-EXPLORATION Un I-EXPLORATION nuevo I-EXPLORATION LCR I-EXPLORATION obtenido I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 72 I-EXPLORATION horas I-EXPLORATION era I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION turbio I-EXPLORATION y I-EXPLORATION tenía I-EXPLORATION 5.050 I-EXPLORATION leucocitos/mm3 I-EXPLORATION con I-EXPLORATION 100% I-EXPLORATION PMN. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION muestra I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Se I-EXPLORATION recibió I-EXPLORATION informe I-EXPLORATION de I-EXPLORATION hemocultivos I-EXPLORATION (2), I-EXPLORATION urocultivo I-EXPLORATION y I-EXPLORATION LCR I-EXPLORATION tomados I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION con I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION Streptococcus I-EXPLORATION grupo I-EXPLORATION viridans I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION penicilina I-EXPLORATION y I-EXPLORATION cefotaxima. I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION microbiología I-EXPLORATION comunicó I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION como I-EXPLORATION preliminar I-EXPLORATION y I-EXPLORATION sujeta I-EXPLORATION a I-EXPLORATION confirmación. I-EXPLORATION I-EXPLORATION Al B-TREATMENT cuarto I-TREATMENT día I-TREATMENT de I-TREATMENT hospitalización I-TREATMENT y I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT mala I-TREATMENT evolución, I-TREATMENT fue I-TREATMENT evaluada I-TREATMENT por I-TREATMENT infectóloga, I-TREATMENT suspendiéndose I-TREATMENT ampicilina I-TREATMENT y I-TREATMENT agregando I-TREATMENT en I-TREATMENT su I-TREATMENT reemplazo I-TREATMENT penicilina I-TREATMENT 400.000 I-TREATMENT UI/kg/día I-TREATMENT y I-TREATMENT gentamicina I-TREATMENT 4 I-TREATMENT mg/kg/día I-TREATMENT como I-TREATMENT esquema I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT asociado I-TREATMENT para I-TREATMENT Streptococcus I-TREATMENT grupo I-TREATMENT viridans. I-TREATMENT La I-TREATMENT dosis I-TREATMENT de I-TREATMENT cefotaxima I-TREATMENT se I-TREATMENT aumentó I-TREATMENT de I-TREATMENT 100 I-TREATMENT a I-TREATMENT 150 I-TREATMENT mg/kg/día I-TREATMENT para I-TREATMENT optimizar I-TREATMENT su I-TREATMENT concentración I-TREATMENT en I-TREATMENT el I-TREATMENT SNC I-TREATMENT y I-TREATMENT por I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT absceso I-TREATMENT cerebral. I-TREATMENT I-TREATMENT Hemocultivos B-EXPLORATION obtenidos I-EXPLORATION intra-tratamiento I-EXPLORATION resultaron I-EXPLORATION negativos, I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION ecocardiografía I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION foramen I-EXPLORATION oval I-EXPLORATION permeable, I-EXPLORATION descartándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION vegetaciones. I-EXPLORATION La I-EXPLORATION RN I-EXPLORATION evolucionó I-EXPLORATION afebril I-EXPLORATION desde I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION cambiado I-EXPLORATION el I-EXPLORATION esquema I-EXPLORATION antimicrobiano. I-EXPLORATION Al I-EXPLORATION séptimo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION vida I-EXPLORATION se I-EXPLORATION controló I-EXPLORATION el I-EXPLORATION LCR I-EXPLORATION informándose: I-EXPLORATION 38 I-EXPLORATION leucocitos/mm3, I-EXPLORATION 93% I-EXPLORATION PMN, I-EXPLORATION proteínas I-EXPLORATION 164 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION glucosa I-EXPLORATION 46 I-EXPLORATION mg/dl, I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION sin I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION negativo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION control I-EXPLORATION ulterior I-EXPLORATION del I-EXPLORATION LCR. I-EXPLORATION I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION recibido, I-EXPLORATION al I-EXPLORATION octavo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION tratamiento, I-EXPLORATION el I-EXPLORATION informe I-EXPLORATION microbiológico I-EXPLORATION definitivo I-EXPLORATION de I-EXPLORATION Streptococcus I-EXPLORATION pneumoniae I-EXPLORATION y I-EXPLORATION susceptibilidad I-EXPLORATION corregida I-EXPLORATION según I-EXPLORATION los I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION para I-EXPLORATION meningitis, I-EXPLORATION se B-TREATMENT completó I-TREATMENT tratamiento I-TREATMENT sólo I-TREATMENT con I-TREATMENT cefotaxima. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION recibiendo I-EVOLUTION cefotaxima I-EVOLUTION durante I-EVOLUTION 21 I-EVOLUTION días, I-EVOLUTION duración I-EVOLUTION determinada I-EVOLUTION por I-EVOLUTION la I-EVOLUTION lenta I-EVOLUTION recuperación I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION de I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION laboratorio. I-EVOLUTION Fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 22 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones, I-EVOLUTION no I-EVOLUTION siendo I-EVOLUTION posible I-EVOLUTION realizar I-EVOLUTION seguimiento I-EVOLUTION post I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Informe B-EXPLORATION microbiológico. I-EXPLORATION Dos I-EXPLORATION hemocultivos, I-EXPLORATION un I-EXPLORATION urocultivo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION LCR I-EXPLORATION obtenidos I-EXPLORATION al I-EXPLORATION ingresar I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION resultaron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION cocáceas I-EXPLORATION grampositivas I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION y I-EXPLORATION en I-EXPLORATION diplo. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION se I-EXPLORATION hicieron I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 7, I-EXPLORATION 3 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION incubación I-EXPLORATION (sistema I-EXPLORATION BacT/Alert®, I-EXPLORATION bioMérieux). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION subcultivo I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION sangre I-EXPLORATION de I-EXPLORATION cordero I-EXPLORATION 5% I-EXPLORATION y I-EXPLORATION agar I-EXPLORATION chocolate I-EXPLORATION (bioMérieux). I-EXPLORATION Las I-EXPLORATION placas I-EXPLORATION se I-EXPLORATION incubaron I-EXPLORATION por I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION a I-EXPLORATION 35°C I-EXPLORATION en I-EXPLORATION atmósfera I-EXPLORATION con I-EXPLORATION 3 I-EXPLORATION a I-EXPLORATION 5% I-EXPLORATION de I-EXPLORATION CO2 I-EXPLORATION obteniéndose I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION colonias I-EXPLORATION a I-EXPLORATION hemolíticas I-EXPLORATION umbilicadas. I-EXPLORATION Dado I-EXPLORATION que I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION colonias I-EXPLORATION fenotípicamente I-EXPLORATION similares I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION cultivos, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION del I-EXPLORATION crecimiento I-EXPLORATION en I-EXPLORATION los I-EXPLORATION hemocultivos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION a I-EXPLORATION optoquina I-EXPLORATION detectó I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION ella, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION emitió I-EXPLORATION un I-EXPLORATION informe I-EXPLORATION preliminar I-EXPLORATION de: I-EXPLORATION Streptococcus I-EXPLORATION grupo I-EXPLORATION viridans. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION para I-EXPLORATION penicilina I-EXPLORATION y I-EXPLORATION cefotaxima I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION mediante I-EXPLORATION E- I-EXPLORATION test I-EXPLORATION y I-EXPLORATION fue I-EXPLORATION interpretado I-EXPLORATION utilizando I-EXPLORATION los I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION NCCLS/CLSI I-EXPLORATION vigentes4 I-EXPLORATION para I-EXPLORATION Streptococcus I-EXPLORATION no I-EXPLORATION pneumoniae I-EXPLORATION resultando I-EXPLORATION sensible I-EXPLORATION para I-EXPLORATION penicilina I-EXPLORATION y I-EXPLORATION cefotaxima I-EXPLORATION (penicilina I-EXPLORATION 0, I-EXPLORATION 015 I-EXPLORATION µg/ml I-EXPLORATION y I-EXPLORATION cefotaxima I-EXPLORATION 0, I-EXPLORATION 032 I-EXPLORATION µg/ml). I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION el I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION colonia I-EXPLORATION era I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION pneumoniae, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION identificación I-EXPLORATION mediante I-EXPLORATION API I-EXPLORATION 20 I-EXPLORATION Strep I-EXPLORATION (bioMérieux) I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION no I-EXPLORATION arrojó I-EXPLORATION resultados I-EXPLORATION concluyentes I-EXPLORATION (S. I-EXPLORATION mitis I-EXPLORATION (33%), I-EXPLORATION S. I-EXPLORATION oralis I-EXPLORATION (20%), I-EXPLORATION S. I-EXPLORATION sanguis I-EXPLORATION (29%)). I-EXPLORATION La I-EXPLORATION cepa I-EXPLORATION fue I-EXPLORATION enviada I-EXPLORATION al I-EXPLORATION Programa I-EXPLORATION de I-EXPLORATION Microbiología, I-EXPLORATION I.C.B.M., I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Chile, I-EXPLORATION donde I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION autores I-EXPLORATION (MTUF) I-EXPLORATION realizó I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION solubilidad I-EXPLORATION en I-EXPLORATION bilis I-EXPLORATION (soluble), I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION antígeno I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION celular I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION pneumoniae I-EXPLORATION por I-EXPLORATION inmunocromatografía I-EXPLORATION (BinaxNow®)(positivo) I-EXPLORATION y I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION de I-EXPLORATION neumolisina I-EXPLORATION (positivo), I-EXPLORATION identificándose I-EXPLORATION el I-EXPLORATION microorganismo I-EXPLORATION definitivamente I-EXPLORATION como I-EXPLORATION Streptococcus I-EXPLORATION pneumoniae. I-EXPLORATION La I-EXPLORATION cepa I-EXPLORATION fue I-EXPLORATION enviada I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION cumpliendo I-EXPLORATION la I-EXPLORATION normativa I-EXPLORATION vigente I-EXPLORATION de I-EXPLORATION envío I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION pneumoniae I-EXPLORATION invasores I-EXPLORATION al I-EXPLORATION centro I-EXPLORATION de I-EXPLORATION referencia. I-EXPLORATION Se I-EXPLORATION recibió I-EXPLORATION informe I-EXPLORATION de I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION como I-EXPLORATION Streptococcus I-EXPLORATION pneumoniae I-EXPLORATION serotipo I-EXPLORATION 5, I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION penicilina. I-EXPLORATION I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION hecho I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION microbiológico, I-EXPLORATION se I-EXPLORATION corrigió I-EXPLORATION la I-EXPLORATION interpretación I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION para I-EXPLORATION cefotaxima I-EXPLORATION según I-EXPLORATION los I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION correspondientes I-EXPLORATION a I-EXPLORATION S. I-EXPLORATION pneumoniae I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION meníngea, I-EXPLORATION permaneciendo I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION categoría I-EXPLORATION de I-EXPLORATION susceptible I-EXPLORATION tanto I-EXPLORATION a I-EXPLORATION penicilina I-EXPLORATION como I-EXPLORATION a I-EXPLORATION cefotaxima. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS residente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Santiago, I-PAST_MEDICAL_HISTORY soltero I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY heterosexual, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY septiembre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2003 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY serología I-PAST_MEDICAL_HISTORY confirmatoria I-PAST_MEDICAL_HISTORY efectuada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY laboratorio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY referencia I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Instituto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Salud I-PAST_MEDICAL_HISTORY Pública I-PAST_MEDICAL_HISTORY (ISP). I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY catalogado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY etapa I-PAST_MEDICAL_HISTORY A, I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY determinación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY linfocitos I-PAST_MEDICAL_HISTORY CD4 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY irregulares I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY policlínica. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY vivía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY calle, I-PAST_MEDICAL_HISTORY dedicado I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY comercio I-PAST_MEDICAL_HISTORY ambulante I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alojaba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY residencia I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY individuos I-PAST_MEDICAL_HISTORY indigentes. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY abril I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2005 I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY volumen I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY frontal, I-PAST_MEDICAL_HISTORY asociándose, I-PAST_MEDICAL_HISTORY además, I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY papulares I-PAST_MEDICAL_HISTORY eritematosas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY extremidades, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY consultó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY policlínica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Infectología-VIH, I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Hospital I-PAST_MEDICAL_HISTORY San I-PAST_MEDICAL_HISTORY Juan I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Dios, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY agosto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2005. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY observaba I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY absceso I-PAST_MEDICAL_HISTORY frontal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY forúnculos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ambas I-PAST_MEDICAL_HISTORY extremidades, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY enviado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY urgencia I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY debridamiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY absceso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY obtención I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cultivos. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS control I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS progresión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS absceso I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS (5 I-PRESENT_ILLNESS x I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro), I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS área I-PRESENT_ILLNESS de I-PRESENT_ILLNESS necrosis I-PRESENT_ILLNESS central I-PRESENT_ILLNESS y I-PRESENT_ILLNESS borde I-PRESENT_ILLNESS eritematoso I-PRESENT_ILLNESS extenso, I-PRESENT_ILLNESS coincidiendo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuevas I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS papulares I-PRESENT_ILLNESS eritematosas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara, I-PRESENT_ILLNESS principalmente, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS barba, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores- I-PRESENT_ILLNESS algunas I-PRESENT_ILLNESS subcutáneas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS consistencia I-PRESENT_ILLNESS blanda, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS dolorosas- I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS violáceas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tórax I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS También I-PRESENT_ILLNESS se I-PRESENT_ILLNESS apreció I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS mucoso, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS exofiticas I-PRESENT_ILLNESS costrosas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ángulo I-PRESENT_ILLNESS interno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ojo, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS conjuntivas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS exofíticas I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ulceración I-PRESENT_ILLNESS central I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mucosa I-PRESENT_ILLNESS oral, I-PRESENT_ILLNESS localizadas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS vestibular I-PRESENT_ILLNESS del I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS inferior, I-PRESENT_ILLNESS paladar I-PRESENT_ILLNESS duro I-PRESENT_ILLNESS y I-PRESENT_ILLNESS blando. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION general I-EXPLORATION se I-EXPLORATION destacó I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION malas I-EXPLORATION condiciones I-EXPLORATION higiénicas, I-EXPLORATION pálido, I-EXPLORATION con I-EXPLORATION candidiasis I-EXPLORATION orofaríngea, I-EXPLORATION T° I-EXPLORATION axilar I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 5° I-EXPLORATION C, I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 18, I-EXPLORATION sin I-EXPLORATION adenopatías I-EXPLORATION regionales. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION cardiovascular I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION alteraciones I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION visceromegalia I-EXPLORATION abdominal. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION compromiso I-EXPLORATION neurológico I-EXPLORATION clínico. I-EXPLORATION I-EXPLORATION Otros B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY relevantes I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY aparecieron I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY mochilero I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Perú I-PAST_MEDICAL_HISTORY (Tacna) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2001 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Bolivia I-PAST_MEDICAL_HISTORY (Ororuro) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2003. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY mascotas; I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY embargo, I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY tener I-PAST_MEDICAL_HISTORY contacto, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY frecuente, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY gatos I-PAST_MEDICAL_HISTORY callejeros I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY todas I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY edades, I-PAST_MEDICAL_HISTORY habiendo I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY rasguñado I-PAST_MEDICAL_HISTORY ocasionalmente. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Se B-EVOLUTION decidió, I-EVOLUTION entonces, I-EVOLUTION su I-EVOLUTION hospitalización I-EVOLUTION para I-EVOLUTION realizar I-EVOLUTION estudios. I-EVOLUTION De B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION generales I-EXPLORATION destacó I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 31% I-EXPLORATION con I-EXPLORATION VCM I-EXPLORATION 80 I-EXPLORATION fl I-EXPLORATION y I-EXPLORATION CHCM I-EXPLORATION 32%, I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 5.700 I-EXPLORATION céls/mm3, I-EXPLORATION sin I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION 310.000 I-EXPLORATION céls/mmm3, I-EXPLORATION VHS I-EXPLORATION 81 I-EXPLORATION mm/h, I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática, I-EXPLORATION con I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION de I-EXPLORATION 85 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION 185 I-EXPLORATION U/L. I-EXPLORATION Del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION su I-EXPLORATION patología I-EXPLORATION de I-EXPLORATION base, I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION (Nuclisens I-EXPLORATION HIV-1 I-EXPLORATION QT, I-EXPLORATION Biomérieux) I-EXPLORATION de I-EXPLORATION 130.000 I-EXPLORATION copias I-EXPLORATION ARN I-EXPLORATION viral/ml I-EXPLORATION y I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 83 I-EXPLORATION céls/mm3. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION automatizados I-EXPLORATION aeróbicos I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION a I-EXPLORATION los I-EXPLORATION siete I-EXPLORATION días I-EXPLORATION de I-EXPLORATION incubación, I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION secreción I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION frontal I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION bacterias, I-EXPLORATION lo I-EXPLORATION mismo I-EXPLORATION la I-EXPLORATION baciloscopia I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION micobacterias. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION realizado I-EXPLORATION mostró: I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION normal, I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION osteolíticas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION envió I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION suero I-EXPLORATION para I-EXPLORATION la I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION IgG I-EXPLORATION para I-EXPLORATION B. I-EXPLORATION henselae I-EXPLORATION y I-EXPLORATION B. I-EXPLORATION quintana I-EXPLORATION por I-EXPLORATION inmunofluorescencia I-EXPLORATION (Focus®) I-EXPLORATION al I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Infectología I-EXPLORATION y I-EXPLORATION Virología I-EXPLORATION Molecular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Pontificia I-EXPLORATION Universidad I-EXPLORATION Católica I-EXPLORATION de I-EXPLORATION Chile, I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION con I-EXPLORATION títulos I-EXPLORATION > I-EXPLORATION 1/256 I-EXPLORATION para I-EXPLORATION B. I-EXPLORATION henselae I-EXPLORATION y I-EXPLORATION > I-EXPLORATION 1: I-EXPLORATION 64 I-EXPLORATION para I-EXPLORATION B. I-EXPLORATION quintana. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION efectuó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION cutánea I-EXPLORATION frontal I-EXPLORATION cuyo I-EXPLORATION informe I-EXPLORATION indicó: I-EXPLORATION piel I-EXPLORATION ulcerada I-EXPLORATION por I-EXPLORATION epitelio I-EXPLORATION escamoso I-EXPLORATION maduro, I-EXPLORATION proliferación I-EXPLORATION lobulillar I-EXPLORATION de I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION calibre, I-EXPLORATION abundantes I-EXPLORATION polimorfos I-EXPLORATION nucleares I-EXPLORATION intersticiales, I-EXPLORATION algunos I-EXPLORATION con I-EXPLORATION cariorrexis. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Warthin I-EXPLORATION Starry I-EXPLORATION demostró I-EXPLORATION estructuras I-EXPLORATION cocobacilares I-EXPLORATION en I-EXPLORATION acúmulos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION Bartonella I-EXPLORATION sp. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT alta I-TREATMENT sospecha I-TREATMENT clínica, I-TREATMENT después I-TREATMENT de I-TREATMENT tomar I-TREATMENT cultivos I-TREATMENT y I-TREATMENT biopsia, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT azitromicina I-TREATMENT 500 I-TREATMENT mg/d I-TREATMENT v.o. I-TREATMENT más I-TREATMENT ciprofloxacina I-TREATMENT 500 I-TREATMENT mg I-TREATMENT c/12 I-TREATMENT hs I-TREATMENT v.o. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT cirugía I-TREATMENT de I-TREATMENT resección I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT exofiticas I-TREATMENT conjuntivales I-TREATMENT bilaterales, I-TREATMENT las B-EXPLORATION que I-EXPLORATION se I-EXPLORATION enviaron I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION que I-EXPLORATION concluyó: I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION con I-EXPLORATION epitelio I-EXPLORATION escamoso I-EXPLORATION y I-EXPLORATION cilíndrico I-EXPLORATION hiperplásico, I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION agudo I-EXPLORATION y I-EXPLORATION crónico, I-EXPLORATION abundantes I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION neoformación, I-EXPLORATION material I-EXPLORATION amorfo I-EXPLORATION intersticial. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Warthin I-EXPLORATION Starry I-EXPLORATION demostró I-EXPLORATION estructuras I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION Bartonella I-EXPLORATION spp, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION angiomatosis I-EXPLORATION bacilar. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION molecular I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION violáceo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION abdominal I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION al I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Biología I-EXPLORATION Molecular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Pontificia I-EXPLORATION Universidad I-EXPLORATION Católica I-EXPLORATION de I-EXPLORATION Chile. I-EXPLORATION La I-EXPLORATION extracción I-EXPLORATION del I-EXPLORATION ADN I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION subcutáneo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION utilizando I-EXPLORATION un I-EXPLORATION método I-EXPLORATION comercial I-EXPLORATION (QIAamp I-EXPLORATION Tissue I-EXPLORATION kit, I-EXPLORATION Qiagen®), I-EXPLORATION según I-EXPLORATION las I-EXPLORATION recomendaciones I-EXPLORATION del I-EXPLORATION fabricante. I-EXPLORATION La I-EXPLORATION amplificación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION que I-EXPLORATION codifica I-EXPLORATION para I-EXPLORATION el I-EXPLORATION 16S I-EXPLORATION ARNr I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION con I-EXPLORATION partidores I-EXPLORATION universales15. I-EXPLORATION Posteriormente, I-EXPLORATION se I-EXPLORATION secuenció I-EXPLORATION el I-EXPLORATION producto I-EXPLORATION amplificado I-EXPLORATION y I-EXPLORATION se I-EXPLORATION evaluó I-EXPLORATION en I-EXPLORATION el I-EXPLORATION analizador I-EXPLORATION genético I-EXPLORATION ABI I-EXPLORATION 310. I-EXPLORATION Para I-EXPLORATION la I-EXPLORATION comparación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION nucleotídica I-EXPLORATION obtenida I-EXPLORATION con I-EXPLORATION las I-EXPLORATION secuencias I-EXPLORATION depositadas I-EXPLORATION en I-EXPLORATION banco I-EXPLORATION de I-EXPLORATION genes I-EXPLORATION Genebank, I-EXPLORATION se I-EXPLORATION utilizó I-EXPLORATION al I-EXPLORATION programa I-EXPLORATION BLAST. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION homología I-EXPLORATION de I-EXPLORATION 100% I-EXPLORATION sobre I-EXPLORATION 418 I-EXPLORATION pares I-EXPLORATION de I-EXPLORATION bases I-EXPLORATION depositadas I-EXPLORATION con I-EXPLORATION la I-EXPLORATION especie I-EXPLORATION B. I-EXPLORATION quintana I-EXPLORATION subespecie I-EXPLORATION Toulouse, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó, I-EXPLORATION posteriormente, I-EXPLORATION por I-EXPLORATION amplificación I-EXPLORATION y I-EXPLORATION secuenciación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION ITS I-EXPLORATION y I-EXPLORATION 336, I-EXPLORATION que I-EXPLORATION son I-EXPLORATION específicos I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION género I-EXPLORATION y I-EXPLORATION de I-EXPLORATION especie, I-EXPLORATION respectivamente. I-EXPLORATION I-EXPLORATION Previo B-TREATMENT al I-TREATMENT alta, I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT antiretroviral I-TREATMENT con I-TREATMENT zidovudina, I-TREATMENT lamivudina I-TREATMENT y I-TREATMENT efavirenz I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT infección I-TREATMENT por I-TREATMENT VIH I-TREATMENT en I-TREATMENT etapa I-TREATMENT B-3 I-TREATMENT y I-TREATMENT angiomatosis I-TREATMENT bacilar I-TREATMENT por I-TREATMENT B. I-TREATMENT quintana. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION antibioterapia I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION satisfactoria, I-EVOLUTION con I-EVOLUTION regresión I-EVOLUTION del I-EVOLUTION compromiso I-EVOLUTION cutáneo I-EVOLUTION y I-EVOLUTION mucoso I-EVOLUTION a I-EVOLUTION los I-EVOLUTION cuatro I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Adolescente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS un I-PRESENT_ILLNESS campamento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS verano I-PRESENT_ILLNESS en I-PRESENT_ILLNESS carpa I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS familia, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS localidad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Quisco, I-PRESENT_ILLNESS Vª I-PRESENT_ILLNESS Región, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS agachó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS recoger I-PRESENT_ILLNESS una I-PRESENT_ILLNESS pelota I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS matorrales. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS sintió I-PRESENT_ILLNESS que I-PRESENT_ILLNESS algo I-PRESENT_ILLNESS apretaba I-PRESENT_ILLNESS su I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS retirar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS vio I-PRESENT_ILLNESS una I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS culebra I-PRESENT_ILLNESS prendada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano, I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dedos I-PRESENT_ILLNESS pulgar I-PRESENT_ILLNESS e I-PRESENT_ILLNESS índice. I-PRESENT_ILLNESS Ella I-PRESENT_ILLNESS cogió I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cabeza I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS culebra I-PRESENT_ILLNESS por I-PRESENT_ILLNESS detrás, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS libre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS al I-PRESENT_ILLNESS cabo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS algunos I-PRESENT_ILLNESS segundos I-PRESENT_ILLNESS el I-PRESENT_ILLNESS reptil I-PRESENT_ILLNESS soltó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano, I-PRESENT_ILLNESS alcanzando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS enrollarse I-PRESENT_ILLNESS alrededor I-PRESENT_ILLNESS del I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS Para I-PRESENT_ILLNESS evitar I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS culebra I-PRESENT_ILLNESS escapara, I-PRESENT_ILLNESS los I-PRESENT_ILLNESS padres I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mataron I-PRESENT_ILLNESS y I-PRESENT_ILLNESS guardaron I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS recipiente. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La I-PRESENT_ILLNESS culebra I-PRESENT_ILLNESS medía I-PRESENT_ILLNESS 137 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS longitud, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS su I-PRESENT_ILLNESS cola I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS una I-PRESENT_ILLNESS franja I-PRESENT_ILLNESS oscura I-PRESENT_ILLNESS al I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS flanqueada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS franjas I-PRESENT_ILLNESS claras I-PRESENT_ILLNESS laterales. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS se I-PRESENT_ILLNESS logró I-PRESENT_ILLNESS encontrar I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dientes I-PRESENT_ILLNESS inocu-ladores I-PRESENT_ILLNESS posteriores. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La I-PRESENT_ILLNESS mordedura I-PRESENT_ILLNESS no I-PRESENT_ILLNESS provocó I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS al I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS y I-PRESENT_ILLNESS no I-PRESENT_ILLNESS se I-PRESENT_ILLNESS logró I-PRESENT_ILLNESS apreciar I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sitio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inoculación. I-PRESENT_ILLNESS Aproximadamente I-PRESENT_ILLNESS al I-PRESENT_ILLNESS cabo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS minutos, I-PRESENT_ILLNESS inició I-PRESENT_ILLNESS un I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sitio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mordedura. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS llevada I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS Carlos I-PRESENT_ILLNESS van I-PRESENT_ILLNESS Buren, I-PRESENT_ILLNESS Valparaíso, I-PRESENT_ILLNESS Vª I-PRESENT_ILLNESS Región. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION un I-EXPLORATION edema I-EXPLORATION circunferencial I-EXPLORATION que I-EXPLORATION abarcaba I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION del I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION brazo, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION herida I-EXPLORATION puntiforme I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION erosión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION vecina, I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION afectada I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION fríos, I-EXPLORATION no I-EXPLORATION refería I-EXPLORATION mialgias. I-EXPLORATION I-EXPLORATION Fue B-TREATMENT hospitalizada I-TREATMENT con I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT mordedura I-TREATMENT por I-TREATMENT ofidio I-TREATMENT y I-TREATMENT observación I-TREATMENT de I-TREATMENT un I-TREATMENT síndrome I-TREATMENT com-partamental. I-TREATMENT Se I-TREATMENT indicó I-TREATMENT como I-TREATMENT tratamiento I-TREATMENT corticoste-roides I-TREATMENT y I-TREATMENT anti-histamínicos I-TREATMENT endovenosos, I-TREATMENT analgésicos I-TREATMENT tipo I-TREATMENT AINE I-TREATMENT y I-TREATMENT ampicilina I-TREATMENT parenteral. I-TREATMENT Las I-TREATMENT medidas I-TREATMENT locales I-TREATMENT indicadas I-TREATMENT fueron I-TREATMENT brazo I-TREATMENT en I-TREATMENT alto I-TREATMENT y I-TREATMENT aplicación I-TREATMENT de I-TREATMENT hielo. I-TREATMENT I-TREATMENT De B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION solicitados I-EXPLORATION destacaban: I-EXPLORATION protrombinemia: I-EXPLORATION 57% I-EXPLORATION (VN= I-EXPLORATION 70-100%), I-EXPLORATION TTPK: I-EXPLORATION 41 I-EXPLORATION seg I-EXPLORATION (VN= I-EXPLORATION 26-36 I-EXPLORATION seg), I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas: I-EXPLORATION 300.000 I-EXPLORATION (VN= I-EXPLORATION 150.000-400.000/mm3), I-EXPLORATION hematocrito: I-EXPLORATION 44% I-EXPLORATION (VN= I-EXPLORATION 34-44%); I-EXPLORATION hemoglobinemia: I-EXPLORATION 14, I-EXPLORATION 6 I-EXPLORATION gr/dL I-EXPLORATION (VN= I-EXPLORATION 11, I-EXPLORATION 6-15 I-EXPLORATION gr/ I-EXPLORATION dL). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos. I-EXPLORATION I-EXPLORATION Evolucionó B-EVOLUTION en I-EVOLUTION regulares I-EVOLUTION condiciones I-EVOLUTION generales I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 24 I-EVOLUTION horas, I-EVOLUTION sin I-EVOLUTION fiebre, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION un I-EVOLUTION intenso I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION superior I-EVOLUTION izquierda. I-EVOLUTION El I-EVOLUTION edema I-EVOLUTION se I-EVOLUTION extendió I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION región I-EVOLUTION del I-EVOLUTION hombro I-EVOLUTION y I-EVOLUTION zona I-EVOLUTION pectoral I-EVOLUTION y I-EVOLUTION los I-EVOLUTION dedos I-EVOLUTION tomaron I-EVOLUTION un I-EVOLUTION aspecto I-EVOLUTION equimótico. I-EVOLUTION Destacó B-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION el I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION afectada I-EXPLORATION y I-EXPLORATION la I-EXPLORATION consistencia I-EXPLORATION acartonada I-EXPLORATION del I-EXPLORATION edema. I-EXPLORATION Presentó I-EXPLORATION cefalea I-EXPLORATION intensa, I-EXPLORATION náuseas I-EXPLORATION y I-EXPLORATION febrículas, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION sangramientos. I-EXPLORATION La I-EXPLORATION orina I-EXPLORATION fue I-EXPLORATION evaluada I-EXPLORATION diariamente I-EXPLORATION por I-EXPLORATION colorometría I-EXPLORATION a I-EXPLORATION ojo I-EXPLORATION desnudo, I-EXPLORATION para I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION hemoglobinuria. I-EXPLORATION I-EXPLORATION Se B-TREATMENT mantuvo I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT analgésicos I-TREATMENT y I-TREATMENT corti-costeroides I-TREATMENT endovenosos I-TREATMENT y I-TREATMENT el I-TREATMENT edema I-TREATMENT del I-TREATMENT antebrazo I-TREATMENT y I-TREATMENT brazo I-TREATMENT comenzó I-TREATMENT a I-TREATMENT disminuir. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION aparecieron I-EVOLUTION bulas I-EVOLUTION serohemorrágicas I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION del I-EVOLUTION pliegue I-EVOLUTION del I-EVOLUTION codo I-EVOLUTION derecho, I-EVOLUTION disminuyó I-EVOLUTION la I-EVOLUTION cefalea, I-EVOLUTION desaparecieron I-EVOLUTION las I-EVOLUTION náuseas I-EVOLUTION y I-EVOLUTION la I-EVOLUTION fiebre, I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION extremidad. I-EVOLUTION La I-EVOLUTION movilidad I-EVOLUTION de I-EVOLUTION los I-EVOLUTION dedos I-EVOLUTION y I-EVOLUTION la I-EVOLUTION muñeca I-EVOLUTION estaban I-EVOLUTION limitadas, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION palpación I-EVOLUTION de I-EVOLUTION pulsos I-EVOLUTION arteriales I-EVOLUTION normales. I-EVOLUTION Los I-EVOLUTION cirujanos I-EVOLUTION descartaron I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION compartamental. I-EVOLUTION I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION tanto I-EVOLUTION el I-EVOLUTION edema I-EVOLUTION como I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION se I-EVOLUTION encontraban I-EVOLUTION en I-EVOLUTION franca I-EVOLUTION regresión I-EVOLUTION y I-EVOLUTION se I-EVOLUTION suspendieron I-EVOLUTION los I-EVOLUTION corticosteroides I-EVOLUTION y I-EVOLUTION anti-histamínicos. I-EVOLUTION Al I-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION casi I-EVOLUTION sin I-EVOLUTION molestias, I-EVOLUTION con B-TREATMENT indicación I-TREATMENT de I-TREATMENT completar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT predni-sona I-TREATMENT durante I-TREATMENT dos I-TREATMENT días I-TREATMENT y I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT por I-TREATMENT seis I-TREATMENT días. I-TREATMENT I-TREATMENT Un B-PRESENT_ILLNESS RN I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY raza I-PAST_MEDICAL_HISTORY negra I-PAST_MEDICAL_HISTORY y B-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5°C, I-PRESENT_ILLNESS rechazo I-PRESENT_ILLNESS al I-PRESENT_ILLNESS pecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS manifestaciones I-PRESENT_ILLNESS catarrales I-PRESENT_ILLNESS respiratorias. I-PRESENT_ILLNESS Los B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY -ocurrido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 39 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gestación- I-PAST_MEDICAL_HISTORY eran I-PAST_MEDICAL_HISTORY normales; I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY puntaje I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY 9-9 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pesó I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacer I-PAST_MEDICAL_HISTORY 2.880 I-PAST_MEDICAL_HISTORY g. I-PAST_MEDICAL_HISTORY Egresó I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY hospital I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lactancia I-PAST_MEDICAL_HISTORY materna I-PAST_MEDICAL_HISTORY exclusiva. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION reingreso I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION buena I-EXPLORATION vitalidad I-EXPLORATION y I-EXPLORATION coloración, I-EXPLORATION pesaba I-EXPLORATION 3.580 I-EXPLORATION g, I-EXPLORATION tenía I-EXPLORATION escasa I-EXPLORATION rinorrea I-EXPLORATION serosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION para I-EXPLORATION pesquisa I-EXPLORATION de I-EXPLORATION sepsis I-EXPLORATION se I-EXPLORATION estableció: I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 8.500/mm3 I-EXPLORATION (PMN I-EXPLORATION 68%), I-EXPLORATION VHS I-EXPLORATION 26 I-EXPLORATION mm/h, I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION normal, I-EXPLORATION examen I-EXPLORATION citoquímico I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION con I-EXPLORATION 6 I-EXPLORATION leucocitos/mm3, I-EXPLORATION 86 I-EXPLORATION hematíes I-EXPLORATION /mm3, I-EXPLORATION proteína I-EXPLORATION 60 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION glucosa I-EXPLORATION 26 I-EXPLORATION mg/dl; I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION pleuro-pulmonares. I-EXPLORATION Por B-TREATMENT sus I-TREATMENT buenas I-TREATMENT condiciones I-TREATMENT clínicas I-TREATMENT y I-TREATMENT exámenes I-TREATMENT de I-TREATMENT laboratorio I-TREATMENT dentro I-TREATMENT de I-TREATMENT rangos I-TREATMENT normales, I-TREATMENT se I-TREATMENT ingresó I-TREATMENT sin I-TREATMENT tratamiento I-TREATMENT antimicrobiano. I-TREATMENT I-TREATMENT Al I-TREATMENT segundo I-TREATMENT día I-TREATMENT reapareció I-TREATMENT la I-TREATMENT fiebre, I-TREATMENT hasta I-TREATMENT 38, I-TREATMENT 0 I-TREATMENT °C I-TREATMENT y I-TREATMENT se I-TREATMENT informó I-TREATMENT un I-TREATMENT resultado I-TREATMENT positivo I-TREATMENT en I-TREATMENT el I-TREATMENT urocultivo, I-TREATMENT (más I-TREATMENT tarde, I-TREATMENT se I-TREATMENT identificó I-TREATMENT una I-TREATMENT Serratia I-TREATMENT sp), I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT gentamicina I-TREATMENT (7 I-TREATMENT mg/kg/día) I-TREATMENT ev. I-TREATMENT El B-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Entre B-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION y I-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION apareció I-EVOLUTION deterioro I-EVOLUTION de I-EVOLUTION su I-EVOLUTION condición I-EVOLUTION clínica, I-EVOLUTION con I-EVOLUTION quejido, I-EVOLUTION rechazo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lactancia I-EVOLUTION materna, I-EVOLUTION adinamia I-EVOLUTION e I-EVOLUTION hiporreflexia, I-EVOLUTION somnolencia I-EVOLUTION con I-EVOLUTION irritabilidad, I-EVOLUTION distensión I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION vómitos, I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION dificultad I-EVOLUTION respiratoria, I-EVOLUTION palidez, I-EVOLUTION cianosis I-EVOLUTION distal, I-EVOLUTION taquicardia, I-EVOLUTION oligoanuria I-EVOLUTION y I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION hipoperfusión I-EVOLUTION tisular, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION aspecto I-EVOLUTION tóxico-infeccioso, I-EVOLUTION presentando I-EVOLUTION convulsiones I-EVOLUTION y I-EVOLUTION bregma I-EVOLUTION nor-motenso. I-EVOLUTION Reevaluado B-EXPLORATION con I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION se I-EXPLORATION encontró: I-EXPLORATION leucocitos I-EXPLORATION 12.300/mm3 I-EXPLORATION (PMN I-EXPLORATION 34% I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION granulaciones I-EXPLORATION tóxicas), I-EXPLORATION VHS I-EXPLORATION 16 I-EXPLORATION mm/h, I-EXPLORATION plaquetas I-EXPLORATION de I-EXPLORATION 110.000/mm3, I-EXPLORATION gasometría I-EXPLORATION con I-EXPLORATION acidosis I-EXPLORATION metabólica; I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION normal, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION aparecieron I-EXPLORATION imágenes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION dificultad I-EXPLORATION respiratoria I-EXPLORATION del I-EXPLORATION adulto. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT apoyado I-TREATMENT con I-TREATMENT cuidados I-TREATMENT intensivos: I-TREATMENT reposición I-TREATMENT de I-TREATMENT volumen, I-TREATMENT inotrópicos, I-TREATMENT ventilación I-TREATMENT mecánica, I-TREATMENT inmuno-moduladores I-TREATMENT (inmunoglobulina I-TREATMENT IV I-TREATMENT y I-TREATMENT corticosteroides) I-TREATMENT y I-TREATMENT recibió I-TREATMENT fenobarbital. I-TREATMENT Se I-TREATMENT indicó I-TREATMENT penicilina I-TREATMENT G I-TREATMENT sódica I-TREATMENT (200.000 I-TREATMENT U/kg/día) I-TREATMENT ev I-TREATMENT al I-TREATMENT conocerse I-TREATMENT resultado I-TREATMENT del I-TREATMENT hemocultivo I-TREATMENT de I-TREATMENT ingreso I-TREATMENT positivo I-TREATMENT a I-TREATMENT S. I-TREATMENT pyogenes. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION antimicrobiano I-EVOLUTION se I-EVOLUTION repitió I-EVOLUTION la I-EVOLUTION punción I-EVOLUTION lumbar I-EVOLUTION y I-EVOLUTION se I-EVOLUTION informó I-EVOLUTION el I-EVOLUTION examen I-EVOLUTION citoquímico I-EVOLUTION del I-EVOLUTION LCR I-EVOLUTION con I-EVOLUTION 47 I-EVOLUTION leucocitos/mm3, I-EVOLUTION 2.304 I-EVOLUTION hematíes/mm3, I-EVOLUTION proteína I-EVOLUTION 87 I-EVOLUTION mg/dl I-EVOLUTION y I-EVOLUTION glucosa I-EVOLUTION 18 I-EVOLUTION mg/dl. I-EVOLUTION El I-EVOLUTION cultivo I-EVOLUTION del I-EVOLUTION LCR I-EVOLUTION de I-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION punción I-EVOLUTION lumbar I-EVOLUTION resultó I-EVOLUTION negativo. I-EVOLUTION I-EVOLUTION En I-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION deterioro I-EVOLUTION clínico I-EVOLUTION progresivo I-EVOLUTION con I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION convulsiones, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION incrementó I-EVOLUTION la I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION anticon-vulsivantes, I-EVOLUTION cayó I-EVOLUTION en I-EVOLUTION coma I-EVOLUTION profundo, I-EVOLUTION con I-EVOLUTION midriasis I-EVOLUTION y I-EVOLUTION respuesta I-EVOLUTION pupilar I-EVOLUTION débil, I-EVOLUTION postura I-EVOLUTION de I-EVOLUTION descerebración I-EVOLUTION y I-EVOLUTION bregma I-EVOLUTION tenso. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION ultrasonido I-EVOLUTION cerebral I-EVOLUTION se I-EVOLUTION apreciaba I-EVOLUTION una I-EVOLUTION hemorragia I-EVOLUTION periventricular I-EVOLUTION e I-EVOLUTION intraventricular. I-EVOLUTION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT para I-TREATMENT la I-TREATMENT hipertensión I-TREATMENT intracraneal I-TREATMENT y I-TREATMENT se I-TREATMENT cambió I-TREATMENT los I-TREATMENT antimicrobianos I-TREATMENT iniciales I-TREATMENT por I-TREATMENT ceftriaxona I-TREATMENT (130 I-TREATMENT mg/kg/día) I-TREATMENT ev. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION el I-EVOLUTION RN I-EVOLUTION falleció. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION necropsia I-EXPLORATION se I-EXPLORATION comprobaron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION meningitis I-EXPLORATION con I-EXPLORATION hemorragias I-EXPLORATION y I-EXPLORATION daño I-EXPLORATION cerebral I-EXPLORATION grave, I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION shock I-EXPLORATION séptico I-EXPLORATION y I-EXPLORATION pulmones I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION el I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION dificultad I-EXPLORATION respiratoria I-EXPLORATION del I-EXPLORATION adulto. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS recién I-PRESENT_ILLNESS nacida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pretérmino, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS gestacional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nacimiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 685 I-PRESENT_ILLNESS g. I-PRESENT_ILLNESS Embarazo I-PRESENT_ILLNESS gemelar I-PRESENT_ILLNESS controlado, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fecundación I-PRESENT_ILLNESS in I-PRESENT_ILLNESS vitro. I-PRESENT_ILLNESS Tras I-PRESENT_ILLNESS un I-PRESENT_ILLNESS parto I-PRESENT_ILLNESS vaginal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS presentación I-PRESENT_ILLNESS cefálica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sufrimiento I-PRESENT_ILLNESS fetal I-PRESENT_ILLNESS (Apgar I-PRESENT_ILLNESS 4-6), I-PRESENT_ILLNESS debió I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS intubada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sala I-PRESENT_ILLNESS de I-PRESENT_ILLNESS parto. I-PRESENT_ILLNESS Se B-TREATMENT trasladó I-TREATMENT a I-TREATMENT la I-TREATMENT unidad I-TREATMENT de I-TREATMENT cuidados I-TREATMENT intensivos I-TREATMENT siendo I-TREATMENT conectada I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica. I-TREATMENT Permaneció I-TREATMENT desde I-TREATMENT el I-TREATMENT primer I-TREATMENT día I-TREATMENT con I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT y I-TREATMENT catéter I-TREATMENT venoso I-TREATMENT central I-TREATMENT y I-TREATMENT precisando I-TREATMENT administración I-TREATMENT de I-TREATMENT surfactante I-TREATMENT pulmonar I-TREATMENT exógeno I-TREATMENT con I-TREATMENT escasa I-TREATMENT respuesta. I-TREATMENT Se B-EXPLORATION obtuvieron I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION hemocultivo I-EXPLORATION y I-EXPLORATION urocultivo I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION e B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT de I-TREATMENT sepsis I-TREATMENT neonatal I-TREATMENT precoz I-TREATMENT (ampi-cilina I-TREATMENT y I-TREATMENT gentamicina). I-TREATMENT Tras B-EVOLUTION cinco I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antimicrobiano I-EVOLUTION presentó I-EVOLUTION empeoramiento I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION alteración I-EVOLUTION de I-EVOLUTION exámenes I-EVOLUTION laboratorio I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT cambió I-TREATMENT la I-TREATMENT antibioterapia I-TREATMENT para I-TREATMENT cobertura I-TREATMENT de I-TREATMENT sepsis I-TREATMENT nosocomial I-TREATMENT (vancomicina I-TREATMENT y I-TREATMENT ceftazidima) I-TREATMENT y B-EXPLORATION se I-EXPLORATION obtuvieron I-EXPLORATION nuevas I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION cultivo I-EXPLORATION (sangre, I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION LCR). I-EXPLORATION I-EXPLORATION A B-TREATMENT la I-TREATMENT semana I-TREATMENT de I-TREATMENT vida I-TREATMENT se I-TREATMENT retiró I-TREATMENT el I-TREATMENT catéter I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT umbilical, I-TREATMENT en B-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION Staphylococcus I-EXPLORATION epider-midis I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION vancomicina. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT la I-TREATMENT ceftazidima I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT la I-TREATMENT vancomicina I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días I-TREATMENT más. I-TREATMENT Los B-EXPLORATION cultivos I-EXPLORATION realizados I-EXPLORATION (sangre, I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION LCR) I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Persistieron B-EVOLUTION las I-EVOLUTION alteraciones I-EVOLUTION hemodi-námicas, I-EVOLUTION respiratorias I-EVOLUTION y I-EVOLUTION hematológicas, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION progresivo I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION fallecimiento I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION Tras B-EXPLORATION su I-EXPLORATION deceso I-EXPLORATION se I-EXPLORATION cultivaron I-EXPLORATION los I-EXPLORATION catéteres I-EXPLORATION (venoso I-EXPLORATION central I-EXPLORATION y I-EXPLORATION arterial) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tubo I-EXPLORATION endotraqueal I-EXPLORATION en I-EXPLORATION caldo I-EXPLORATION de I-EXPLORATION enriquecimiento I-EXPLORATION tioglicolato I-EXPLORATION y I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION chocolate. I-EXPLORATION En I-EXPLORATION todos I-EXPLORATION ellos, I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION incubación I-EXPLORATION a I-EXPLORATION 37 I-EXPLORATION °C I-EXPLORATION se I-EXPLORATION observó, I-EXPLORATION en I-EXPLORATION cultivo I-EXPLORATION puro, I-EXPLORATION colonias I-EXPLORATION secas I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION crema I-EXPLORATION y I-EXPLORATION superficie I-EXPLORATION rugosa I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION resembradas I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION Albicans I-EXPLORATION (Biomerieux®) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION SGC2 I-EXPLORATION (Biomerieux®) I-EXPLORATION e I-EXPLORATION incubadas I-EXPLORATION a I-EXPLORATION 30 I-EXPLORATION °C I-EXPLORATION Posteriormente, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION su I-EXPLORATION identificación I-EXPLORATION mediante I-EXPLORATION tarjeta I-EXPLORATION ID I-EXPLORATION Yeast I-EXPLORATION en I-EXPLORATION el I-EXPLORATION sistema I-EXPLORATION automatizado I-EXPLORATION Vitek I-EXPLORATION (Biomerieux I-EXPLORATION ®), I-EXPLORATION obteniéndose I-EXPLORATION como I-EXPLORATION resultado I-EXPLORATION T. I-EXPLORATION asahii. I-EXPLORATION Paralelamente, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION visión I-EXPLORATION directa I-EXPLORATION al I-EXPLORATION microscopio I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION hifas I-EXPLORATION ramificadas I-EXPLORATION con I-EXPLORATION artroconidios I-EXPLORATION intercalares I-EXPLORATION y I-EXPLORATION terminales I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION rectangular. I-EXPLORATION Por I-EXPLORATION último, I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION positividad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ureasa I-EXPLORATION como I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION con I-EXPLORATION Geotrichum I-EXPLORATION sp. I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION susceptibilidad I-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION un I-EXPLORATION Sensititre I-EXPLORATION YeastOne I-EXPLORATION Y I-EXPLORATION 07 I-EXPLORATION (Trek I-EXPLORATION Diagnostic I-EXPLORATION Systems®) I-EXPLORATION que, I-EXPLORATION en I-EXPLORATION su I-EXPLORATION lectura I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas, I-EXPLORATION arrojó I-EXPLORATION una I-EXPLORATION CIM I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION μg/ml I-EXPLORATION para I-EXPLORATION flucona-zol, I-EXPLORATION 0, I-EXPLORATION 25 I-EXPLORATION μg/ml I-EXPLORATION para I-EXPLORATION itraconazol I-EXPLORATION y I-EXPLORATION 1 I-EXPLORATION μg/ml I-EXPLORATION para I-EXPLORATION keto-conazol, I-EXPLORATION para I-EXPLORATION 5-fluocitosina I-EXPLORATION una I-EXPLORATION CIM I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION μg/ml I-EXPLORATION y I-EXPLORATION para I-EXPLORATION anfotericina I-EXPLORATION B I-EXPLORATION una I-EXPLORATION CIM, I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION horas, I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION μg/ml. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION del I-EXPLORATION otro I-EXPLORATION gemelo, I-EXPLORATION que I-EXPLORATION también I-EXPLORATION ingresó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Unidad I-EXPLORATION de I-EXPLORATION Ciudados I-EXPLORATION Intensivos I-EXPLORATION Neonatales, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION patógeno I-EXPLORATION de I-EXPLORATION interés I-EXPLORATION alguno, I-EXPLORATION teniendo B-EVOLUTION una I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION en I-EVOLUTION su I-EVOLUTION estadía I-EVOLUTION hospitalaria. I-EVOLUTION I-EVOLUTION Preescolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS sano, B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY con B-PRESENT_ILLNESS controles I-PRESENT_ILLNESS ocasionales I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS año. I-PRESENT_ILLNESS Estado B-EXPLORATION nutricional I-EXPLORATION eutrófico I-EXPLORATION según I-EXPLORATION P/E I-EXPLORATION y I-EXPLORATION P/T. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION el I-EXPLORATION desaseo I-EXPLORATION personal. I-EXPLORATION I-EXPLORATION La B-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY procedía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY rural I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Casablanca, I-PAST_MEDICAL_HISTORY Región I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Valparaíso, I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY dedicaban I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY crianza I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vacunos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aves. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY casa I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY piso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY madera, I-PAST_MEDICAL_HISTORY disponía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY agua I-PAST_MEDICAL_HISTORY potable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcantarillado, I-PAST_MEDICAL_HISTORY patio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tierra. I-PAST_MEDICAL_HISTORY Tenían I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY perros, I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellos I-PAST_MEDICAL_HISTORY adulto I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY gato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Las I-PAST_MEDICAL_HISTORY mascotas I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY contaban I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY veterinario. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY niño I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abundantes I-PAST_MEDICAL_HISTORY pulgas. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY niño I-PAST_MEDICAL_HISTORY jugaba I-PAST_MEDICAL_HISTORY frecuentemente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY mascotas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Cátedra I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Parasitología I-DERIVED_FROM/TO para I-DERIVED_FROM/TO control I-DERIVED_FROM/TO post I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO Hymenolepis I-DERIVED_FROM/TO diminuta, I-DERIVED_FROM/TO diagnosticada I-DERIVED_FROM/TO en I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO había I-DERIVED_FROM/TO consultado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO abdominal. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Al B-PAST_MEDICAL_HISTORY interrogar I-PAST_MEDICAL_HISTORY dirigidamente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY eliminación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY elementos I-PAST_MEDICAL_HISTORY blanquecinos I-PAST_MEDICAL_HISTORY móviles I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY deposiciones. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION copro-parasitológico I-EXPLORATION y I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Graham, I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION los I-EXPLORATION elementos I-EXPLORATION eliminados I-EXPLORATION por I-EXPLORATION las I-EXPLORATION deposiciones I-EXPLORATION del I-EXPLORATION niño. I-EXPLORATION I-EXPLORATION La I-EXPLORATION observación I-EXPLORATION macro I-EXPLORATION y I-EXPLORATION microscópica I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION elementos I-EXPLORATION permitió I-EXPLORATION la I-EXPLORATION visualización I-EXPLORATION de I-EXPLORATION un I-EXPLORATION doble I-EXPLORATION poro I-EXPLORATION genital I-EXPLORATION característico I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION huevos I-EXPLORATION agrupados I-EXPLORATION en I-EXPLORATION una I-EXPLORATION membrana I-EXPLORATION o I-EXPLORATION cápsula I-EXPLORATION ovígera, I-EXPLORATION con I-EXPLORATION liberación I-EXPLORATION de I-EXPLORATION huevos. I-EXPLORATION De I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION macro I-EXPLORATION y I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION dipilidiosis. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT medidas I-TREATMENT preventivas I-TREATMENT para I-TREATMENT dipilidiosis I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT praziquantel I-TREATMENT por I-TREATMENT una I-TREATMENT vez. I-TREATMENT Acudió B-EVOLUTION a I-EVOLUTION control I-EVOLUTION con I-EVOLUTION estudio I-EVOLUTION copro-parasitológico I-EVOLUTION de I-EVOLUTION deposiciones I-EVOLUTION post I-EVOLUTION tratamiento, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION y I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION todos I-EVOLUTION negativos. I-EVOLUTION No I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION eliminar I-EVOLUTION proglótidas I-EVOLUTION y I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION actualmente I-EVOLUTION asinto-mático. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION último I-EVOLUTION control I-EVOLUTION se I-EVOLUTION informó I-EVOLUTION de I-EVOLUTION la I-EVOLUTION muerte I-EVOLUTION del I-EVOLUTION perro I-EVOLUTION adulto. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano, I-PAST_MEDICAL_HISTORY derivado B-DERIVED_FROM/TO desde I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Urgencia I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Dermatología I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Barros I-DERIVED_FROM/TO Luco I-DERIVED_FROM/TO Trudeau, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO un I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO dos I-DERIVED_FROM/TO semanas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución, I-DERIVED_FROM/TO caracterizado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO la I-DERIVED_FROM/TO aparición I-DERIVED_FROM/TO aguda I-DERIVED_FROM/TO y I-DERIVED_FROM/TO progresiva I-DERIVED_FROM/TO de I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO cutáneas I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO tronco. I-DERIVED_FROM/TO En B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY erupción I-PAST_MEDICAL_HISTORY recurrente I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tronco I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY caracterizada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY pápulas I-PAST_MEDICAL_HISTORY eritematosas I-PAST_MEDICAL_HISTORY asintomáticas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY preesternal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY brazos. I-PAST_MEDICAL_HISTORY Sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY infecciones I-FAMILY_HISTORY herpéticas I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY piel I-FAMILY_HISTORY o I-FAMILY_HISTORY genitales, I-FAMILY_HISTORY ni I-FAMILY_HISTORY enfermedades I-FAMILY_HISTORY cutáneas I-FAMILY_HISTORY familiares. I-FAMILY_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION afebril I-EXPLORATION y I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION pápulas I-EXPLORATION y I-EXPLORATION pústulas I-EXPLORATION umbilicadas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tronco, I-EXPLORATION confluentes, I-EXPLORATION con I-EXPLORATION algunas I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION etapa I-EXPLORATION de I-EXPLORATION costra. I-EXPLORATION Sin I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara, I-EXPLORATION genitales I-EXPLORATION ni I-EXPLORATION mucosas. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION manos I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION pápulas I-EXPLORATION aplanadas I-EXPLORATION color I-EXPLORATION piel I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso, I-EXPLORATION pits I-EXPLORATION palmares I-EXPLORATION y I-EXPLORATION alternancia I-EXPLORATION de I-EXPLORATION líneas I-EXPLORATION rojas I-EXPLORATION y I-EXPLORATION blancas I-EXPLORATION en I-EXPLORATION las I-EXPLORATION uñas, I-EXPLORATION hallazgos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Darier. I-EXPLORATION Se I-EXPLORATION hospitalizó I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION de I-EXPLORATION eccema I-EXPLORATION herpético I-EXPLORATION y I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Darier. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION generales, I-EXPLORATION cultivo I-EXPLORATION corriente I-EXPLORATION y I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simplex I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pústulas, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Darier. I-EXPLORATION Empíricamente B-TREATMENT se I-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT aciclovir I-TREATMENT oral I-TREATMENT 400 I-TREATMENT mg I-TREATMENT 5 I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT cloxacilina I-TREATMENT ev I-TREATMENT 1 I-TREATMENT gr I-TREATMENT cada I-TREATMENT 6 I-TREATMENT hrs, I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días. I-TREATMENT Entre B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION generales I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION normal, I-EXPLORATION VHS I-EXPLORATION 29 I-EXPLORATION mm/h, I-EXPLORATION PCR I-EXPLORATION 123 I-EXPLORATION mg/L, I-EXPLORATION GGT I-EXPLORATION 108 I-EXPLORATION U/L. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION del I-EXPLORATION VDRL I-EXPLORATION y I-EXPLORATION las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION y I-EXPLORATION VHB I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Staphylococcus I-EXPLORATION aureus I-EXPLORATION resistente I-EXPLORATION sólo I-EXPLORATION a I-EXPLORATION clindamicina I-EXPLORATION y I-EXPLORATION eritromicina, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION RPC I-EXPLORATION en I-EXPLORATION tiempo I-EXPLORATION real, I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Virología I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Ciencias I-EXPLORATION Biomédicas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Facultad I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Chile, I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION VHS I-EXPLORATION 2. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION histopatológicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Darier. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION respondió I-EVOLUTION rápidamente I-EVOLUTION al I-EVOLUTION tratamiento, I-EVOLUTION siendo I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días. 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 oriundo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Montevideo. I-PRESENT_ILLNESS Buen I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS y I-PRESENT_ILLNESS desarrollo. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Calendario B-PRESENT_ILLNESS de I-PRESENT_ILLNESS inmunizaciones I-PRESENT_ILLNESS completo. I-PRESENT_ILLNESS Ingresó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS °C I-PRESENT_ILLNESS axilar. I-PRESENT_ILLNESS Alas I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS iniciada I-PRESENT_ILLNESS la I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS se I-PRESENT_ILLNESS instaló I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lumbalgia I-PRESENT_ILLNESS permanente, I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS irradiaciones, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS componente I-PRESENT_ILLNESS nocturno, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS exacerbaba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS los I-PRESENT_ILLNESS movimientos. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS tenía I-PRESENT_ILLNESS limitación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS movilidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS columna I-PRESENT_ILLNESS tóraco-lumbar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS deambulación. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS esfinteriano. I-PRESENT_ILLNESS Había B-TREATMENT consultado I-TREATMENT en I-TREATMENT forma I-TREATMENT ambulatoria I-TREATMENT donde I-TREATMENT le I-TREATMENT fuera I-TREATMENT indicada I-TREATMENT amoxicilina I-TREATMENT por I-TREATMENT 7 I-TREATMENT días I-TREATMENT y I-TREATMENT a I-TREATMENT continuación I-TREATMENT cotrimoxazol I-TREATMENT durante I-TREATMENT 48 I-TREATMENT horas. I-TREATMENT El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION a I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION mialgias, I-EXPLORATION febril I-EXPLORATION 38, I-EXPLORATION 5 I-EXPLORATION °C I-EXPLORATION axilar, I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION ni I-EXPLORATION mucosas I-EXPLORATION o I-EXPLORATION adenopatías. I-EXPLORATION La I-EXPLORATION columna I-EXPLORATION presentaba I-EXPLORATION rigidez I-EXPLORATION y I-EXPLORATION limitación I-EXPLORATION total I-EXPLORATION de I-EXPLORATION la I-EXPLORATION movilidad I-EXPLORATION a I-EXPLORATION la I-EXPLORATION flexión: I-EXPLORATION actitud I-EXPLORATION escoliótica I-EXPLORATION del I-EXPLORATION tronco, I-EXPLORATION con I-EXPLORATION desvío I-EXPLORATION axial I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION a I-EXPLORATION izquierda. I-EXPLORATION Dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION masas I-EXPLORATION musculares I-EXPLORATION paravertebrales. I-EXPLORATION Abdomen I-EXPLORATION simétrico, I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION del I-EXPLORATION hipogastrio, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION ni I-EXPLORATION visceromegalias. I-EXPLORATION Fosas I-EXPLORATION lumbares I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION leucocitos I-EXPLORATION 9.900/mm3 I-EXPLORATION (neu-trófilos I-EXPLORATION 4.800/mm3, I-EXPLORATION linfocitos I-EXPLORATION 3.700/mm3), I-EXPLORATION hemoglobina I-EXPLORATION 11, I-EXPLORATION 1 I-EXPLORATION g/dl, I-EXPLORATION hematocnto I-EXPLORATION 38%, I-EXPLORATION plaquetas I-EXPLORATION 407.000/mm3; I-EXPLORATION PCR I-EXPLORATION 7, I-EXPLORATION 6 I-EXPLORATION mg/1. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemocultivo I-EXPLORATION se I-EXPLORATION desarrolló I-EXPLORATION Staphylococcus I-EXPLORATION coagulasa I-EXPLORATION negativa. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION escoliosis I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION estructurales, I-EXPLORATION sin I-EXPLORATION componente I-EXPLORATION rotacional. I-EXPLORATION El I-EXPLORATION cintigrama I-EXPLORATION óseo I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hiperémica I-EXPLORATION leve, I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION precoz, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION 2a I-EXPLORATION vértebra I-EXPLORATION lumbar. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION sustitutivo I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION 2a I-EXPLORATION vértebra I-EXPLORATION lumbar I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION medular I-EXPLORATION y I-EXPLORATION foramen I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION indemnidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION discos I-EXPLORATION intervertebrales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION del I-EXPLORATION pedículo I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION dicha I-EXPLORATION vértebra. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informó I-EXPLORATION proliferación I-EXPLORATION polimorfa I-EXPLORATION con I-EXPLORATION linfocitos, I-EXPLORATION polimorfonucleares I-EXPLORATION y I-EXPLORATION escasos I-EXPLORATION eosinófilos; I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION osteomielitis. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION bacteriológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION biopsia I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cefuroxima I-TREATMENT ev I-TREATMENT 100 I-TREATMENT mg/kg/día I-TREATMENT el I-TREATMENT que I-TREATMENT mantuvo I-TREATMENT durante I-TREATMENT 23 I-TREATMENT días; I-TREATMENT vancomicina I-TREATMENT 40 I-TREATMENT mg/kg/ I-TREATMENT día I-TREATMENT por I-TREATMENT 3 I-TREATMENT días, I-TREATMENT ceftriaxona I-TREATMENT 100 I-TREATMENT mg/kg/día I-TREATMENT durante I-TREATMENT 8 I-TREATMENT días I-TREATMENT y I-TREATMENT finalmente I-TREATMENT rifampicina I-TREATMENT 10 I-TREATMENT mg/kg/día I-TREATMENT más I-TREATMENT ciprofloxacina I-TREATMENT 20 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT 11 I-TREATMENT días. I-TREATMENT En I-TREATMENT total I-TREATMENT recibió I-TREATMENT 45 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antimicrobiano. I-TREATMENT I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION imágenes I-EXPLORATION hipodensas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hígado, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION micro-abscesos. I-EXPLORATION Frente I-EXPLORATION a I-EXPLORATION este I-EXPLORATION hallazgo I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION efectuar I-EXPLORATION una I-EXPLORATION tinción I-EXPLORATION argéntica I-EXPLORATION con I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Warthin-Starry I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION vertebral, I-EXPLORATION lográndose I-EXPLORATION detectar I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION bacilos I-EXPLORATION gramnegativos I-EXPLORATION con I-EXPLORATION morfología I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION B. I-EXPLORATION henselae. I-EXPLORATION En B-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION persistió I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION lumbar I-EVOLUTION y I-EVOLUTION fiebre I-EVOLUTION durante I-EVOLUTION 30 I-EVOLUTION días. I-EVOLUTION Se I-EVOLUTION otorgó I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION estando I-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION con I-EVOLUTION movilidad I-EVOLUTION prácticamente I-EVOLUTION normal I-EVOLUTION de I-EVOLUTION la I-EVOLUTION columna I-EVOLUTION vertebral. I-EVOLUTION La B-EXPLORATION PCR I-EXPLORATION y I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION se I-EXPLORATION normalizaron I-EXPLORATION en I-EXPLORATION la I-EXPLORATION evolución. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS con I-PRESENT_ILLNESS 47 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 mayores; I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 27 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY extirpado I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuerpo I-PAST_MEDICAL_HISTORY extraño I-PAST_MEDICAL_HISTORY (cuesco I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cereza) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY fosa I-PAST_MEDICAL_HISTORY nasal I-PAST_MEDICAL_HISTORY derecha. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS consistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS descarga I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS recurrente, I-PRESENT_ILLNESS muco-purulenta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS restos I-PRESENT_ILLNESS hemáticos, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS terapia I-PRESENT_ILLNESS antibacteriana. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION desviación I-EXPLORATION del I-EXPLORATION tabique I-EXPLORATION nasal I-EXPLORATION a I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION imagenológico I-EXPLORATION con I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales I-EXPLORATION mostró I-EXPLORATION opacidad I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como: I-EXPLORATION "seno I-EXPLORATION maxilar I-EXPLORATION derecho I-EXPLORATION ocupado I-EXPLORATION por I-EXPLORATION material I-EXPLORATION con I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION burbujas I-EXPLORATION de I-EXPLORATION gas, I-EXPLORATION con I-EXPLORATION extensión I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION canal I-EXPLORATION osteo-infundibular I-EXPLORATION y I-EXPLORATION levemente I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION ipsilateral, I-EXPLORATION ensanchamiento I-EXPLORATION y I-EXPLORATION remodelación I-EXPLORATION ósea I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION infundibular, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION erosiones". I-EXPLORATION La I-EXPLORATION naso-fibro-broncoscopia I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION polipoidea I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION derecha I-EXPLORATION a I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION del I-EXPLORATION meato I-EXPLORATION medio, I-EXPLORATION hacia I-EXPLORATION posterior, I-EXPLORATION sin I-EXPLORATION alcanzar I-EXPLORATION la I-EXPLORATION coana, I-EXPLORATION vascularizada. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION rinofaringe I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION tejido I-EXPLORATION adenoideo I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION orofaringe I-EXPLORATION e I-EXPLORATION hipofaringe I-EXPLORATION tenían I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacables: I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION hemoglobina I-EXPLORATION 12, I-EXPLORATION 5 I-EXPLORATION g/dl, I-EXPLORATION leucocitos I-EXPLORATION 4.500 I-EXPLORATION céls/mm3 I-EXPLORATION (eosinófilos I-EXPLORATION 2%, I-EXPLORATION segmentados I-EXPLORATION 58%, I-EXPLORATION linfocitos I-EXPLORATION 31%y I-EXPLORATION monocitos I-EXPLORATION 8%), I-EXPLORATION plaquetas I-EXPLORATION 312.000 I-EXPLORATION céls/mm3, I-EXPLORATION VHS I-EXPLORATION 44 I-EXPLORATION mm/h. I-EXPLORATION B-TREATMENT Se I-TREATMENT le I-TREATMENT realizó I-TREATMENT cirugía I-TREATMENT de I-TREATMENT remoción I-TREATMENT del I-TREATMENT contenido I-TREATMENT sinusal I-TREATMENT mediante I-TREATMENT técnica I-TREATMENT de I-TREATMENT Caldwell-Luc, I-TREATMENT con I-TREATMENT una I-TREATMENT incisión I-TREATMENT por I-TREATMENT el I-TREATMENT reborde I-TREATMENT alveolar I-TREATMENT superior I-TREATMENT derecho I-TREATMENT y I-TREATMENT apertura I-TREATMENT de I-TREATMENT una I-TREATMENT ventana I-TREATMENT ósea I-TREATMENT en I-TREATMENT el I-TREATMENT seno I-TREATMENT maxilar, I-TREATMENT dando I-TREATMENT salida I-TREATMENT a I-TREATMENT secreción I-TREATMENT negruzca I-TREATMENT barrosa I-TREATMENT de I-TREATMENT gran I-TREATMENT cantidad. I-TREATMENT No I-TREATMENT se I-TREATMENT encontró I-TREATMENT lesiones I-TREATMENT de I-TREATMENT la I-TREATMENT fosa I-TREATMENT nasal I-TREATMENT derecha I-TREATMENT ni I-TREATMENT tejido I-TREATMENT adenoideo I-TREATMENT anómalo I-TREATMENT en I-TREATMENT las I-TREATMENT coanas I-TREATMENT o I-TREATMENT rinofaringe. I-TREATMENT Evolucionó B-EVOLUTION en I-EVOLUTION forma I-EVOLUTION satisfactoria I-EVOLUTION en I-EVOLUTION el I-EVOLUTION post-operatorio. I-EVOLUTION El B-EXPLORATION material I-EXPLORATION obtenido I-EXPLORATION fue I-EXPLORATION enviado I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION e I-EXPLORATION histopatológico. I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION anátomo-patológico I-EXPLORATION fue: I-EXPLORATION "sinusitis I-EXPLORATION crónica I-EXPLORATION erosiva, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hongo I-EXPLORATION filamentoso I-EXPLORATION con I-EXPLORATION hifas I-EXPLORATION hialinas I-EXPLORATION septadasy I-EXPLORATION ramificadas, I-EXPLORATION sugerente I-EXPLORATION deAspergillus I-EXPLORATION sp. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION invasión I-EXPLORATION micótica I-EXPLORATION ni I-EXPLORATION atiplas".. I-EXPLORATION Se I-EXPLORATION aisló I-EXPLORATION un I-EXPLORATION hongo I-EXPLORATION filamentoso I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION rápido I-EXPLORATION a I-EXPLORATION 25 I-EXPLORATION °C, I-EXPLORATION con I-EXPLORATION colonias I-EXPLORATION de I-EXPLORATION textura I-EXPLORATION aterciopelada I-EXPLORATION a I-EXPLORATION algodonosa, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION crema I-EXPLORATION a I-EXPLORATION café I-EXPLORATION canela, I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION pigmento I-EXPLORATION café. I-EXPLORATION Microscópicamente I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hifas I-EXPLORATION hialinas I-EXPLORATION septadas I-EXPLORATION con I-EXPLORATION conidióforos I-EXPLORATION rectos, I-EXPLORATION de I-EXPLORATION largo I-EXPLORATION variable I-EXPLORATION con I-EXPLORATION generación I-EXPLORATION en I-EXPLORATION su I-EXPLORATION porción I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION aneloconidio I-EXPLORATION unicelular I-EXPLORATION oval I-EXPLORATION y I-EXPLORATION base I-EXPLORATION trunca, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION identificado I-EXPLORATION como I-EXPLORATION S. I-EXPLORATION apios-permum, I-EXPLORATION forma I-EXPLORATION anamorfa I-EXPLORATION o I-EXPLORATION asexuada I-EXPLORATION de I-EXPLORATION Pseudallescheria I-EXPLORATION boydii. I-EXPLORATION Se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Micología I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Ciencias I-EXPLORATION Biomédicas I-EXPLORATION (ICBM), I-EXPLORATION Facultad I-EXPLORATION de I-EXPLORATION Medicina, I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Chile. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT su I-TREATMENT larga I-TREATMENT evolución I-TREATMENT sintomática I-TREATMENT y I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT una I-TREATMENT lesión I-TREATMENT polipoidea I-TREATMENT de I-TREATMENT tipo I-TREATMENT invasora I-TREATMENT se I-TREATMENT dejó I-TREATMENT inicialmente I-TREATMENT tratamiento I-TREATMENT antifúngico I-TREATMENT con I-TREATMENT 200 I-TREATMENT mg I-TREATMENT de I-TREATMENT itraconazol I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas, I-TREATMENT siendo I-TREATMENT bien I-TREATMENT tolerado, I-TREATMENT sin I-TREATMENT alteración I-TREATMENT de I-TREATMENT las I-TREATMENT pruebas I-TREATMENT hepáticas, I-TREATMENT el I-TREATMENT que I-TREATMENT fue I-TREATMENT suspendido I-TREATMENT al I-TREATMENT no I-TREATMENT evidenciarse I-TREATMENT compromiso I-TREATMENT micótico I-TREATMENT invasor I-TREATMENT en I-TREATMENT la I-TREATMENT biopsia. I-TREATMENT B-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION a I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION plazo I-EVOLUTION fue I-EVOLUTION satisfactoria; I-EVOLUTION una B-EXPLORATION nueva I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales I-EXPLORATION mostró I-EXPLORATION su I-EXPLORATION total I-EXPLORATION neumatización I-EXPLORATION y I-EXPLORATION simetría, I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION maxilectomía I-EXPLORATION medial I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION elementos I-EXPLORATION inflamatorios I-EXPLORATION marginales I-EXPLORATION con I-EXPLORATION pequeño I-EXPLORATION nivel I-EXPLORATION hidro-aéreo I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS HLC I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS junio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS 2007. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY colecistectomizado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY inguinal. I-PAST_MEDICAL_HISTORY Era I-PAST_MEDICAL_HISTORY casado, I-PAST_MEDICAL_HISTORY jubilado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY trabajado, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY parte I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vida, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY criaderos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aves I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY zonas I-PAST_MEDICAL_HISTORY rurales I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Área I-PAST_MEDICAL_HISTORY Metropolitana. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Su B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS iniciado I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS con I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS moderado I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS vespertina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS cuantificaba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS kilos. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS ambulatoria I-PRESENT_ILLNESS en I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS oportunidades I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS realizaron I-PRESENT_ILLNESS diversos I-PRESENT_ILLNESS exámenes I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS llegar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS diagnóstico. I-PRESENT_ILLNESS Destacaban I-PRESENT_ILLNESS una I-PRESENT_ILLNESS ecograñay I-PRESENT_ILLNESS tomograña I-PRESENT_ILLNESS axial I-PRESENT_ILLNESS computariza-da I-PRESENT_ILLNESS (TAC) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS abdomen I-PRESENT_ILLNESS "sin I-PRESENT_ILLNESS hallazgos I-PRESENT_ILLNESS significativos" I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS ecocardiograma I-PRESENT_ILLNESS trans-torácico I-PRESENT_ILLNESS que I-PRESENT_ILLNESS informaba I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS aórtica I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dilatación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cavidades I-PRESENT_ILLNESS izquierdas. I-PRESENT_ILLNESS Fue B-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO HLC I-DERIVED_FROM/TO para I-DERIVED_FROM/TO completar I-DERIVED_FROM/TO estudio. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Al B-EXPLORATION ingreso I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refería I-EXPLORATION molestias I-EXPLORATION específicas I-EXPLORATION y I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION contribuía I-EXPLORATION para I-EXPLORATION orientar I-EXPLORATION el I-EXPLORATION diagnóstico. I-EXPLORATION No I-EXPLORATION tenía I-EXPLORATION soplo I-EXPLORATION cardíaco, I-EXPLORATION visceromegalia, I-EXPLORATION lesiones I-EXPLORATION cutáneas I-EXPLORATION ni I-EXPLORATION mucosas, I-EXPLORATION alteraciones I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION pulmonar I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION sistemas. I-EXPLORATION Sólo I-EXPLORATION se I-EXPLORATION verificó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION fiebre I-EXPLORATION irregular, I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 38°C, I-EXPLORATION y I-EXPLORATION decaimiento. I-EXPLORATION Se I-EXPLORATION inició I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION síndrome I-EXPLORATION febril I-EXPLORATION prolongado. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION mostraba I-EXPLORATION anemia I-EXPLORATION moderada I-EXPLORATION (hematocrito I-EXPLORATION 34, I-EXPLORATION 1%, I-EXPLORATION hemoglobina I-EXPLORATION 11, I-EXPLORATION 3 I-EXPLORATION gr%), I-EXPLORATION leucocitos I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal, I-EXPLORATION neutrofilia I-EXPLORATION de I-EXPLORATION 76%) I-EXPLORATION sin I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 36 I-EXPLORATION mm/h. I-EXPLORATION La I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION renal I-EXPLORATION estaban I-EXPLORATION normales, I-EXPLORATION la I-EXPLORATION albuminemia I-EXPLORATION disminuida I-EXPLORATION (3, I-EXPLORATION 3 I-EXPLORATION gr%), I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION moderadamente I-EXPLORATION elevada I-EXPLORATION y I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION evidenciaba I-EXPLORATION alteraciones I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION pulmonar I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION la I-EXPLORATION silueta I-EXPLORATION cardíaca. I-EXPLORATION Tanto I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecograña I-EXPLORATION abdominal I-EXPLORATION como I-EXPLORATION en I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen, I-EXPLORATION realizadas I-EXPLORATION durante I-EXPLORATION su I-EXPLORATION hospitalización, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION nodulos I-EXPLORATION espíemeos. I-EXPLORATION Estaba I-EXPLORATION solicitado I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION trans-esofágico. I-EXPLORATION Por I-EXPLORATION no I-EXPLORATION presentar I-EXPLORATION expectoración, I-EXPLORATION se I-EXPLORATION le I-EXPLORATION hicieron I-EXPLORATION baciloscopias I-EXPLORATION de I-EXPLORATION contenido I-EXPLORATION gástrico I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION negativas. I-EXPLORATION El I-EXPLORATION urocultivo I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION tomados I-EXPLORATION al I-EXPLORATION ingreso, I-EXPLORATION no I-EXPLORATION presentaron I-EXPLORATION desarrollo. I-EXPLORATION Como I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION febril I-EXPLORATION prolongado I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION también I-EXPLORATION exámenes I-EXPLORATION inmunológicos: I-EXPLORATION anticuerpos I-EXPLORATION antinucleares, I-EXPLORATION factor I-EXPLORATION reumatold I-EXPLORATION eo, I-EXPLORATION cuantificación I-EXPLORATION de I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION C4, I-EXPLORATION anticuerpos I-EXPLORATION anti-cardiolipina, I-EXPLORATION todo I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION hipoalbuminemia I-EXPLORATION e I-EXPLORATION hipergamaglobulinemia I-EXPLORATION difusa I-EXPLORATION moderada. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION 11° I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización, I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION petequias I-EXPLORATION subconjuntivales. I-EXPLORATION Con B-TREATMENT este I-TREATMENT nuevo I-TREATMENT hallazgo I-TREATMENT al I-TREATMENT examen I-TREATMENT físico, I-TREATMENT se I-TREATMENT planteó I-TREATMENT la I-TREATMENT hipótesis I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT endocarditis I-TREATMENT infecciosa I-TREATMENT y, I-TREATMENT previa I-TREATMENT toma I-TREATMENT de I-TREATMENT nueva I-TREATMENT serie I-TREATMENT de I-TREATMENT hemocultivos, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT penicilina I-TREATMENT y I-TREATMENT gentamicina I-TREATMENT por I-TREATMENT vía I-TREATMENT endovenosa. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION estable I-EVOLUTION en I-EVOLUTION su I-EVOLUTION condición, I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION irregular I-EVOLUTION y, I-EVOLUTION posteriormente, I-EVOLUTION se I-EVOLUTION pesquisó I-EVOLUTION un I-EVOLUTION soplo I-EVOLUTION cardíaco. I-EVOLUTION I-EVOLUTION Al B-EXPLORATION 14° I-EXPLORATION día I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION crecimiento I-EXPLORATION bacteriano I-EXPLORATION en I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION tomados I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION tres I-EXPLORATION días I-EXPLORATION antes. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION directamente I-EXPLORATION del I-EXPLORATION vial I-EXPLORATION de I-EXPLORATION cultivo, I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION cocobacilos I-EXPLORATION grampositivos. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION aclaró I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION cocobacilos I-EXPLORATION gramnegativos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION 17° I-EXPLORATION día I-EXPLORATION de I-EXPLORATION ingresado I-EXPLORATION se I-EXPLORATION emitió I-EXPLORATION un I-EXPLORATION pre-informe I-EXPLORATION dando I-EXPLORATION cuenta I-EXPLORATION del I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION un I-EXPLORATION bacilo I-EXPLORATION gramnegativo, I-EXPLORATION probablemente I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION HACEK. I-EXPLORATION Por I-EXPLORATION la I-EXPLORATION dificultad I-EXPLORATION en I-EXPLORATION llegar I-EXPLORATION a I-EXPLORATION un I-EXPLORATION diagnóstico I-EXPLORATION microbiológico I-EXPLORATION exacto, I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION al I-EXPLORATION ISP I-EXPLORATION para I-EXPLORATION identificación. I-EXPLORATION Con B-TREATMENT el I-TREATMENT resultado I-TREATMENT de I-TREATMENT este I-TREATMENT examen I-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT esquema I-TREATMENT antimicrobiano I-TREATMENT a I-TREATMENT ampicilina, I-TREATMENT gentamicina I-TREATMENT y I-TREATMENT ceftriaxona. I-TREATMENT I-TREATMENT El B-EXPLORATION 22° I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION ecocardiograma I-EXPLORATION trans-esofágico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION cardiología I-EXPLORATION del I-EXPLORATION Hospital I-EXPLORATION Barros I-EXPLORATION Luco I-EXPLORATION Trudeau. I-EXPLORATION En I-EXPLORATION dicho I-EXPLORATION examen I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION múltiples I-EXPLORATION vegetaciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION aórtica I-EXPLORATION con I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION absceso I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION aneurismática I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION coronario I-EXPLORATION derecho, I-EXPLORATION insuficiencia I-EXPLORATION aórtica, I-EXPLORATION dilatación I-EXPLORATION auricular I-EXPLORATION izquierda, I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION hipertrofia I-EXPLORATION excéntrica I-EXPLORATION dilatada I-EXPLORATION y I-EXPLORATION disfunción I-EXPLORATION sistólica I-EXPLORATION leve. I-EXPLORATION I-EXPLORATION Ese B-DERIVED_FROM/TO mismo I-DERIVED_FROM/TO día I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Instituto I-DERIVED_FROM/TO Nacional I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Enfermedades I-DERIVED_FROM/TO Respiratorias I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Tórax I-DERIVED_FROM/TO (INERYCT) I-DERIVED_FROM/TO para I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO quirúrgico. I-DERIVED_FROM/TO Al B-EVOLUTION ingreso I-EVOLUTION a I-EVOLUTION dicho I-EVOLUTION centro I-EVOLUTION asistencial I-EVOLUTION se I-EVOLUTION verificó I-EVOLUTION un I-EVOLUTION paciente I-EVOLUTION tranquilo I-EVOLUTION que I-EVOLUTION no I-EVOLUTION refería I-EVOLUTION molestias I-EVOLUTION específicas, I-EVOLUTION enflaquecido, I-EVOLUTION he-modinámicamente I-EVOLUTION estable, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION cardíaca, I-EVOLUTION con I-EVOLUTION soplo I-EVOLUTION cardíaco I-EVOLUTION 4/6 I-EVOLUTION en I-EVOLUTION el I-EVOLUTION foco I-EVOLUTION aórtico. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION agravó I-EVOLUTION bruscamente I-EVOLUTION presentando I-EVOLUTION dolor I-EVOLUTION retro-esternal, I-EVOLUTION disnea, I-EVOLUTION ingurgitación I-EVOLUTION yugular, I-EVOLUTION hipotensión, I-EVOLUTION shock I-EVOLUTION y I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION conciencia. I-EVOLUTION Fue B-TREATMENT trasladado I-TREATMENT a I-TREATMENT la I-TREATMENT unidad I-TREATMENT de I-TREATMENT cuidados I-TREATMENT intensivos I-TREATMENT y, I-TREATMENT al I-TREATMENT día I-TREATMENT siguiente, I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT cirugía I-TREATMENT de I-TREATMENT urgencia. I-TREATMENT En I-TREATMENT el I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT verificó I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT una I-TREATMENT válvula I-TREATMENT aórtica I-TREATMENT bicúspide I-TREATMENT con I-TREATMENT gran I-TREATMENT destrucción I-TREATMENT de I-TREATMENT los I-TREATMENT velos I-TREATMENT coronarios I-TREATMENT y I-TREATMENT del I-TREATMENT anillo, I-TREATMENT con I-TREATMENT una I-TREATMENT cavidad I-TREATMENT de I-TREATMENT 2 I-TREATMENT por I-TREATMENT 3 I-TREATMENT cm I-TREATMENT en I-TREATMENT relación I-TREATMENT al I-TREATMENT seno I-TREATMENT coronario I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT gran I-TREATMENT cantidad I-TREATMENT de I-TREATMENT vegetaciones. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT un I-TREATMENT reemplazo I-TREATMENT valvular, I-TREATMENT con I-TREATMENT prótesis I-TREATMENT Edwards I-TREATMENT Lifesciences I-TREATMENT de I-TREATMENT 23 I-TREATMENT mm, I-TREATMENT y I-TREATMENT reparación I-TREATMENT del I-TREATMENT anillo I-TREATMENT con I-TREATMENT parche I-TREATMENT de I-TREATMENT pericardio I-TREATMENT bovino. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION post-operatorio I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION muy I-EVOLUTION grave I-EVOLUTION durante I-EVOLUTION cuatro I-EVOLUTION a I-EVOLUTION cinco I-EVOLUTION días, I-EVOLUTION debió B-TREATMENT ser I-TREATMENT re-intervenido I-TREATMENT por I-TREATMENT sangrado I-TREATMENT local, I-TREATMENT presentó B-EVOLUTION insuficiencia I-EVOLUTION renal I-EVOLUTION aguda, I-EVOLUTION fibrilación I-EVOLUTION auricular I-EVOLUTION paroxística, I-EVOLUTION estuvo B-TREATMENT conectado I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasora I-TREATMENT durante I-TREATMENT cinco I-TREATMENT días, I-TREATMENT recibió I-TREATMENT aminas I-TREATMENT vasoactivas I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT y I-TREATMENT cloxacilina I-TREATMENT por I-TREATMENT vía I-TREATMENT endovenosa. I-TREATMENT I-TREATMENT El B-EXPLORATION 33° I-EXPLORATION día I-EXPLORATION de I-EXPLORATION internado I-EXPLORATION se I-EXPLORATION conoció I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION del I-EXPLORATION bacilo I-EXPLORATION gramnegativo I-EXPLORATION aislado I-EXPLORATION en I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION HLC; I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION Brucella I-EXPLORATION abortus. I-EXPLORATION En B-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT esquema I-TREATMENT antimicrobiano I-TREATMENT a I-TREATMENT doxiciclina I-TREATMENT más I-TREATMENT rifampicina I-TREATMENT y I-TREATMENT gentamicina. I-TREATMENT El B-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION operatoria I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION tórpida I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION tendencia I-EVOLUTION a I-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION modo I-EVOLUTION que, I-EVOLUTION cumplidos I-EVOLUTION 54 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización, I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION relativa I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION y B-TREATMENT con I-TREATMENT indicación I-TREATMENT de I-TREATMENT continuar I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT doxiciclina I-TREATMENT y I-TREATMENT rifampicina. I-TREATMENT I-TREATMENT El B-EVOLUTION día I-EVOLUTION 88° I-EVOLUTION desde I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION fue I-EVOLUTION controlado I-EVOLUTION por I-EVOLUTION cardio-cirujano I-EVOLUTION encontrándose I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales. I-EVOLUTION Se B-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION ecocardiograma I-EXPLORATION de I-EXPLORATION control I-EXPLORATION y B-TREATMENT se I-TREATMENT le I-TREATMENT suspendieron I-TREATMENT los I-TREATMENT antimicrobianos. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION cinco I-EVOLUTION meses I-EVOLUTION post I-EVOLUTION alta I-EVOLUTION fue I-EVOLUTION evaluado I-EVOLUTION en I-EVOLUTION HLC. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION asintomático, I-EVOLUTION en I-EVOLUTION muy I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION cardíaca. I-EVOLUTION Traía B-EXPLORATION exámenes I-EXPLORATION obtenidos I-EXPLORATION un I-EXPLORATION mes I-EXPLORATION antes: I-EXPLORATION creatininemia: I-EXPLORATION 1, I-EXPLORATION 01 I-EXPLORATION mg/dL, I-EXPLORATION albuminemia: I-EXPLORATION 4, I-EXPLORATION 62 I-EXPLORATION g/%, I-EXPLORATION VHS: I-EXPLORATION 15 I-EXPLORATION mm/h, I-EXPLORATION orina I-EXPLORATION completa: I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION reciente I-EXPLORATION indicaba I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 36, I-EXPLORATION 4%, I-EXPLORATION hemoglobina I-EXPLORATION 12, I-EXPLORATION 5 I-EXPLORATION g/% I-EXPLORATION y I-EXPLORATION leucocitos I-EXPLORATION 9.500/mm3. I-EXPLORATION Se B-DERIVED_FROM/TO le I-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO para I-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO con I-DERIVED_FROM/TO cardiólogo. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION en I-EVOLUTION el I-EVOLUTION INERYCT I-EVOLUTION se I-EVOLUTION pesquisaron I-EVOLUTION síntomas I-EVOLUTION y I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION cardíaca I-EVOLUTION y I-EVOLUTION la I-EVOLUTION ecocardiograña I-EVOLUTION evidenció I-EVOLUTION reflujo I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION la I-EVOLUTION válvula I-EVOLUTION protésica. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Luego B-PRESENT_ILLNESS de I-PRESENT_ILLNESS estar I-PRESENT_ILLNESS consumiendo I-PRESENT_ILLNESS drogas I-PRESENT_ILLNESS (clorhidrato I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pasta I-PRESENT_ILLNESS base) I-PRESENT_ILLNESS notó I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS AV I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ojos I-PRESENT_ILLNESS rojos. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompañó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fotopsias I-PRESENT_ILLNESS bilaterales. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS después. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION oftalmológico I-EXPLORATION destacaba: I-EXPLORATION AVMC I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION igual I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 05 I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí I-EXPLORATION igual I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 1. I-EXPLORATION Visión I-EXPLORATION de I-EXPLORATION colores I-EXPLORATION alterada I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos. I-EXPLORATION Reflejos I-EXPLORATION pupilares I-EXPLORATION lentos I-EXPLORATION bilaterales I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION DPAR. I-EXPLORATION PIÓ I-EXPLORATION igual I-EXPLORATION a I-EXPLORATION 24 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 23 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION al I-EXPLORATION biomicroscopio I-EXPLORATION destacaba I-EXPLORATION Tyndall I-EXPLORATION +++ I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION ojos. I-EXPLORATION Presentaba I-EXPLORATION al I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION vitreítis I-EXPLORATION ++ I-EXPLORATION bilateral. I-EXPLORATION Ambas I-EXPLORATION papilas I-EXPLORATION estaban I-EXPLORATION levemente I-EXPLORATION pálidas. I-EXPLORATION El I-EXPLORATION campo I-EXPLORATION visual I-EXPLORATION de I-EXPLORATION Goldmann I-EXPLORATION mostró I-EXPLORATION escotomas I-EXPLORATION centro I-EXPLORATION centrales I-EXPLORATION bilaterales. I-EXPLORATION I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION neuritis I-EXPLORATION óptica I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION panuveitis. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION mostró I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION (+), I-EXPLORATION título: I-EXPLORATION 1/128, I-EXPLORATION FTA-ABS I-EXPLORATION (+) I-EXPLORATION y I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION (-). I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION citoquímico I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT penicilina I-TREATMENT según I-TREATMENT pautas. I-TREATMENT Diez B-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION iniciada I-EVOLUTION la I-EVOLUTION terapia I-EVOLUTION los I-EVOLUTION campos I-EVOLUTION visuales I-EVOLUTION mostraron I-EVOLUTION una I-EVOLUTION importante I-EVOLUTION mejoría I-EVOLUTION y I-EVOLUTION la I-EVOLUTION agudeza I-EVOLUTION visual I-EVOLUTION mejoró I-EVOLUTION a I-EVOLUTION 0, I-EVOLUTION 67 I-EVOLUTION en I-EVOLUTION ambos I-EVOLUTION ojos. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS antecedente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS visión I-PRESENT_ILLNESS borrosa I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS ya I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sífilis. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION oftalmológico I-EXPLORATION destacaba I-EXPLORATION AVMC I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 025 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 05 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí. I-EXPLORATION Pupilas I-EXPLORATION isocóricas I-EXPLORATION reactivas I-EXPLORATION y I-EXPLORATION simétricas. I-EXPLORATION Disociación I-EXPLORATION luz-cerca I-EXPLORATION positiva, I-EXPLORATION con I-EXPLORATION DPAR I-EXPLORATION (+) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION al I-EXPLORATION biomicroscopio I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION cornea I-EXPLORATION clara, I-EXPLORATION cámara I-EXPLORATION anterior I-EXPLORATION amplia I-EXPLORATION y I-EXPLORATION cristalino I-EXPLORATION claro. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION papilas I-EXPLORATION pálidas, I-EXPLORATION excavación I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION revelaron I-EXPLORATION concentraciones I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B-12 I-EXPLORATION normales, I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION (+), I-EXPLORATION título I-EXPLORATION 1/32, I-EXPLORATION FTA-ABS I-EXPLORATION (+), I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION (+), I-EXPLORATION ELISA I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION (-). I-EXPLORATION RM I-EXPLORATION cerebral I-EXPLORATION normal. I-EXPLORATION Campo I-EXPLORATION visual I-EXPLORATION de I-EXPLORATION Goldmann I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION altitudinal I-EXPLORATION bilateral. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION una I-EXPLORATION neuritis I-EXPLORATION óptica I-EXPLORATION bilateral I-EXPLORATION luética. I-EXPLORATION Se B-TREATMENT hospitalizó I-TREATMENT e I-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT penicilina I-TREATMENT en I-TREATMENT esquema I-TREATMENT habitual. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION AV I-EVOLUTION (AVMC: I-EVOLUTION 0, I-EVOLUTION 2 I-EVOLUTION en I-EVOLUTION el I-EVOLUTION OD I-EVOLUTION y I-EVOLUTION 0, I-EVOLUTION 3 I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Oí) I-EVOLUTION y I-EVOLUTION del I-EVOLUTION campo I-EVOLUTION visual I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY portador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY VIH, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY anti-retro I-PAST_MEDICAL_HISTORY viral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sífilis I-PAST_MEDICAL_HISTORY genital. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evolucionaba I-PRESENT_ILLNESS hacían I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS semanas, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS rojo I-PRESENT_ILLNESS bilateral, I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS OD. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION oftalmológico I-EXPLORATION presentaba I-EXPLORATION AVMC I-EXPLORATION igual I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 05 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 0, I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí. I-EXPLORATION PIÓ I-EXPLORATION de I-EXPLORATION 27 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION 25 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION al I-EXPLORATION biomicroscopio I-EXPLORATION presentaba I-EXPLORATION hiperemia I-EXPLORATION conjuntival I-EXPLORATION bilateral, I-EXPLORATION cornea I-EXPLORATION con I-EXPLORATION precipitados I-EXPLORATION queráticos I-EXPLORATION pequeños, I-EXPLORATION mayor I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD, I-EXPLORATION sinequias I-EXPLORATION posteriores I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí, I-EXPLORATION Tyndall I-EXPLORATION ++ I-EXPLORATION en I-EXPLORATION el I-EXPLORATION OD I-EXPLORATION y I-EXPLORATION + I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Oí. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION del I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION destacaba I-EXPLORATION vitreítis I-EXPLORATION bilateral, I-EXPLORATION papila I-EXPLORATION rosada, I-EXPLORATION bordes I-EXPLORATION netos, I-EXPLORATION excavación I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 3 I-EXPLORATION bilateral. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION (+), I-EXPLORATION título I-EXPLORATION 1/32, I-EXPLORATION VDRL I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION (+), I-EXPLORATION estudio I-EXPLORATION cito-químico I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION normal, I-EXPLORATION FTA-ABS I-EXPLORATION (+). I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION Se B-TREATMENT diagnosticó I-TREATMENT una.panuveítis I-TREATMENT bilateral I-TREATMENT por I-TREATMENT sífilis I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT practicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT esquema I-TREATMENT habitual I-TREATMENT de I-TREATMENT penicilina. I-TREATMENT Evoluciono B-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION inflamación I-EVOLUTION bilateral I-EVOLUTION a I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION y I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION AV. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY residencia I-PAST_MEDICAL_HISTORY urbana I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Región I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Araucanía, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Dr. I-PRESENT_ILLNESS Hernán I-PRESENT_ILLNESS Henríquez I-PRESENT_ILLNESS Aravena I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Temuco I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS anorexia, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS generalizadas, I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esfuerzos I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días, I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS habitado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS sector I-PRESENT_ILLNESS rural I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS recientemente. I-PRESENT_ILLNESS Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION mostraban I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 47%, I-EXPLORATION leucocitos I-EXPLORATION 5.600/mm3 I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION 60.000/mm3 I-EXPLORATION con I-EXPLORATION infiltrados I-EXPLORATION intersticiales I-EXPLORATION difusos I-EXPLORATION bilaterales I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax. I-EXPLORATION Dado I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico I-EXPLORATION y I-EXPLORATION los I-EXPLORATION antecedentes I-EXPLORATION epidemiológicos I-EXPLORATION se I-EXPLORATION planteó I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION cardiopulmonar I-EXPLORATION por I-EXPLORATION hantavirus I-EXPLORATION confirmándose I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION mediante I-EXPLORATION test I-EXPLORATION rápido I-EXPLORATION específico I-EXPLORATION (inmunocromatografía I-EXPLORATION para I-EXPLORATION IgM). I-EXPLORATION Se B-TREATMENT inició I-TREATMENT manejo I-TREATMENT de I-TREATMENT soporte I-TREATMENT e I-TREATMENT indicó I-TREATMENT 1 I-TREATMENT g/día I-TREATMENT de I-TREATMENT metilprednisolona I-TREATMENT iv I-TREATMENT durante I-TREATMENT 5 I-TREATMENT días. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION disfunción I-EVOLUTION miocárdica, I-EVOLUTION requiriendo B-TREATMENT altas I-TREATMENT dosis I-TREATMENT de I-TREATMENT fármacos I-TREATMENT vasoactivos. I-TREATMENT Desarrolló I-TREATMENT durante I-TREATMENT su I-TREATMENT estadía I-TREATMENT hospitalaria I-TREATMENT una I-TREATMENT neumonía I-TREATMENT asociada I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT tratada I-TREATMENT inicialmente I-TREATMENT con I-TREATMENT imipenem, I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT amikacina. I-TREATMENT En B-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION secreción I-EXPLORATION bronquial I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION Staphylococcus I-EXPLORATION aureus I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION meticilina, I-EXPLORATION cambiándose I-EXPLORATION vancomicina I-EXPLORATION por I-EXPLORATION linezolid. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION inició I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION ictericia I-EVOLUTION progresiva I-EVOLUTION con I-EVOLUTION hiperbilirrubinemia I-EVOLUTION (13, I-EVOLUTION 9 I-EVOLUTION mg/dL) I-EVOLUTION de I-EVOLUTION predominio I-EVOLUTION directa I-EVOLUTION (12, I-EVOLUTION 4 I-EVOLUTION mg/dL), I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION fosfatasas I-EVOLUTION alcalinas I-EVOLUTION (854 I-EVOLUTION U/l) I-EVOLUTION y B-EXPLORATION una I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION alitiásica, I-EXPLORATION la B-TREATMENT que I-TREATMENT fue I-TREATMENT resuelta I-TREATMENT quirúrgicamente I-TREATMENT el I-TREATMENT mismo I-TREATMENT día. I-TREATMENT I-TREATMENT Durante B-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION y I-EVOLUTION tercera I-EVOLUTION semana, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION continuó I-EVOLUTION febril I-EVOLUTION con I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION costrosas I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION la I-EVOLUTION cara, I-EVOLUTION una I-EVOLUTION de I-EVOLUTION ellas I-EVOLUTION de I-EVOLUTION localización I-EVOLUTION nasal. I-EVOLUTION Se B-EXPLORATION obtuvieron I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION aspirado I-EXPLORATION endotraqueal, I-EXPLORATION los I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION informados I-EXPLORATION como I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Candida I-EXPLORATION albicans I-EXPLORATION y I-EXPLORATION Pseudomonas I-EXPLORATION aeruginosa I-EXPLORATION respectivamente, I-EXPLORATION agregándose I-EXPLORATION al I-EXPLORATION esquema I-EXPLORATION antimicrobiano I-EXPLORATION cobertura I-EXPLORATION con I-EXPLORATION anidulafungina I-EXPLORATION para I-EXPLORATION C. I-EXPLORATION albicans I-EXPLORATION y I-EXPLORATION cefoperazona/sulbactam I-EXPLORATION para I-EXPLORATION Pseudomonas I-EXPLORATION aeruginosa. I-EXPLORATION Permaneció B-EVOLUTION grave, I-EVOLUTION aunque I-EVOLUTION afebril I-EVOLUTION y, I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION cardiopulmonar, I-EVOLUTION requiriendo I-EVOLUTION menor I-EVOLUTION apoyo I-EVOLUTION ventilatorio, I-EVOLUTION con I-EVOLUTION modificación I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION soporte I-EVOLUTION y I-EVOLUTION de I-EVOLUTION aminas I-EVOLUTION vasoactivas. I-EVOLUTION Durante I-EVOLUTION la I-EVOLUTION cuarta I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION se I-EVOLUTION describió I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION una I-EVOLUTION lesión I-EVOLUTION ulcerada I-EVOLUTION en I-EVOLUTION el I-EVOLUTION dorso I-EVOLUTION nasal, I-EVOLUTION de I-EVOLUTION fondo I-EVOLUTION necrótico I-EVOLUTION y I-EVOLUTION bordes I-EVOLUTION irregulares, I-EVOLUTION además I-EVOLUTION de I-EVOLUTION una I-EVOLUTION escara I-EVOLUTION sacra I-EVOLUTION y I-EVOLUTION otras I-EVOLUTION en I-EVOLUTION los I-EVOLUTION talones. I-EVOLUTION I-EVOLUTION Continuó I-EVOLUTION afebril I-EVOLUTION y B-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cefoperazona/ I-TREATMENT sulbactam I-TREATMENT y I-TREATMENT anidulafungina. I-TREATMENT Un B-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION nasal I-EXPLORATION fue I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION C. I-EXPLORATION albicans. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION abundantes I-EXPLORATION elementos I-EXPLORATION micóticos I-EXPLORATION tipo I-EXPLORATION hifas I-EXPLORATION no I-EXPLORATION septadas, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION mucor, I-EXPLORATION en I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION del I-EXPLORATION ala I-EXPLORATION nasal. I-EXPLORATION Con B-TREATMENT estos I-TREATMENT resultados I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT anidulafungina I-TREATMENT e I-TREATMENT inició I-TREATMENT terapia I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT desoxicolato I-TREATMENT en I-TREATMENT dosis I-TREATMENT ajustada I-TREATMENT según I-TREATMENT función I-TREATMENT renal I-TREATMENT (creatininemia: I-TREATMENT 3 I-TREATMENT mg/dL). I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo, I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION concomitancia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION profundas. I-EXPLORATION I-EXPLORATION Permaneció B-EVOLUTION grave, I-EVOLUTION con I-EVOLUTION ictericia I-EVOLUTION intensa I-EVOLUTION (bilirrubinemia I-EVOLUTION total: I-EVOLUTION 21 I-EVOLUTION mg/dL, I-EVOLUTION bilirrubinemia I-EVOLUTION directa: I-EVOLUTION 19 I-EVOLUTION mg/dL, I-EVOLUTION fosfatasas I-EVOLUTION alcalinas: I-EVOLUTION 854 I-EVOLUTION U/l, I-EVOLUTION GOT: I-EVOLUTION 83 I-EVOLUTION U/L, I-EVOLUTION GPT: I-EVOLUTION 8 I-EVOLUTION U/L). I-EVOLUTION La B-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen-pélvis I-EXPLORATION demostró I-EXPLORATION hepatomegalia I-EXPLORATION difusa I-EXPLORATION sin I-EXPLORATION abscedación, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION de I-EXPLORATION estructura I-EXPLORATION conservada. I-EXPLORATION Una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION extensa I-EXPLORATION efusión I-EXPLORATION pleural I-EXPLORATION a I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION el I-EXPLORATION colapso I-EXPLORATION pulmonar I-EXPLORATION ipsilateral. I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION efusión I-EXPLORATION dio I-EXPLORATION salida I-EXPLORATION a I-EXPLORATION líquido I-EXPLORATION hemático I-EXPLORATION que I-EXPLORATION no I-EXPLORATION coagulaba I-EXPLORATION y B-TREATMENT se I-TREATMENT instaló I-TREATMENT un I-TREATMENT tubo I-TREATMENT de I-TREATMENT drenaje I-TREATMENT pleural. I-TREATMENT I-TREATMENT En B-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION evolucionó I-EVOLUTION febril, I-EVOLUTION en I-EVOLUTION anuria, I-EVOLUTION con I-EVOLUTION altos I-EVOLUTION requerimientos I-EVOLUTION de I-EVOLUTION apoyo I-EVOLUTION ventilatorio I-EVOLUTION y I-EVOLUTION hemodinámico. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION falleció, I-EVOLUTION habiendo B-TREATMENT completado I-TREATMENT cinco I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT y I-TREATMENT luego I-TREATMENT de I-TREATMENT efectuarse I-TREATMENT dos I-TREATMENT aseos I-TREATMENT quirúrgicos I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT nasal. I-TREATMENT I-TREATMENT Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY irregular I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY metabólico I-PAST_MEDICAL_HISTORY (amaurosis I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY hospitalizaciones I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cetoacidosis I-PAST_MEDICAL_HISTORY diabética), I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY inicialmente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY glibenclamida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY insulina I-PAST_MEDICAL_HISTORY NPH. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS caída, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS somnolencia, I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS respiratoria, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS una I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS primario I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS administró I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS millones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS UI I-PRESENT_ILLNESS de I-PRESENT_ILLNESS penicilina I-PRESENT_ILLNESS G I-PRESENT_ILLNESS sódica. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION se I-EXPLORATION le I-EXPLORATION constató I-EXPLORATION en I-EXPLORATION sopor, I-EXPLORATION afebril, I-EXPLORATION hipotenso I-EXPLORATION y I-EXPLORATION deshidratado. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION necrótica I-EXPLORATION y I-EXPLORATION flictenas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION pretibial I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION x I-EXPLORATION 10 I-EXPLORATION cm, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulsos I-EXPLORATION poplíteo I-EXPLORATION y I-EXPLORATION pedio I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION mostraron I-EXPLORATION leucocitosis I-EXPLORATION (20.400/mm3), I-EXPLORATION hiperglicemia I-EXPLORATION (539 I-EXPLORATION mg/dL), I-EXPLORATION acidosis I-EXPLORATION metabólica I-EXPLORATION (pH I-EXPLORATION 6, I-EXPLORATION 9), I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION elevada I-EXPLORATION (189 I-EXPLORATION mg/L) I-EXPLORATION y I-EXPLORATION disfunción I-EXPLORATION renal I-EXPLORATION (creatininemia: I-EXPLORATION 1, I-EXPLORATION 87 I-EXPLORATION mg/dL, I-EXPLORATION potasio: I-EXPLORATION 5, I-EXPLORATION 5 I-EXPLORATION mmol/L). I-EXPLORATION I-EXPLORATION Se B-TREATMENT le I-TREATMENT efectuó I-TREATMENT aseo I-TREATMENT quirúrgico I-TREATMENT encontrándose I-TREATMENT una I-TREATMENT necrosis I-TREATMENT muscular I-TREATMENT del I-TREATMENT compartimiento I-TREATMENT antero I-TREATMENT lateral I-TREATMENT de I-TREATMENT la I-TREATMENT pierna I-TREATMENT izquierda; I-TREATMENT se B-EXPLORATION envió I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION cultivo I-EXPLORATION y I-EXPLORATION biopsia. I-EXPLORATION Ingresó B-TREATMENT a I-TREATMENT la I-TREATMENT UCI I-TREATMENT con I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT fascitis I-TREATMENT necrosante I-TREATMENT y I-TREATMENT sepsis I-TREATMENT grave, I-TREATMENT iniciando I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT y I-TREATMENT clindamicina, I-TREATMENT analgesia I-TREATMENT con I-TREATMENT fentanilo I-TREATMENT y I-TREATMENT corrección I-TREATMENT metabólica I-TREATMENT con I-TREATMENT bicarbonato I-TREATMENT de I-TREATMENT sodio, I-TREATMENT gluconato I-TREATMENT de I-TREATMENT calcio, I-TREATMENT aporte I-TREATMENT de I-TREATMENT volumen I-TREATMENT e I-TREATMENT insulina. I-TREATMENT I-TREATMENT Evolucionó B-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION estabilidad, I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION parámetros I-EVOLUTION metabólicos I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION y I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION necrótica I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION izquierda. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION informó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION fibroconectivo I-EXPLORATION denso I-EXPLORATION y I-EXPLORATION muscular I-EXPLORATION esquelético I-EXPLORATION con I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION agudo I-EXPLORATION necrosante I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION elementos I-EXPLORATION micóticos I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION hifas I-EXPLORATION no I-EXPLORATION septadas, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION mucor, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION indicó I-EXPLORATION anfotericina I-EXPLORATION B I-EXPLORATION desoxicolato. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION resultó I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION elementos I-EXPLORATION micóticos. I-EXPLORATION I-EXPLORATION Luego I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION antifúngico I-EXPLORATION y I-EXPLORATION tres I-EXPLORATION aseos I-EXPLORATION quirúrgicos, I-EXPLORATION la I-EXPLORATION RM I-EXPLORATION evidenciaba I-EXPLORATION un I-EXPLORATION compromiso I-EXPLORATION infeccioso I-EXPLORATION necrosante I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION tuberosidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tibia I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION amputación I-EXPLORATION suprapatelar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pierna I-EXPLORATION izquierda. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION intra-operatoria I-EXPLORATION del I-EXPLORATION margen I-EXPLORATION de I-EXPLORATION sección I-EXPLORATION proximal I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION elementos I-EXPLORATION micóticos I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION mucor. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION quirúrgico I-EVOLUTION e I-EVOLUTION infeccioso I-EVOLUTION completando I-EVOLUTION 30 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION anfotericina I-EVOLUTION B. I-EVOLUTION Fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION encontrándose, I-EVOLUTION al I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION preparar I-EVOLUTION este I-EVOLUTION reporte, I-EVOLUTION bajo I-EVOLUTION controles I-EVOLUTION con I-EVOLUTION fisiatra I-EVOLUTION y I-EVOLUTION terapia I-EVOLUTION ocupacional. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 42 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS soltero B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY comerciante, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS marzo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2009 I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Dr. I-PRESENT_ILLNESS Sótero I-PRESENT_ILLNESS Del I-PRESENT_ILLNESS Río I-PRESENT_ILLNESS (HSDR) I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Refería I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS progresivo, I-PRESENT_ILLNESS indoloro, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS lógica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS compromiso 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 sudoración I-PRESENT_ILLNESS nocturna I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS con I-PRESENT_ILLNESS temperatura I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuantificada. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS por I-PRESENT_ILLNESS sistemas I-PRESENT_ILLNESS no I-PRESENT_ILLNESS destacaban I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY relevantes I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY sexuales I-PAST_MEDICAL_HISTORY previas I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hombres I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY preservativo. I-PAST_MEDICAL_HISTORY Negaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY drogas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION buenas I-EXPLORATION condiciones I-EXPLORATION generales, I-EXPLORATION afebril, I-EXPLORATION piel I-EXPLORATION con I-EXPLORATION descamación I-EXPLORATION fina I-EXPLORATION difusa, I-EXPLORATION algorra I-EXPLORATION en I-EXPLORATION el I-EXPLORATION paladar I-EXPLORATION y I-EXPLORATION leucoplaquia I-EXPLORATION vellosa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION lengua. I-EXPLORATION Destacaba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION cervical I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cms, I-EXPLORATION indolora, I-EXPLORATION pétrea, I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION profundos, I-EXPLORATION de I-EXPLORATION textura I-EXPLORATION nodular I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION hospitalizar I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION por I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION inmunosupresión. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION principales I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION fueron I-EXPLORATION anemia I-EXPLORATION normocítica I-EXPLORATION - I-EXPLORATION normocrómica I-EXPLORATION con I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 31, I-EXPLORATION 1%, I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 5.900 I-EXPLORATION céls/mm3 I-EXPLORATION con I-EXPLORATION 65, I-EXPLORATION 6% I-EXPLORATION de I-EXPLORATION granulocitos I-EXPLORATION y I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION de I-EXPLORATION 161.000 I-EXPLORATION céls/mm3, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION 56 I-EXPLORATION mg/L I-EXPLORATION (N I-EXPLORATION < I-EXPLORATION 5 I-EXPLORATION mg/L). I-EXPLORATION Creatininemia, I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION coagulación, I-EXPLORATION electrolitos I-EXPLORATION plasmáticos, I-EXPLORATION perfil I-EXPLORATION bioquímico I-EXPLORATION y I-EXPLORATION el I-EXPLORATION sedimento I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Baciloscopias I-EXPLORATION de I-EXPLORATION expectoración I-EXPLORATION y I-EXPLORATION urocultivo I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION test I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION positivo I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VHB I-EXPLORATION y I-EXPLORATION VHC, I-EXPLORATION ambas I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cerebro, I-EXPLORATION cuello, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION cervical I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION depender I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION submandibular I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION 8, I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION neoplásico I-EXPLORATION infiltrativo, I-EXPLORATION en I-EXPLORATION cuyo I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION se I-EXPLORATION sugería I-EXPLORATION considerar I-EXPLORATION carcinoma I-EXPLORATION adenoide I-EXPLORATION quístico I-EXPLORATION con I-EXPLORATION baja I-EXPLORATION probabilidad I-EXPLORATION de I-EXPLORATION linfoma. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION recibieron I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION del I-EXPLORATION hemocultivo I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Salmonella I-EXPLORATION grupo I-EXPLORATION B I-EXPLORATION multisensible I-EXPLORATION (sensible I-EXPLORATION a I-EXPLORATION cefo-taxima, I-EXPLORATION ciprofloxacina, I-EXPLORATION ácido I-EXPLORATION nalidíxico, I-EXPLORATION cloranfenicol I-EXPLORATION y I-EXPLORATION cotrimoxazol) I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION 3, I-EXPLORATION 8 I-EXPLORATION horas I-EXPLORATION de I-EXPLORATION incubación I-EXPLORATION (automatizados). I-EXPLORATION I-EXPLORATION Además, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION quirúrgica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION tejido I-EXPLORATION tumoral I-EXPLORATION cerebroideo I-EXPLORATION con I-EXPLORATION sangrado I-EXPLORATION profuso I-EXPLORATION y I-EXPLORATION gran I-EXPLORATION compromiso I-EXPLORATION inflamatorio I-EXPLORATION circundante. I-EXPLORATION Se I-EXPLORATION enviaron I-EXPLORATION muestras I-EXPLORATION a I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION corriente I-EXPLORATION y I-EXPLORATION de I-EXPLORATION Koch, I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION directa I-EXPLORATION y I-EXPLORATION baciloscopia. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Salmonella I-EXPLORATION grupo I-EXPLORATION B I-EXPLORATION multisensible, I-EXPLORATION al I-EXPLORATION tercer I-EXPLORATION día I-EXPLORATION de I-EXPLORATION incubación. I-EXPLORATION Ambos I-EXPLORATION cultivos I-EXPLORATION fueron I-EXPLORATION enviados I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION (ISP) I-EXPLORATION para I-EXPLORATION su I-EXPLORATION confirmación I-EXPLORATION y I-EXPLORATION tipificación, I-EXPLORATION correspondiendo I-EXPLORATION a I-EXPLORATION Salmonella I-EXPLORATION Typhimurium. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT ev I-TREATMENT 2 I-TREATMENT g/día I-TREATMENT por I-TREATMENT 14 I-TREATMENT días I-TREATMENT seguido I-TREATMENT por I-TREATMENT ciprofloxacina I-TREATMENT oral I-TREATMENT 500 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT por I-TREATMENT 30 I-TREATMENT días. I-TREATMENT El B-EXPLORATION examen I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION cervical I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION crónico I-EXPLORATION granulomatoso I-EXPLORATION no I-EXPLORATION necrosante I-EXPLORATION con I-EXPLORATION focos I-EXPLORATION supurativos. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION elementos I-EXPLORATION celulares I-EXPLORATION malignos I-EXPLORATION ni I-EXPLORATION microorganismos I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION microscópico. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION Koch I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION masa I-EVOLUTION cervical I-EVOLUTION y I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION febril, I-EVOLUTION no I-EVOLUTION requiriendo I-EVOLUTION nuevas I-EVOLUTION intervenciones I-EVOLUTION quirúrgicas. I-EVOLUTION Fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION 44 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION con I-EVOLUTION indicación I-EVOLUTION de I-EVOLUTION mantener I-EVOLUTION ciprofloxacina I-EVOLUTION oral I-EVOLUTION hasta I-EVOLUTION completar I-EVOLUTION 30 I-EVOLUTION días. I-EVOLUTION Se I-EVOLUTION controló I-EVOLUTION posteriormente I-EVOLUTION en I-EVOLUTION la I-EVOLUTION policlínica I-EVOLUTION de I-EVOLUTION Infectología I-EVOLUTION en I-EVOLUTION el I-EVOLUTION HSDR I-EVOLUTION y I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones, I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION síntomas I-EVOLUTION sistémicos; I-EVOLUTION PCR I-EVOLUTION 3 I-EVOLUTION mg/L. I-EVOLUTION Con B-TREATMENT confirmación I-TREATMENT del I-TREATMENT Instituto I-TREATMENT de I-TREATMENT Salud I-TREATMENT Pública I-TREATMENT de I-TREATMENT la I-TREATMENT serología I-TREATMENT positiva I-TREATMENT para I-TREATMENT VIH I-TREATMENT y I-TREATMENT confirmación I-TREATMENT de I-TREATMENT identidad I-TREATMENT informada I-TREATMENT luego I-TREATMENT del I-TREATMENT alta, I-TREATMENT se I-TREATMENT realizó I-TREATMENT ingreso I-TREATMENT al I-TREATMENT Programa I-TREATMENT de I-TREATMENT VIH/SIDA I-TREATMENT para I-TREATMENT iniciar I-TREATMENT terapia I-TREATMENT anti-retroviral I-TREATMENT (TARV) I-TREATMENT con I-TREATMENT tenofovir, I-TREATMENT lamivudina I-TREATMENT y I-TREATMENT atazanavir/ritonavir I-TREATMENT con I-TREATMENT un I-TREATMENT recuento I-TREATMENT de I-TREATMENT linfocitos I-TREATMENT CD4 I-TREATMENT de I-TREATMENT 12 I-TREATMENT céls/mL I-TREATMENT y I-TREATMENT carga I-TREATMENT viral I-TREATMENT de I-TREATMENT 1.800 I-TREATMENT copias I-TREATMENT ARN/ml. I-TREATMENT La I-TREATMENT decisión I-TREATMENT de I-TREATMENT utilizar I-TREATMENT este I-TREATMENT esquema, I-TREATMENT el I-TREATMENT cual I-TREATMENT no I-TREATMENT es I-TREATMENT el I-TREATMENT de I-TREATMENT uso I-TREATMENT habitual I-TREATMENT como I-TREATMENT primera I-TREATMENT línea, I-TREATMENT fue I-TREATMENT decisión I-TREATMENT del I-TREATMENT equipo I-TREATMENT de I-TREATMENT Infectología I-TREATMENT para I-TREATMENT mejorar I-TREATMENT la I-TREATMENT adherencia I-TREATMENT del I-TREATMENT paciente I-TREATMENT ya I-TREATMENT que I-TREATMENT es I-TREATMENT mejor I-TREATMENT tolerado I-TREATMENT en I-TREATMENT pacientes I-TREATMENT operados I-TREATMENT y I-TREATMENT con I-TREATMENT un I-TREATMENT nivel I-TREATMENT avanzado I-TREATMENT de I-TREATMENT inmunosupresión. I-TREATMENT Una B-EXPLORATION nuevo I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION y I-EXPLORATION cuello I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION 18 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION antimicrobiano, I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION adenopatías I-EXPLORATION susceptibles I-EXPLORATION de I-EXPLORATION ser I-EXPLORATION biopsiadas I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION dado I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION por I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION Cirugía I-EXPLORATION de I-EXPLORATION Cabeza I-EXPLORATION y I-EXPLORATION Cuello. I-EXPLORATION I-EXPLORATION Un B-EVOLUTION año I-EVOLUTION después I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones, I-EVOLUTION con I-EVOLUTION resolución I-EVOLUTION definitiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION masa I-EVOLUTION cervical I-EVOLUTION y I-EVOLUTION en I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION el I-EVOLUTION mismo I-EVOLUTION esquema I-EVOLUTION de I-EVOLUTION TARV I-EVOLUTION A I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION plazo I-EVOLUTION presentaba I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION indetectable, I-EVOLUTION con I-EVOLUTION recuento I-EVOLUTION de I-EVOLUTION linfocitos I-EVOLUTION CD4 I-EVOLUTION de I-EVOLUTION 181 I-EVOLUTION céls/mL I-EVOLUTION y I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION nuevas I-EVOLUTION infecciones I-EVOLUTION bacterianas I-EVOLUTION graves. I-EVOLUTION I-EVOLUTION Prescolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY asfixia I-PAST_MEDICAL_HISTORY neonatal I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY circular I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cuello, I-PAST_MEDICAL_HISTORY bronconeumonía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY virus I-PAST_MEDICAL_HISTORY respiratorio I-PAST_MEDICAL_HISTORY sincicial I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY calendario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vacunación I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY nacional I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inmunizaciones I-PAST_MEDICAL_HISTORY completo I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS inició I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS diagnóstico, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS gastrointestinales I-PRESENT_ILLNESS caracterizados I-PRESENT_ILLNESS por I-PRESENT_ILLNESS constipación, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso, I-PRESENT_ILLNESS intermitente, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS intensificó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS siguientes. I-PRESENT_ILLNESS Consultó B-TREATMENT reiteradamente I-TREATMENT a I-TREATMENT pediatra I-TREATMENT y I-TREATMENT gastroenterólogo I-TREATMENT infantil, I-TREATMENT indicándose I-TREATMENT dieta I-TREATMENT y I-TREATMENT lactulosa; I-TREATMENT además B-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION eco-grafía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION tres I-EVOLUTION semanas I-EVOLUTION se I-EVOLUTION agregó I-EVOLUTION decaimiento, I-EVOLUTION irritabilidad I-EVOLUTION nocturna, I-EVOLUTION dolor I-EVOLUTION lumbar I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION postración I-EVOLUTION relativa I-EVOLUTION (no I-EVOLUTION caminaba, I-EVOLUTION no I-EVOLUTION jugaba) I-EVOLUTION y I-EVOLUTION dificultad I-EVOLUTION para I-EVOLUTION mantenerse I-EVOLUTION sentado. I-EVOLUTION Se B-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION lumbar I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION normal. I-EXPLORATION Por B-TREATMENT persistencia I-TREATMENT de I-TREATMENT sintomatología, I-TREATMENT fue I-TREATMENT hospitalizada I-TREATMENT con I-TREATMENT la I-TREATMENT hipótesis I-TREATMENT de I-TREATMENT síndrome I-TREATMENT de I-TREATMENT Guillain I-TREATMENT Barré. I-TREATMENT Una B-EXPLORATION segunda I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION lumbar I-EXPLORATION y I-EXPLORATION evaluación I-EXPLORATION neurológica I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Hemograma I-EXPLORATION con I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 7%, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION 9.300/mm3, I-EXPLORATION sin I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda, I-EXPLORATION plaquetas I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 48 I-EXPLORATION mm/hora, I-EXPLORATION con I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION mg/dL I-EXPLORATION (normal: I-EXPLORATION 0-1). I-EXPLORATION Un I-EXPLORATION cintigrama I-EXPLORATION óseo I-EXPLORATION mostró I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION L2-L3. I-EXPLORATION En I-EXPLORATION virtud I-EXPLORATION de I-EXPLORATION este I-EXPLORATION hallazgo, I-EXPLORATION se I-EXPLORATION reevaluó I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION obtenida I-EXPLORATION con I-EXPLORATION anterioridad, I-EXPLORATION evidenciándose I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION intervertebral I-EXPLORATION L2-L3. I-EXPLORATION Una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION espondilodiscitis. I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION del I-EXPLORATION disco I-EXPLORATION vertebral I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION L2- I-EXPLORATION L3 I-EXPLORATION bajo I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TC), I-EXPLORATION mostró I-EXPLORATION líquido I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION polimorfonucleares. I-EXPLORATION Se I-EXPLORATION envió I-EXPLORATION a I-EXPLORATION cultivo I-EXPLORATION corriente, I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION Koch I-EXPLORATION y I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION ARN I-EXPLORATION 16S I-EXPLORATION universal. I-EXPLORATION Se B-TREATMENT tomaron I-TREATMENT hemocultivos I-TREATMENT que I-TREATMENT resultaron I-TREATMENT negativos I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT empírico I-TREATMENT iv I-TREATMENT con I-TREATMENT cloxacilina I-TREATMENT y I-TREATMENT cefotaxima, I-TREATMENT además I-TREATMENT de I-TREATMENT analgesia I-TREATMENT con I-TREATMENT ketoprofeno. I-TREATMENT Evolucionó B-EVOLUTION favorablemente, I-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION dolor. I-EVOLUTION Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostraron I-EXPLORATION lenta I-EXPLORATION regresión I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION infecciosos I-EXPLORATION inflamatorios, I-EXPLORATION con I-EXPLORATION 8.900 I-EXPLORATION leucocitos/mm3 I-EXPLORATION sin I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda, I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 35 I-EXPLORATION mm/hora I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION mg/dL. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION articular I-EXPLORATION resultó I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION la I-EXPLORATION RPC I-EXPLORATION universal I-EXPLORATION demostró I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION K. I-EXPLORATION kingae. I-EXPLORATION I-EXPLORATION Una B-TREATMENT vez I-TREATMENT completado I-TREATMENT los I-TREATMENT 10 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT iv, I-TREATMENT y I-TREATMENT dada I-TREATMENT la I-TREATMENT buena I-TREATMENT evolución I-TREATMENT tanto I-TREATMENT clínica I-TREATMENT como I-TREATMENT de I-TREATMENT laboratorio, I-TREATMENT se I-TREATMENT decidió I-TREATMENT dar I-TREATMENT el I-TREATMENT alta, I-TREATMENT con I-TREATMENT inmovilización I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT un I-TREATMENT corset I-TREATMENT y I-TREATMENT con I-TREATMENT indicación I-TREATMENT de I-TREATMENT completar I-TREATMENT cuatro I-TREATMENT semanas I-TREATMENT vía I-TREATMENT oral I-TREATMENT con I-TREATMENT amoxicilina. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sana, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY en B-PRESENT_ILLNESS proceso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS amamantamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hijo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS Procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY suburbana I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Villa I-PAST_MEDICAL_HISTORY Alemana, I-PAST_MEDICAL_HISTORY Región I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Valparaíso. I-PAST_MEDICAL_HISTORY Vive I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY casa I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY dispone I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY agua I-PAST_MEDICAL_HISTORY potable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcantarillado; I-PAST_MEDICAL_HISTORY posee I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY perro, I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY gatos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY conejo I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY mascotas. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY dueña I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY casa, I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY ella I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY prepara I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY alimentos. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY mes, I-PAST_MEDICAL_HISTORY separado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY quince I-PAST_MEDICAL_HISTORY dias, I-PAST_MEDICAL_HISTORY habia I-PAST_MEDICAL_HISTORY efectuado I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ciudad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Talcahuano, I-PAST_MEDICAL_HISTORY Concepción, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY consecuencias I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY desastre I-PAST_MEDICAL_HISTORY ocurrido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY casa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY familiar I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY terremoto I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tsunami I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY febrero I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2010. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Consultorio I-PRESENT_ILLNESS Periférico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Villa I-PRESENT_ILLNESS Alemana I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS ejemplares I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gusanos I-PRESENT_ILLNESS eliminados I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS boca I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS dias. I-PRESENT_ILLNESS Relató I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontraba I-PRESENT_ILLNESS durmiendo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS despertó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS sentir I-PRESENT_ILLNESS una I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS extraña I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS garganta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS boca; I-PRESENT_ILLNESS frente I-PRESENT_ILLNESS al I-PRESENT_ILLNESS movimiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS extraño I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS boca, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS lengua I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS aprisionó I-PRESENT_ILLNESS contra I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paladar I-PRESENT_ILLNESS para I-PRESENT_ILLNESS retirarlo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS dedos. I-PRESENT_ILLNESS Lo I-PRESENT_ILLNESS dejó I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS su I-PRESENT_ILLNESS velador I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS observó I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS enroscaba. I-PRESENT_ILLNESS Posteriormente I-PRESENT_ILLNESS eliminó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS ejemplar; I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS tos, I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS vómito. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dia I-PRESENT_ILLNESS habia I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS acuosa, I-PRESENT_ILLNESS hiporexia, I-PRESENT_ILLNESS dispepsia, I-PRESENT_ILLNESS meteorismo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Relató I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS consumido I-PRESENT_ILLNESS merluza I-PRESENT_ILLNESS cruda I-PRESENT_ILLNESS (cebiche) I-PRESENT_ILLNESS once I-PRESENT_ILLNESS días I-PRESENT_ILLNESS atrás I-PRESENT_ILLNESS y I-PRESENT_ILLNESS negó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS consumo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS verduras I-PRESENT_ILLNESS crudas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS familia. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS integrada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS componentes: I-PRESENT_ILLNESS su I-PRESENT_ILLNESS esposo, I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hermana I-PRESENT_ILLNESS (18 I-PRESENT_ILLNESS años), I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS hijos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS el I-PRESENT_ILLNESS menor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS presentaron I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS El B-TREATMENT médico I-TREATMENT tratante I-TREATMENT le I-TREATMENT indicó I-TREATMENT terapia I-TREATMENT con I-TREATMENT mebendazol I-TREATMENT 100 I-TREATMENT mg, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT por I-TREATMENT tres I-TREATMENT días. I-TREATMENT I-TREATMENT En I-TREATMENT el I-TREATMENT laboratorio I-TREATMENT del I-TREATMENT consultorio, I-TREATMENT por I-TREATMENT las I-TREATMENT características I-TREATMENT morfométricas I-TREATMENT se I-TREATMENT sospechó I-TREATMENT que I-TREATMENT los I-TREATMENT ejemplares I-TREATMENT correspondían I-TREATMENT a I-TREATMENT A. I-TREATMENT lumbricoides I-TREATMENT en I-TREATMENT estado I-TREATMENT juvenil. I-TREATMENT Por B-EXPLORATION igual I-EXPLORATION motivo I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION examen I-EXPLORATION copro-parasitario I-EXPLORATION seriado, I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION ejemplares I-EXPLORATION de I-EXPLORATION los I-EXPLORATION gusanos I-EXPLORATION eliminados I-EXPLORATION fue I-EXPLORATION derivado I-EXPLORATION al I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION Parasitología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Escuela I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Valparaíso I-EXPLORATION para I-EXPLORATION comprobar I-EXPLORATION el I-EXPLORATION diagnóstico. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION morfométrico, I-EXPLORATION destacando I-EXPLORATION su I-EXPLORATION color I-EXPLORATION amarillento, I-EXPLORATION una I-EXPLORATION forma I-EXPLORATION cilíndrica I-EXPLORATION de I-EXPLORATION extremos I-EXPLORATION aguzados I-EXPLORATION rojizos, I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION y I-EXPLORATION 1, I-EXPLORATION 0 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION ancho. I-EXPLORATION Microscópicamente, I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tres I-EXPLORATION labios I-EXPLORATION en I-EXPLORATION el I-EXPLORATION extremo I-EXPLORATION anterior; I-EXPLORATION uno I-EXPLORATION dorsal I-EXPLORATION con I-EXPLORATION dos I-EXPLORATION papilas I-EXPLORATION y I-EXPLORATION con I-EXPLORATION sólo I-EXPLORATION una I-EXPLORATION cada I-EXPLORATION uno I-EXPLORATION en I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION labios I-EXPLORATION ventrolaterales3 I-EXPLORATION rodeando I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION oral. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION objeto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION mejor I-EXPLORATION observación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION características I-EXPLORATION del I-EXPLORATION gusano, I-EXPLORATION el I-EXPLORATION ejemplar I-EXPLORATION fue I-EXPLORATION sometido I-EXPLORATION a I-EXPLORATION diafanización I-EXPLORATION en I-EXPLORATION lactofenol I-EXPLORATION de I-EXPLORATION Amann. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION fue I-EXPLORATION corroborado I-EXPLORATION al I-EXPLORATION visualizar I-EXPLORATION microscópicamente I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION labios I-EXPLORATION que I-EXPLORATION rodean I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION oral I-EXPLORATION triangular I-EXPLORATION en I-EXPLORATION el I-EXPLORATION extremo I-EXPLORATION anterior, I-EXPLORATION y I-EXPLORATION por I-EXPLORATION las I-EXPLORATION características I-EXPLORATION del I-EXPLORATION tubo I-EXPLORATION digestivo I-EXPLORATION por I-EXPLORATION transparencia I-EXPLORATION (esófago I-EXPLORATION corto, I-EXPLORATION intestino I-EXPLORATION aplanado I-EXPLORATION recorriendo I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION longitud I-EXPLORATION del I-EXPLORATION cuerpo, I-EXPLORATION terminado I-EXPLORATION en I-EXPLORATION recto). I-EXPLORATION I-EXPLORATION Obtenido I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION certeza, I-EXPLORATION se I-EXPLORATION sostuvo I-EXPLORATION entrevista I-EXPLORATION telefónica I-EXPLORATION con I-EXPLORATION la I-EXPLORATION paciente: I-EXPLORATION se I-EXPLORATION le I-EXPLORATION indicó I-EXPLORATION las I-EXPLORATION medidas I-EXPLORATION profilácticas I-EXPLORATION para I-EXPLORATION evitar I-EXPLORATION la I-EXPLORATION reinfección I-EXPLORATION y I-EXPLORATION se I-EXPLORATION le I-EXPLORATION sugirió I-EXPLORATION control I-EXPLORATION mediante I-EXPLORATION examen I-EXPLORATION copro-parasitario I-EXPLORATION seriado, I-EXPLORATION el I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION formas I-EXPLORATION vacuoladas I-EXPLORATION de I-EXPLORATION Blastocystis I-EXPLORATION hominis. I-EXPLORATION Como I-EXPLORATION investigación I-EXPLORATION complementaria I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION examen I-EXPLORATION copro-parasitario I-EXPLORATION seriado I-EXPLORATION a I-EXPLORATION los I-EXPLORATION integrantes I-EXPLORATION de I-EXPLORATION su I-EXPLORATION grupo I-EXPLORATION familiar, I-EXPLORATION evidenciándose I-EXPLORATION formas I-EXPLORATION vacuoladas I-EXPLORATION de I-EXPLORATION B. I-EXPLORATION hominis I-EXPLORATION y I-EXPLORATION quistes I-EXPLORATION de I-EXPLORATION Entamoeba I-EXPLORATION coli I-EXPLORATION en I-EXPLORATION su I-EXPLORATION hermana; I-EXPLORATION en I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION los I-EXPLORATION integrantes I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Un B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diabético, B-PAST_MEDICAL_HISTORY fue B-PRESENT_ILLNESS internado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rigidez I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuca I-PRESENT_ILLNESS aparecidos I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cursar I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS aguda. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION diagnosticó I-EXPLORATION una I-EXPLORATION meningoencefalitis I-EXPLORATION aséptica I-EXPLORATION (LCR I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION claro, I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION H2O; I-EXPLORATION leucocitos: I-EXPLORATION 200/mm3; I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION directa I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION bacteriano: I-EXPLORATION negativos) I-EXPLORATION y B-TREATMENT recibió I-TREATMENT ceftriaxona I-TREATMENT más I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT corticoterapia I-TREATMENT (dexametasona, I-TREATMENT 10 I-TREATMENT mg I-TREATMENT iv I-TREATMENT cada I-TREATMENT 6-horas I-TREATMENT durante I-TREATMENT 4 I-TREATMENT días). I-TREATMENT Inicialmente B-EVOLUTION ingresó I-EVOLUTION en I-EVOLUTION una I-EVOLUTION UCI I-EVOLUTION y I-EVOLUTION estuvo I-EVOLUTION en I-EVOLUTION ventilación I-EVOLUTION mecánica, I-EVOLUTION siendo I-EVOLUTION desconectado I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION días. I-EVOLUTION I-EVOLUTION Desarrolló I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION tos I-EVOLUTION productiva I-EVOLUTION tras I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION evolución. I-EVOLUTION Una B-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION detectó I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION pulmonar I-EXPLORATION bilateral. I-EXPLORATION Tres I-EXPLORATION días I-EXPLORATION más I-EXPLORATION tarde, I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION Rx I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION abscesos I-EXPLORATION pulmonares I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION hidro-aéreos. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION cavitarias I-EXPLORATION con I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION gas. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION toracoscopia I-EXPLORATION video-asistida I-EXPLORATION e B-TREATMENT inserción I-TREATMENT de I-TREATMENT drenaje. I-TREATMENT Se I-TREATMENT inició I-TREATMENT entonces I-TREATMENT terapia I-TREATMENT asociada I-TREATMENT con I-TREATMENT linezolid I-TREATMENT (600 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12h I-TREATMENT iv) I-TREATMENT y I-TREATMENT meropenem I-TREATMENT (1, I-TREATMENT 0 I-TREATMENT gm I-TREATMENT cada I-TREATMENT 8h I-TREATMENT iv), I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT por I-TREATMENT dos I-TREATMENT semanas. I-TREATMENT La B-EXPLORATION efusión I-EXPLORATION pleural I-EXPLORATION (de I-EXPLORATION aspecto I-EXPLORATION purulento, I-EXPLORATION glucosa: I-EXPLORATION 40 I-EXPLORATION mg/dL, I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 18) I-EXPLORATION dio I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION para I-EXPLORATION P I-EXPLORATION aeruginosa I-EXPLORATION (susceptible I-EXPLORATION a I-EXPLORATION amikacina, I-EXPLORATION gentamicina, I-EXPLORATION ciprofloxacina, I-EXPLORATION cefepime, I-EXPLORATION ceftazidima I-EXPLORATION e I-EXPLORATION imipenem). I-EXPLORATION Hubo B-EVOLUTION recuperación I-EVOLUTION ad I-EVOLUTION integrum I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION completarse I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION y I-EVOLUTION la I-EVOLUTION antibioterapia. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS nacido B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Buenos I-PAST_MEDICAL_HISTORY Aires, I-PAST_MEDICAL_HISTORY vendedor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY comercio I-PAST_MEDICAL_HISTORY céntrico, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY efectuado I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY fuera I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ciudad I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY poseía I-PAST_MEDICAL_HISTORY mascotas, I-PAST_MEDICAL_HISTORY realizaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY alimentación I-PAST_MEDICAL_HISTORY balanceada, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY comidas I-PAST_MEDICAL_HISTORY diarias. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY significación. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Sanatorio I-PRESENT_ILLNESS IPENSA I-PRESENT_ILLNESS de I-PRESENT_ILLNESS La I-PRESENT_ILLNESS Plata I-PRESENT_ILLNESS por I-PRESENT_ILLNESS omalgia I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS al I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS abducción, I-PRESENT_ILLNESS aducción I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rotación I-PRESENT_ILLNESS interna, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS data I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana. I-PRESENT_ILLNESS Posteriormente B-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION placa I-EXPLORATION eritematosa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION torácica I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION cuatro I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION no I-EXPLORATION indurada, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios I-EXPLORATION superficiales. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION fiebre, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION hemoptisis, I-EXPLORATION ni I-EXPLORATION historia I-EXPLORATION previa I-EXPLORATION de I-EXPLORATION traumatismo. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos I-EXPLORATION con I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION hemitórax I-EXPLORATION derecho I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION heterogénea I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 89 I-EXPLORATION cm, I-EXPLORATION ubicada I-EXPLORATION a I-EXPLORATION 2, I-EXPLORATION 46 I-EXPLORATION cm I-EXPLORATION bajo I-EXPLORATION la I-EXPLORATION piel, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION celulitis. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION miembro I-EXPLORATION superior I-EXPLORATION ipsilateral, I-EXPLORATION adenopatías, I-EXPLORATION soplo I-EXPLORATION cardíaco I-EXPLORATION ni I-EXPLORATION dolores I-EXPLORATION óseos. I-EXPLORATION I-EXPLORATION Comenzó B-TREATMENT con I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT (cefalexina I-TREATMENT 1 I-TREATMENT gramo I-TREATMENT cada I-TREATMENT 12 I-TREATMENT hs); I-TREATMENT a B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION registro I-EVOLUTION febril I-EVOLUTION de I-EVOLUTION 38, I-EVOLUTION 6°C I-EVOLUTION y I-EVOLUTION una I-EVOLUTION tumoración I-EVOLUTION en I-EVOLUTION la I-EVOLUTION región I-EVOLUTION pectoral I-EVOLUTION derecha. I-EVOLUTION I-EVOLUTION El B-EXPLORATION laboratorio I-EXPLORATION mostró I-EXPLORATION leucocitos I-EXPLORATION 16.600/mm3 I-EXPLORATION (81% I-EXPLORATION neutró I-EXPLORATION filos I-EXPLORATION segmentados), I-EXPLORATION hematocrito I-EXPLORATION 40%, I-EXPLORATION hemoglobina I-EXPLORATION 12, I-EXPLORATION 3 I-EXPLORATION g%, I-EXPLORATION (VCM I-EXPLORATION 89, I-EXPLORATION 7 I-EXPLORATION fl), I-EXPLORATION 250.000 I-EXPLORATION plaquetas/mm3, I-EXPLORATION glicemia I-EXPLORATION 85 I-EXPLORATION mg/dL, I-EXPLORATION VHS I-EXPLORATION 110 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION primer I-EXPLORATION hora, I-EXPLORATION TGO I-EXPLORATION 40 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION TGP I-EXPLORATION 70 I-EXPLORATION U/L. I-EXPLORATION La I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION creatin-fosfoquinasa I-EXPLORATION (CPK) I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ensanchamiento I-EXPLORATION mediastinal, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION cuello I-EXPLORATION con I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION ev I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION hemitórax I-EXPLORATION derecho I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION con I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos, I-EXPLORATION que I-EXPLORATION provocaba I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION pectorales. I-EXPLORATION Dicha I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION mediastino I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION superior, I-EXPLORATION en I-EXPLORATION proximidad I-EXPLORATION con I-EXPLORATION los I-EXPLORATION grandes I-EXPLORATION vasos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION asociaba I-EXPLORATION a I-EXPLORATION cambios I-EXPLORATION densitométricos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION mediastinal. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT punción-aspirativa I-TREATMENT guiada I-TREATMENT por I-TREATMENT TAC, I-TREATMENT obteniéndose I-TREATMENT 25 I-TREATMENT ml I-TREATMENT de I-TREATMENT material I-TREATMENT purulento I-TREATMENT de I-TREATMENT la I-TREATMENT colección I-TREATMENT parietal I-TREATMENT y I-TREATMENT 7 I-TREATMENT ml I-TREATMENT de I-TREATMENT la I-TREATMENT mediastinal I-TREATMENT Se I-TREATMENT remitieron I-TREATMENT a I-TREATMENT estudio I-TREATMENT microbiológico I-TREATMENT y I-TREATMENT se I-TREATMENT ajustó I-TREATMENT el I-TREATMENT esquema I-TREATMENT anti-infeccioso I-TREATMENT a I-TREATMENT vancomicina I-TREATMENT 1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT (dosis I-TREATMENT máxima), I-TREATMENT clindamicina I-TREATMENT 600 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 6 I-TREATMENT horas I-TREATMENT y I-TREATMENT ceftazidima I-TREATMENT 2 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT ev. I-TREATMENT I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT drenó I-TREATMENT quirúrgicamente I-TREATMENT el I-TREATMENT absceso I-TREATMENT pectoral. I-TREATMENT En B-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION cocáceas I-EXPLORATION grampositivas I-EXPLORATION agrupadas I-EXPLORATION en I-EXPLORATION racimos I-EXPLORATION y I-EXPLORATION al I-EXPLORATION tercer I-EXPLORATION día I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION aureus I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION oxacilina, I-EXPLORATION cefalotina, I-EXPLORATION eritromicina, I-EXPLORATION clindamicina, I-EXPLORATION cotri-moxazol, I-EXPLORATION vancomicina I-EXPLORATION y I-EXPLORATION ciprofloxacina. I-EXPLORATION Las I-EXPLORATION tinciones I-EXPLORATION de I-EXPLORATION Ziehl-Neelsen, I-EXPLORATION Giemsa I-EXPLORATION y I-EXPLORATION Gomori-Grocott I-EXPLORATION resultaron I-EXPLORATION negativas. I-EXPLORATION Se B-TREATMENT modificó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT indicado I-TREATMENT a I-TREATMENT cefazolina I-TREATMENT 2 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT ev. I-TREATMENT Las B-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION el I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION (VIH) I-EXPLORATION y I-EXPLORATION VDRL I-EXPLORATION fueron I-EXPLORATION no I-EXPLORATION reactivas. I-EXPLORATION El I-EXPLORATION urocultivo, I-EXPLORATION hemocultivos, I-EXPLORATION cultivos I-EXPLORATION para I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION micobacterias I-EXPLORATION del I-EXPLORATION material I-EXPLORATION purulento I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION Un I-EXPLORATION ecocardiograma I-EXPLORATION bidimensional I-EXPLORATION transtorácico I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION vegetaciones I-EXPLORATION valvulares. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION alteraciones. I-EXPLORATION Al B-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION 72 I-EVOLUTION hs I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION evidente. I-EVOLUTION Dada B-TREATMENT la I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT postquirúrgica I-TREATMENT y I-TREATMENT habiendo I-TREATMENT aislado I-TREATMENT en I-TREATMENT todas I-TREATMENT las I-TREATMENT muestras I-TREATMENT S. I-TREATMENT aureus I-TREATMENT sensible I-TREATMENT a I-TREATMENT meticilina I-TREATMENT se I-TREATMENT cambió I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT cefalexina I-TREATMENT 1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT vía I-TREATMENT oral, I-TREATMENT evolucionando B-EVOLUTION favorablemente. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY nacionalidad I-PAST_MEDICAL_HISTORY chilena, I-PAST_MEDICAL_HISTORY residente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Italia I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY aproximadamente. I-PAST_MEDICAL_HISTORY Presentó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS coxalgia I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS realizándose B-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION neo-formación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ala I-EXPLORATION ilíaca I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION muscular I-EXPLORATION adyacente. I-EXPLORATION Una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION linfoma I-EXPLORATION no-Hodgkin, I-EXPLORATION isotipo I-EXPLORATION linfo-plasmocitario. I-EXPLORATION Asociado I-EXPLORATION a I-EXPLORATION esto, I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION falla I-EXPLORATION renal I-EXPLORATION aguda I-EXPLORATION con I-EXPLORATION hipercalcemia I-EXPLORATION y I-EXPLORATION proteinuria, I-EXPLORATION principalmente I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION Bence I-EXPLORATION Jones, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION componente I-EXPLORATION monoclonal I-EXPLORATION tipo I-EXPLORATION IgD-lambda. I-EXPLORATION I-EXPLORATION En B-EVOLUTION junio I-EVOLUTION del I-EVOLUTION año I-EVOLUTION 2011 I-EVOLUTION ingresó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Hemato-Oncología I-EVOLUTION del I-EVOLUTION Hospital I-EVOLUTION de I-EVOLUTION Lucca, I-EVOLUTION Italia, I-EVOLUTION iniciándose B-TREATMENT esquema I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT bortezomib I-TREATMENT más I-TREATMENT dexame-tasona, I-TREATMENT asociado I-TREATMENT a I-TREATMENT ácido I-TREATMENT zolendrónico. I-TREATMENT I-TREATMENT En B-EXPLORATION julio I-EXPLORATION de I-EXPLORATION 2011 I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION debido I-EXPLORATION al I-EXPLORATION deterioro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION nefropatía I-EXPLORATION tubulo-intersticial, I-EXPLORATION comenzando I-EXPLORATION con I-EXPLORATION terapia I-EXPLORATION de I-EXPLORATION sustitución I-EXPLORATION renal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION centro. I-EXPLORATION I-EXPLORATION En B-EVOLUTION agosto I-EVOLUTION de I-EVOLUTION 2011 I-EVOLUTION se I-EVOLUTION reevaluó I-EVOLUTION al I-EVOLUTION paciente, I-EVOLUTION el I-EVOLUTION que I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión, I-EVOLUTION siendo I-EVOLUTION internado I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION Hematología I-EVOLUTION del I-EVOLUTION Hospital I-EVOLUTION Universitario I-EVOLUTION de I-EVOLUTION Pisa. I-EVOLUTION Se B-TREATMENT le I-TREATMENT indicó I-TREATMENT un I-TREATMENT esquema I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT VDT-PACE I-TREATMENT (bortezomib, I-TREATMENT talidomida, I-TREATMENT dexametasona, I-TREATMENT cisplatino, I-TREATMENT doxorrubicina, I-TREATMENT ciclofosfamida I-TREATMENT y I-TREATMENT etopósido). I-TREATMENT Previo B-EVOLUTION a I-EVOLUTION esto, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION habría I-EVOLUTION sufrido I-EVOLUTION una I-EVOLUTION gastrectomía I-EVOLUTION parcial I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION una I-EVOLUTION úlcera I-EVOLUTION péptica I-EVOLUTION perforada. I-EVOLUTION I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT luego I-TREATMENT continuar I-TREATMENT con I-TREATMENT un I-TREATMENT esquema I-TREATMENT CHOP I-TREATMENT (ciclofosfamida, I-TREATMENT doxirrubicinada, I-TREATMENT vincristina, I-TREATMENT prednisona), I-TREATMENT recibiendo I-TREATMENT el I-TREATMENT primer I-TREATMENT ciclo I-TREATMENT en I-TREATMENT el I-TREATMENT mismo I-TREATMENT centro. I-TREATMENT En B-EXPLORATION evaluaciones I-EXPLORATION sucesivas I-EXPLORATION durante I-EXPLORATION su I-EXPLORATION hospitalización, I-EXPLORATION la I-EXPLORATION ecotomografía I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION compromiso I-EXPLORATION infiltrativo I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION ala I-EXPLORATION ilíaca I-EXPLORATION derecha I-EXPLORATION hasta I-EXPLORATION las I-EXPLORATION asas I-EXPLORATION intestinales, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION tamizaje I-EXPLORATION con I-EXPLORATION hisopado I-EXPLORATION rectal I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Klebsiella I-EXPLORATION pneumoniae I-EXPLORATION multi-resistente. I-EXPLORATION I-EXPLORATION Estando B-EVOLUTION en I-EVOLUTION su I-EVOLUTION domicilio I-EVOLUTION en I-EVOLUTION Italia, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION varias I-EVOLUTION crisis I-EVOLUTION convulsivas I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION atribuidas I-EVOLUTION a I-EVOLUTION trastornos I-EVOLUTION metabólicos. I-EVOLUTION Se I-EVOLUTION descartó I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION intracerebrales. I-EVOLUTION Fue B-DERIVED_FROM/TO referido I-DERIVED_FROM/TO entonces I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Versilia, I-DERIVED_FROM/TO Italia; I-DERIVED_FROM/TO recibió B-TREATMENT allí I-TREATMENT un I-TREATMENT segundo I-TREATMENT y I-TREATMENT tercer I-TREATMENT ciclo I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT esquema I-TREATMENT CHOP, I-TREATMENT el I-TREATMENT 22.12.2011 I-TREATMENT y I-TREATMENT el I-TREATMENT 19.01.2012, I-TREATMENT respectivamente, I-TREATMENT presentando I-TREATMENT aplasia I-TREATMENT medular I-TREATMENT secundaria I-TREATMENT que I-TREATMENT requirió I-TREATMENT apoyo I-TREATMENT con I-TREATMENT estimulador I-TREATMENT de I-TREATMENT colonia I-TREATMENT de I-TREATMENT granulocitos I-TREATMENT y I-TREATMENT eritropoyetina. I-TREATMENT I-TREATMENT Viajó I-TREATMENT desde I-TREATMENT Italia I-TREATMENT a I-TREATMENT Chile, I-TREATMENT ingresando I-TREATMENT directamente I-TREATMENT desde I-TREATMENT el I-TREATMENT aeropuerto I-TREATMENT de I-TREATMENT Santiago I-TREATMENT el I-TREATMENT día I-TREATMENT 28.02.2012 I-TREATMENT al I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Medicina I-TREATMENT del I-TREATMENT Hospital I-TREATMENT Clínico I-TREATMENT San I-TREATMENT Borja I-TREATMENT Arriarán, I-TREATMENT para I-TREATMENT coordinar I-TREATMENT la I-TREATMENT hemodiálisis I-TREATMENT y I-TREATMENT evaluación I-TREATMENT por I-TREATMENT el I-TREATMENT equipo I-TREATMENT de I-TREATMENT hemato-oncología I-TREATMENT para I-TREATMENT eventual I-TREATMENT quimioterapia I-TREATMENT paliativa. I-TREATMENT I-TREATMENT Se I-TREATMENT realizó I-TREATMENT el I-TREATMENT primer I-TREATMENT procedimiento I-TREATMENT de I-TREATMENT hemodiálisis I-TREATMENT el I-TREATMENT día I-TREATMENT 01.03.2012 I-TREATMENT presentando B-EVOLUTION fiebre I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION hemocultivos I-EXPLORATION con I-EXPLORATION tiempo I-EXPLORATION diferencial I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION del I-EXPLORATION tracto I-EXPLORATION sanguíneo I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION catéter I-EXPLORATION venoso I-EXPLORATION central, I-EXPLORATION y I-EXPLORATION urocultivo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION 6 I-EXPLORATION de I-EXPLORATION marzo I-EXPLORATION de I-EXPLORATION 2012 I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION urocultivo I-EXPLORATION una I-EXPLORATION cepa I-EXPLORATION de I-EXPLORATION K. I-EXPLORATION pneumoniae I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION ami-noglucósidos, I-EXPLORATION quinolonas, I-EXPLORATION β-lactámicos, I-EXPLORATION cefalosporinas I-EXPLORATION y I-EXPLORATION carbapenémicos I-EXPLORATION con I-EXPLORATION halo I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm I-EXPLORATION (de I-EXPLORATION contacto) I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION retuvo I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION dado I-EXPLORATION el I-EXPLORATION perfil I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION no I-EXPLORATION descrito I-EXPLORATION antes I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION país. I-EXPLORATION Además I-EXPLORATION de I-EXPLORATION lo I-EXPLORATION anterior, I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION series I-EXPLORATION de I-EXPLORATION hemocultivos I-EXPLORATION de I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION positividad I-EXPLORATION diferencial I-EXPLORATION un I-EXPLORATION bacilo I-EXPLORATION gramnegativo I-EXPLORATION no I-EXPLORATION fermen-tador I-EXPLORATION que I-EXPLORATION posteriormente I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Microbiología I-EXPLORATION del I-EXPLORATION Hospital I-EXPLORATION Clínico I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Chile I-EXPLORATION identificó I-EXPLORATION como I-EXPLORATION Achromobacter I-EXPLORATION denitrificans I-EXPLORATION realizándose I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION ITS/CVC I-EXPLORATION e I-EXPLORATION interpretándose I-EXPLORATION el I-EXPLORATION urocultivo I-EXPLORATION como I-EXPLORATION una I-EXPLORATION bacteriuria I-EXPLORATION asintomática. I-EXPLORATION I-EXPLORATION El I-EXPLORATION 8 I-EXPLORATION de I-EXPLORATION marzo I-EXPLORATION de I-EXPLORATION 2012, I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Microbiología I-EXPLORATION y I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION Control I-EXPLORATION de I-EXPLORATION Infecciones I-EXPLORATION obtuvieron I-EXPLORATION el I-EXPLORATION antecedente I-EXPLORATION epidemiológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION procedencia I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION (hospital I-EXPLORATION en I-EXPLORATION Italia). I-EXPLORATION Frente I-EXPLORATION a I-EXPLORATION dicho I-EXPLORATION antecedente I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION la I-EXPLORATION posible I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION carbapenemasa I-EXPLORATION KPC I-EXPLORATION importada, I-EXPLORATION indicándose I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION portación I-EXPLORATION de I-EXPLORATION KPC I-EXPLORATION mediante I-EXPLORATION hisopado I-EXPLORATION rectal. I-EXPLORATION Se I-EXPLORATION repitió I-EXPLORATION el I-EXPLORATION urocultivo, I-EXPLORATION se I-EXPLORATION iniciaron I-EXPLORATION las I-EXPLORATION medidas I-EXPLORATION de I-EXPLORATION contención I-EXPLORATION de I-EXPLORATION la I-EXPLORATION transmisión I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION comunicación I-EXPLORATION vía I-EXPLORATION correo I-EXPLORATION electrónico I-EXPLORATION con I-EXPLORATION el I-EXPLORATION médico I-EXPLORATION tratante I-EXPLORATION italiano I-EXPLORATION para I-EXPLORATION consultarle I-EXPLORATION si I-EXPLORATION la I-EXPLORATION K. I-EXPLORATION pneumoniae I-EXPLORATION multi-resistente I-EXPLORATION indicada I-EXPLORATION en I-EXPLORATION resumen I-EXPLORATION de I-EXPLORATION traslado I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION una I-EXPLORATION poseedora I-EXPLORATION de I-EXPLORATION BLEE I-EXPLORATION o I-EXPLORATION KPC. I-EXPLORATION I-EXPLORATION El I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION hemato-oncología I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION etapificación I-EXPLORATION con I-EXPLORATION imágenes I-EXPLORATION el I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION compromiso I-EXPLORATION óseo I-EXPLORATION difuso I-EXPLORATION y I-EXPLORATION una I-EXPLORATION extensa I-EXPLORATION lesión I-EXPLORATION lítica I-EXPLORATION del I-EXPLORATION ilíaco I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tejidos I-EXPLORATION blandos. I-EXPLORATION Desde B-TREATMENT el I-TREATMENT punto I-TREATMENT de I-TREATMENT vista I-TREATMENT hemato-oncológico, I-TREATMENT el I-TREATMENT paciente I-TREATMENT sería I-TREATMENT candidato I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT paliativo I-TREATMENT dado I-TREATMENT el I-TREATMENT estadio I-TREATMENT actual I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT de I-TREATMENT base I-TREATMENT y I-TREATMENT sus I-TREATMENT magras I-TREATMENT condiciones I-TREATMENT generales. I-TREATMENT I-TREATMENT El B-EXPLORATION 11 I-EXPLORATION de I-EXPLORATION marzo I-EXPLORATION se I-EXPLORATION recibió I-EXPLORATION confirmación I-EXPLORATION desde I-EXPLORATION Italia I-EXPLORATION del I-EXPLORATION antecedente I-EXPLORATION de I-EXPLORATION KPC. I-EXPLORATION Se I-EXPLORATION logró I-EXPLORATION identificar I-EXPLORATION nuevamente I-EXPLORATION una I-EXPLORATION K. I-EXPLORATION pneumoniae I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION antimicrobianos I-EXPLORATION excepto I-EXPLORATION colistin I-EXPLORATION y I-EXPLORATION tigeciclina I-EXPLORATION en I-EXPLORATION el I-EXPLORATION urocultivo I-EXPLORATION e I-EXPLORATION hisopado I-EXPLORATION rectal, I-EXPLORATION los I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION estudiados I-EXPLORATION con I-EXPLORATION batería I-EXPLORATION bioquímica I-EXPLORATION convencional I-EXPLORATION para I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION especie I-EXPLORATION y I-EXPLORATION antibio-grama I-EXPLORATION por I-EXPLORATION difusión I-EXPLORATION con I-EXPLORATION discos I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION estándares I-EXPLORATION CLSI6. I-EXPLORATION Siguiendo I-EXPLORATION con I-EXPLORATION el I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION vigilancia I-EXPLORATION acordado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Grupo I-EXPLORATION Colaborativo I-EXPLORATION de I-EXPLORATION Resistencia I-EXPLORATION de I-EXPLORATION Chile I-EXPLORATION (datos I-EXPLORATION no I-EXPLORATION publicados I-EXPLORATION Reunión-Curso I-EXPLORATION de I-EXPLORATION Resistencia I-EXPLORATION Santa I-EXPLORATION Cruz I-EXPLORATION 2009), I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION fue I-EXPLORATION derivada I-EXPLORATION al I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Microbiología I-EXPLORATION Molecular I-EXPLORATION del I-EXPLORATION Departamento I-EXPLORATION de I-EXPLORATION Laboratorios I-EXPLORATION Clínicos I-EXPLORATION Pontificia I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Chile I-EXPLORATION para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION de I-EXPLORATION genes I-EXPLORATION de I-EXPLORATION resistencia I-EXPLORATION antimicrobiana. I-EXPLORATION I-EXPLORATION El I-EXPLORATION día I-EXPLORATION 12 I-EXPLORATION de I-EXPLORATION marzo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION in I-EXPLORATION vitro I-EXPLORATION por I-EXPLORATION CIM I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION de I-EXPLORATION K. I-EXPLORATION pneumoniae I-EXPLORATION y I-EXPLORATION los I-EXPLORATION test I-EXPLORATION fenotípicos6 I-EXPLORATION de I-EXPLORATION Hodge I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION borónico, I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION estándares I-EXPLORATION CLSI. I-EXPLORATION Se I-EXPLORATION obtuvo I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION ambos I-EXPLORATION test I-EXPLORATION fenotípicos I-EXPLORATION confirmándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION blaKPC I-EXPLORATION (grupo I-EXPLORATION KPC-2/ I-EXPLORATION KPC-3), I-EXPLORATION blaTEM I-EXPLORATION y I-EXPLORATION bla I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION β-lactamasas I-EXPLORATION tipo I-EXPLORATION CTX-M, I-EXPLORATION β-lactamasas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION AmpC, I-EXPLORATION metalo-β-lactamasas I-EXPLORATION (blaIMI I-EXPLORATION blaVIM I-EXPLORATION blaNDM-1), I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION las I-EXPLORATION car I-EXPLORATION bapenemasas I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION A I-EXPLORATION (blaGES I-EXPLORATION blaIMI I-EXPLORATION blaSME). I-EXPLORATION I-EXPLORATION Finalmente, I-EXPLORATION el I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública, I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION hallazgo I-EXPLORATION de I-EXPLORATION KPC I-EXPLORATION (KPC-2/KPC-3) I-EXPLORATION el I-EXPLORATION día I-EXPLORATION 13 I-EXPLORATION de I-EXPLORATION marzo. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS corporal, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY parálisis I-PAST_MEDICAL_HISTORY cerebral I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY asfixia I-PAST_MEDICAL_HISTORY neonatal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY epilepsia, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY prolongado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY valproico I-PAST_MEDICAL_HISTORY oral, I-PAST_MEDICAL_HISTORY 32 I-PAST_MEDICAL_HISTORY mg/kg/día I-PAST_MEDICAL_HISTORY administrados I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sonda I-PAST_MEDICAL_HISTORY nasogástrica I-PAST_MEDICAL_HISTORY (SNG). I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS UPC I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS neumonía I-PRESENT_ILLNESS por I-PRESENT_ILLNESS adenovirus, I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS grave I-PRESENT_ILLNESS y I-PRESENT_ILLNESS shock I-PRESENT_ILLNESS séptico-hipovolémico I-PRESENT_ILLNESS refractario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS catecolaminas, I-PRESENT_ILLNESS recibiendo B-TREATMENT hidrocortisona I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT estrés I-TREATMENT y I-TREATMENT asociándose I-TREATMENT terapia I-TREATMENT antimicrobiana I-TREATMENT con I-TREATMENT cefotaxima, I-TREATMENT clindamicina I-TREATMENT y I-TREATMENT amikacina I-TREATMENT iv. I-TREATMENT El B-EVOLUTION octavo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION se I-EVOLUTION tomó I-EVOLUTION un I-EVOLUTION nivel I-EVOLUTION plasmático I-EVOLUTION de I-EVOLUTION ácido I-EVOLUTION valproico, I-EVOLUTION el I-EVOLUTION que I-EVOLUTION resultó I-EVOLUTION en I-EVOLUTION 90, I-EVOLUTION 1 I-EVOLUTION μg/ml. I-EVOLUTION El I-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION deterioro I-EVOLUTION hemodinámico I-EVOLUTION y I-EVOLUTION respiratorio, I-EVOLUTION con I-EVOLUTION cultivo I-EVOLUTION de I-EVOLUTION aspirado I-EVOLUTION traqueal I-EVOLUTION para I-EVOLUTION Pseudomonas I-EVOLUTION aeruginosa, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT cambió I-TREATMENT esquema I-TREATMENT antimicrobiano I-TREATMENT a I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT meropenem I-TREATMENT (120 I-TREATMENT mg/kg/día), I-TREATMENT manteniendo I-TREATMENT amikacina. I-TREATMENT Tras B-EXPLORATION cinco I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION meropenem I-EXPLORATION se I-EXPLORATION monitorizó I-EXPLORATION el I-EXPLORATION ácido I-EXPLORATION valproico, I-EXPLORATION encontrándose I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION plasmático I-EXPLORATION < I-EXPLORATION 3 I-EXPLORATION μg/ I-EXPLORATION ml. I-EXPLORATION Por B-TREATMENT estrategia I-TREATMENT de I-TREATMENT de-escalamiento I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT carbapenémico. I-TREATMENT El B-EVOLUTION ácido I-EVOLUTION valproico I-EVOLUTION se I-EVOLUTION aumentó I-EVOLUTION a I-EVOLUTION 45 I-EVOLUTION mg/kg/día, I-EVOLUTION controlándose I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION nivel I-EVOLUTION plasmático I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION de I-EVOLUTION meropenem, I-EVOLUTION cuyo I-EVOLUTION resultado I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 55 I-EVOLUTION μg/ml. I-EVOLUTION Catorce I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION de I-EVOLUTION mero-penem I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION nuevo I-EVOLUTION deterioro I-EVOLUTION hemodinámico I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION una I-EVOLUTION sepsis I-EVOLUTION por I-EVOLUTION Enterobacter I-EVOLUTION cloacae I-EVOLUTION identificada I-EVOLUTION en I-EVOLUTION hemocultivos I-EVOLUTION y I-EVOLUTION secreción I-EVOLUTION traqueal, I-EVOLUTION reiniciándose B-TREATMENT nuevamente I-TREATMENT el I-TREATMENT carbapenémico I-TREATMENT a I-TREATMENT igual I-TREATMENT dosis I-TREATMENT que I-TREATMENT la I-TREATMENT vez I-TREATMENT anterior, I-TREATMENT provocando B-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION caída I-EVOLUTION de I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION plasmáticos I-EVOLUTION de I-EVOLUTION ácido I-EVOLUTION valproico I-EVOLUTION a I-EVOLUTION < I-EVOLUTION 3 I-EVOLUTION μg/ml, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION de I-EVOLUTION reiniciado. I-EVOLUTION Se B-TREATMENT mantuvo I-TREATMENT con I-TREATMENT igual I-TREATMENT dosis I-TREATMENT de I-TREATMENT valproato. I-TREATMENT Transcurridos B-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION terapia I-EVOLUTION carbapenémica I-EVOLUTION falleció I-EVOLUTION por I-EVOLUTION falla I-EVOLUTION hipoxémica I-EVOLUTION refractaria. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY crónico, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hemitórax I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuanti-ficada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS sensible I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS al I-PRESENT_ILLNESS músculo I-PRESENT_ILLNESS pectoral I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS La B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION opacidad I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION perihiliar I-EXPLORATION izquierda. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 3 I-EXPLORATION por I-EXPLORATION 5, I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION pulmonar I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION (flecha I-EXPLORATION larga I-EXPLORATION Figura I-EXPLORATION 1B) I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION extenso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION torácica I-EXPLORATION anterior, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION invasión I-EXPLORATION ni I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION bronquio-vasculares I-EXPLORATION centrales, I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION neoplásica I-EXPLORATION broncogénica I-EXPLORATION periférica I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION adenopatías I-EXPLORATION hiliares I-EXPLORATION y I-EXPLORATION mediastínicas I-EXPLORATION ipsilaterales I-EXPLORATION (flecha I-EXPLORATION corta I-EXPLORATION Figura I-EXPLORATION 1B). I-EXPLORATION Con I-EXPLORATION estos I-EXPLORATION hallazgos, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION fibrobroncoscopia I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION carina, I-EXPLORATION língula I-EXPLORATION y I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION intraluminales. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION tres I-EXPLORATION muestras I-EXPLORATION transbronquiales I-EXPLORATION cuya I-EXPLORATION biopsia I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION una I-EXPLORATION bronquitis I-EXPLORATION crónica I-EXPLORATION inespecífica I-EXPLORATION con I-EXPLORATION metaplasia I-EXPLORATION escamosa I-EXPLORATION incompleta. I-EXPLORATION Fue B-EVOLUTION internado I-EVOLUTION para I-EVOLUTION completar I-EVOLUTION su I-EVOLUTION estudio I-EVOLUTION evolucionando I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION persistente I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION la I-EVOLUTION masa I-EVOLUTION tumoral, I-EVOLUTION sin I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION con I-EVOLUTION hemodinamia I-EVOLUTION estable. I-EVOLUTION Dentro B-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION (hemoglobina I-EXPLORATION 9, I-EXPLORATION 5 I-EXPLORATION g/dl), I-EXPLORATION trombocitosis I-EXPLORATION (776.000 I-EXPLORATION /mm3) I-EXPLORATION y I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda I-EXPLORATION (42.600/ I-EXPLORATION mm3 I-EXPLORATION con I-EXPLORATION 37% I-EXPLORATION de I-EXPLORATION baciliformes). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION mielograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hiperplasia I-EXPLORATION mieloide I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION médula I-EXPLORATION reactiva I-EXPLORATION sin I-EXPLORATION constituir I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION hematológica. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION percutánea I-EXPLORATION por I-EXPLORATION radiología I-EXPLORATION intervencional I-EXPLORATION que I-EXPLORATION dio I-EXPLORATION salida I-EXPLORATION a I-EXPLORATION contenido I-EXPLORATION purulento, I-EXPLORATION cuyo I-EXPLORATION cultivo I-EXPLORATION bacteriano I-EXPLORATION aeróbico I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Por B-TREATMENT sospecha I-TREATMENT de I-TREATMENT tumor I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT costal I-TREATMENT abscedado, I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT drenaje I-TREATMENT quirúrgico I-TREATMENT del I-TREATMENT absceso, I-TREATMENT aseo I-TREATMENT y I-TREATMENT desbridamiento I-TREATMENT del I-TREATMENT tejido I-TREATMENT desvitalizado. I-TREATMENT Se I-TREATMENT tomó I-TREATMENT una I-TREATMENT muestra I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT torácica I-TREATMENT para I-TREATMENT biopsia I-TREATMENT y I-TREATMENT se I-TREATMENT instaló I-TREATMENT un I-TREATMENT sistema I-TREATMENT aspirativo I-TREATMENT para I-TREATMENT cierre I-TREATMENT de I-TREATMENT la I-TREATMENT herida. I-TREATMENT I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION una I-EXPLORATION actinomicosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION torácica, I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION piel, I-EXPLORATION tejido I-EXPLORATION subcutáneo, I-EXPLORATION músculo I-EXPLORATION pectoral I-EXPLORATION y I-EXPLORATION porción I-EXPLORATION perióstica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION costilla, I-EXPLORATION sin I-EXPLORATION elementos I-EXPLORATION histológicos I-EXPLORATION malignos. I-EXPLORATION Fue B-TREATMENT evaluado I-TREATMENT por I-TREATMENT el I-TREATMENT equipo I-TREATMENT de I-TREATMENT infectología I-TREATMENT decidiéndose I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT penicilina I-TREATMENT G I-TREATMENT sódica I-TREATMENT i.v. I-TREATMENT durante I-TREATMENT 2 I-TREATMENT semanas. I-TREATMENT Evolucionó B-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION con I-EVOLUTION regresión I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios I-EVOLUTION y I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION débito I-EVOLUTION de I-EVOLUTION los I-EVOLUTION drenajes. I-EVOLUTION A B-TREATMENT las I-TREATMENT tres I-TREATMENT semanas I-TREATMENT postoperatorias I-TREATMENT se I-TREATMENT realizó I-TREATMENT el I-TREATMENT último I-TREATMENT aseo I-TREATMENT quirúrgico I-TREATMENT y I-TREATMENT cierre I-TREATMENT definitivo I-TREATMENT de I-TREATMENT la I-TREATMENT herida. I-TREATMENT I-TREATMENT Se B-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION amoxicilina I-EVOLUTION hasta I-EVOLUTION completar I-EVOLUTION tres I-EVOLUTION meses. I-EVOLUTION Se I-EVOLUTION mantuvo I-EVOLUTION en I-EVOLUTION controles I-EVOLUTION ambulatorios, I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION de I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION con I-EVOLUTION control I-EVOLUTION radiológico I-EVOLUTION a I-EVOLUTION los I-EVOLUTION siete I-EVOLUTION meses I-EVOLUTION postoperatorios I-EVOLUTION que I-EVOLUTION mostró I-EVOLUTION regresión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión. I-EVOLUTION I-EVOLUTION RNT B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS gestación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS semanas, I-PRESENT_ILLNESS AEG, I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nacimiento I-PRESENT_ILLNESS 3.510 I-PRESENT_ILLNESS gr I-PRESENT_ILLNESS y I-PRESENT_ILLNESS talla I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS Apgar B-PAST_MEDICAL_HISTORY 9-10, I-PAST_MEDICAL_HISTORY segunda I-PAST_MEDICAL_HISTORY hija I-PAST_MEDICAL_HISTORY de B-FAMILY_HISTORY padres I-FAMILY_HISTORY sanos. I-FAMILY_HISTORY Nació B-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY electiva I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY anterior. I-PAST_MEDICAL_HISTORY La B-FAMILY_HISTORY madre I-FAMILY_HISTORY tenía I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY un I-FAMILY_HISTORY embarazo I-FAMILY_HISTORY fisiológico, I-FAMILY_HISTORY una I-FAMILY_HISTORY infección I-FAMILY_HISTORY urinaria I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY primer I-FAMILY_HISTORY trimestre I-FAMILY_HISTORY de I-FAMILY_HISTORY gestación I-FAMILY_HISTORY y I-FAMILY_HISTORY detección I-FAMILY_HISTORY de I-FAMILY_HISTORY portación I-FAMILY_HISTORY recto-vaginal I-FAMILY_HISTORY de I-FAMILY_HISTORY Streptococcus I-FAMILY_HISTORY agalactiae I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY tercer I-FAMILY_HISTORY trimestre I-FAMILY_HISTORY del I-FAMILY_HISTORY embarazo. I-FAMILY_HISTORY I-FAMILY_HISTORY Inició B-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida, I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS mioclónicos I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hemicuerpo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS estando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS vigilia; I-PRESENT_ILLNESS la I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS la I-PRESENT_ILLNESS notó I-PRESENT_ILLNESS somnolienta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS demanda I-PRESENT_ILLNESS por I-PRESENT_ILLNESS alimentos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS llevada I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS (SU) I-PRESENT_ILLNESS para I-PRESENT_ILLNESS su I-PRESENT_ILLNESS evaluación. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION estaba I-EXPLORATION febril, I-EXPLORATION en I-EXPLORATION relativas I-EXPLORATION buenas I-EXPLORATION condiciones I-EXPLORATION generales, I-EXPLORATION sin I-EXPLORATION movimientos I-EXPLORATION anormales, I-EXPLORATION fontanela I-EXPLORATION con I-EXPLORATION tensión I-EXPLORATION normal, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas I-EXPLORATION y I-EXPLORATION su I-EXPLORATION examen I-EXPLORATION segmentario I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Signos I-EXPLORATION vitales: I-EXPLORATION FC I-EXPLORATION 177 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION FR I-EXPLORATION 52 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION T° I-EXPLORATION 38, I-EXPLORATION 3° I-EXPLORATION C I-EXPLORATION axilar, I-EXPLORATION P. I-EXPLORATION arterial I-EXPLORATION 91/55 I-EXPLORATION mm/Hg, I-EXPLORATION P. I-EXPLORATION arterial I-EXPLORATION media I-EXPLORATION 62 I-EXPLORATION mm/Hg, I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION O2 I-EXPLORATION 97%. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION iniciales: I-EXPLORATION leucocitos I-EXPLORATION 6.800/mm3 I-EXPLORATION (52% I-EXPLORATION linfocitos), I-EXPLORATION hematocrito I-EXPLORATION 40, I-EXPLORATION 7%, I-EXPLORATION PCR: I-EXPLORATION 0 I-EXPLORATION mg/L, I-EXPLORATION perfil I-EXPLORATION bioquímico I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION hiperbilirrubinemia I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION indirecto. I-EXPLORATION Examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION normales. I-EXPLORATION Durante B-EVOLUTION la I-EVOLUTION observación I-EVOLUTION en I-EVOLUTION el I-EVOLUTION SU I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION respiración I-EVOLUTION irregular, I-EVOLUTION piel I-EVOLUTION reticulada I-EVOLUTION y I-EVOLUTION movimientos I-EVOLUTION mioclónicos I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hemicuerpo I-EVOLUTION derecho I-EVOLUTION que I-EVOLUTION no I-EVOLUTION cedían I-EVOLUTION a I-EVOLUTION la I-EVOLUTION contención. I-EVOLUTION Por B-TREATMENT su I-TREATMENT condición I-TREATMENT clínica I-TREATMENT se I-TREATMENT le I-TREATMENT indicó I-TREATMENT apoyo I-TREATMENT con I-TREATMENT oxígeno, I-TREATMENT solución I-TREATMENT salina I-TREATMENT isotónica I-TREATMENT (NaCl I-TREATMENT 9%) I-TREATMENT 20 I-TREATMENT ml/kg I-TREATMENT en I-TREATMENT bolo, I-TREATMENT lorazepam I-TREATMENT 0. I-TREATMENT 1 I-TREATMENT mg/kg I-TREATMENT i.v., I-TREATMENT iniciándose I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT empírico I-TREATMENT con I-TREATMENT ampicilina I-TREATMENT + I-TREATMENT cefotaxima I-TREATMENT i.v. I-TREATMENT luego I-TREATMENT de I-TREATMENT obtener I-TREATMENT hemocultivos I-TREATMENT y I-TREATMENT las I-TREATMENT muestras I-TREATMENT de I-TREATMENT LCR. I-TREATMENT El B-EXPLORATION análisis I-EXPLORATION citoquímico I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION directa I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION bacterias I-EXPLORATION (muestra I-EXPLORATION 1, I-EXPLORATION Tabla I-EXPLORATION 1). I-EXPLORATION Un I-EXPLORATION ml I-EXPLORATION adicional I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION se I-EXPLORATION guardó I-EXPLORATION a I-EXPLORATION 4°C I-EXPLORATION para I-EXPLORATION estudios I-EXPLORATION posteriores I-EXPLORATION de I-EXPLORATION biología I-EXPLORATION molecular. I-EXPLORATION I-EXPLORATION Se B-DERIVED_FROM/TO trasladó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cuidados I-DERIVED_FROM/TO Intensivos I-DERIVED_FROM/TO Neonatales I-DERIVED_FROM/TO para I-DERIVED_FROM/TO su I-DERIVED_FROM/TO monitorización. I-DERIVED_FROM/TO A B-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION internación, I-EVOLUTION nuevamente I-EVOLUTION presentó I-EVOLUTION fiebre, I-EVOLUTION hiporreactividad, I-EVOLUTION y I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION fijación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mirada I-EVOLUTION con I-EVOLUTION repetición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION crisis I-EVOLUTION convulsiva I-EVOLUTION focal. I-EVOLUTION Se B-EXPLORATION plantearon I-EXPLORATION como I-EXPLORATION posibles I-EXPLORATION diagnósticos I-EXPLORATION una I-EXPLORATION meningitis I-EXPLORATION bacteriana I-EXPLORATION aguda I-EXPLORATION inicial I-EXPLORATION o I-EXPLORATION una I-EXPLORATION encefalitis I-EXPLORATION herpética I-EXPLORATION por I-EXPLORATION los I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION repetir I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION y B-TREATMENT adicionar I-TREATMENT a I-TREATMENT la I-TREATMENT terapia I-TREATMENT antimicrobiana, I-TREATMENT aciclovir I-TREATMENT i.v. I-TREATMENT 60 I-TREATMENT mg/kg/día I-TREATMENT fraccionado I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h. I-TREATMENT En B-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION citoquímico I-EXPLORATION del I-EXPLORATION segundo I-EXPLORATION LCR I-EXPLORATION destacó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION 190 I-EXPLORATION leucocitos/mm3 I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION mononuclear I-EXPLORATION (79%), I-EXPLORATION 170 I-EXPLORATION eritrocitos/mm3, I-EXPLORATION glucorraquia I-EXPLORATION y I-EXPLORATION proteínorraquia I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION directa I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION bacterias I-EXPLORATION (muestra I-EXPLORATION 2, I-EXPLORATION Tabla I-EXPLORATION 1). I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION RPC I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION cualitativa I-EXPLORATION para I-EXPLORATION VHS I-EXPLORATION tipos I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION (herpes I-EXPLORATION simplex I-EXPLORATION virus I-EXPLORATION 1/2 I-EXPLORATION Real I-EXPLORATION Time I-EXPLORATION PCR I-EXPLORATION kit, I-EXPLORATION InsideGen® I-EXPLORATION Bioscan, I-EXPLORATION Chile) I-EXPLORATION sin I-EXPLORATION lograrse I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION viral. I-EXPLORATION Pese B-TREATMENT al I-TREATMENT resultado I-TREATMENT negativo I-TREATMENT de I-TREATMENT RPC-TR I-TREATMENT a I-TREATMENT las I-TREATMENT 24 I-TREATMENT h I-TREATMENT de I-TREATMENT iniciado I-TREATMENT el I-TREATMENT cuadro I-TREATMENT clínico, I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT aciclovir I-TREATMENT 1. I-TREATMENT v. I-TREATMENT ya I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT permanecía I-TREATMENT con I-TREATMENT compromiso I-TREATMENT de I-TREATMENT conciencia I-TREATMENT y I-TREATMENT crisis I-TREATMENT focales. I-TREATMENT I-TREATMENT Una B-EXPLORATION TAC I-EXPLORATION cerebral, I-EXPLORATION al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización, I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION electroencefalograma I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION lentitud I-EXPLORATION hipovoltada I-EXPLORATION difusa I-EXPLORATION y I-EXPLORATION ocasionales I-EXPLORATION paroxismos I-EXPLORATION agudos I-EXPLORATION multifocales. I-EXPLORATION Se B-TREATMENT le I-TREATMENT administró I-TREATMENT fenobarbital I-TREATMENT 15 I-TREATMENT mg/ I-TREATMENT kg I-TREATMENT i.v. I-TREATMENT y I-TREATMENT luego I-TREATMENT 5 I-TREATMENT mg/kg/día I-TREATMENT v.o. I-TREATMENT como I-TREATMENT dosis I-TREATMENT de I-TREATMENT mantención. I-TREATMENT Los B-EXPLORATION cultivos I-EXPLORATION bacteriológicos I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION y I-EXPLORATION segundo I-EXPLORATION LCR I-EXPLORATION y I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION del I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION conciencia, I-EVOLUTION posturas I-EVOLUTION anormales I-EVOLUTION en I-EVOLUTION reposo, I-EVOLUTION crisis I-EVOLUTION clónicas I-EVOLUTION multifocales I-EVOLUTION múltiples I-EVOLUTION y B-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION alta I-EXPLORATION sospecha I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION encefalitis I-EXPLORATION herpética, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION tercera I-EXPLORATION RPC-TR I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION para I-EXPLORATION VHS I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION iniciado I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 24 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION comenzar I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION aciclovir, I-EXPLORATION la I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION VHS I-EXPLORATION 1 I-EXPLORATION (muestra I-EXPLORATION 3, I-EXPLORATION Tabla I-EXPLORATION 1). I-EXPLORATION I-EXPLORATION Las I-EXPLORATION funciones I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION renal I-EXPLORATION fueron I-EXPLORATION normales, I-EXPLORATION al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION oftalmológica. I-EXPLORATION Las B-EVOLUTION manifestaciones I-EVOLUTION convulsivas I-EVOLUTION persistieron I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización. I-EVOLUTION De I-EVOLUTION allí I-EVOLUTION en I-EVOLUTION adelante, I-EVOLUTION se I-EVOLUTION le I-EVOLUTION apreció I-EVOLUTION alerta, I-EVOLUTION con I-EVOLUTION succión I-EVOLUTION vigorosa, I-EVOLUTION sin I-EVOLUTION nuevas I-EVOLUTION crisis, I-EVOLUTION destacando I-EVOLUTION sólo I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION tembloroso I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION superior I-EVOLUTION izquierda. I-EVOLUTION I-EVOLUTION Una B-EXPLORATION RM I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION efectuada I-EXPLORATION al I-EXPLORATION día I-EXPLORATION 10 I-EXPLORATION de I-EXPLORATION internación I-EXPLORATION evidenció I-EXPLORATION lesiones I-EXPLORATION hiperintensas I-EXPLORATION subcorticales I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION peri-rolándica I-EXPLORATION bilateral, I-EXPLORATION frontomedial I-EXPLORATION e I-EXPLORATION insular I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION impregnación I-EXPLORATION leptomeníngea I-EXPLORATION focal, I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION una I-EXPLORATION meningo-encefalitis. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION obtener I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION RPC-TR I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION VHS I-EXPLORATION 1, I-EXPLORATION se I-EXPLORATION reinterrogó I-EXPLORATION a I-EXPLORATION la I-EXPLORATION madre I-EXPLORATION dirigidamente I-EXPLORATION quien I-EXPLORATION relató I-EXPLORATION que I-EXPLORATION el I-EXPLORATION padre I-EXPLORATION habría I-EXPLORATION presentado I-EXPLORATION una I-EXPLORATION erupción I-EXPLORATION labial I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION herpes I-EXPLORATION labial I-EXPLORATION dos I-EXPLORATION semanas I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION enfermar I-EXPLORATION la I-EXPLORATION niña I-EXPLORATION y I-EXPLORATION tenía I-EXPLORATION recurrencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 20 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION antiviral I-EXPLORATION se I-EXPLORATION controló I-EXPLORATION el I-EXPLORATION LCR I-EXPLORATION certificándose I-EXPLORATION la I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION RPC-TR I-EXPLORATION para I-EXPLORATION VHS I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION en I-EXPLORATION LCR. I-EXPLORATION Completó B-TREATMENT 21 I-TREATMENT días I-TREATMENT con I-TREATMENT aciclovir, I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT I-TREATMENT Desde B-EVOLUTION su I-EVOLUTION alta, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION controló I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION sistemática I-EVOLUTION en I-EVOLUTION las I-EVOLUTION Policlínicas I-EVOLUTION de I-EVOLUTION Infectología I-EVOLUTION y I-EVOLUTION Neurología I-EVOLUTION infantil. I-EVOLUTION En I-EVOLUTION nuestra I-EVOLUTION última I-EVOLUTION evaluación, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION una I-EVOLUTION lactante I-EVOLUTION eutrófica I-EVOLUTION con I-EVOLUTION un I-EVOLUTION significativo I-EVOLUTION retraso I-EVOLUTION del I-EVOLUTION desarrollo I-EVOLUTION psicomotor. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano, I-PAST_MEDICAL_HISTORY originario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Concepción I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY radicado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY AAntofagasta I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año. I-PAST_MEDICAL_HISTORY Fue B-PRESENT_ILLNESS internado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS privado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS alta, I-PRESENT_ILLNESS mialgias, I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS alimentarios. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY viajado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Región I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Bío-Bío I-PAST_MEDICAL_HISTORY (zona I-PAST_MEDICAL_HISTORY urbana I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Concepción) I-PAST_MEDICAL_HISTORY 36 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY tenido I-PAST_MEDICAL_HISTORY contacto I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY amigo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY cursando I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY diarreico. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION presentaba I-EXPLORATION escasas I-EXPLORATION crepitaciones I-EXPLORATION a I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION había I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION consolidación. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION 28.400 I-EXPLORATION leucocitos/mm3 I-EXPLORATION y I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda I-EXPLORATION (63% I-EXPLORATION segmentados I-EXPLORATION y I-EXPLORATION 17% I-EXPLORATION baciliformes), I-EXPLORATION 35.000 I-EXPLORATION plaquetas/mm3, I-EXPLORATION PCR I-EXPLORATION 7, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION (N I-EXPLORATION = I-EXPLORATION 0-1), I-EXPLORATION LDH I-EXPLORATION y I-EXPLORATION transaminasas I-EXPLORATION elevadas. I-EXPLORATION Al B-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION presentó I-EVOLUTION disnea, I-EVOLUTION polipnea I-EVOLUTION e I-EVOLUTION hipoxemia. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION opacidades I-EXPLORATION pulmonares I-EXPLORATION bilaterales. I-EXPLORATION Se B-DERIVED_FROM/TO trasladó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cuidados I-DERIVED_FROM/TO Intensivos I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO conectó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO ventilación I-DERIVED_FROM/TO mecánica. I-DERIVED_FROM/TO Evolucionó B-EVOLUTION rápidamente I-EVOLUTION con I-EVOLUTION un I-EVOLUTION SDRA I-EVOLUTION y I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION disfunción I-EVOLUTION multiorgánica. I-EVOLUTION Se B-TREATMENT manejó I-TREATMENT con I-TREATMENT corticoesteroides I-TREATMENT i.v., I-TREATMENT aminas I-TREATMENT vasoactivas, I-TREATMENT antimicrobianos I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro I-TREATMENT y I-TREATMENT oseltamivir I-TREATMENT empíricos. I-TREATMENT La B-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION y I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION influenza I-EXPLORATION A I-EXPLORATION H1N1, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION hantavirus I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública. I-EXPLORATION Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION falleció I-EVOLUTION por I-EVOLUTION hipotensión I-EVOLUTION arterial I-EVOLUTION refractaria, I-EVOLUTION oligoanuria, I-EVOLUTION hipoxemia I-EVOLUTION y I-EVOLUTION acidosis I-EVOLUTION metabólica I-EVOLUTION grave. I-EVOLUTION Postmortem B-EXPLORATION se I-EXPLORATION informó I-EXPLORATION una I-EXPLORATION serología I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION hantavirus I-EXPLORATION (IgM I-EXPLORATION e I-EXPLORATION IgG) I-EXPLORATION 10. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY adquirida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY transmisión I-PAST_MEDICAL_HISTORY vertical, I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS cutáneas I-PRESENT_ILLNESS maculares I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS necrótico. I-PRESENT_ILLNESS Posteriormente, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS agregó I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefaleas I-PRESENT_ILLNESS intensas I-PRESENT_ILLNESS asociadas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS internado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS probable I-PRESENT_ILLNESS de I-PRESENT_ILLNESS meningitis. I-PRESENT_ILLNESS Dentro B-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION céfalo-raquídeo I-EXPLORATION (LCR) I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION tinta I-EXPLORATION china I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION hubo I-EXPLORATION aislamiento I-EXPLORATION de I-EXPLORATION Cryptococcus I-EXPLORATION neoformans. I-EXPLORATION En I-EXPLORATION ese I-EXPLORATION momento, I-EXPLORATION tenía I-EXPLORATION linfocitos I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 158 I-EXPLORATION céls/mm3 I-EXPLORATION (9%). I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT deoxicolato I-TREATMENT i.v I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT fluconazol I-TREATMENT por I-TREATMENT vía I-TREATMENT oral I-TREATMENT con I-TREATMENT buena I-TREATMENT evolución. I-TREATMENT Se I-TREATMENT mantuvo I-TREATMENT hospitalizado I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT antifúngico I-TREATMENT durante I-TREATMENT 42 I-TREATMENT días. I-TREATMENT Tres I-TREATMENT meses I-TREATMENT después I-TREATMENT se I-TREATMENT inició I-TREATMENT monoterapia I-TREATMENT con I-TREATMENT zidovudina I-TREATMENT (AZT), I-TREATMENT que I-TREATMENT luego I-TREATMENT de I-TREATMENT 8 I-TREATMENT meses I-TREATMENT se I-TREATMENT cambió I-TREATMENT a I-TREATMENT didanosina I-TREATMENT (ddI). I-TREATMENT Posteriormente, I-TREATMENT recibió I-TREATMENT biterapia I-TREATMENT con I-TREATMENT ddI I-TREATMENT y I-TREATMENT ritonavir. I-TREATMENT Falleció B-EVOLUTION a I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION edad. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS por I-PRESENT_ILLNESS VIH I-PRESENT_ILLNESS por I-PRESENT_ILLNESS transmisión I-PRESENT_ILLNESS vertical, I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mala I-PAST_MEDICAL_HISTORY adherencia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY regímenes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY propuestos, I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY rechazado I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY TAR. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY internado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY enfermedades I-PAST_MEDICAL_HISTORY intercurrentes I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY microorganismos I-PAST_MEDICAL_HISTORY habituales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY oportunistas. I-PAST_MEDICAL_HISTORY Fue B-PRESENT_ILLNESS internado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS acompañados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5° I-PRESENT_ILLNESS C I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS exantema I-PRESENT_ILLNESS máculo-papular I-PRESENT_ILLNESS generalizado. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION además I-EXPLORATION del I-EXPLORATION exantema, I-EXPLORATION una I-EXPLORATION desnutrición I-EXPLORATION secundaria, I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION adenopatías I-EXPLORATION cervicales, I-EXPLORATION estertores I-EXPLORATION húmedos I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION campos I-EXPLORATION pulmonares, I-EXPLORATION caries I-EXPLORATION dentales I-EXPLORATION y I-EXPLORATION otorrea I-EXPLORATION purulenta I-EXPLORATION a I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION ese I-EXPLORATION momento I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION (CV) I-EXPLORATION de I-EXPLORATION 95.000 I-EXPLORATION copias/ml I-EXPLORATION y I-EXPLORATION linfocitos I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 26 I-EXPLORATION céls/mm3. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT antibioterapia, I-TREATMENT sin B-EVOLUTION embargo, I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION persistía I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION a I-EVOLUTION la I-EVOLUTION que I-EVOLUTION se I-EVOLUTION agregó I-EVOLUTION cefalea I-EVOLUTION intensa, I-EVOLUTION vómitos, I-EVOLUTION fotofobia I-EVOLUTION y I-EVOLUTION acusofobia. I-EVOLUTION I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal; I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION citoquímico I-EXPLORATION de I-EXPLORATION LCR: I-EXPLORATION glucosa I-EXPLORATION 0, I-EXPLORATION 43 I-EXPLORATION g/l, I-EXPLORATION proteínas I-EXPLORATION 1, I-EXPLORATION 15 I-EXPLORATION gr/l, I-EXPLORATION celularidad: I-EXPLORATION 5 I-EXPLORATION leucocitos/mm3; I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION microbio-lógico I-EXPLORATION directo I-EXPLORATION (tinta I-EXPLORATION china) I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION C. I-EXPLORATION neoformans. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT deoxicolato I-TREATMENT i.v. I-TREATMENT durante I-TREATMENT 21 I-TREATMENT días I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT fluconazol I-TREATMENT por I-TREATMENT vía I-TREATMENT oral I-TREATMENT en I-TREATMENT plan I-TREATMENT de I-TREATMENT mantención. I-TREATMENT Hubo B-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 21 I-EXPLORATION días I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION con I-EXPLORATION cultivo I-EXPLORATION negativo. I-EXPLORATION Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 33 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION ya I-EVOLUTION evidenciaba I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION y I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general. I-EVOLUTION El B-EXPLORATION test I-EXPLORATION de I-EXPLORATION genotipificación I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION mutaciones I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION resistencia I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT AZT, I-TREATMENT lamivudina I-TREATMENT (3TC) I-TREATMENT y I-TREATMENT lopinavir/ritonavir. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuantificada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS odinofagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS confirmándose I-PRESENT_ILLNESS una I-PRESENT_ILLNESS candidiasis I-PRESENT_ILLNESS orofaríngea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS esofágica I-PRESENT_ILLNESS por I-PRESENT_ILLNESS endoscopia. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS recibió I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS específico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS procedió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS investigar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS posible I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS por I-PRESENT_ILLNESS VIH, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS que I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS confirmó. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION enflaquecimiento I-EXPLORATION marcado I-EXPLORATION y I-EXPLORATION lesiones I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION candidiasis I-EXPLORATION orofaríngea. I-EXPLORATION Se I-EXPLORATION encontraba I-EXPLORATION afebril, I-EXPLORATION eupneico, I-EXPLORATION con I-EXPLORATION examen I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Inició B-TREATMENT profilaxis I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT 960 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT ácido I-TREATMENT folínico I-TREATMENT 15 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT fluconazol I-TREATMENT 150 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT terapia I-TREATMENT anti-retroviral I-TREATMENT (TAR) I-TREATMENT con I-TREATMENT abacavir/lamivudina I-TREATMENT y I-TREATMENT efavirenz, I-TREATMENT con I-TREATMENT muy I-TREATMENT buena I-TREATMENT tolerancia I-TREATMENT y I-TREATMENT adherencia. I-TREATMENT Dos B-EVOLUTION semanas I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION de I-EVOLUTION fiebre I-EVOLUTION hasta I-EVOLUTION 39°C, I-EVOLUTION cefalea I-EVOLUTION y I-EVOLUTION tos I-EVOLUTION seca. I-EVOLUTION Se I-EVOLUTION decidió I-EVOLUTION su I-EVOLUTION internación I-EVOLUTION por I-EVOLUTION fiebre I-EVOLUTION de I-EVOLUTION 39°C, I-EVOLUTION taquicardia I-EVOLUTION y I-EVOLUTION saturación I-EVOLUTION de I-EVOLUTION oxígeno I-EVOLUTION de I-EVOLUTION 93% I-EVOLUTION con I-EVOLUTION aire I-EVOLUTION ambiental. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION había I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION candidiasis I-EXPLORATION oral I-EXPLORATION y I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION pulmonar I-EXPLORATION en I-EXPLORATION esos I-EXPLORATION momentos I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION algodonoso I-EXPLORATION difuso I-EXPLORATION bilateral. I-EXPLORATION Los I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION expectoración, I-EXPLORATION urocultivo, I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION baciloscopias I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION La I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION Pneumocystis I-EXPLORATION jiroveci I-EXPLORATION en I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION expectoración I-EXPLORATION inducida I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION Se B-TREATMENT ajustó I-TREATMENT el I-TREATMENT cotrimoxazol I-TREATMENT de I-TREATMENT dosis I-TREATMENT profiláctica I-TREATMENT a I-TREATMENT terapéutica I-TREATMENT por I-TREATMENT vía I-TREATMENT iv, I-TREATMENT se I-TREATMENT agregó I-TREATMENT prednisona I-TREATMENT y I-TREATMENT ceftriaxona I-TREATMENT iv, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT ácido I-TREATMENT folínico I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT la I-TREATMENT TAR I-TREATMENT iniciada I-TREATMENT recientemente. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION saturación I-EVOLUTION de I-EVOLUTION oxígeno I-EVOLUTION adecuada I-EVOLUTION y I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios. I-EVOLUTION Se B-TREATMENT dio I-TREATMENT el I-TREATMENT alta I-TREATMENT hospitalaria I-TREATMENT al I-TREATMENT quinto I-TREATMENT día I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT oral I-TREATMENT y I-TREATMENT prednisona I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 21 I-TREATMENT días. I-TREATMENT En B-EVOLUTION el I-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION estaba I-EVOLUTION completamente I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION la I-EVOLUTION radiografía I-EVOLUTION mostró I-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION infiltrado I-EVOLUTION pulmonar. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS hospitalario I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS atropello I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tejido. I-PRESENT_ILLNESS Previo B-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO ingreso I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO atendido I-DERIVED_FROM/TO en I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO salud I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realizó I-DERIVED_FROM/TO una I-DERIVED_FROM/TO curación I-DERIVED_FROM/TO amplia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO herida I-DERIVED_FROM/TO y I-DERIVED_FROM/TO hemostasia, I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO cual I-DERIVED_FROM/TO nos I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO para I-DERIVED_FROM/TO resolución I-DERIVED_FROM/TO quirúrgica. I-DERIVED_FROM/TO Ingresó B-EXPLORATION consciente I-EXPLORATION (Glasgow I-EXPLORATION 15), I-EXPLORATION afebril, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION PA I-EXPLORATION de I-EXPLORATION 80/60 I-EXPLORATION mm I-EXPLORATION Hg, I-EXPLORATION FC: I-EXPLORATION 115 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION FR: I-EXPLORATION 21 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION vía I-EXPLORATION aérea I-EXPLORATION permeable, I-EXPLORATION inmovilización I-EXPLORATION cervical I-EXPLORATION y I-EXPLORATION ventilación I-EXPLORATION espontánea. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION izquierda I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION hemorragia I-EXPLORATION activa I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION piel, I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION y I-EXPLORATION músculo I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION inframaleolar I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION punta I-EXPLORATION del I-EXPLORATION pie, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION falanges I-EXPLORATION distales I-EXPLORATION del I-EXPLORATION primer, I-EXPLORATION segundo, I-EXPLORATION tercer I-EXPLORATION y I-EXPLORATION cuarto I-EXPLORATION ortejos, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION clasificado I-EXPLORATION como I-EXPLORATION traumatismo I-EXPLORATION grave I-EXPLORATION Gustilo I-EXPLORATION 3 I-EXPLORATION c. I-EXPLORATION I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT estabilización I-TREATMENT hemodinámica I-TREATMENT con I-TREATMENT aporte I-TREATMENT de I-TREATMENT cristaloides I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT Dentro B-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 20.310/mm3, I-EXPLORATION neutrófilos I-EXPLORATION 86%, I-EXPLORATION baciliformes I-EXPLORATION 2%. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION se I-EXPLORATION constató, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION blando, I-EXPLORATION una I-EXPLORATION fractura I-EXPLORATION del I-EXPLORATION maléolo I-EXPLORATION tibial I-EXPLORATION interno I-EXPLORATION discretamente I-EXPLORATION diastasado. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION angiotomografía I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION calibre I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION tibiales I-EXPLORATION anteriores, I-EXPLORATION con I-EXPLORATION vasoespasmo I-EXPLORATION y I-EXPLORATION compresión I-EXPLORATION por I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos I-EXPLORATION adyacentes I-EXPLORATION sin I-EXPLORATION extravasación I-EXPLORATION del I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT primera I-TREATMENT exploración I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT deforramiento I-TREATMENT total I-TREATMENT del I-TREATMENT pie I-TREATMENT izquierdo I-TREATMENT más I-TREATMENT un I-TREATMENT colgajo I-TREATMENT en I-TREATMENT la I-TREATMENT región I-TREATMENT plantar I-TREATMENT con I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT dispositivo I-TREATMENT para I-TREATMENT el I-TREATMENT cierre I-TREATMENT asistido I-TREATMENT de I-TREATMENT las I-TREATMENT heridas I-TREATMENT por I-TREATMENT presión I-TREATMENT negativa. I-TREATMENT Se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT empírico I-TREATMENT con I-TREATMENT ampicilina/sulbactam I-TREATMENT iv. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION satisfactoria I-EVOLUTION en I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 48 I-EVOLUTION h, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION registro I-EVOLUTION único I-EVOLUTION de I-EVOLUTION temperatura I-EVOLUTION bucal I-EVOLUTION de I-EVOLUTION 37, I-EVOLUTION 5°C I-EVOLUTION post-quirúrgico, I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION atribuido I-EVOLUTION al I-EVOLUTION proceso I-EVOLUTION inflamatorio. I-EVOLUTION Al B-TREATMENT tercer I-TREATMENT día I-TREATMENT de I-TREATMENT hospitalización I-TREATMENT se I-TREATMENT planificó I-TREATMENT realizar I-TREATMENT un I-TREATMENT autoinjerto, I-TREATMENT procedimiento I-TREATMENT que I-TREATMENT fue I-TREATMENT sustituido I-TREATMENT por I-TREATMENT un I-TREATMENT aseo I-TREATMENT quirúrgico I-TREATMENT más I-TREATMENT un I-TREATMENT desbridamiento, I-TREATMENT al I-TREATMENT encontrarse I-TREATMENT en I-TREATMENT la I-TREATMENT cirugía I-TREATMENT escaso I-TREATMENT tejido I-TREATMENT de I-TREATMENT granulación I-TREATMENT con I-TREATMENT secreción I-TREATMENT en I-TREATMENT moderada I-TREATMENT cantidad, I-TREATMENT de I-TREATMENT mal I-TREATMENT olor. I-TREATMENT Luego B-EXPLORATION del I-EXPLORATION procedimiento I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION secreción. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION células I-EXPLORATION escasas, I-EXPLORATION con I-EXPLORATION moderada I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION polimorfonucleares I-EXPLORATION (PMN) I-EXPLORATION y I-EXPLORATION bacilos I-EXPLORATION gramnegativos. I-EXPLORATION A I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION h, I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION evidenció I-EXPLORATION el I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION un I-EXPLORATION bacilo I-EXPLORATION gramnegativo, I-EXPLORATION lactosa I-EXPLORATION negativa. I-EXPLORATION Desde B-EVOLUTION el I-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION internación, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION hasta I-EVOLUTION 3 I-EVOLUTION 8°C I-EVOLUTION bucal, I-EVOLUTION con I-EVOLUTION mala I-EVOLUTION condición I-EVOLUTION del I-EVOLUTION tejido I-EVOLUTION en I-EVOLUTION cicatrización, I-EVOLUTION incremento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION secreción I-EVOLUTION y I-EVOLUTION mal I-EVOLUTION olor. I-EVOLUTION Los B-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 12.800/mm3 I-EXPLORATION y I-EXPLORATION una I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 308 I-EXPLORATION mg/L. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT realizar, I-TREATMENT por I-TREATMENT deterioro I-TREATMENT de I-TREATMENT su I-TREATMENT estado I-TREATMENT clínico I-TREATMENT y I-TREATMENT sospecha I-TREATMENT de I-TREATMENT infección I-TREATMENT en I-TREATMENT el I-TREATMENT sitio I-TREATMENT de I-TREATMENT arrollamiento, I-TREATMENT una I-TREATMENT amputación I-TREATMENT corta I-TREATMENT bajo I-TREATMENT la I-TREATMENT articulación I-TREATMENT de I-TREATMENT la I-TREATMENT rodilla I-TREATMENT del I-TREATMENT miembro I-TREATMENT inferior I-TREATMENT izquierdo I-TREATMENT con I-TREATMENT técnica I-TREATMENT de I-TREATMENT Lisfranc. I-TREATMENT Finalmente, B-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION secreción, I-EXPLORATION al I-EXPLORATION quinto I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización, I-EXPLORATION analizado I-EXPLORATION por I-EXPLORATION métodos I-EXPLORATION automatizados I-EXPLORATION Bact/Alert® I-EXPLORATION 3d I-EXPLORATION 60 I-EXPLORATION (Biomérieux, I-EXPLORATION France) I-EXPLORATION fue I-EXPLORATION informado I-EXPLORATION con I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION Cedecea I-EXPLORATION lapagei I-EXPLORATION susceptible I-EXPLORATION a I-EXPLORATION cefuroxima, I-EXPLORATION amikacina, I-EXPLORATION cotrimoxazol, I-EXPLORATION ciprofloxacina, I-EXPLORATION cefotaxima, I-EXPLORATION carbapenémicos I-EXPLORATION y I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION ampicilina I-EXPLORATION y I-EXPLORATION ampicilina/sulbactam. I-EXPLORATION El I-EXPLORATION aislado I-EXPLORATION fue I-EXPLORATION confirmado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Centro I-EXPLORATION de I-EXPLORATION Referencia I-EXPLORATION (Centro I-EXPLORATION de I-EXPLORATION Microbiología, I-EXPLORATION Hospital I-EXPLORATION Vozandes, I-EXPLORATION Quito). I-EXPLORATION Tres B-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION a I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica I-EVOLUTION y I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION intravenoso I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta; I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION infección I-EVOLUTION y I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY oficio I-PAST_MEDICAL_HISTORY clasificador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY residuos. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY pareja I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY utilizaba I-PAST_MEDICAL_HISTORY métodos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY barrera. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS emergencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS líquidas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS sangre, I-PRESENT_ILLNESS mucus I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS pus; I-PRESENT_ILLNESS acompañadas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Presentaba I-PRESENT_ILLNESS una I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION vigil, I-EXPLORATION afebril, I-EXPLORATION normotenso I-EXPLORATION (120/70), I-EXPLORATION con I-EXPLORATION una I-EXPLORATION FC I-EXPLORATION de I-EXPLORATION 82 I-EXPLORATION por I-EXPLORATION min, I-EXPLORATION pálido I-EXPLORATION y I-EXPLORATION en I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION presentó I-EVOLUTION fiebre I-EVOLUTION de I-EVOLUTION hasta I-EVOLUTION 38, I-EVOLUTION 5° I-EVOLUTION C I-EVOLUTION axilar I-EVOLUTION y I-EVOLUTION heces I-EVOLUTION líquidas I-EVOLUTION con I-EVOLUTION sangre I-EVOLUTION y I-EVOLUTION mucus I-EVOLUTION en I-EVOLUTION varias I-EVOLUTION oportunidades. I-EVOLUTION Fue I-EVOLUTION internado I-EVOLUTION en I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION sala I-EVOLUTION que I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION paciente, I-EVOLUTION con I-EVOLUTION diagnóstico I-EVOLUTION clínico I-EVOLUTION de I-EVOLUTION diarrea I-EVOLUTION en I-EVOLUTION paciente I-EVOLUTION con I-EVOLUTION probable I-EVOLUTION infección I-EVOLUTION por I-EVOLUTION VIH. I-EVOLUTION I-EVOLUTION De B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaban: I-EXPLORATION hemoglobina I-EXPLORATION 9, I-EXPLORATION 8 I-EXPLORATION g/dl; I-EXPLORATION hematocrito: I-EXPLORATION 28, I-EXPLORATION 3%; I-EXPLORATION VCM I-EXPLORATION 77, I-EXPLORATION 2 I-EXPLORATION fl I-EXPLORATION y I-EXPLORATION HCM I-EXPLORATION 24, I-EXPLORATION 9 I-EXPLORATION pg; I-EXPLORATION leucocitos: I-EXPLORATION 5.500/mm3; I-EXPLORATION linfocitos: I-EXPLORATION 750/ I-EXPLORATION mm3 I-EXPLORATION (17,1%); I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION CD4 I-EXPLORATION 150 I-EXPLORATION céls/ I-EXPLORATION mm3; I-EXPLORATION VHS: I-EXPLORATION 69 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION 1° I-EXPLORATION hora. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION directo I-EXPLORATION de I-EXPLORATION deposiciones I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION abundantes I-EXPLORATION PMN I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION coprocultivo I-EXPLORATION se I-EXPLORATION desarrolló I-EXPLORATION Shigella I-EXPLORATION sp. I-EXPLORATION así I-EXPLORATION como I-EXPLORATION en I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION hemocultivos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION fue I-EXPLORATION reactiva I-EXPLORATION y I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Western I-EXPLORATION blot I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Referencia I-EXPLORATION Nacional. I-EXPLORATION I-EXPLORATION Estudios I-EXPLORATION bacteriológicos I-EXPLORATION I-EXPLORATION Las I-EXPLORATION cepas I-EXPLORATION se I-EXPLORATION enviaron I-EXPLORATION al I-EXPLORATION Departamento I-EXPLORATION de I-EXPLORATION Bacteriología I-EXPLORATION y I-EXPLORATION Virología, I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Higiene, I-EXPLORATION para I-EXPLORATION completar I-EXPLORATION su I-EXPLORATION estudio. I-EXPLORATION La I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION género I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION por I-EXPLORATION métodos I-EXPLORATION fenotípicos I-EXPLORATION convencionales I-EXPLORATION utilizando I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION medios I-EXPLORATION de I-EXPLORATION identificación: I-EXPLORATION triple I-EXPLORATION azúcar I-EXPLORATION hierro I-EXPLORATION (TSI), I-EXPLORATION movilidad-indol-ornitina I-EXPLORATION decarboxilasa I-EXPLORATION (MIO), I-EXPLORATION citrato I-EXPLORATION de I-EXPLORATION Simmons, I-EXPLORATION fenilalanina I-EXPLORATION deaminasa, I-EXPLORATION agar I-EXPLORATION hierro-lisina I-EXPLORATION (LIA), I-EXPLORATION arginina I-EXPLORATION dehidrolasa, I-EXPLORATION utilización I-EXPLORATION de I-EXPLORATION mucato, I-EXPLORATION malonato I-EXPLORATION y I-EXPLORATION fermentación I-EXPLORATION de I-EXPLORATION carbohidratos I-EXPLORATION en I-EXPLORATION caldo I-EXPLORATION con I-EXPLORATION rojo-fenol10. I-EXPLORATION I-EXPLORATION El I-EXPLORATION serogrupo I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cepas I-EXPLORATION de I-EXPLORATION Shigella I-EXPLORATION se I-EXPLORATION determinó I-EXPLORATION por I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION aglutinación I-EXPLORATION en I-EXPLORATION lámina I-EXPLORATION utilizando I-EXPLORATION antisueros I-EXPLORATION policlonales I-EXPLORATION comerciales I-EXPLORATION (BD, I-EXPLORATION Difco I-EXPLORATION TM) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION serotipo I-EXPLORATION con I-EXPLORATION antisueros I-EXPLORATION absorbidos I-EXPLORATION serotipo-específicos. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION susceptibilidad I-EXPLORATION antimicrobiana I-EXPLORATION se I-EXPLORATION utilizó I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION difusión I-EXPLORATION en I-EXPLORATION disco I-EXPLORATION en I-EXPLORATION agar11. I-EXPLORATION Los I-EXPLORATION antibacterianos I-EXPLORATION ensayados I-EXPLORATION fueron: I-EXPLORATION ampicilina, I-EXPLORATION ampicilina/sulbactam, I-EXPLORATION cefradina, I-EXPLORATION cefoxitina, I-EXPLORATION ceftriaxona, I-EXPLORATION ácido I-EXPLORATION nalidíxico, I-EXPLORATION ciprofloxacina, I-EXPLORATION tetraciclina I-EXPLORATION y I-EXPLORATION cotrimoxazol I-EXPLORATION (Oxoid I-EXPLORATION Ltd., I-EXPLORATION Basingstoke, I-EXPLORATION Hampshire, I-EXPLORATION Inglaterra). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION evaluación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad I-EXPLORATION a I-EXPLORATION azitromicina I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION no I-EXPLORATION existen I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION para I-EXPLORATION la I-EXPLORATION interpretación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION por I-EXPLORATION esta I-EXPLORATION técnica I-EXPLORATION para I-EXPLORATION azitromicina I-EXPLORATION en I-EXPLORATION EUCAST I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION CLSI11. I-EXPLORATION I-EXPLORATION La I-EXPLORATION electroforesis I-EXPLORATION en I-EXPLORATION gel I-EXPLORATION en I-EXPLORATION campo I-EXPLORATION pulsado I-EXPLORATION (PFGE) I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuatro I-EXPLORATION aislados I-EXPLORATION de I-EXPLORATION Shigella I-EXPLORATION spp. I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION al I-EXPLORATION procedimiento I-EXPLORATION estándar I-EXPLORATION del I-EXPLORATION CDC12. I-EXPLORATION La I-EXPLORATION interpretación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION patrones I-EXPLORATION de I-EXPLORATION bandas I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION visualmente I-EXPLORATION siguiendo I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION Tenover I-EXPLORATION y I-EXPLORATION cols13. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION cuatro I-EXPLORATION cepas I-EXPLORATION correspondieron I-EXPLORATION a I-EXPLORATION Shigella I-EXPLORATION flexneri I-EXPLORATION del I-EXPLORATION serotipo I-EXPLORATION 6 I-EXPLORATION y I-EXPLORATION presentaron I-EXPLORATION resistencia I-EXPLORATION sólo I-EXPLORATION a I-EXPLORATION cotrimoxa-zol. I-EXPLORATION Las I-EXPLORATION dos I-EXPLORATION cepas I-EXPLORATION recuperadas I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION paciente I-EXPLORATION (heces I-EXPLORATION y I-EXPLORATION sangre) I-EXPLORATION mostraron I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION bandas I-EXPLORATION idéntico I-EXPLORATION entre I-EXPLORATION sí I-EXPLORATION y I-EXPLORATION muy I-EXPLORATION similar I-EXPLORATION al I-EXPLORATION patrón I-EXPLORATION obtenido I-EXPLORATION con I-EXPLORATION las I-EXPLORATION cepas I-EXPLORATION del I-EXPLORATION otro I-EXPLORATION paciente. I-EXPLORATION Las I-EXPLORATION cepas I-EXPLORATION se I-EXPLORATION definieron I-EXPLORATION como I-EXPLORATION muy I-EXPLORATION relacionadas I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION vista I-EXPLORATION genético. I-EXPLORATION I-EXPLORATION Tratamiento B-TREATMENT antimicrobiano I-TREATMENT y I-TREATMENT evolución I-TREATMENT I-TREATMENT El I-TREATMENT primer I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT cotrimoxazol, I-TREATMENT 800/160 I-TREATMENT mg, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h, I-TREATMENT por I-TREATMENT 48 I-TREATMENT h. I-TREATMENT Luego I-TREATMENT de I-TREATMENT conocer I-TREATMENT el I-TREATMENT resultado I-TREATMENT bacteriológico I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT cambió I-TREATMENT a I-TREATMENT ampicilina I-TREATMENT 1 I-TREATMENT gr I-TREATMENT iv, I-TREATMENT 4 I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT durante I-TREATMENT 6 I-TREATMENT días, I-TREATMENT y I-TREATMENT luego I-TREATMENT ciprofloxacina I-TREATMENT 500 I-TREATMENT mg I-TREATMENT vía I-TREATMENT oral, I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h, I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 14 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT I-TREATMENT El I-TREATMENT segundo I-TREATMENT paciente I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT sin I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT hasta I-TREATMENT el I-TREATMENT resultado I-TREATMENT bacteriológico. I-TREATMENT Recibió I-TREATMENT ciprofloxacina I-TREATMENT 400 I-TREATMENT mg I-TREATMENT iv, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT por I-TREATMENT 7 I-TREATMENT días I-TREATMENT y I-TREATMENT luego I-TREATMENT 500 I-TREATMENT mg I-TREATMENT vía I-TREATMENT oral, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 14 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT I-TREATMENT En B-EVOLUTION ambos I-EVOLUTION casos I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION con I-EVOLUTION remisión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION digestiva I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION otras I-EVOLUTION complicaciones, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION dados I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS portador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY reflujo I-PAST_MEDICAL_HISTORY vesicoureteral I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY 5, I-PAST_MEDICAL_HISTORY bilateral, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hidronefrosis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY desnutrición I-PAST_MEDICAL_HISTORY grave. I-PAST_MEDICAL_HISTORY Recibía I-PAST_MEDICAL_HISTORY profilaxis I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ITU I-PAST_MEDICAL_HISTORY recurrentes I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cotrimoxazol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY exposición I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY antibacterianos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY (cefuroximo, I-PAST_MEDICAL_HISTORY ceftriaxona I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ciprofloxacina). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS UCI I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS pielonefritis I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS e I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS reagudizada. I-PRESENT_ILLNESS El B-EXPLORATION urocultivo I-EXPLORATION realizado I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION a I-EXPLORATION E.coli I-EXPLORATION (cepa I-EXPLORATION ITU1) I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION ampicilina, I-EXPLORATION cefalotina, I-EXPLORATION cefuroximo, I-EXPLORATION ceftriaxona I-EXPLORATION y I-EXPLORATION gentamicina; I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION ciprofloxacina I-EXPLORATION y I-EXPLORATION cotrimoxazol. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cefuroximo I-TREATMENT iv I-TREATMENT 150 I-TREATMENT mg/kg/día. I-TREATMENT Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION sepsis I-EVOLUTION de I-EVOLUTION foco I-EVOLUTION urinario. I-EVOLUTION Se B-TREATMENT cambió I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT ceftriaxona I-TREATMENT iv I-TREATMENT a I-TREATMENT 100 I-TREATMENT mg/ I-TREATMENT kg/día I-TREATMENT previa I-TREATMENT toma I-TREATMENT de I-TREATMENT urocultivo. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION persistía I-EVOLUTION febril. I-EVOLUTION El B-EXPLORATION urocultivo I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION con I-EXPLORATION > I-EXPLORATION 105 I-EXPLORATION UFC/ml I-EXPLORATION de I-EXPLORATION E. I-EXPLORATION coli I-EXPLORATION (cepa I-EXPLORATION ITU2) I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION imipenem, I-EXPLORATION meropenem, I-EXPLORATION amikacina I-EXPLORATION y I-EXPLORATION gentamicina; I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION ampicilina, I-EXPLORATION cefalotina, I-EXPLORATION cefuroximo, I-EXPLORATION ceftriaxona, I-EXPLORATION ciprofloxacina I-EXPLORATION y I-EXPLORATION cotrimoxazol. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT meropenem I-TREATMENT iv I-TREATMENT 60 I-TREATMENT mg/kg/día, I-TREATMENT con I-TREATMENT buena I-TREATMENT evolución I-TREATMENT clínica I-TREATMENT y I-TREATMENT urocultivo I-TREATMENT de I-TREATMENT control, I-TREATMENT intra-tratamiento, I-TREATMENT sin I-TREATMENT desarrollo I-TREATMENT bacteriano. I-TREATMENT I-TREATMENT Tipificación B-EXPLORATION molecular I-EXPLORATION y I-EXPLORATION mecanismo I-EXPLORATION de I-EXPLORATION resistencia: I-EXPLORATION Mediante I-EXPLORATION EFCP I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION que I-EXPLORATION ambas I-EXPLORATION cepas I-EXPLORATION eran I-EXPLORATION genéticamente I-EXPLORATION indistinguibles. I-EXPLORATION La I-EXPLORATION cepa I-EXPLORATION ITU2 I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION BLEE I-EXPLORATION SHV-5 I-EXPLORATION codificada I-EXPLORATION en I-EXPLORATION un I-EXPLORATION plásmido I-EXPLORATION conjugativo I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION IncFIB, I-EXPLORATION ausente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION ITU1. I-EXPLORATION I-EXPLORATION Recién B-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 I-PRESENT_ILLNESS días, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY perinatales I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY destacar. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS internación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS UCI I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS bronquiolitis I-PRESENT_ILLNESS por I-PRESENT_ILLNESS VRS I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS flebitis I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS venosa I-PRESENT_ILLNESS periférica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS dolorosa, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS rubor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS calor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS segunda I-PRESENT_ILLNESS articulación I-PRESENT_ILLNESS condrocostal I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Con B-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT osteoartritis I-TREATMENT condrocostal I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT empírico I-TREATMENT con I-TREATMENT meropenem I-TREATMENT 60 I-TREATMENT mg/kg/día I-TREATMENT y I-TREATMENT vancomicina I-TREATMENT 40 I-TREATMENT mg/kg/día I-TREATMENT durante I-TREATMENT 72 I-TREATMENT h. I-TREATMENT Los B-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION Klebsiella I-EXPLORATION pneumoniae I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION oxiiminocefaslosporinas, I-EXPLORATION amikacina, I-EXPLORATION gentamicina, I-EXPLORATION meropenem I-EXPLORATION e I-EXPLORATION imipenem. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT continuó I-TREATMENT con I-TREATMENT meropenem I-TREATMENT durante I-TREATMENT 14 I-TREATMENT días I-TREATMENT con B-EXPLORATION negativización I-EXPLORATION del I-EXPLORATION hemocultivo I-EXPLORATION al I-EXPLORATION 7° I-EXPLORATION día I-EXPLORATION de I-EXPLORATION terapia. I-EXPLORATION Mejoraron B-EVOLUTION los I-EVOLUTION signos I-EVOLUTION locales I-EVOLUTION pero I-EVOLUTION continuó I-EVOLUTION febril I-EVOLUTION y I-EVOLUTION se I-EVOLUTION agregó I-EVOLUTION limitación I-EVOLUTION a I-EVOLUTION la I-EVOLUTION rotación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cadera I-EVOLUTION derecha. I-EVOLUTION Con B-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT probable I-TREATMENT osteoartritis I-TREATMENT coxofemoral I-TREATMENT se I-TREATMENT realizó I-TREATMENT punción I-TREATMENT articular I-TREATMENT y I-TREATMENT drenaje I-TREATMENT quirúrgico I-TREATMENT que I-TREATMENT dio I-TREATMENT salida I-TREATMENT a I-TREATMENT material I-TREATMENT purulento. I-TREATMENT En I-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT agregó I-TREATMENT amikacina I-TREATMENT 15 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT el I-TREATMENT antecedente I-TREATMENT de I-TREATMENT K. I-TREATMENT pneumoniae I-TREATMENT aislada I-TREATMENT del I-TREATMENT hemocultivo. I-TREATMENT Del B-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION articular I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION K. I-EXPLORATION pneumoniae I-EXPLORATION (cepa I-EXPLORATION OA1) I-EXPLORATION con I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION perfil I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION que I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION aislada I-EXPLORATION en I-EXPLORATION sangre. I-EXPLORATION Dado B-TREATMENT que I-TREATMENT persistió I-TREATMENT febril, I-TREATMENT se I-TREATMENT realizaron I-TREATMENT aseos I-TREATMENT quirúrgicos I-TREATMENT sucesivos I-TREATMENT aislándose, B-EXPLORATION a I-EXPLORATION los I-EXPLORATION 17 I-EXPLORATION días I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION aislado I-EXPLORATION (OA1), I-EXPLORATION K. I-EXPLORATION pneumoniae I-EXPLORATION (cepa I-EXPLORATION OA2) I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION oxiiminocefalosporinas, I-EXPLORATION amikacina I-EXPLORATION y I-EXPLORATION gentamicina. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION realizados I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION manteniéndose I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION esquema I-EXPLORATION antibacteriano. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION evaluación I-EXPLORATION inmunológica I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION Luego B-TREATMENT de I-TREATMENT múltiples I-TREATMENT aseos I-TREATMENT quirúrgicos, I-TREATMENT 35 I-TREATMENT días I-TREATMENT de I-TREATMENT fiebre I-TREATMENT y I-TREATMENT 45 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT se B-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION posterior. I-EVOLUTION I-EVOLUTION Tipificación B-EXPLORATION molecular I-EXPLORATION y I-EXPLORATION mecanismo I-EXPLORATION de I-EXPLORATION resistencia: I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION por I-EXPLORATION EFCP I-EXPLORATION mostró I-EXPLORATION que I-EXPLORATION las I-EXPLORATION cepas I-EXPLORATION OA1 I-EXPLORATION y I-EXPLORATION OA2 I-EXPLORATION no I-EXPLORATION estaban I-EXPLORATION genéticamente I-EXPLORATION relacionadas. I-EXPLORATION I-EXPLORATION A I-EXPLORATION diferencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION OA1, I-EXPLORATION OA2 I-EXPLORATION presentó I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION para I-EXPLORATION la I-EXPLORATION BLEE I-EXPLORATION CTX-M-9 I-EXPLORATION en I-EXPLORATION un I-EXPLORATION plásmido I-EXPLORATION IncHI1-HI2 I-EXPLORATION no I-EXPLORATION conjugativo. I-EXPLORATION Adicionalmente I-EXPLORATION OA2 I-EXPLORATION presentaba I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION aac I-EXPLORATION (6') I-EXPLORATION 1b, I-EXPLORATION que I-EXPLORATION confiere I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION amikacina I-EXPLORATION y I-EXPLORATION un I-EXPLORATION integrón I-EXPLORATION de I-EXPLORATION clase I-EXPLORATION 1 I-EXPLORATION con I-EXPLORATION los I-EXPLORATION genes I-EXPLORATION aadB-aadA2 I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION variable, I-EXPLORATION responsables I-EXPLORATION de I-EXPLORATION la I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION gentamicina. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS jubilado, B-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estudio. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY coartación I-PAST_MEDICAL_HISTORY aórtica I-PAST_MEDICAL_HISTORY operada, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY recambio I-PAST_MEDICAL_HISTORY valvular I-PAST_MEDICAL_HISTORY aórtico I-PAST_MEDICAL_HISTORY hacían I-PAST_MEDICAL_HISTORY ya I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY reemplazo I-PAST_MEDICAL_HISTORY compuesto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY válvula I-PAST_MEDICAL_HISTORY aórtica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aorta I-PAST_MEDICAL_HISTORY ascendente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY reemplazo I-PAST_MEDICAL_HISTORY valvular I-PAST_MEDICAL_HISTORY mitral, I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY anticoagulante I-PAST_MEDICAL_HISTORY oral. I-PAST_MEDICAL_HISTORY Además I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardíaca I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY control. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS cuantificada I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS °C I-PRESENT_ILLNESS axilar, I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS moderado I-PRESENT_ILLNESS difuso, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carácter I-PRESENT_ILLNESS inespecífico, I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS mes. I-PRESENT_ILLNESS Sin I-PRESENT_ILLNESS diarrea, I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS tos, I-PRESENT_ILLNESS disuria, I-PRESENT_ILLNESS artralgias I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS cutáneas. I-PRESENT_ILLNESS Dentro B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY epidemiológicos, I-PAST_MEDICAL_HISTORY residía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Santiago I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY viajes I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY extranjero. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION consciente, I-EXPLORATION vigil, I-EXPLORATION cooperador, I-EXPLORATION con I-EXPLORATION hemodinamia I-EXPLORATION estable, I-EXPLORATION yugulares I-EXPLORATION planas I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION adenopatías I-EXPLORATION palpables. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION pulmonar I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION cardíaco I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION sistólico I-EXPLORATION en I-EXPLORATION foco I-EXPLORATION aórtico I-EXPLORATION 3/6, I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION era I-EXPLORATION blando, I-EXPLORATION depresible, I-EXPLORATION sensible I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION difusa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION ni I-EXPLORATION visceromegalia. I-EXPLORATION Las I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION lechos I-EXPLORATION ungueales I-EXPLORATION no I-EXPLORATION tenían I-EXPLORATION lesiones. I-EXPLORATION El I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION destacando I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION completa I-EXPLORATION y I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION normales, I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION normocítica I-EXPLORATION normocrómica I-EXPLORATION (hemoglobina I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION gr/dL I-EXPLORATION y I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 31, I-EXPLORATION 7%), I-EXPLORATION con I-EXPLORATION las I-EXPLORATION otras I-EXPLORATION series I-EXPLORATION normales; I-EXPLORATION VHS I-EXPLORATION 82 I-EXPLORATION mm I-EXPLORATION 1° I-EXPLORATION hora; I-EXPLORATION PCR I-EXPLORATION 5, I-EXPLORATION 3 I-EXPLORATION mg/dL I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1 I-EXPLORATION mg/dL) I-EXPLORATION y I-EXPLORATION un I-EXPLORATION INR I-EXPLORATION 2, I-EXPLORATION 5. I-EXPLORATION Por I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION pruebas I-EXPLORATION hepáticas: I-EXPLORATION GOT I-EXPLORATION 45 I-EXPLORATION UI/L, I-EXPLORATION GGT I-EXPLORATION 81 I-EXPLORATION UI/L, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 0, I-EXPLORATION 69 I-EXPLORATION mg/dL, I-EXPLORATION LDH I-EXPLORATION 360 I-EXPLORATION U/L, I-EXPLORATION GPT I-EXPLORATION y I-EXPLORATION fosfatasas I-EXPLORATION alcalinas I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION y I-EXPLORATION VIH I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION negativas, I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION Widal I-EXPLORATION negativa, I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Entre I-EXPLORATION otros I-EXPLORATION exámenes I-EXPLORATION destacaba I-EXPLORATION TSH I-EXPLORATION 0, I-EXPLORATION 84 I-EXPLORATION U/ml I-EXPLORATION (VN I-EXPLORATION 0, I-EXPLORATION 3-4, I-EXPLORATION 2 I-EXPLORATION U/ml) I-EXPLORATION y I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION persistencia I-EXPLORATION del I-EXPLORATION cuadro, I-EXPLORATION fue I-EXPLORATION internado I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION continuó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION AP I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Por I-EXPLORATION el I-EXPLORATION antecedente I-EXPLORATION de I-EXPLORATION una I-EXPLORATION válvula I-EXPLORATION protésica I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION transesofágico I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION filamentosa I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION x I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION aórtica. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT para I-TREATMENT una I-TREATMENT EI I-TREATMENT asociada I-TREATMENT a I-TREATMENT válvula I-TREATMENT protésica I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT iv I-TREATMENT 1 I-TREATMENT g, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT gentamicina I-TREATMENT iv I-TREATMENT 80 I-TREATMENT mg, I-TREATMENT tres I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT rifampicina I-TREATMENT 600 I-TREATMENT mg I-TREATMENT al I-TREATMENT día. I-TREATMENT Los B-EXPLORATION dos I-EXPLORATION hemocultivos I-EXPLORATION tomados I-EXPLORATION previo I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION antibacteriano, I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 23 I-EXPLORATION hrs. I-EXPLORATION a I-EXPLORATION un I-EXPLORATION bacilo I-EXPLORATION grampositivo, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION identificado I-EXPLORATION como I-EXPLORATION L. I-EXPLORATION monocytogenes. I-EXPLORATION Se B-TREATMENT ajustó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT ampicilina I-TREATMENT 2 I-TREATMENT g I-TREATMENT iv, I-TREATMENT seis I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT gentamicina I-TREATMENT 80 I-TREATMENT mg, I-TREATMENT tres I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT I-TREATMENT Por B-EVOLUTION presentar I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION y B-TREATMENT continuó I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT intravenoso I-TREATMENT en I-TREATMENT forma I-TREATMENT ambulatoria. I-TREATMENT Se B-EVOLUTION controló I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION mensual I-EVOLUTION durante I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION primeros I-EVOLUTION meses, I-EVOLUTION luego I-EVOLUTION cada I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION hasta I-EVOLUTION completar I-EVOLUTION un I-EVOLUTION año I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION cada I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION durante I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION año. I-EVOLUTION Durante I-EVOLUTION su I-EVOLUTION seguimiento I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION un I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios I-EVOLUTION y I-EVOLUTION se I-EVOLUTION ajustaron I-EVOLUTION las I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION los I-EVOLUTION antibacterianos I-EVOLUTION según I-EVOLUTION su I-EVOLUTION función I-EVOLUTION renal. I-EVOLUTION Completó B-TREATMENT tres I-TREATMENT semanas I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT gentamicina I-TREATMENT 80 I-TREATMENT mg, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT suspendiéndose I-TREATMENT por I-TREATMENT deterioro I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal; I-TREATMENT ampicilina I-TREATMENT 2 I-TREATMENT g, I-TREATMENT cuatro I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT por I-TREATMENT doce I-TREATMENT semanas I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT mantención I-TREATMENT con I-TREATMENT amoxicilina I-TREATMENT 1 I-TREATMENT g, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT y I-TREATMENT luego I-TREATMENT terapia I-TREATMENT supresora I-TREATMENT con I-TREATMENT 500 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT hasta I-TREATMENT completar I-TREATMENT dos I-TREATMENT años, I-TREATMENT para I-TREATMENT garantizar I-TREATMENT la I-TREATMENT esterilidad I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT residual. I-TREATMENT El B-EXPLORATION último I-EXPLORATION ecocardiograma I-EXPLORATION de I-EXPLORATION control I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION variaciones I-EXPLORATION significativas I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION inicial. I-EXPLORATION Actualmente, B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS residente B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ciudad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Iquitos, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Inició B-PRESENT_ILLNESS su I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS (día I-PRESENT_ILLNESS 1) I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS mialgias, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS óseo, I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS retro-ocular. I-PRESENT_ILLNESS Ante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS persistencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estos I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS los I-PRESENT_ILLNESS días I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 3, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS dengue I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alarma, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS rash, I-PRESENT_ILLNESS por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT le I-TREATMENT indicó I-TREATMENT paracetamol I-TREATMENT (500 I-TREATMENT mg I-TREATMENT tres I-TREATMENT veces I-TREATMENT al I-TREATMENT día) I-TREATMENT e I-TREATMENT hidratación I-TREATMENT oral. I-TREATMENT En B-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION del I-EXPLORATION proyecto I-EXPLORATION de I-EXPLORATION investigación I-EXPLORATION "Vigilancia I-EXPLORATION y I-EXPLORATION etiología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION febril I-EXPLORATION aguda I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Perú", I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION venosa I-EXPLORATION para I-EXPLORATION ser I-EXPLORATION enviada I-EXPLORATION al I-EXPLORATION laboratorio I-EXPLORATION del I-EXPLORATION Naval I-EXPLORATION Medical I-EXPLORATION Research I-EXPLORATION Unit I-EXPLORATION Six I-EXPLORATION (NAMRU-6) I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION para I-EXPLORATION dengue I-EXPLORATION y I-EXPLORATION leptospirosis, I-EXPLORATION IgM I-EXPLORATION por I-EXPLORATION método I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION viral I-EXPLORATION para I-EXPLORATION otras I-EXPLORATION arbovirosis. I-EXPLORATION Al B-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION se I-EVOLUTION agregó I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION moderado I-EVOLUTION a I-EVOLUTION intenso, I-EVOLUTION tipo I-EVOLUTION cólico, I-EVOLUTION localizado I-EVOLUTION en I-EVOLUTION el I-EVOLUTION epigastrio I-EVOLUTION e I-EVOLUTION hipocondrio I-EVOLUTION derecho, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION náuseas I-EVOLUTION y I-EVOLUTION vómitos. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION días I-EVOLUTION 6 I-EVOLUTION y I-EVOLUTION 7 I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION aumentaron I-EVOLUTION en I-EVOLUTION intensidad I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION consultó I-EVOLUTION nuevamente. I-EVOLUTION Recibió B-TREATMENT hidratación I-TREATMENT y I-TREATMENT analgesia I-TREATMENT intravenosa; I-TREATMENT sin I-TREATMENT embargo, I-TREATMENT al I-TREATMENT no I-TREATMENT presentar I-TREATMENT mejoría I-TREATMENT se I-TREATMENT decidió I-TREATMENT su I-TREATMENT internación. I-TREATMENT Ingresó B-EVOLUTION en I-EVOLUTION mal I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION quejumbrosa, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION temperatura I-EVOLUTION de I-EVOLUTION 37, I-EVOLUTION 6°C I-EVOLUTION axilar, I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION 90/60 I-EVOLUTION mmHg, I-EVOLUTION frecuencia I-EVOLUTION respiratoria I-EVOLUTION 26 I-EVOLUTION por I-EVOLUTION min, I-EVOLUTION y I-EVOLUTION frecuencia I-EVOLUTION cardíaca I-EVOLUTION 98 I-EVOLUTION latidos/ I-EVOLUTION min. I-EVOLUTION Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION deshidratación I-EXPLORATION y I-EXPLORATION un I-EXPLORATION rash I-EXPLORATION eritematoso I-EXPLORATION generalizado, I-EXPLORATION sin I-EXPLORATION linfadenopatías. I-EXPLORATION Presentaba I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION con I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Murphy I-EXPLORATION positivo. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION cardiopulmonar I-EXPLORATION y I-EXPLORATION el I-EXPLORATION neurológico I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION prueba I-EXPLORATION del I-EXPLORATION lazo I-EXPLORATION o I-EXPLORATION torniquete I-EXPLORATION resultó I-EXPLORATION negativa. I-EXPLORATION Entre I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION ALT I-EXPLORATION (alanino I-EXPLORATION aminotransferasa) I-EXPLORATION 180 I-EXPLORATION U/L, I-EXPLORATION AST I-EXPLORATION (aspartato I-EXPLORATION aminotransferasa) I-EXPLORATION 365 I-EXPLORATION U/L, I-EXPLORATION albúmina I-EXPLORATION sérica I-EXPLORATION 2, I-EXPLORATION 39 I-EXPLORATION g/dl, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 0, I-EXPLORATION 18 I-EXPLORATION mg/dl, I-EXPLORATION bilirrubina I-EXPLORATION indirecta I-EXPLORATION 0, I-EXPLORATION 09 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION 43%, I-EXPLORATION recuento I-EXPLORATION plaquetario I-EXPLORATION 100.000/mm3. I-EXPLORATION La I-EXPLORATION glicemia, I-EXPLORATION urea I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION sérica I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION amilasa I-EXPLORATION sérica I-EXPLORATION inicial I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 41 I-EXPLORATION U/L. I-EXPLORATION Se B-TREATMENT continuó I-TREATMENT con I-TREATMENT hidratación I-TREATMENT y I-TREATMENT medicación I-TREATMENT sintomática I-TREATMENT intravenosa I-TREATMENT (hioscina, I-TREATMENT metamizol I-TREATMENT y I-TREATMENT dimenhidrinato). I-TREATMENT El B-EVOLUTION día I-EVOLUTION 8 I-EVOLUTION ya I-EVOLUTION no I-EVOLUTION presentaba I-EVOLUTION fiebre, I-EVOLUTION pero I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION los I-EVOLUTION vómitos I-EVOLUTION se I-EVOLUTION hicieron I-EVOLUTION aún I-EVOLUTION más I-EVOLUTION intensos. I-EVOLUTION Se B-EXPLORATION controló I-EXPLORATION la I-EXPLORATION amilasa I-EXPLORATION sérica I-EXPLORATION 213 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION las I-EXPLORATION fosfatasas I-EXPLORATION alcalinas I-EXPLORATION 75, I-EXPLORATION 5 I-EXPLORATION U/L I-EXPLORATION (VN I-EXPLORATION hasta I-EXPLORATION 270 I-EXPLORATION U/L). I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ultrasonografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION escasa I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION ascítico, I-EXPLORATION efusión I-EXPLORATION pleural, I-EXPLORATION edema I-EXPLORATION peri-vesicular I-EXPLORATION y I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION vesicular I-EXPLORATION (8, I-EXPLORATION 5 I-EXPLORATION mm), I-EXPLORATION sin I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION litiasis I-EXPLORATION o I-EXPLORATION visceromegalia. I-EXPLORATION El I-EXPLORATION día I-EXPLORATION 10 I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION abdominal I-EXPLORATION cuya I-EXPLORATION mala I-EXPLORATION calidad I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION mayores I-EXPLORATION detalles I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION pero I-EXPLORATION permitió I-EXPLORATION descartar I-EXPLORATION el I-EXPLORATION compromiso I-EXPLORATION pancreático. I-EXPLORATION La I-EXPLORATION prueba I-EXPLORATION del I-EXPLORATION lazo, I-EXPLORATION realizada I-EXPLORATION ese I-EXPLORATION mismo I-EXPLORATION día, I-EXPLORATION resultó I-EXPLORATION positiva. I-EXPLORATION Se B-TREATMENT continuó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT soporte I-TREATMENT hasta I-TREATMENT el I-TREATMENT día I-TREATMENT 12, I-TREATMENT cuando B-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION su I-EVOLUTION alta I-EVOLUTION médica I-EVOLUTION por I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION parcial I-EVOLUTION (disminución I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION náuseas I-EVOLUTION y I-EVOLUTION vómitos) I-EVOLUTION con I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION dengue I-EVOLUTION y I-EVOLUTION colecistitis I-EVOLUTION alitiásica. I-EVOLUTION La I-EVOLUTION sintomatología I-EVOLUTION disminuyó I-EVOLUTION progresivamente I-EVOLUTION y I-EVOLUTION el I-EVOLUTION día I-EVOLUTION 25 I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION un I-EVOLUTION control I-EVOLUTION de I-EVOLUTION transaminasas I-EVOLUTION ALT I-EVOLUTION y I-EVOLUTION AST I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION de I-EVOLUTION 18 I-EVOLUTION y I-EVOLUTION 25 I-EVOLUTION U/L, I-EVOLUTION respectivamente. I-EVOLUTION I-EVOLUTION El B-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION otras I-EXPLORATION infecciones I-EXPLORATION resultaron I-EXPLORATION negativas: I-EXPLORATION leptospirosis I-EXPLORATION (RPC), I-EXPLORATION rickettsiosis I-EXPLORATION (IgG), I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION (HBsAg) I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION arbovirosis I-EXPLORATION como I-EXPLORATION la I-EXPLORATION encefalitis I-EXPLORATION equina I-EXPLORATION venezolana, I-EXPLORATION mayaro, I-EXPLORATION oropuche, I-EXPLORATION fiebre I-EXPLORATION amarilla I-EXPLORATION y I-EXPLORATION virus I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION C I-EXPLORATION (serología I-EXPLORATION IgM I-EXPLORATION y I-EXPLORATION aislamiento I-EXPLORATION viral). I-EXPLORATION La I-EXPLORATION gota I-EXPLORATION gruesa I-EXPLORATION para I-EXPLORATION malaria I-EXPLORATION también I-EXPLORATION resultó I-EXPLORATION negativa. I-EXPLORATION La I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION dengue I-EXPLORATION resultó I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION el I-EXPLORATION virus I-EXPLORATION dengue I-EXPLORATION serotipo I-EXPLORATION 4. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY TEC I-PAST_MEDICAL_HISTORY simple I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY secuelas I-PAST_MEDICAL_HISTORY y B-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rinorrea I-PRESENT_ILLNESS acuosa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS cefalea. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS otorrinolaringología I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS probable I-PRESENT_ILLNESS rinitis I-PRESENT_ILLNESS vasomotora. I-PRESENT_ILLNESS Se B-TREATMENT prescribió I-TREATMENT corticoides I-TREATMENT intranasales I-TREATMENT y I-TREATMENT sistémicos I-TREATMENT (prednisona I-TREATMENT 10 I-TREATMENT mg I-TREATMENT al I-TREATMENT día) I-TREATMENT y I-TREATMENT azitromicina I-TREATMENT por I-TREATMENT siete I-TREATMENT días. I-TREATMENT I-TREATMENT Luego B-EVOLUTION de I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION transitoria I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION cefalea I-EVOLUTION holocránea I-EVOLUTION de I-EVOLUTION inicio I-EVOLUTION súbito, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION un I-EVOLUTION dolor I-EVOLUTION cervical, I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION conciencia I-EVOLUTION sin I-EVOLUTION focalidad I-EVOLUTION neurológica I-EVOLUTION evidente I-EVOLUTION y I-EVOLUTION calofríos, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION consultó I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencia I-EVOLUTION de I-EVOLUTION nuestro I-EVOLUTION hospital. I-EVOLUTION Al B-EXPLORATION ingreso I-EXPLORATION destacaban I-EXPLORATION cifras I-EXPLORATION tensionales I-EXPLORATION límites I-EXPLORATION (presión I-EXPLORATION arterial I-EXPLORATION 108/70 I-EXPLORATION mm I-EXPLORATION Hg) I-EXPLORATION que I-EXPLORATION respondieron I-EXPLORATION a I-EXPLORATION volumen, I-EXPLORATION fiebre I-EXPLORATION (T° I-EXPLORATION 38, I-EXPLORATION 5°C), I-EXPLORATION desorientación I-EXPLORATION temporo-espacial, I-EXPLORATION agitación I-EXPLORATION psicomotora I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION meníngeos. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION que I-EXPLORATION dio I-EXPLORATION salida I-EXPLORATION a I-EXPLORATION LCR I-EXPLORATION turbio, I-EXPLORATION citoquímico: I-EXPLORATION 8.480 I-EXPLORATION céls/mm3, I-EXPLORATION 100% I-EXPLORATION polimorfonucleares, I-EXPLORATION proteínas I-EXPLORATION 370 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION glucosa I-EXPLORATION 2 I-EXPLORATION mg/dl. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT una I-TREATMENT MBA I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT 2 I-TREATMENT g, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día I-TREATMENT y I-TREATMENT dexametasona I-TREATMENT i.v. I-TREATMENT 10 I-TREATMENT mg, I-TREATMENT 4 I-TREATMENT veces I-TREATMENT al I-TREATMENT día, I-TREATMENT esta I-TREATMENT última I-TREATMENT por I-TREATMENT 4 I-TREATMENT días. I-TREATMENT La B-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION Fue B-EVOLUTION admitida I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Pacientes I-EVOLUTION Críticos, I-EVOLUTION donde I-EVOLUTION evolucionó I-EVOLUTION sin I-EVOLUTION requerimiento I-EVOLUTION de I-EVOLUTION fármacos I-EVOLUTION vasoactivos, I-EVOLUTION con I-EVOLUTION caída I-EVOLUTION de I-EVOLUTION la I-EVOLUTION curva I-EVOLUTION febril I-EVOLUTION y I-EVOLUTION recuperación I-EVOLUTION en I-EVOLUTION su I-EVOLUTION condición I-EVOLUTION neurológica I-EVOLUTION en I-EVOLUTION menos I-EVOLUTION de I-EVOLUTION 24 I-EVOLUTION h. I-EVOLUTION I-EVOLUTION En B-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION naranja I-EXPLORATION de I-EXPLORATION acridina I-EXPLORATION mostró I-EXPLORATION formas I-EXPLORATION cocoides. I-EXPLORATION Tanto I-EXPLORATION en I-EXPLORATION el I-EXPLORATION LCR I-EXPLORATION como I-EXPLORATION en I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION hubo I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION agalactiae I-EXPLORATION susceptible I-EXPLORATION a I-EXPLORATION penicilina, I-EXPLORATION eritromicina I-EXPLORATION y I-EXPLORATION clindamicina. I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION (Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION de I-EXPLORATION Chile) I-EXPLORATION confirmó I-EXPLORATION posteriormente I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cultivos, I-EXPLORATION informando I-EXPLORATION además I-EXPLORATION que I-EXPLORATION correspondía I-EXPLORATION al I-EXPLORATION serotipo I-EXPLORATION Ib. I-EXPLORATION I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION fue I-EXPLORATION evaluada I-EXPLORATION por I-EXPLORATION ginecología I-EXPLORATION encontrándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION vulvovaginitis I-EXPLORATION y I-EXPLORATION miomas I-EXPLORATION uterinos, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION microbiológico. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION otorrino-laringológico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION rinorrea I-EXPLORATION acuosa I-EXPLORATION abundante I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION izquierda I-EXPLORATION evidenciada I-EXPLORATION con I-EXPLORATION la I-EXPLORATION maniobra I-EXPLORATION de I-EXPLORATION Valsalva. I-EXPLORATION Por I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION fístula I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION continuidad I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lámina I-EXPLORATION cribosa I-EXPLORATION del I-EXPLORATION etmoides I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION adelgazamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION postero-lateral I-EXPLORATION del I-EXPLORATION hemiseno I-EXPLORATION esfenoidal I-EXPLORATION izquierdo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION aspecto I-EXPLORATION más I-EXPLORATION craneal I-EXPLORATION con I-EXPLORATION engrasamiento I-EXPLORATION mucoso. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION β2-transferrina I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION nasal, I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION positivo. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION además I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION que I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION importancia. I-EXPLORATION I-EXPLORATION Su B-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios, I-EVOLUTION completando I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION con I-EVOLUTION ceftriaxona. I-EVOLUTION Se I-EVOLUTION decidió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION una I-EVOLUTION programación I-EVOLUTION diferida I-EVOLUTION de I-EVOLUTION resolución I-EVOLUTION quirúrgica I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fístula I-EVOLUTION de I-EVOLUTION LCR. I-EVOLUTION Se B-TREATMENT recomendó I-TREATMENT la I-TREATMENT vacunación I-TREATMENT antineumocócica I-TREATMENT polisacárida I-TREATMENT y I-TREATMENT antimeningocócica I-TREATMENT cuadrivalente I-TREATMENT conjugada. I-TREATMENT I-TREATMENT En B-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY dirigida I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY golpes I-PAST_MEDICAL_HISTORY menores I-PAST_MEDICAL_HISTORY recurrentes I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cabeza I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY previas I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY muro I-PAST_MEDICAL_HISTORY debajo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY escalera I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY permitía I-PAST_MEDICAL_HISTORY acceder I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY patio I-PAST_MEDICAL_HISTORY común I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY tender I-PAST_MEDICAL_HISTORY ropa. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY reconoció I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY ocupado I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY papel I-PAST_MEDICAL_HISTORY higiénico I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY limpiarse I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY genital I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY nasal I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY escasez I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY éste I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY baño, I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY visita I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY atendiendo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY intensa I-PAST_MEDICAL_HISTORY rinorrea. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tras B-EVOLUTION el I-EVOLUTION alta I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION salida I-EVOLUTION de I-EVOLUTION LCR I-EVOLUTION por I-EVOLUTION la I-EVOLUTION nariz. I-EVOLUTION A B-TREATMENT pesar I-TREATMENT de I-TREATMENT esto, I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT presentaba I-TREATMENT una I-TREATMENT fístula I-TREATMENT de I-TREATMENT probable I-TREATMENT origen I-TREATMENT espontáneo I-TREATMENT y I-TREATMENT que I-TREATMENT ya I-TREATMENT había I-TREATMENT tenido I-TREATMENT un I-TREATMENT episodio I-TREATMENT de I-TREATMENT MBA, I-TREATMENT se I-TREATMENT le I-TREATMENT aconsejó I-TREATMENT someterse I-TREATMENT a I-TREATMENT una I-TREATMENT cirugía I-TREATMENT endoscópica I-TREATMENT nasal I-TREATMENT para I-TREATMENT reparar I-TREATMENT la I-TREATMENT zona I-TREATMENT dehiscente I-TREATMENT en I-TREATMENT la I-TREATMENT base I-TREATMENT del I-TREATMENT cráneo I-TREATMENT anterior. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS cutánea I-PRESENT_ILLNESS dolorosa I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS pápula, I-PRESENT_ILLNESS pardo-negruzca, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bordes I-PRESENT_ILLNESS eritematosos, I-PRESENT_ILLNESS ubicada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pulpejo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS ortejo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION múltiples I-EXPLORATION huevecillos I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blanco, I-EXPLORATION de I-EXPLORATION menos I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY regresado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY viaje I-PAST_MEDICAL_HISTORY turístico I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Paraguay I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY Se B-TREATMENT realizó I-TREATMENT la I-TREATMENT extracción I-TREATMENT quirúrgica I-TREATMENT de I-TREATMENT los I-TREATMENT parásitos. I-TREATMENT Además I-TREATMENT se I-TREATMENT indicaron I-TREATMENT antibacterianos I-TREATMENT tópicos I-TREATMENT y I-TREATMENT profilaxis I-TREATMENT antitetánica, I-TREATMENT con B-EVOLUTION resolución I-EVOLUTION total I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS punzante, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS productiva. I-PRESENT_ILLNESS Además I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS lógica, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS (siete I-PRESENT_ILLNESS kg) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION tomó I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION hemoglobina I-EXPLORATION 6, I-EXPLORATION 2 I-EXPLORATION g/dl, I-EXPLORATION leucocitos I-EXPLORATION 9.830/mm3, I-EXPLORATION plaquetas I-EXPLORATION 77.200/mm3, I-EXPLORATION PCR I-EXPLORATION 216 I-EXPLORATION mg/l I-EXPLORATION y I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION consolidación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Se B-EVOLUTION hospitalizó I-EVOLUTION para I-EVOLUTION estudio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION bicitopenia, I-EVOLUTION disfagia I-EVOLUTION y I-EVOLUTION síndrome I-EVOLUTION consuntivo. I-EVOLUTION Se I-EVOLUTION diagnosticó B-TREATMENT una I-TREATMENT neumonía I-TREATMENT bacteriana I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT recibió I-TREATMENT ceftriaxona I-TREATMENT por I-TREATMENT 10 I-TREATMENT días, I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica. I-EVOLUTION I-EVOLUTION Dentro B-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION disfagia I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION endoscopía I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION (EDA) I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION tres I-EXPLORATION úlceras I-EXPLORATION esofágicas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION viral I-EXPLORATION (citomegalovirus) I-EXPLORATION (CMV). I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION y B-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ganciclovir I-TREATMENT por I-TREATMENT 10 I-TREATMENT días, I-TREATMENT con B-EVOLUTION escasa I-EVOLUTION respuesta I-EVOLUTION clínica. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION una I-EXPLORATION erosión I-EXPLORATION mucosa I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION citopáticos I-EXPLORATION de I-EXPLORATION CMV. I-EXPLORATION La I-EXPLORATION RPC I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION para I-EXPLORATION CMV I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION La I-EXPLORATION bicitopenia I-EXPLORATION fue I-EXPLORATION confirmada I-EXPLORATION con I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION neutropenia I-EXPLORATION de I-EXPLORATION 200 I-EXPLORATION neutrófilos/mm3; I-EXPLORATION 88% I-EXPLORATION de I-EXPLORATION blastos I-EXPLORATION y I-EXPLORATION un I-EXPLORATION mielograma I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION una I-EXPLORATION leucemia I-EXPLORATION mieloide I-EXPLORATION aguda I-EXPLORATION (LMA). I-EXPLORATION Una B-TREATMENT vez I-TREATMENT finalizados I-TREATMENT los I-TREATMENT tratamientos I-TREATMENT antimicrobianos I-TREATMENT inició I-TREATMENT quimioterapia. I-TREATMENT I-TREATMENT Tres B-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION quimioterapia I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION neutropenia I-EVOLUTION febril I-EVOLUTION (NF) I-EVOLUTION con I-EVOLUTION un I-EVOLUTION RAN I-EVOLUTION de I-EVOLUTION 20 I-EVOLUTION neutrófilos/mm3. I-EVOLUTION Una B-EXPLORATION nueva I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION cambios I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION anterior. I-EXPLORATION Inició B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT imipenem I-TREATMENT y I-TREATMENT vancomicina I-TREATMENT i.v. I-TREATMENT Por B-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION la I-EXPLORATION neutropenia, I-EXPLORATION al I-EXPLORATION cuarto I-EXPLORATION día I-EXPLORATION se I-EXPLORATION repitieron I-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION pulmonar, I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION pelvis. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION pulmonar I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION "signo I-EXPLORATION del I-EXPLORATION halo". I-EXPLORATION Se B-TREATMENT inició I-TREATMENT voriconazol I-TREATMENT sospechando I-TREATMENT una I-TREATMENT aspergilosis I-TREATMENT pulmonar. I-TREATMENT Los B-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION los I-EXPLORATION galactomananos I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION disfagia, I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION EDA I-EXPLORATION mostró I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION úlceras I-EXPLORATION esofágicas. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION evidenció I-EXPLORATION hifas I-EXPLORATION septadas, I-EXPLORATION ramificadas I-EXPLORATION en I-EXPLORATION 45°, I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION Aspergillus I-EXPLORATION spp. I-EXPLORATION I-EXPLORATION Luego B-EVOLUTION de I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antifúngico I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION sin I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION disfagia. I-EVOLUTION Se B-TREATMENT completaron I-TREATMENT 18 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT y I-TREATMENT 21 I-TREATMENT días I-TREATMENT de I-TREATMENT voriconazol. I-TREATMENT I-TREATMENT Un B-PRESENT_ILLNESS adulto I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY Departamento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Neurología I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Ataque I-PAST_MEDICAL_HISTORY Isquémico I-PAST_MEDICAL_HISTORY Transitorio I-PAST_MEDICAL_HISTORY (AIT). I-PAST_MEDICAL_HISTORY Sin B-PRESENT_ILLNESS embargo, I-PRESENT_ILLNESS ya I-PRESENT_ILLNESS en I-PRESENT_ILLNESS casa, I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS su I-PRESENT_ILLNESS egreso I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS nuevamente I-PRESENT_ILLNESS hospitalizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS AIT. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS esta I-PRESENT_ILLNESS ocasión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dado I-PRESENT_ILLNESS su I-PRESENT_ILLNESS curso I-PRESENT_ILLNESS febril, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS evaluado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Departamento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Infectología. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY comunes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY desarrollar I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY EI, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY sometido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY AC I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY raíz I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY torácico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY causa I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY precisada. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Hallazgos B-EXPLORATION destacables I-EXPLORATION en I-EXPLORATION su I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION eran: I-EXPLORATION fiebre I-EXPLORATION de I-EXPLORATION 39, I-EXPLORATION 7°C I-EXPLORATION acompañada I-EXPLORATION de I-EXPLORATION calofríos I-EXPLORATION solemnes, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION motricidad I-EXPLORATION en I-EXPLORATION grado I-EXPLORATION 3/5 I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION superior I-EXPLORATION e I-EXPLORATION inferior I-EXPLORATION derechas, I-EXPLORATION borde I-EXPLORATION hepático I-EXPLORATION palpable I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION bajo I-EXPLORATION el I-EXPLORATION reborde I-EXPLORATION costal I-EXPLORATION derecho, I-EXPLORATION y I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION sistólico I-EXPLORATION de I-EXPLORATION eyección, I-EXPLORATION 3/6, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION borde I-EXPLORATION esternal I-EXPLORATION izquierdo. I-EXPLORATION No I-EXPLORATION había I-EXPLORATION estigmas I-EXPLORATION periféricos I-EXPLORATION de I-EXPLORATION EI. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraban: I-EXPLORATION recuento I-EXPLORATION leucocitario I-EXPLORATION de I-EXPLORATION 19.870/mm3, I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 10, I-EXPLORATION 9 I-EXPLORATION g/dL, I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 31 I-EXPLORATION mg/dL, I-EXPLORATION creatininemia I-EXPLORATION 1, I-EXPLORATION 3 I-EXPLORATION mg/dL. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION químicos I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION Habiendo B-TREATMENT obtenido I-TREATMENT hemocultivos, I-TREATMENT se I-TREATMENT inició I-TREATMENT una I-TREATMENT antibioterapia I-TREATMENT combinada I-TREATMENT de I-TREATMENT cefepime I-TREATMENT y I-TREATMENT amikacina, I-TREATMENT considerando I-TREATMENT el I-TREATMENT antecedente I-TREATMENT de I-TREATMENT la I-TREATMENT hospitalización I-TREATMENT en I-TREATMENT el I-TREATMENT mes I-TREATMENT previo. I-TREATMENT Una B-EXPLORATION ETT I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION vegetación I-EXPLORATION libremente I-EXPLORATION móvil I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION mm I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION mitral, I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION cierto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION mitral. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION días I-EXPLORATION de I-EXPLORATION incubación, I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION P. I-EXPLORATION aeruginosa I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION hemocultivos. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION que I-EXPLORATION esta I-EXPLORATION cepa I-EXPLORATION tenía I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION antibiograma I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION 1. I-EXPLORATION La B-TREATMENT antibioterapia I-TREATMENT en I-TREATMENT curso I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT y, B-EXPLORATION en I-EXPLORATION un I-EXPLORATION control I-EXPLORATION ecocadiográfico, I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION reducción I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vegetación. I-EXPLORATION No B-EVOLUTION obstante, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION día I-EVOLUTION 24 I-EVOLUTION de I-EVOLUTION antibioterapia, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION una I-EVOLUTION falla I-EVOLUTION cardiaca I-EVOLUTION aguda. I-EVOLUTION Fue B-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cuidados I-DERIVED_FROM/TO intensivos I-DERIVED_FROM/TO (UCI) I-DERIVED_FROM/TO y I-DERIVED_FROM/TO apoyado I-DERIVED_FROM/TO con I-DERIVED_FROM/TO ventilación I-DERIVED_FROM/TO mecánica. I-DERIVED_FROM/TO Se B-TREATMENT le I-TREATMENT sometió I-TREATMENT a I-TREATMENT cirugía I-TREATMENT cardiaca I-TREATMENT con I-TREATMENT reemplazo I-TREATMENT mitral I-TREATMENT por I-TREATMENT una I-TREATMENT válvula I-TREATMENT protésica. I-TREATMENT Diez B-EVOLUTION días I-EVOLUTION tras I-EVOLUTION ser I-EVOLUTION operado, I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION tamponamiento I-EVOLUTION cardiaco, I-EVOLUTION drenándose B-TREATMENT quirúrgicamente I-TREATMENT abundante I-TREATMENT fluido. I-TREATMENT La B-EVOLUTION condición I-EVOLUTION clínica I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION mejoró, I-EVOLUTION pero I-EVOLUTION 16 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION cirugía, I-EVOLUTION reapareció I-EVOLUTION la I-EVOLUTION fiebre, I-EVOLUTION acompañada I-EVOLUTION de I-EVOLUTION leucocitosis, I-EVOLUTION secreción I-EVOLUTION respiratoria I-EVOLUTION purulenta, I-EVOLUTION y I-EVOLUTION una I-EVOLUTION efusión I-EVOLUTION pleural I-EVOLUTION masiva. I-EVOLUTION Se B-TREATMENT cambió I-TREATMENT la I-TREATMENT terapia I-TREATMENT a I-TREATMENT meropenem I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT efectuó I-TREATMENT una I-TREATMENT toracostomia I-TREATMENT a I-TREATMENT izquierda. I-TREATMENT Se B-EVOLUTION comprobó I-EVOLUTION la I-EVOLUTION existencia I-EVOLUTION de I-EVOLUTION una I-EVOLUTION neumonía I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION ventilación I-EVOLUTION mecánica, I-EVOLUTION por I-EVOLUTION Acinetobacter I-EVOLUTION baumannii.: I-EVOLUTION La I-EVOLUTION condición I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION hemodinámica I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION empeoró I-EVOLUTION y I-EVOLUTION finalmente I-EVOLUTION falleció. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS peruana, B-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Lima, I-PAST_MEDICAL_HISTORY consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS pruriginosas, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Posteriormente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS asoció I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS extremidad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS evaluación. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedente, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY visitado I-PAST_MEDICAL_HISTORY Tulum I-PAST_MEDICAL_HISTORY (Riviera I-PAST_MEDICAL_HISTORY Maya, I-PAST_MEDICAL_HISTORY México) I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY días, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY caminó I-PAST_MEDICAL_HISTORY descalza I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY arena I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY practicó I-PAST_MEDICAL_HISTORY buceo, I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sufrido I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY picaduras I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY mosquitos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY extremidades I-PAST_MEDICAL_HISTORY inferiores. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY retornado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Lima I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consultar. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION serpiginosas, I-EXPLORATION solevantadas, I-EXPLORATION eritematosas, I-EXPLORATION confluentes, I-EXPLORATION de I-EXPLORATION uno I-EXPLORATION a I-EXPLORATION tres I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION y I-EXPLORATION de I-EXPLORATION uno I-EXPLORATION a I-EXPLORATION dos I-EXPLORATION milímetros I-EXPLORATION de I-EXPLORATION espesor, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION y I-EXPLORATION 2°, I-EXPLORATION 3° I-EXPLORATION y I-EXPLORATION 4° I-EXPLORATION ortejos I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION derecho. I-EXPLORATION Además, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION pequeñas I-EXPLORATION vesículas I-EXPLORATION pruriginosas. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT clínico I-TREATMENT de I-TREATMENT larva I-TREATMENT migrans I-TREATMENT cutánea I-TREATMENT y I-TREATMENT se I-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ivermectina I-TREATMENT 6 I-TREATMENT mg/ml, I-TREATMENT solución I-TREATMENT oral I-TREATMENT en I-TREATMENT gotas, I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 200 I-TREATMENT μg/kg I-TREATMENT de I-TREATMENT peso, I-TREATMENT durante I-TREATMENT dos I-TREATMENT días I-TREATMENT y I-TREATMENT reposo. I-TREATMENT Presentó B-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION fiebre, I-EVOLUTION de I-EVOLUTION 38°C I-EVOLUTION axilar. I-EVOLUTION Las I-EVOLUTION lesiones I-EVOLUTION empezaron I-EVOLUTION a I-EVOLUTION remitir I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION del I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION después I-EVOLUTION del I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY poliquística I-PAST_MEDICAL_HISTORY hepatorenal, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Crohn I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fenotipo I-PAST_MEDICAL_HISTORY inflamatorio I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY yeyuno I-PAST_MEDICAL_HISTORY (demostrado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY tomografía I-PAST_MEDICAL_HISTORY computada I-PAST_MEDICAL_HISTORY [TC] I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abdomen I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pelvis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cápsula I-PAST_MEDICAL_HISTORY endoscópica) I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY íleon I-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY infliximab I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY azatioprina. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY sometido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY íleon I-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ileoascendo I-PAST_MEDICAL_HISTORY anastomosis, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY baja I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY base I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diverticulitis I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY motivaron I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY suspensión I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY biológica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY desarrolló I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bacteriemia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Escherichia I-PAST_MEDICAL_HISTORY coli, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY quinolonas I-PAST_MEDICAL_HISTORY (ciprofloxacina) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cefalosporinas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3era I-PAST_MEDICAL_HISTORY generación I-PAST_MEDICAL_HISTORY (ceftriaxona). I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION estudio I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION otro I-EXPLORATION foco I-EXPLORATION primario, I-EXPLORATION incluyendo I-EXPLORATION ecocardiograma I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION por I-EXPLORATION emisión I-EXPLORATION de I-EXPLORATION positrones I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TEP-TC), I-EXPLORATION entre I-EXPLORATION otros. I-EXPLORATION Un B-EVOLUTION mes I-EVOLUTION después I-EVOLUTION del I-EVOLUTION segundo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION bacteriemia I-EVOLUTION por I-EVOLUTION E. I-EVOLUTION coli I-EVOLUTION se I-EVOLUTION hospitalizó I-EVOLUTION por I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION febril I-EVOLUTION y I-EVOLUTION diarrea I-EVOLUTION por I-EVOLUTION CD I-EVOLUTION (toxina I-EVOLUTION A I-EVOLUTION positiva) I-EVOLUTION y I-EVOLUTION colonoscopia I-EVOLUTION completa I-EVOLUTION con I-EVOLUTION ileoscopia I-EVOLUTION compatible I-EVOLUTION con I-EVOLUTION colitis I-EVOLUTION pseudomebranosa I-EVOLUTION siendo B-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT vía I-TREATMENT oral I-TREATMENT por I-TREATMENT 14 I-TREATMENT días I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT Aproximadamente B-EVOLUTION un I-EVOLUTION año I-EVOLUTION después, I-EVOLUTION presentó I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION febril. I-EVOLUTION La B-EXPLORATION TC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION perforación I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION yeyuno I-EXPLORATION atribuido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn I-EXPLORATION activa. I-EXPLORATION Por B-TREATMENT hemocultivos I-TREATMENT positivos I-TREATMENT a I-TREATMENT E. I-TREATMENT coli I-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT y I-TREATMENT metronidazol. I-TREATMENT Posteriormente B-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION diarrea I-EVOLUTION por I-EVOLUTION CD, I-EVOLUTION con I-EVOLUTION toxina I-EVOLUTION A I-EVOLUTION y I-EVOLUTION B I-EVOLUTION positiva, I-EVOLUTION siendo B-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT por I-TREATMENT 14 I-TREATMENT días I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT I-TREATMENT Un B-EVOLUTION mes I-EVOLUTION después I-EVOLUTION del I-EVOLUTION cuarto I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION bacteriemia I-EVOLUTION por I-EVOLUTION E. I-EVOLUTION coli, I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION diarrea I-EVOLUTION por I-EVOLUTION CD, I-EVOLUTION con I-EVOLUTION toxina I-EVOLUTION A I-EVOLUTION y I-EVOLUTION B I-EVOLUTION positiva, I-EVOLUTION siendo B-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT por I-TREATMENT 14 I-TREATMENT días I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta, I-EVOLUTION sin I-EVOLUTION embargo, I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION recaída I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION completado I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION motivo B-TREATMENT por I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT trató I-TREATMENT nuevamente I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT en I-TREATMENT disminución I-TREATMENT progresiva I-TREATMENT y I-TREATMENT probióticos I-TREATMENT (Sacharomyces I-TREATMENT boulardi), I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT I-TREATMENT Un B-EVOLUTION año I-EVOLUTION después, I-EVOLUTION estando I-EVOLUTION con I-EVOLUTION profilaxis I-EVOLUTION de I-EVOLUTION su I-EVOLUTION diverticulitis I-EVOLUTION con I-EVOLUTION rifaximina I-EVOLUTION y I-EVOLUTION mesalazina, I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION diarrea I-EVOLUTION por I-EVOLUTION CD, I-EVOLUTION con I-EVOLUTION RPC I-EVOLUTION positiva I-EVOLUTION en I-EVOLUTION deposiciones. I-EVOLUTION Fue B-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT por I-TREATMENT 14 I-TREATMENT días I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION recaída I-EVOLUTION a I-EVOLUTION los I-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION terminado I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION Fue B-TREATMENT tratado I-TREATMENT nuevamente I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT en I-TREATMENT disminución I-TREATMENT progresiva I-TREATMENT y I-TREATMENT probióticos. I-TREATMENT Evolucionó B-EVOLUTION en I-EVOLUTION forma I-EVOLUTION tórpida I-EVOLUTION con I-EVOLUTION fiebre, I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION diarrea, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT fue I-TREATMENT internado I-TREATMENT y I-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT vía I-TREATMENT oral I-TREATMENT asociado I-TREATMENT a I-TREATMENT metronidazol I-TREATMENT intravenoso I-TREATMENT (IV). I-TREATMENT Al I-TREATMENT no I-TREATMENT presentar I-TREATMENT mejoría I-TREATMENT al I-TREATMENT 3° I-TREATMENT día I-TREATMENT recibió I-TREATMENT inmunoglobulina I-TREATMENT IV I-TREATMENT 400 I-TREATMENT mg/kg I-TREATMENT al I-TREATMENT día, I-TREATMENT en I-TREATMENT cinco I-TREATMENT dosis, I-TREATMENT con I-TREATMENT una I-TREATMENT respuesta I-TREATMENT clínica I-TREATMENT parcial. I-TREATMENT I-TREATMENT Dada I-TREATMENT la I-TREATMENT mala I-TREATMENT evolución I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT todas I-TREATMENT las I-TREATMENT terapias I-TREATMENT probadas I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT un I-TREATMENT TMF I-TREATMENT vía I-TREATMENT colonoscopia I-TREATMENT con I-TREATMENT deposiciones I-TREATMENT de I-TREATMENT un I-TREATMENT donante I-TREATMENT familiar I-TREATMENT directo I-TREATMENT sin I-TREATMENT antecedentes I-TREATMENT de I-TREATMENT patologías I-TREATMENT y I-TREATMENT con I-TREATMENT estudio I-TREATMENT pre-trasplante I-TREATMENT en I-TREATMENT sangre I-TREATMENT y I-TREATMENT deposiciones I-TREATMENT (3) I-TREATMENT negativo. I-TREATMENT Se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT azatioprina I-TREATMENT y I-TREATMENT antimicrobianos, I-TREATMENT cinco I-TREATMENT días I-TREATMENT y I-TREATMENT 24 I-TREATMENT h I-TREATMENT antes I-TREATMENT del I-TREATMENT TMF, I-TREATMENT respectivamente. I-TREATMENT I-TREATMENT Descripción I-TREATMENT del I-TREATMENT procedimiento: I-TREATMENT se I-TREATMENT utilizaron I-TREATMENT 69 I-TREATMENT g I-TREATMENT de I-TREATMENT deposiciones I-TREATMENT sólidas I-TREATMENT diluidas I-TREATMENT en I-TREATMENT 300 I-TREATMENT cc I-TREATMENT de I-TREATMENT suero I-TREATMENT fisiológico I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT filtradas. I-TREATMENT La I-TREATMENT solución I-TREATMENT fue I-TREATMENT instilada I-TREATMENT desde I-TREATMENT el I-TREATMENT íleon I-TREATMENT terminal I-TREATMENT hasta I-TREATMENT el I-TREATMENT sigmoides I-TREATMENT incluyendo I-TREATMENT el I-TREATMENT área I-TREATMENT con I-TREATMENT divertículos. I-TREATMENT I-TREATMENT A I-TREATMENT las I-TREATMENT 24 I-TREATMENT h I-TREATMENT del I-TREATMENT TMF I-TREATMENT presentó I-TREATMENT un I-TREATMENT cuadro I-TREATMENT febril I-TREATMENT (T° I-TREATMENT axilar I-TREATMENT 39°C) I-TREATMENT con I-TREATMENT hemocultivos I-TREATMENT positivos I-TREATMENT a I-TREATMENT E. I-TREATMENT coli. I-TREATMENT Fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT aztreonam I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica I-TREATMENT y I-TREATMENT de I-TREATMENT laboratorio. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION realizado I-EVOLUTION el I-EVOLUTION TMF, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION bacteriemia I-EVOLUTION por I-EVOLUTION E. I-EVOLUTION coli I-EVOLUTION siendo B-TREATMENT nuevamente I-TREATMENT tratado I-TREATMENT con I-TREATMENT aztreonam. I-TREATMENT A I-TREATMENT las I-TREATMENT dos I-TREATMENT semanas I-TREATMENT de I-TREATMENT completar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT evolucionó I-TREATMENT con I-TREATMENT un I-TREATMENT nuevo I-TREATMENT cuadro I-TREATMENT de I-TREATMENT diarrea I-TREATMENT por I-TREATMENT CD I-TREATMENT con I-TREATMENT RPC I-TREATMENT positiva I-TREATMENT para I-TREATMENT CD. I-TREATMENT Fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT por I-TREATMENT 14 I-TREATMENT días I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT Un B-EVOLUTION año I-EVOLUTION y I-EVOLUTION cuatro I-EVOLUTION meses I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION TMF I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION diarrea I-EVOLUTION por I-EVOLUTION CD I-EVOLUTION (con I-EVOLUTION RPC I-EVOLUTION positiva) I-EVOLUTION que B-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT vancomicina, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT en I-TREATMENT disminución I-TREATMENT progresiva, I-TREATMENT probióticos I-TREATMENT e I-TREATMENT inmunoglobulina I-TREATMENT IV I-TREATMENT 400 I-TREATMENT mg/kg I-TREATMENT día I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT Actualmente B-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION en I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION azatioprina I-EVOLUTION por I-EVOLUTION su I-EVOLUTION enfermedad I-EVOLUTION de I-EVOLUTION Crohn. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 42 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 infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY ocho I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY inmunológicos I-PAST_MEDICAL_HISTORY periódicos, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY criterios I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antirretroviral. I-PAST_MEDICAL_HISTORY Tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY leishmaniasis I-PAST_MEDICAL_HISTORY cutánea I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antebrazo I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY residía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Madre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Dios I-PAST_MEDICAL_HISTORY (Amazonía I-PAST_MEDICAL_HISTORY oriental I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Perú). I-PAST_MEDICAL_HISTORY Refirió I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY recibido I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY incompleto, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY pudo I-PAST_MEDICAL_HISTORY especificar. I-PAST_MEDICAL_HISTORY Además I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY colesteatoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY oído I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY parálisis I-PAST_MEDICAL_HISTORY facial I-PAST_MEDICAL_HISTORY periférica I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY secuela. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY enfermedades. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tenía I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY clínicos I-PAST_MEDICAL_HISTORY anuales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carga I-PAST_MEDICAL_HISTORY viral I-PAST_MEDICAL_HISTORY (CV) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY niveles I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY linfocitos I-PAST_MEDICAL_HISTORY T I-PAST_MEDICAL_HISTORY CD4, I-PAST_MEDICAL_HISTORY manteniéndose I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY valores I-PAST_MEDICAL_HISTORY estables I-PAST_MEDICAL_HISTORY (CV I-PAST_MEDICAL_HISTORY < I-PAST_MEDICAL_HISTORY 20.000 I-PAST_MEDICAL_HISTORY copias/ml I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY CD4 I-PAST_MEDICAL_HISTORY > I-PAST_MEDICAL_HISTORY 700 I-PAST_MEDICAL_HISTORY cél/mm3), I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY evidenció I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY leve I-PAST_MEDICAL_HISTORY disminución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY CD4 I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 643 I-PAST_MEDICAL_HISTORY (28%) I-PAST_MEDICAL_HISTORY cél/mm3 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY importante I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY CV I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 47.466 I-PAST_MEDICAL_HISTORY copias/ml. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY intercurrentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diarrea I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY coriza I-PAST_MEDICAL_HISTORY autolimitados. I-PAST_MEDICAL_HISTORY Tenía I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY marcadores I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY positivos: I-PAST_MEDICAL_HISTORY HBsAg I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anticore I-PAST_MEDICAL_HISTORY total, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY alteración I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY pruebas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY función I-PAST_MEDICAL_HISTORY hepática. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS control I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Infectología I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS parietal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS congestión I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS persistente, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS examen I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nasofaringe. I-PRESENT_ILLNESS Un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS después I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS epistaxis, I-PRESENT_ILLNESS secreción I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS mucopurulenta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS observó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS (ala I-PRESENT_ILLNESS nasal). I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION lesiones I-EXPLORATION pápulo-ulcerativas I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION vestibular I-EXPLORATION y I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION derecha, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION secreción I-EXPLORATION mucopurulenta I-EXPLORATION y I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION exofítica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION nasal I-EXPLORATION para I-EXPLORATION estudio. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION además I-EXPLORATION una I-EXPLORATION cicatriz I-EXPLORATION deprimida, I-EXPLORATION delgada, I-EXPLORATION lisa, I-EXPLORATION hipopigmentada, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION el I-EXPLORATION antebrazo I-EXPLORATION derecho, I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION antigua I-EXPLORATION de I-EXPLORATION leishmaniasis I-EXPLORATION cutánea. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antirretroviral I-TREATMENT de I-TREATMENT gran I-TREATMENT actividad I-TREATMENT (TARGA) I-TREATMENT con I-TREATMENT zidovudina, I-TREATMENT lamivudina, I-TREATMENT lopinavir I-TREATMENT y I-TREATMENT ritonavir, I-TREATMENT ante I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT síntomas I-TREATMENT y I-TREATMENT sospecha I-TREATMENT de I-TREATMENT neoplasia I-TREATMENT relacionada I-TREATMENT al I-TREATMENT VIH. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION mostró I-EXPLORATION estructuras I-EXPLORATION ovaladas, I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION a I-EXPLORATION 4 I-EXPLORATION μm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION uniforme, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cinetoplasto I-EXPLORATION periférico, I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION citoplasma I-EXPLORATION de I-EXPLORATION los I-EXPLORATION histiocitos, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION amastigotes I-EXPLORATION de I-EXPLORATION Leishmania I-EXPLORATION spp. I-EXPLORATION La I-EXPLORATION inmunofluorescencia I-EXPLORATION indirecta I-EXPLORATION (IFI) I-EXPLORATION (con I-EXPLORATION antígeno I-EXPLORATION total I-EXPLORATION para I-EXPLORATION L. I-EXPLORATION boliviana I-EXPLORATION y I-EXPLORATION L. I-EXPLORATION brasiliensis) I-EXPLORATION detectó I-EXPLORATION anticuerpos I-EXPLORATION anti-Leishmania I-EXPLORATION a I-EXPLORATION una I-EXPLORATION dilución I-EXPLORATION de I-EXPLORATION 1/80, I-EXPLORATION confirmándose I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION leishmaniasis. I-EXPLORATION Al B-TREATMENT mes I-TREATMENT siguiente I-TREATMENT de I-TREATMENT iniciado I-TREATMENT el I-TREATMENT TARGA I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT estibogluconato I-TREATMENT sódico, I-TREATMENT 20 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT 30 I-TREATMENT días. I-TREATMENT I-TREATMENT Luego B-EVOLUTION de I-EVOLUTION completar I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION estibogluconato I-EVOLUTION sódico, I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION mejoró I-EVOLUTION entre I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION y I-EVOLUTION cuatro I-EVOLUTION semanas, I-EVOLUTION hasta I-EVOLUTION su I-EVOLUTION cicatrización I-EVOLUTION completa. I-EVOLUTION Tres I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION CD4 I-EVOLUTION se I-EVOLUTION elevaron I-EVOLUTION hasta I-EVOLUTION 843 I-EVOLUTION cél/ml I-EVOLUTION y I-EVOLUTION la I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION disminuyó I-EVOLUTION a I-EVOLUTION < I-EVOLUTION 40 I-EVOLUTION copias/ml. I-EVOLUTION Actualmente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION TARGA, I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION recaída I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION ni I-EVOLUTION lesiones I-EVOLUTION similares. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Down, I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY congénita I-PAST_MEDICAL_HISTORY operada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY (canal I-PAST_MEDICAL_HISTORY aurículo-ventricular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ductus I-PAST_MEDICAL_HISTORY arterioso I-PAST_MEDICAL_HISTORY persistente). I-PAST_MEDICAL_HISTORY Tenía B-PRESENT_ILLNESS las I-PRESENT_ILLNESS vacunas I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Programa I-PRESENT_ILLNESS Nacional I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Inmunizaciones I-PRESENT_ILLNESS (PNI) I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vacunas I-PRESENT_ILLNESS extra-PNI. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS Infantil I-PRESENT_ILLNESS (SUI) I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS eritrodermia. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS eritema I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hemi-cara I-PRESENT_ILLNESS y I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS se I-PRESENT_ILLNESS extendió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS contra-lateral. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS día I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 40° I-PRESENT_ILLNESS C, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS eritema I-PRESENT_ILLNESS en I-PRESENT_ILLNESS progresión I-PRESENT_ILLNESS descendente, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS comprometió I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuello, I-PRESENT_ILLNESS tronco I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS superiores. I-PRESENT_ILLNESS Además I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompañó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS flictenas I-PRESENT_ILLNESS eritematosas, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS pruriginosas, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS mentoniana I-PRESENT_ILLNESS y I-PRESENT_ILLNESS preauricular I-PRESENT_ILLNESS que I-PRESENT_ILLNESS desaparecieron I-PRESENT_ILLNESS espontáneamente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS transcurso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS día. I-PRESENT_ILLNESS Se B-EXPLORATION evaluó I-EXPLORATION con I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION destacando I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION normales I-EXPLORATION (10.470/mm3) I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION polimorfonuclear I-EXPLORATION (92,3%), I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION serie I-EXPLORATION roja I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1 I-EXPLORATION mg/dl). I-EXPLORATION Se B-TREATMENT le I-TREATMENT hizo I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT una I-TREATMENT dermatitis I-TREATMENT alérgica I-TREATMENT y I-TREATMENT se I-TREATMENT indicó I-TREATMENT clorfenamina I-TREATMENT y I-TREATMENT glucocorticoides I-TREATMENT vía I-TREATMENT oral, I-TREATMENT durante I-TREATMENT tres I-TREATMENT días. I-TREATMENT I-TREATMENT Por B-DERIVED_FROM/TO persistencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO sintomatología, I-DERIVED_FROM/TO consultó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO pediatra I-DERIVED_FROM/TO tratante I-DERIVED_FROM/TO quien I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO nuevamente I-DERIVED_FROM/TO al I-DERIVED_FROM/TO SUI. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EVOLUTION ese I-EVOLUTION momento, I-EVOLUTION en I-EVOLUTION su I-EVOLUTION 8° I-EVOLUTION día I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION 7° I-EVOLUTION día I-EVOLUTION de I-EVOLUTION fiebre, I-EVOLUTION se I-EVOLUTION apreciaba I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales. I-EVOLUTION Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION describía I-EXPLORATION una I-EXPLORATION "lesión I-EXPLORATION eritro-descamativa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION que I-EXPLORATION respetaba I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION peribucal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION placa I-EXPLORATION eritematosa I-EXPLORATION en I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION que I-EXPLORATION respetaba I-EXPLORATION las I-EXPLORATION muñecas, I-EXPLORATION manos I-EXPLORATION y I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION codo. I-EXPLORATION También I-EXPLORATION afectaba I-EXPLORATION el I-EXPLORATION cuero I-EXPLORATION cabelludo, I-EXPLORATION cuello I-EXPLORATION y I-EXPLORATION mitad I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION tronco, I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION delimitados, I-EXPLORATION sin I-EXPLORATION adenopatías I-EXPLORATION palpables. I-EXPLORATION Presentaba I-EXPLORATION una I-EXPLORATION inyección I-EXPLORATION conjuntival I-EXPLORATION sin I-EXPLORATION secreción I-EXPLORATION y I-EXPLORATION lengua I-EXPLORATION aframbuesada. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION cardíaco I-EXPLORATION era I-EXPLORATION normal, I-EXPLORATION y I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION descamación I-EXPLORATION periungueal". I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION destacando I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION leucopenia I-EXPLORATION de I-EXPLORATION 4.880/mm3, I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION polimorfonuclear I-EXPLORATION (90%), I-EXPLORATION plaquetas I-EXPLORATION 198.000/mm3, I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 20, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION anti-estreptolisina I-EXPLORATION O I-EXPLORATION 759 I-EXPLORATION U/ I-EXPLORATION ml I-EXPLORATION (VN: I-EXPLORATION < I-EXPLORATION 200). I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION faríngeo I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION hemocultivos I-EXPLORATION periféricos. I-EXPLORATION I-EXPLORATION Ingresó B-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Pediatría I-EVOLUTION al I-EVOLUTION 8° I-EVOLUTION día I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION con I-EVOLUTION estabilidad I-EVOLUTION hemodinámica I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION conciencia. I-EVOLUTION Se B-TREATMENT planteó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT escarlatina I-TREATMENT e I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT amoxicilina, I-TREATMENT vía I-TREATMENT oral. I-TREATMENT Además B-EXPLORATION se I-EXPLORATION planteó I-EXPLORATION la I-EXPLORATION necesidad I-EXPLORATION de I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Kawasaki I-EXPLORATION atípica I-EXPLORATION o I-EXPLORATION una I-EXPLORATION endocarditis I-EXPLORATION infecciosa. I-EXPLORATION Se B-EVOLUTION controlaron I-EVOLUTION exámenes I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso. I-EVOLUTION Tenía I-EVOLUTION una I-EVOLUTION PCR I-EVOLUTION de I-EVOLUTION 23, I-EVOLUTION 9 I-EVOLUTION mg/dl I-EVOLUTION y I-EVOLUTION un I-EVOLUTION perfil I-EVOLUTION bioquímico I-EVOLUTION normal. I-EVOLUTION Evaluada B-TREATMENT por I-TREATMENT infectología, I-TREATMENT se I-TREATMENT decidió I-TREATMENT cambiar I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT a I-TREATMENT penicilina I-TREATMENT sódica I-TREATMENT i.v. I-TREATMENT I-TREATMENT Evolucionó B-EVOLUTION desde I-EVOLUTION el I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION antimicrobiano, I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION incubación I-EVOLUTION se I-EVOLUTION informaron I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION hemocultivos I-EVOLUTION positivos I-EVOLUTION para I-EVOLUTION Streptococcus I-EVOLUTION ß- I-EVOLUTION hemolítico I-EVOLUTION del I-EVOLUTION grupo I-EVOLUTION G, I-EVOLUTION con I-EVOLUTION susceptibilidad I-EVOLUTION in I-EVOLUTION vitro I-EVOLUTION a I-EVOLUTION penicilina, I-EVOLUTION clindamicina, I-EVOLUTION cloxacilina, I-EVOLUTION eritromicina I-EVOLUTION y I-EVOLUTION levofloxacino, I-EVOLUTION y I-EVOLUTION resistencia I-EVOLUTION a I-EVOLUTION cotrimoxazol. I-EVOLUTION El I-EVOLUTION ecocardiograma I-EVOLUTION realizado I-EVOLUTION fue I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION no I-EVOLUTION hubo I-EVOLUTION detección I-EVOLUTION de I-EVOLUTION otros I-EVOLUTION focos I-EVOLUTION clínicos I-EVOLUTION secundarios. I-EVOLUTION I-EVOLUTION Evolucionó I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION franca I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION eritema I-EVOLUTION facial I-EVOLUTION y I-EVOLUTION de I-EVOLUTION tronco. I-EVOLUTION Al I-EVOLUTION 5° I-EVOLUTION día I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antimicrobiano, I-EVOLUTION se I-EVOLUTION informó I-EVOLUTION que I-EVOLUTION la I-EVOLUTION especie I-EVOLUTION identificada, I-EVOLUTION por I-EVOLUTION método I-EVOLUTION de I-EVOLUTION Vitek®, I-EVOLUTION correspondía I-EVOLUTION a I-EVOLUTION Streptococcus I-EVOLUTION dysgalactiae I-EVOLUTION subespecie I-EVOLUTION equisimilis. I-EVOLUTION I-EVOLUTION La B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT 10 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT i.v. I-TREATMENT más I-TREATMENT cuatro I-TREATMENT días I-TREATMENT de I-TREATMENT amoxicilina/ácido I-TREATMENT clavulánico, I-TREATMENT vía I-TREATMENT oral, I-TREATMENT completando I-TREATMENT en I-TREATMENT la I-TREATMENT fase I-TREATMENT ambulatoria I-TREATMENT 14 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT El B-EVOLUTION control I-EVOLUTION posterior I-EVOLUTION demostró I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION satisfactoria. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION básico I-EXPLORATION de I-EXPLORATION inmunodeficiencia I-EXPLORATION descartándose I-EXPLORATION una I-EXPLORATION hipogamaglobulinemia, I-EXPLORATION hipocomplementemia I-EXPLORATION o I-EXPLORATION leucopenia I-EXPLORATION secundaria I-EXPLORATION al I-EXPLORATION Síndrome I-EXPLORATION de I-EXPLORATION Down. I-EXPLORATION I-EXPLORATION La I-EXPLORATION cepa I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION al I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Biología I-EXPLORATION Molecular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION Católica I-EXPLORATION para I-EXPLORATION genotipificación. I-EXPLORATION Por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION RPC I-EXPLORATION universal I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION Streptococcus I-EXPLORATION dysgalactiae I-EXPLORATION subespecie I-EXPLORATION equisimilis, I-EXPLORATION genotipo I-EXPLORATION stg653.0. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 84 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS nacionalidad B-PAST_MEDICAL_HISTORY chilena, I-PAST_MEDICAL_HISTORY dueña I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY casa. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS policlínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Dermatología I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nódulos I-PRESENT_ILLNESS cutáneos I-PRESENT_ILLNESS eritematosos I-PRESENT_ILLNESS ulcerados, I-PRESENT_ILLNESS asintomáticos, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS palmar I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dedo I-PRESENT_ILLNESS meñique I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS ventral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS antebrazo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS siguiendo I-PRESENT_ILLNESS un I-PRESENT_ILLNESS patrón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disposición I-PRESENT_ILLNESS lineal I-PRESENT_ILLNESS a I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS largo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS trayecto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vasos I-PRESENT_ILLNESS linfáticos I-PRESENT_ILLNESS ; I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS acompañantes. I-PRESENT_ILLNESS La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY esencial, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardíaca I-PAST_MEDICAL_HISTORY congestiva, I-PAST_MEDICAL_HISTORY hipotiroidis-mo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY hemolítica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY crioaglutininas. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tuberculosis, I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY corticoides, I-PAST_MEDICAL_HISTORY inmunosupresión I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY reciente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY zonas I-PAST_MEDICAL_HISTORY afectadas. I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY existían I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY relevancia I-FAMILY_HISTORY ni I-FAMILY_HISTORY viajes I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY último I-FAMILY_HISTORY tiempo. I-FAMILY_HISTORY I-FAMILY_HISTORY Se B-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION de I-EXPLORATION micosis I-EXPLORATION subcutánea, I-EXPLORATION micobacteriosis I-EXPLORATION tuberculosa I-EXPLORATION y I-EXPLORATION micobacteriosis I-EXPLORATION atípica, I-EXPLORATION realizándose I-EXPLORATION biopsia I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION cutáneas. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION histopatológico I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION paniculitis I-EXPLORATION granulomatosa I-EXPLORATION supurativa I-EXPLORATION sin I-EXPLORATION caseificación. I-EXPLORATION Las I-EXPLORATION tinciones I-EXPLORATION de I-EXPLORATION PAS, I-EXPLORATION Grocott, I-EXPLORATION Ziehl-Neelsen I-EXPLORATION y I-EXPLORATION Gram I-EXPLORATION no I-EXPLORATION revelaron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION microorganismos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION muestra. I-EXPLORATION Sin I-EXPLORATION embargo, I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION M. I-EXPLORATION tuberculosis. I-EXPLORATION Dentro I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION hemograma, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación, I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION orina, I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION los I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION todos I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION Quantiferon I-EXPLORATION TB I-EXPLORATION gold® I-EXPLORATION resultó I-EXPLORATION positivo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION PPD. I-EXPLORATION I-EXPLORATION Basado I-EXPLORATION en I-EXPLORATION los I-EXPLORATION resultados, I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION tuberculosis I-EXPLORATION cutánea I-EXPLORATION y B-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT esquema I-TREATMENT primario I-TREATMENT de I-TREATMENT cuatro I-TREATMENT fármacos: I-TREATMENT isoniacida, I-TREATMENT pirazinamida, I-TREATMENT rifampicina I-TREATMENT y I-TREATMENT etambutol. I-TREATMENT Durante I-TREATMENT dos I-TREATMENT meses I-TREATMENT de I-TREATMENT seguimiento I-TREATMENT la I-TREATMENT paciente I-TREATMENT continuó I-TREATMENT con I-TREATMENT el I-TREATMENT esquema I-TREATMENT de I-TREATMENT terapia I-TREATMENT antituberculosa I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT a I-TREATMENT los I-TREATMENT protocolos I-TREATMENT establecidos, I-TREATMENT demostrando B-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION clínicamente I-EVOLUTION significativa I-EVOLUTION con I-EVOLUTION regresión I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION ulcerativas I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION efectos I-EVOLUTION secundarios I-EVOLUTION reportados. I-EVOLUTION I-EVOLUTION Comunicamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Iquitos, I-PAST_MEDICAL_HISTORY selva I-PAST_MEDICAL_HISTORY peruana, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia. I-PAST_MEDICAL_HISTORY Tenía B-PRESENT_ILLNESS una I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS febril, I-PRESENT_ILLNESS calofríos, I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS epigastralgia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS gingivorragia. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 5°C, I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 110/80 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION y I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION respiraciones I-EXPLORATION por I-EXPLORATION min. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION alteraciones. I-EXPLORATION Al B-EVOLUTION día I-EVOLUTION siguiente, I-EVOLUTION se I-EVOLUTION agregó I-EVOLUTION distensión I-EVOLUTION abdominal, I-EVOLUTION disnea I-EVOLUTION a I-EVOLUTION mediano I-EVOLUTION esfuerzo I-EVOLUTION y I-EVOLUTION deposiciones I-EVOLUTION con I-EVOLUTION contenido I-EVOLUTION rojizo I-EVOLUTION oscuro, I-EVOLUTION cuyo I-EVOLUTION cultivo I-EVOLUTION fue I-EVOLUTION negativo; I-EVOLUTION al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION pulmonar I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION murmullo I-EXPLORATION vesicular I-EXPLORATION disminuido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION inferior, I-EXPLORATION sin I-EXPLORATION ruidos I-EXPLORATION agregados. I-EXPLORATION Dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 48% I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION en I-EXPLORATION 51.000/mm3. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION dengue I-EXPLORATION y I-EXPLORATION leptospira, I-EXPLORATION resultando I-EXPLORATION la I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION dengue I-EXPLORATION positiva. I-EXPLORATION Se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION dengue I-EXPLORATION con I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION IgM. I-EXPLORATION Por I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION disnea I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION y I-EXPLORATION troponina I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION que I-EXPLORATION configuró I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION una I-EXPLORATION miocarditis. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION cardiomegalia I-EXPLORATION con I-EXPLORATION derrame I-EXPLORATION pleural. I-EXPLORATION Se B-EVOLUTION ingresó I-EVOLUTION a I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos I-EVOLUTION por I-EVOLUTION mala I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fiebre. I-EVOLUTION Por B-TREATMENT insuficiencia I-TREATMENT respiratoria I-TREATMENT y I-TREATMENT compromiso I-TREATMENT de I-TREATMENT conciencia I-TREATMENT (Glasgow I-TREATMENT 10) I-TREATMENT se I-TREATMENT conectó I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasora. I-TREATMENT Dentro B-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION auxiliares I-EXPLORATION destacaban I-EXPLORATION gases I-EXPLORATION arteriales: I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 52; I-EXPLORATION pCO2 I-EXPLORATION 58 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION PO2 I-EXPLORATION (A-a) I-EXPLORATION 368 I-EXPLORATION mmHg, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION 157.000/mm3, I-EXPLORATION hematocrito I-EXPLORATION 43%, I-EXPLORATION glucosa I-EXPLORATION 167 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION 1, I-EXPLORATION 08 I-EXPLORATION mg/dl. I-EXPLORATION Se B-EVOLUTION diagnosticó I-EVOLUTION dengue I-EVOLUTION grave I-EVOLUTION con I-EVOLUTION injuria I-EVOLUTION renal I-EVOLUTION aguda, I-EVOLUTION insuficiencia I-EVOLUTION cardíaca, I-EVOLUTION respiratoria I-EVOLUTION y I-EVOLUTION sepsis I-EVOLUTION grave. I-EVOLUTION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ciprofloxacina, I-TREATMENT ceftazidima I-TREATMENT en I-TREATMENT forma I-TREATMENT empírica, I-TREATMENT vitamina I-TREATMENT K I-TREATMENT y I-TREATMENT furosemida I-TREATMENT i.v. I-TREATMENT A B-EVOLUTION los I-EVOLUTION dos I-EVOLUTION días, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION mejoría, I-EVOLUTION con I-EVOLUTION ventilación I-EVOLUTION espontánea I-EVOLUTION y I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION edema. I-EVOLUTION Dentro B-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION el I-EXPLORATION control I-EXPLORATION de I-EXPLORATION troponina I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecocardiografia I-EXPLORATION de I-EXPLORATION control I-EXPLORATION a I-EXPLORATION la I-EXPLORATION semana I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS dedicado B-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY construcción, I-PAST_MEDICAL_HISTORY originario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Guanajuato, I-PAST_MEDICAL_HISTORY Gto., I-PAST_MEDICAL_HISTORY sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY o B-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY importantes. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS verrugosa I-PRESENT_ILLNESS nodular I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS nariz I-PRESENT_ILLNESS con I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS gradual I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS Un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS había I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS abscesos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS los I-PRESENT_ILLNESS cuales I-PRESENT_ILLNESS fueron I-PRESENT_ILLNESS drenados, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después I-PRESENT_ILLNESS notó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tercer I-PRESENT_ILLNESS absceso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS brazo. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION periorbitaria I-EXPLORATION y I-EXPLORATION antecubital I-EXPLORATION derecho I-EXPLORATION placas I-EXPLORATION nodulares I-EXPLORATION verrugosas, I-EXPLORATION edematosas I-EXPLORATION y I-EXPLORATION cubiertas I-EXPLORATION por I-EXPLORATION costras I-EXPLORATION hemáticas. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION directo I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Coccidioides I-EXPLORATION spp. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT coccidioidomicosis I-TREATMENT cutánea I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT itraconazol I-TREATMENT oral I-TREATMENT 400 I-TREATMENT mg I-TREATMENT al I-TREATMENT día. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS chofer, B-PAST_MEDICAL_HISTORY originario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Jiquilpan, I-PAST_MEDICAL_HISTORY Mich I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY residente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Tijuana, I-PAST_MEDICAL_HISTORY B.C. I-PAST_MEDICAL_HISTORY Con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nueve I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipoglicemiantes I-PAST_MEDICAL_HISTORY orales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY osteoartrosis I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY meloxicam I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY corticoesteroides I-PAST_MEDICAL_HISTORY intralesionales I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY ocasiones. I-PAST_MEDICAL_HISTORY Además I-PAST_MEDICAL_HISTORY mencionó I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY neumonía I-PAST_MEDICAL_HISTORY aparentemente I-PAST_MEDICAL_HISTORY bacteriana I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antibacterianos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS localizadas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS glabelar, I-PRESENT_ILLNESS nariz I-PRESENT_ILLNESS y I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS paranasal I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Las B-EXPLORATION lesiones I-EXPLORATION eran I-EXPLORATION placas I-EXPLORATION nodulares I-EXPLORATION poco I-EXPLORATION elevadas, I-EXPLORATION ulceradas, I-EXPLORATION con I-EXPLORATION fondo I-EXPLORATION granulomatoso I-EXPLORATION y I-EXPLORATION costras I-EXPLORATION sanguíneas, I-EXPLORATION de I-EXPLORATION 1-2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION con I-EXPLORATION examen I-EXPLORATION directo I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Coccidioides I-EXPLORATION spp. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION intradermorreacción I-EXPLORATION positiva. I-EXPLORATION I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT itraconazol I-TREATMENT oral I-TREATMENT 400 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT por I-TREATMENT cuatro I-TREATMENT meses I-TREATMENT y I-TREATMENT por I-TREATMENT intolerancia I-TREATMENT gástrica I-TREATMENT tuvo I-TREATMENT que I-TREATMENT ser I-TREATMENT sustituido I-TREATMENT por I-TREATMENT terbinafina I-TREATMENT oral I-TREATMENT 500 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT durante I-TREATMENT cinco I-TREATMENT meses. I-TREATMENT Al B-EVOLUTION suspender I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION acudió I-EVOLUTION con I-EVOLUTION una I-EVOLUTION flogosis I-EVOLUTION de I-EVOLUTION ambas I-EVOLUTION rodillas I-EVOLUTION y I-EVOLUTION salida I-EVOLUTION de I-EVOLUTION material I-EVOLUTION purulento I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION fístulas. I-EVOLUTION Se B-TREATMENT aisló I-TREATMENT C. I-TREATMENT posadasii I-TREATMENT y I-TREATMENT se I-TREATMENT internó I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS originario B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Puebla I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY residente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Tijuana, I-PAST_MEDICAL_HISTORY B.C., I-PAST_MEDICAL_HISTORY agricultor, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY amlodipino. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ala I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS caracterizada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen, I-PRESENT_ILLNESS eritema, I-PRESENT_ILLNESS exulceraciones I-PRESENT_ILLNESS y I-PRESENT_ILLNESS exudado I-PRESENT_ILLNESS seroso, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS El B-EXPLORATION diagnóstico I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION con I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION esférulas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION directo I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION positivo I-EXPLORATION a I-EXPLORATION Coccidioides I-EXPLORATION spp. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT itraconazol I-TREATMENT 400 I-TREATMENT mg I-TREATMENT al I-TREATMENT día. I-TREATMENT I-TREATMENT Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS género I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hospitalizaciones I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY patología I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY Un B-PRESENT_ILLNESS mes I-PRESENT_ILLNESS previo I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hospitalización I-PRESENT_ILLNESS había I-PRESENT_ILLNESS recibido I-PRESENT_ILLNESS flucloxacilina I-PRESENT_ILLNESS como I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS impétigo. I-PRESENT_ILLNESS Su B-FAMILY_HISTORY madre I-FAMILY_HISTORY era I-FAMILY_HISTORY portadora I-FAMILY_HISTORY de I-FAMILY_HISTORY un I-FAMILY_HISTORY lupus I-FAMILY_HISTORY eritematoso I-FAMILY_HISTORY sistémico, I-FAMILY_HISTORY dueña I-FAMILY_HISTORY de I-FAMILY_HISTORY casa I-FAMILY_HISTORY y I-FAMILY_HISTORY su I-FAMILY_HISTORY padre, I-FAMILY_HISTORY trabajador I-FAMILY_HISTORY en I-FAMILY_HISTORY servicios I-FAMILY_HISTORY de I-FAMILY_HISTORY correo I-FAMILY_HISTORY internacional. I-FAMILY_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS una I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Emergencia I-PRESENT_ILLNESS (UE) I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS rodilla I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS contusión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS manejó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS ambulatoria I-PRESENT_ILLNESS con I-PRESENT_ILLNESS inmovilización I-PRESENT_ILLNESS y I-PRESENT_ILLNESS analgesia. I-PRESENT_ILLNESS Dada I-PRESENT_ILLNESS la I-PRESENT_ILLNESS persistencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS vuelve I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consultar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS después. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION dolor I-EXPLORATION espontáneo I-EXPLORATION intenso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION derecha, I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION metáfisis I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tibia I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION local, I-EXPLORATION sin I-EXPLORATION fiebre, I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION hemodinámico, I-EXPLORATION ni I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION leucocitosis I-EXPLORATION y I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION izquierda I-EXPLORATION (24% I-EXPLORATION baciliformes), I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION 270 I-EXPLORATION mg/L I-EXPLORATION y I-EXPLORATION VHS I-EXPLORATION 101 I-EXPLORATION mm/h. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION discreto I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION lesión I-EXPLORATION ósea I-EXPLORATION asociada. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION aseo I-EXPLORATION quirúrgico I-EXPLORATION y I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION tratamiento I-EXPLORATION antimicrobiano I-EXPLORATION con I-EXPLORATION cloxacilina I-EXPLORATION iv I-EXPLORATION (185 I-EXPLORATION mg/kg/día) I-EXPLORATION cada I-EXPLORATION 6 I-EXPLORATION h. I-EXPLORATION Al I-EXPLORATION tercer I-EXPLORATION día I-EXPLORATION post-operatorio, I-EXPLORATION persistió I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION intenso I-EXPLORATION y I-EXPLORATION comenzó I-EXPLORATION con I-EXPLORATION fiebre I-EXPLORATION y I-EXPLORATION compromiso I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION Los I-EXPLORATION dos I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION óseo I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION SARM, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT vancomicina, I-TREATMENT aislamiento I-TREATMENT de I-TREATMENT contacto I-TREATMENT según I-TREATMENT la I-TREATMENT norma I-TREATMENT institucional I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT nuevo I-TREATMENT aseo I-TREATMENT quirúrgico. I-TREATMENT Dada B-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fiebre I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION cintigrama I-EXPLORATION óseo I-EXPLORATION trifásico, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION actividad I-EXPLORATION osteoblástica I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION metáfisis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tibia I-EXPLORATION proximal I-EXPLORATION derecha. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION tórpida, I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fiebre I-EVOLUTION hasta I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION iniciado I-EVOLUTION vancomicina, I-EVOLUTION requiriendo I-EVOLUTION múltiples I-EVOLUTION aseos I-EVOLUTION quirúrgicos I-EVOLUTION en I-EVOLUTION los I-EVOLUTION que I-EVOLUTION se I-EVOLUTION encontraron I-EVOLUTION colecciones I-EVOLUTION y I-EVOLUTION daño I-EVOLUTION articular. I-EVOLUTION Los I-EVOLUTION cultivos I-EVOLUTION intraoperatorios I-EVOLUTION persistieron I-EVOLUTION positivos I-EVOLUTION hasta I-EVOLUTION 12 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION iniciado I-EVOLUTION vancomicina. I-EVOLUTION Por I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fiebre I-EVOLUTION se I-EVOLUTION descartaron I-EVOLUTION focos I-EVOLUTION secundarios I-EVOLUTION u I-EVOLUTION otra I-EVOLUTION infección. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION inmunológico I-EXPLORATION básico I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION El B-TREATMENT día I-TREATMENT 18 I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT presentó I-TREATMENT un I-TREATMENT exantema I-TREATMENT máculo-papular I-TREATMENT morbiliforme, I-TREATMENT que I-TREATMENT fue I-TREATMENT considerada I-TREATMENT como I-TREATMENT una I-TREATMENT reacción I-TREATMENT adversa I-TREATMENT a I-TREATMENT fármacos, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT cambió I-TREATMENT la I-TREATMENT terapia I-TREATMENT a I-TREATMENT clindamicina I-TREATMENT iv. I-TREATMENT Evolucionó B-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION dolor I-EVOLUTION local, I-EVOLUTION completando I-EVOLUTION en I-EVOLUTION total I-EVOLUTION 56 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antibacteriano: I-EVOLUTION 17 B-TREATMENT días I-TREATMENT de I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT 39 I-TREATMENT días I-TREATMENT de I-TREATMENT clindamicina. I-TREATMENT Fue B-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION parámetros I-EVOLUTION inflamatorios I-EVOLUTION en I-EVOLUTION descenso I-EVOLUTION (VHS I-EVOLUTION 28 I-EVOLUTION mm/h I-EVOLUTION y I-EVOLUTION PCR I-EVOLUTION 19, I-EVOLUTION 2 I-EVOLUTION mg/L), I-EVOLUTION y I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION linezolid I-EVOLUTION vía I-EVOLUTION oral I-EVOLUTION (300 I-EVOLUTION mg, I-EVOLUTION dos I-EVOLUTION veces I-EVOLUTION al I-EVOLUTION día), I-EVOLUTION por I-EVOLUTION 20 I-EVOLUTION días. I-EVOLUTION El B-EXPLORATION ISP I-EXPLORATION confirmó I-EXPLORATION que I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION fue I-EXPLORATION SARM, I-EXPLORATION PVL I-EXPLORATION negativa. I-EXPLORATION Además, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION portación I-EXPLORATION nasal I-EXPLORATION familiar I-EXPLORATION en I-EXPLORATION que I-EXPLORATION la I-EXPLORATION madre I-EXPLORATION resultó I-EXPLORATION ser I-EXPLORATION positiva I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION decolonización I-EXPLORATION con I-EXPLORATION mupirocina I-EXPLORATION tópica. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION genético I-EXPLORATION y I-EXPLORATION la I-EXPLORATION caracterización I-EXPLORATION molecular I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION cepas I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION del I-EXPLORATION marcador I-EXPLORATION PV-L I-EXPLORATION y I-EXPLORATION determinaron I-EXPLORATION un I-EXPLORATION mismo I-EXPLORATION subtipo I-EXPLORATION genético I-EXPLORATION por I-EXPLORATION PFGE I-EXPLORATION (CL-SAU-COM-SMA-017) I-EXPLORATION y I-EXPLORATION por I-EXPLORATION MLST I-EXPLORATION al I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION secuencia I-EXPLORATION ST8. I-EXPLORATION I-EXPLORATION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS género I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY patologías I-PAST_MEDICAL_HISTORY crónicas, I-PAST_MEDICAL_HISTORY hospitalizaciones, I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antibacterianos I-PAST_MEDICAL_HISTORY recientes. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lumbalgia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS trauma I-PRESENT_ILLNESS dorso-lumbar I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39° I-PRESENT_ILLNESS C. I-PRESENT_ILLNESS Se B-EVOLUTION internó I-EVOLUTION para I-EVOLUTION estudio I-EVOLUTION evolucionando I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION PCR I-EVOLUTION hasta I-EVOLUTION 150 I-EVOLUTION mg/L. I-EVOLUTION A B-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION h, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION renal I-EXPLORATION izquierda, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT inició I-TREATMENT cefotaxima I-TREATMENT en I-TREATMENT forma I-TREATMENT empírica. I-TREATMENT Al I-TREATMENT día I-TREATMENT siguiente I-TREATMENT se I-TREATMENT cambió I-TREATMENT a I-TREATMENT cloxacilina I-TREATMENT (170 I-TREATMENT mg/kg/día) I-TREATMENT cada I-TREATMENT 6 I-TREATMENT h. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION angio-TAC I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION absceso I-EXPLORATION renal I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION Al B-TREATMENT cuarto I-TREATMENT día I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT dada I-TREATMENT persistencia I-TREATMENT de I-TREATMENT la I-TREATMENT fiebre I-TREATMENT e I-TREATMENT incremento I-TREATMENT de I-TREATMENT PCR I-TREATMENT hasta I-TREATMENT 270 I-TREATMENT mg/L, I-TREATMENT se I-TREATMENT cambió I-TREATMENT esquema I-TREATMENT a I-TREATMENT vancomicina I-TREATMENT (40 I-TREATMENT mg/kg/día) I-TREATMENT y I-TREATMENT meropenem I-TREATMENT (60 I-TREATMENT mg/kg/ I-TREATMENT día). I-TREATMENT Luego B-DERIVED_FROM/TO de I-DERIVED_FROM/TO seis I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vancomicina I-DERIVED_FROM/TO y I-DERIVED_FROM/TO con I-DERIVED_FROM/TO una I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO desfavorable, I-DERIVED_FROM/TO aumento I-DERIVED_FROM/TO de I-DERIVED_FROM/TO los I-DERIVED_FROM/TO parámetros I-DERIVED_FROM/TO inflamatorios I-DERIVED_FROM/TO y I-DERIVED_FROM/TO del I-DERIVED_FROM/TO tamaño I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO lesión I-DERIVED_FROM/TO renal I-DERIVED_FROM/TO se I-DERIVED_FROM/TO trasladó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO otra I-DERIVED_FROM/TO institución I-DERIVED_FROM/TO para I-DERIVED_FROM/TO la I-DERIVED_FROM/TO instalación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO un I-DERIVED_FROM/TO catéter I-DERIVED_FROM/TO ureteral I-DERIVED_FROM/TO (pig-tail) I-DERIVED_FROM/TO y I-DERIVED_FROM/TO drenaje I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO colección I-DERIVED_FROM/TO renal, I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO que I-DERIVED_FROM/TO se I-DERIVED_FROM/TO tomó I-DERIVED_FROM/TO una I-DERIVED_FROM/TO muestra I-DERIVED_FROM/TO para I-DERIVED_FROM/TO cultivo. I-DERIVED_FROM/TO Al B-EVOLUTION 5o I-EVOLUTION día I-EVOLUTION post-operatorio I-EVOLUTION bajó I-EVOLUTION la I-EVOLUTION fiebre, I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION parámetros I-EVOLUTION inflamatorios. I-EVOLUTION El B-EXPLORATION resultado I-EXPLORATION del I-EXPLORATION cultivo I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION SARM. I-EXPLORATION Con B-TREATMENT el I-TREATMENT informe I-TREATMENT microbiológico I-TREATMENT se I-TREATMENT suspendió I-TREATMENT meropenem I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT vancomicina I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION definitivamente I-EVOLUTION afebril I-EVOLUTION después I-EVOLUTION de I-EVOLUTION 12 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION drenaje I-EVOLUTION quirúrgico, I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION PCR, I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION siempre I-EVOLUTION conservada I-EVOLUTION e I-EVOLUTION imagen I-EVOLUTION ecográfica I-EVOLUTION con I-EVOLUTION absceso I-EVOLUTION en I-EVOLUTION regresión. I-EVOLUTION Completó B-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 36 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT vancomicina. I-TREATMENT Se B-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION cepa I-EXPLORATION como I-EXPLORATION SARM, I-EXPLORATION PV-L I-EXPLORATION positivo. I-EXPLORATION La I-EXPLORATION caracterización I-EXPLORATION molecular I-EXPLORATION correspondió I-EXPLORATION al I-EXPLORATION subtipo I-EXPLORATION CL-SAU-COM-SMA-002 I-EXPLORATION (PFGE) I-EXPLORATION y I-EXPLORATION al I-EXPLORATION ST731 I-EXPLORATION perteneciente I-EXPLORATION al I-EXPLORATION CC I-EXPLORATION 30 I-EXPLORATION por I-EXPLORATION MLST. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION portación I-EXPLORATION nasal I-EXPLORATION a I-EXPLORATION ambos I-EXPLORATION padres, I-EXPLORATION hermanos I-EXPLORATION y I-EXPLORATION abuelos, I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Preescolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY vacunas I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY PNI I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY asistencia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY jardín I-PAST_MEDICAL_HISTORY infantil. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS menos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 40°C I-PRESENT_ILLNESS axilar, I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS alimentarios, I-PRESENT_ILLNESS coriza I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS frontal. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS alucinaciones I-PRESENT_ILLNESS visuales I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Urgencia I-EXPLORATION (SU) I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION febril, I-EXPLORATION decaída, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION segmentario I-EXPLORATION y I-EXPLORATION neurológico I-EXPLORATION normal. I-EXPLORATION Dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaban I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 36.100 I-EXPLORATION céls/mm3 I-EXPLORATION (25% I-EXPLORATION segmentados), I-EXPLORATION PCR I-EXPLORATION 205 I-EXPLORATION mg/L I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 10), I-EXPLORATION orina I-EXPLORATION completa I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION con I-EXPLORATION escaso I-EXPLORATION infiltrado I-EXPLORATION intersticial. I-EXPLORATION Se I-EXPLORATION hospitalizó I-EXPLORATION con I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION febril I-EXPLORATION sin I-EXPLORATION foco. I-EXPLORATION Evolucionó I-EXPLORATION con I-EXPLORATION fiebre I-EXPLORATION persistente, I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION sin I-EXPLORATION foco I-EXPLORATION evidente I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION y I-EXPLORATION con I-EXPLORATION parámetros I-EXPLORATION inflamatorios I-EXPLORATION elevados. I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION una I-EXPLORATION probable I-EXPLORATION neumonía I-EXPLORATION neumocóccica; I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION no I-EXPLORATION evidenciaba I-EXPLORATION consolidación I-EXPLORATION pulmonar. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT ampicilina I-TREATMENT i.v. I-TREATMENT 100 I-TREATMENT mg/kg/día I-TREATMENT fraccionado I-TREATMENT cada I-TREATMENT 6 I-TREATMENT h, I-TREATMENT previa I-TREATMENT toma I-TREATMENT de I-TREATMENT hemocultivos. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION complementó I-EXPLORATION con I-EXPLORATION un I-EXPLORATION panel I-EXPLORATION viral I-EXPLORATION (por I-EXPLORATION inmunofluorescencia) I-EXPLORATION de I-EXPLORATION aspirado I-EXPLORATION nasofaríngeo, I-EXPLORATION urocultivo, I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION y I-EXPLORATION hemocultivos I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Por I-EXPLORATION persistir I-EXPLORATION febril, I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION 48 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION terapia I-EXPLORATION antimicrobiana, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION asimetría I-EXPLORATION renal, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION más I-EXPLORATION grande, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION más I-EXPLORATION globuloso I-EXPLORATION y I-EXPLORATION mayor I-EXPLORATION ecogenicidad. I-EXPLORATION Se B-TREATMENT ajustó I-TREATMENT terapia I-TREATMENT antimicrobiana I-TREATMENT a I-TREATMENT ceftriaxona I-TREATMENT 50 I-TREATMENT mg/kg/día I-TREATMENT una I-TREATMENT vez I-TREATMENT al I-TREATMENT día, I-TREATMENT por I-TREATMENT sospecha I-TREATMENT de I-TREATMENT un I-TREATMENT foco I-TREATMENT urinario I-TREATMENT y I-TREATMENT se I-TREATMENT solicitó I-TREATMENT un I-TREATMENT cintigrama I-TREATMENT renal I-TREATMENT con I-TREATMENT DMSA I-TREATMENT (dimercaptosuccinic I-TREATMENT acid), I-TREATMENT que I-TREATMENT se I-TREATMENT informó I-TREATMENT como I-TREATMENT sugerente I-TREATMENT de I-TREATMENT un I-TREATMENT proceso I-TREATMENT inflamatorio I-TREATMENT agudo I-TREATMENT renal I-TREATMENT izquierdo. I-TREATMENT La B-EVOLUTION fiebre I-EVOLUTION cedió I-EVOLUTION al I-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION ceftriaxona, I-EVOLUTION junto I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios. I-EVOLUTION Se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION séptimo I-EVOLUTION día, I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION clínicas, I-EVOLUTION con I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION una I-EVOLUTION nefronia I-EVOLUTION izquierda. I-EVOLUTION Recibió B-TREATMENT cefadroxilo I-TREATMENT 30 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT siete I-TREATMENT días, I-TREATMENT completando I-TREATMENT 14 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT en I-TREATMENT total. I-TREATMENT Se I-TREATMENT mantuvo B-EVOLUTION en I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION policlínico I-EVOLUTION de I-EVOLUTION infectología I-EVOLUTION y I-EVOLUTION nefrología, I-EVOLUTION con I-EVOLUTION evolución I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS oriundo B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Buenos I-PAST_MEDICAL_HISTORY Aires, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY adquirida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY transmisión I-PAST_MEDICAL_HISTORY vertical, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY abandono I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY tratamientos I-PAST_MEDICAL_HISTORY antirretrovirales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gran I-PAST_MEDICAL_HISTORY actividad I-PAST_MEDICAL_HISTORY (TARGA). I-PAST_MEDICAL_HISTORY Se B-PRESENT_ILLNESS internó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kg. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION febril, I-EXPLORATION en I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION y I-EXPLORATION con I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas. I-EXPLORATION Se I-EXPLORATION palpaba I-EXPLORATION una I-EXPLORATION hepato-esplenomegalia I-EXPLORATION indolora I-EXPLORATION y I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION pulmonar I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION generalizada I-EXPLORATION del I-EXPLORATION murmullo I-EXPLORATION pulmonar I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION campos I-EXPLORATION pulmonares. I-EXPLORATION I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION opacidad I-EXPLORATION parahiliar I-EXPLORATION y I-EXPLORATION basal I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION neumónico. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION al I-EXPLORATION ingreso I-EXPLORATION fueron: I-EXPLORATION entro-sedimentación I-EXPLORATION > I-EXPLORATION 140 I-EXPLORATION mm I-EXPLORATION 1° I-EXPLORATION hora, I-EXPLORATION hematocrito I-EXPLORATION 21%, I-EXPLORATION hemoglobina I-EXPLORATION 6, I-EXPLORATION 6 I-EXPLORATION g/L, I-EXPLORATION leucocitos I-EXPLORATION 4.400 I-EXPLORATION cél/mm3, I-EXPLORATION plaquetas I-EXPLORATION 40.000 I-EXPLORATION cél/mm3, I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 68%, I-EXPLORATION urea I-EXPLORATION 16 I-EXPLORATION mg/dL, I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 9 I-EXPLORATION mg/dL, I-EXPLORATION transaminasas I-EXPLORATION GOT I-EXPLORATION 61 I-EXPLORATION UI/L, I-EXPLORATION GPT I-EXPLORATION 20 I-EXPLORATION UI/L, I-EXPLORATION fosfatasas I-EXPLORATION alcalinas: I-EXPLORATION 185 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION láctico I-EXPLORATION deshidrogenasa: I-EXPLORATION 400 I-EXPLORATION U/l. I-EXPLORATION El I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION CD4 I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 21 I-EXPLORATION cél/mm3 I-EXPLORATION (8%). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION expectoración I-EXPLORATION para I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION bacterias I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION corriente, I-EXPLORATION micobacterias I-EXPLORATION y I-EXPLORATION hongos. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION directo I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Zielh-Neelsen, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION 10 I-EXPLORATION bacilos I-EXPLORATION ácido-alcohol I-EXPLORATION resistentes I-EXPLORATION (BAAR) I-EXPLORATION por I-EXPLORATION cada I-EXPLORATION 10 I-EXPLORATION campos. I-EXPLORATION La I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION hepato-esplenomegalia I-EXPLORATION y I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION adenopatías I-EXPLORATION hipoecogénicas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION retroperitoneo, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior I-EXPLORATION y I-EXPLORATION al I-EXPLORATION ligamento I-EXPLORATION hepato-duodenal. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION imágenes I-EXPLORATION hipoecogénicas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION bazo, I-EXPLORATION mesenterio I-EXPLORATION y I-EXPLORATION retroperitoneo. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT una I-TREATMENT probable I-TREATMENT tuberculosis I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT isoniacida, I-TREATMENT rifampicina, I-TREATMENT pirazinamida I-TREATMENT y I-TREATMENT etambutol I-TREATMENT en I-TREATMENT forma I-TREATMENT diaria I-TREATMENT y I-TREATMENT en I-TREATMENT dosis I-TREATMENT habituales. I-TREATMENT I-TREATMENT A B-EVOLUTION la I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION iniciada I-EVOLUTION la I-EVOLUTION terapia I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION referir I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION articulación I-EVOLUTION coxo-femoral I-EVOLUTION izquierda I-EVOLUTION que I-EVOLUTION se I-EVOLUTION irradiaba I-EVOLUTION hacia I-EVOLUTION el I-EVOLUTION muslo, I-EVOLUTION produciendo I-EVOLUTION impotencia I-EVOLUTION funcional I-EVOLUTION y I-EVOLUTION posición I-EVOLUTION antiálgica I-EVOLUTION en I-EVOLUTION semiflexión. I-EVOLUTION Presentaba I-EVOLUTION dolor I-EVOLUTION a I-EVOLUTION la I-EVOLUTION palpación I-EVOLUTION de I-EVOLUTION dicha I-EVOLUTION articulación I-EVOLUTION coxo-femoral I-EVOLUTION con I-EVOLUTION imposibilidad I-EVOLUTION de I-EVOLUTION extensión I-EVOLUTION activa I-EVOLUTION y I-EVOLUTION pasiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION inferior I-EVOLUTION izquierda. I-EVOLUTION La I-EVOLUTION ecotomografía I-EVOLUTION mostró I-EVOLUTION una I-EVOLUTION moderada I-EVOLUTION cantidad I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION articular I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tomografía I-EVOLUTION axial I-EVOLUTION computarizada I-EVOLUTION (TAC) I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION una I-EVOLUTION imagen I-EVOLUTION radiolúcida, I-EVOLUTION redondeada, I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cabeza I-EVOLUTION y I-EVOLUTION el I-EVOLUTION cuello I-EVOLUTION femoral, I-EVOLUTION con I-EVOLUTION solución I-EVOLUTION de I-EVOLUTION continuidad I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION cortical I-EVOLUTION ósea. I-EVOLUTION La I-EVOLUTION cavidad I-EVOLUTION acetabular I-EVOLUTION y I-EVOLUTION la I-EVOLUTION cabeza I-EVOLUTION femoral I-EVOLUTION estaban I-EVOLUTION respetadas I-EVOLUTION igual I-EVOLUTION que I-EVOLUTION la I-EVOLUTION sínfisis I-EVOLUTION pubiana I-EVOLUTION y I-EVOLUTION las I-EVOLUTION ramas I-EVOLUTION isquio I-EVOLUTION e I-EVOLUTION ilio-pubianas. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION cavidad I-EVOLUTION articular I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION un I-EVOLUTION moderado I-EVOLUTION volumen I-EVOLUTION de I-EVOLUTION líquido. I-EVOLUTION I-EVOLUTION Se I-EVOLUTION realizó I-EVOLUTION una I-EVOLUTION artrocentesis I-EVOLUTION obteniéndose I-EVOLUTION un I-EVOLUTION material I-EVOLUTION sero-hemático. I-EVOLUTION Se I-EVOLUTION enviaron I-EVOLUTION muestras I-EVOLUTION para I-EVOLUTION la I-EVOLUTION identificación I-EVOLUTION de I-EVOLUTION bacterias I-EVOLUTION de I-EVOLUTION crecimiento I-EVOLUTION común, I-EVOLUTION micobacterias I-EVOLUTION y I-EVOLUTION hongos. I-EVOLUTION El I-EVOLUTION examen I-EVOLUTION directo I-EVOLUTION mediante I-EVOLUTION la I-EVOLUTION técnica I-EVOLUTION de I-EVOLUTION Zielh-Neelsen, I-EVOLUTION mostró I-EVOLUTION cinco I-EVOLUTION a I-EVOLUTION nueve I-EVOLUTION BAAR I-EVOLUTION por I-EVOLUTION cada I-EVOLUTION 100 I-EVOLUTION campos I-EVOLUTION de I-EVOLUTION observación. I-EVOLUTION I-EVOLUTION Además B-TREATMENT del I-TREATMENT tratamiento I-TREATMENT antituberculoso I-TREATMENT se I-TREATMENT agregaron I-TREATMENT analgésicos I-TREATMENT y I-TREATMENT corticoesteroides. I-TREATMENT Siete B-EVOLUTION días I-EVOLUTION después, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION paulatina I-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION movilidad I-EVOLUTION del I-EVOLUTION miembro I-EVOLUTION inferior I-EVOLUTION izquierdo, I-EVOLUTION apoyada I-EVOLUTION con I-EVOLUTION soporte I-EVOLUTION kinésico. I-EVOLUTION I-EVOLUTION Los B-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION esputo I-EXPLORATION como I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION articular, I-EXPLORATION permitieron I-EXPLORATION identificar I-EXPLORATION Mycobacterium I-EXPLORATION tuberculosis I-EXPLORATION con I-EXPLORATION susceptibilidad I-EXPLORATION conservada I-EXPLORATION a I-EXPLORATION los I-EXPLORATION fármacos I-EXPLORATION proscriptos. I-EXPLORATION I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 30 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION se I-EVOLUTION comprobó I-EVOLUTION una I-EVOLUTION marcada I-EVOLUTION mejoría I-EVOLUTION en I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION pulmonares I-EVOLUTION y I-EVOLUTION el I-EVOLUTION examen I-EVOLUTION directo I-EVOLUTION de I-EVOLUTION expectoración I-EVOLUTION de I-EVOLUTION control I-EVOLUTION fue I-EVOLUTION negativo I-EVOLUTION para I-EVOLUTION BAAR. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Huaral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Lima I-PAST_MEDICAL_HISTORY Metropolitana, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ocupación I-PAST_MEDICAL_HISTORY dueña I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY casa, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pesadez I-PRESENT_ILLNESS y I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS post-prandial I-PRESENT_ILLNESS con I-PRESENT_ILLNESS todo I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS comida. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS estos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS se I-PRESENT_ILLNESS asociaron I-PRESENT_ILLNESS a I-PRESENT_ILLNESS epigastralgia I-PRESENT_ILLNESS urente I-PRESENT_ILLNESS leve. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION el I-EXPLORATION epigastrio, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION peritoneales. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION demostraron I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 11.700/mm3 I-EXPLORATION y I-EXPLORATION una I-EXPLORATION eosinofilia I-EXPLORATION de I-EXPLORATION 6.300/mm3, I-EXPLORATION las I-EXPLORATION fosfatasas I-EXPLORATION alcalinas, I-EXPLORATION GGT, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION y I-EXPLORATION alfa-fetoproteínas I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION En I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION dos I-EXPLORATION imágenes I-EXPLORATION quísticas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hígado, I-EXPLORATION una I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION VII I-EXPLORATION y I-EXPLORATION la I-EXPLORATION otra I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION II. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION hipodensa I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares, I-EXPLORATION de I-EXPLORATION 35 I-EXPLORATION por I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION hepático I-EXPLORATION II. I-EXPLORATION Se I-EXPLORATION internó I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION hepático I-EXPLORATION para I-EXPLORATION realizarse I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION percutánea I-EXPLORATION guiada I-EXPLORATION por I-EXPLORATION ecografía. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION histopatológicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION fueron: I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION linfocitos, I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION y I-EXPLORATION eosinófilos, I-EXPLORATION estos I-EXPLORATION últimos I-EXPLORATION en I-EXPLORATION gran I-EXPLORATION cantidad. I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION además I-EXPLORATION hepatocitos I-EXPLORATION reactivos, I-EXPLORATION regenerativos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parén-quima I-EXPLORATION hepático. I-EXPLORATION Por I-EXPLORATION este I-EXPLORATION motivo, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION Fas2-Elisa I-EXPLORATION para I-EXPLORATION F. I-EXPLORATION hepatica, I-EXPLORATION el I-EXPLORATION que I-EXPLORATION tuvo I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 37 I-EXPLORATION (valor I-EXPLORATION normal: I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 2), I-EXPLORATION muy I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION infección. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT triclabendazol I-TREATMENT 10 I-TREATMENT mg/kg, I-TREATMENT en I-TREATMENT dosis I-TREATMENT única. I-TREATMENT Evolucionó B-EVOLUTION favorablemente; I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION desapareció I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION y I-EVOLUTION la I-EVOLUTION eosinofilia. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION TAC I-EVOLUTION abdominal I-EVOLUTION realizada I-EVOLUTION al I-EVOLUTION sexto I-EVOLUTION mes I-EVOLUTION post-tratamiento, I-EVOLUTION se I-EVOLUTION evidenció I-EVOLUTION regresión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION hepática. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY medicamentos I-PAST_MEDICAL_HISTORY recientes. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS odinofagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS pruriginosas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS muslos. I-PRESENT_ILLNESS Se B-TREATMENT diagnosticó I-TREATMENT una I-TREATMENT faringoamigdalitis I-TREATMENT aguda I-TREATMENT con I-TREATMENT una I-TREATMENT escarlatina I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT lincomicina I-TREATMENT oral, I-TREATMENT sin I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT sintomatología I-TREATMENT ni I-TREATMENT remisión I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT cutáneas. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h, I-EVOLUTION se I-EVOLUTION agregó I-EVOLUTION fiebre I-EVOLUTION hasta I-EVOLUTION 38, I-EVOLUTION 5°C I-EVOLUTION y I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION se I-EVOLUTION diseminaron I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION centrípeta, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION consultó I-EVOLUTION nuevamente. I-EVOLUTION La B-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION en I-EXPLORATION regulares I-EXPLORATION condiciones I-EXPLORATION generales, I-EXPLORATION hemodinámicamente I-EXPLORATION estable. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION eritema I-EXPLORATION faríngeo I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION pulmonar I-EXPLORATION normal. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION pesquisaron I-EXPLORATION adenopatías. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION cutáneo, I-EXPLORATION destacaban I-EXPLORATION máculas I-EXPLORATION y I-EXPLORATION pápulas I-EXPLORATION eritematosas I-EXPLORATION palmoplantares I-EXPLORATION y I-EXPLORATION pústulas I-EXPLORATION no I-EXPLORATION foliculares, I-EXPLORATION de I-EXPLORATION base I-EXPLORATION eritematosa, I-EXPLORATION confluentes I-EXPLORATION en I-EXPLORATION placas, I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION cuello, I-EXPLORATION dorso, I-EXPLORATION región I-EXPLORATION lumbar I-EXPLORATION y I-EXPLORATION muslos. I-EXPLORATION El I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Nikolsky I-EXPLORATION era I-EXPLORATION negativo. I-EXPLORATION No I-EXPLORATION tenía I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION oral, I-EXPLORATION ocular I-EXPLORATION ni I-EXPLORATION genital. I-EXPLORATION Sin B-TREATMENT embargo, I-TREATMENT dado I-TREATMENT el I-TREATMENT compromiso I-TREATMENT cutáneo I-TREATMENT extenso, I-TREATMENT se I-TREATMENT decidió I-TREATMENT su I-TREATMENT internación. I-TREATMENT I-TREATMENT Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION (15.500 I-EXPLORATION neutrófilos/mm3, I-EXPLORATION sin I-EXPLORATION eosinofilia), I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 14, I-EXPLORATION 7 I-EXPLORATION mg/dL I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 1 I-EXPLORATION mg/dL) I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION levemente I-EXPLORATION alteradas: I-EXPLORATION GOT: I-EXPLORATION 23 I-EXPLORATION UI/L I-EXPLORATION (VN I-EXPLORATION 9-25), I-EXPLORATION GPT: I-EXPLORATION 48 I-EXPLORATION UI/L I-EXPLORATION (VN I-EXPLORATION 7-30), I-EXPLORATION fosfatasas I-EXPLORATION alcalinas: I-EXPLORATION 199 I-EXPLORATION UI/L I-EXPLORATION (VN I-EXPLORATION 30-100), I-EXPLORATION GGT: I-EXPLORATION 110 I-EXPLORATION UI/L I-EXPLORATION (VN I-EXPLORATION 4-50). I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION escaso I-EXPLORATION infiltrado I-EXPLORATION intersticial, I-EXPLORATION sin I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION consolidación. I-EXPLORATION El I-EXPLORATION panel I-EXPLORATION viral I-EXPLORATION respiratorio I-EXPLORATION molecular, I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC), I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION La I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION M. I-EXPLORATION pneumoniae I-EXPLORATION (técnica I-EXPLORATION cualitativa I-EXPLORATION por I-EXPLORATION ELISA) I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización I-EXPLORATION (correspondiente I-EXPLORATION al I-EXPLORATION noveno I-EXPLORATION día I-EXPLORATION de I-EXPLORATION evolución). I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION VIH, I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION B, I-EXPLORATION C, I-EXPLORATION y I-EXPLORATION sífilis I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION corriente I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pústulas I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION en I-EXPLORATION que I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION mostró I-EXPLORATION acantosis, I-EXPLORATION espongiosis, I-EXPLORATION exocitosis I-EXPLORATION de I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION pústulas I-EXPLORATION intracórneas, I-EXPLORATION intraepidérmicas I-EXPLORATION e I-EXPLORATION intrafoliculares. I-EXPLORATION La I-EXPLORATION dermis I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION perivascular I-EXPLORATION difuso I-EXPLORATION con I-EXPLORATION linfocitos I-EXPLORATION y I-EXPLORATION neutrófilos. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION PAS I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION microorganismos. I-EXPLORATION Dado I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION clínicos I-EXPLORATION e I-EXPLORATION histopatológicos, I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION una I-EXPLORATION PEGA, I-EXPLORATION probablemente I-EXPLORATION causada I-EXPLORATION por I-EXPLORATION M. I-EXPLORATION pneumoniae. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT hidrocortisona I-TREATMENT i.v., I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 50 I-TREATMENT mg I-TREATMENT fraccionada I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h, I-TREATMENT y I-TREATMENT levofloxacina I-TREATMENT oral I-TREATMENT 400 I-TREATMENT mg I-TREATMENT al I-TREATMENT día, I-TREATMENT con B-EVOLUTION excelente I-EVOLUTION evolución I-EVOLUTION marcada I-EVOLUTION por I-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION cutáneas, I-EVOLUTION dándose I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION con B-TREATMENT prednisona I-TREATMENT en I-TREATMENT dosis I-TREATMENT decrecientes I-TREATMENT y I-TREATMENT el I-TREATMENT mismo I-TREATMENT antimicrobiano, I-TREATMENT ambos I-TREATMENT por I-TREATMENT 7 I-TREATMENT días I-TREATMENT más. I-TREATMENT Al B-EVOLUTION control I-EVOLUTION de I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas, I-EVOLUTION ya I-EVOLUTION no I-EVOLUTION presentaba I-EVOLUTION lesiones I-EVOLUTION en I-EVOLUTION la I-EVOLUTION piel. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY insulino-requiriente, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY dislipide-mia, I-PAST_MEDICAL_HISTORY gota, I-PAST_MEDICAL_HISTORY glaucoma I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY meningo-encefalitis I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY hospital. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS brusco I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pocas I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS y I-PRESENT_ILLNESS calofríos, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS conductuales I-PRESENT_ILLNESS (agresividad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS familiares) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS rápido I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia. I-PRESENT_ILLNESS Una B-EXPLORATION medición I-EXPLORATION de I-EXPLORATION glicemia I-EXPLORATION capilar I-EXPLORATION en I-EXPLORATION domicilio I-EXPLORATION descartó I-EXPLORATION una I-EXPLORATION hipoglicemia. I-EXPLORATION Ingresó I-EXPLORATION a I-EXPLORATION un I-EXPLORATION centro I-EXPLORATION asistencial I-EXPLORATION con I-EXPLORATION un I-EXPLORATION puntaje I-EXPLORATION de I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION Glasgow I-EXPLORATION de I-EXPLORATION coma I-EXPLORATION (GCS) I-EXPLORATION de I-EXPLORATION 14 I-EXPLORATION puntos, I-EXPLORATION confuso, I-EXPLORATION desorientado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION agitación I-EXPLORATION psicomotora I-EXPLORATION (que I-EXPLORATION se I-EXPLORATION contuvo I-EXPLORATION farmacológicamente I-EXPLORATION con I-EXPLORATION propofol, I-EXPLORATION ketamina I-EXPLORATION y I-EXPLORATION lorazepam) I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION meníngeos I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION y I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION encéfalo I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION informadas I-EXPLORATION como I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION líquido I-EXPLORATION incoloro, I-EXPLORATION glucorraquia I-EXPLORATION de I-EXPLORATION 132 I-EXPLORATION mg/dL I-EXPLORATION (glicemia I-EXPLORATION de I-EXPLORATION 199 I-EXPLORATION mg/dL), I-EXPLORATION proteínas I-EXPLORATION 249 I-EXPLORATION mg/dL, I-EXPLORATION pleocitosis I-EXPLORATION de I-EXPLORATION 940 I-EXPLORATION céls/mm3 I-EXPLORATION con I-EXPLORATION 36% I-EXPLORATION polimorfonucleares I-EXPLORATION y I-EXPLORATION 64% I-EXPLORATION mononucleares, I-EXPLORATION hematíes I-EXPLORATION 100 I-EXPLORATION céls/mm3, I-EXPLORATION 100% I-EXPLORATION frescos I-EXPLORATION y I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION sin I-EXPLORATION bacterias I-EXPLORATION visibles. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION con I-EXPLORATION cultivo I-EXPLORATION y I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION varicela I-EXPLORATION zoster, I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simplex I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION 6, I-EXPLORATION citomegalovirus, I-EXPLORATION test I-EXPLORATION de I-EXPLORATION látex I-EXPLORATION para I-EXPLORATION N. I-EXPLORATION meningitidis, I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION urocultivo, I-EXPLORATION fueron I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION generales I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 14.850 I-EXPLORATION céls/mm3, I-EXPLORATION neutrofilia I-EXPLORATION (82%), I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION eritrosedimentación I-EXPLORATION (VHS) I-EXPLORATION discretamente I-EXPLORATION elevada I-EXPLORATION (21 I-EXPLORATION mm/h), I-EXPLORATION pruebas I-EXPLORATION bioquímicas I-EXPLORATION y I-EXPLORATION hepáticas I-EXPLORATION normales, I-EXPLORATION salvo I-EXPLORATION una I-EXPLORATION hiperglicemia I-EXPLORATION y I-EXPLORATION alza I-EXPLORATION leve I-EXPLORATION de I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION plasmática I-EXPLORATION (1, I-EXPLORATION 3 I-EXPLORATION mg/dL). I-EXPLORATION Los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (5, I-EXPLORATION 5 I-EXPLORATION mg/L) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION procalcitonina I-EXPLORATION bajos I-EXPLORATION (< I-EXPLORATION 0, I-EXPLORATION 05 I-EXPLORATION ng/mL). I-EXPLORATION Evolucionó B-TREATMENT con I-TREATMENT una I-TREATMENT hipotensión I-TREATMENT arterial I-TREATMENT (96/56 I-TREATMENT mm I-TREATMENT Hg) I-TREATMENT que I-TREATMENT respondió I-TREATMENT a I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT volumen, I-TREATMENT además I-TREATMENT de I-TREATMENT compromiso I-TREATMENT de I-TREATMENT conciencia I-TREATMENT fluctuante I-TREATMENT (Glasgow I-TREATMENT bajó I-TREATMENT a I-TREATMENT 11). I-TREATMENT Se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT antimicrobiana I-TREATMENT empírica I-TREATMENT con I-TREATMENT ceftriaxona, I-TREATMENT ampicilina I-TREATMENT y I-TREATMENT aciclovir I-TREATMENT i.v. I-TREATMENT y I-TREATMENT glucocorticoides I-TREATMENT (dexametasona I-TREATMENT 8 I-TREATMENT mg). I-TREATMENT Se B-DERIVED_FROM/TO trasladó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO ingresó I-DERIVED_FROM/TO en I-DERIVED_FROM/TO Glasgow I-DERIVED_FROM/TO fluctuante I-DERIVED_FROM/TO (entre I-DERIVED_FROM/TO 10 I-DERIVED_FROM/TO y I-DERIVED_FROM/TO 13 I-DERIVED_FROM/TO puntos), I-DERIVED_FROM/TO con I-DERIVED_FROM/TO hemodinamia I-DERIVED_FROM/TO estable, I-DERIVED_FROM/TO febril I-DERIVED_FROM/TO (38, I-DERIVED_FROM/TO 5 I-DERIVED_FROM/TO oC), I-DERIVED_FROM/TO con I-DERIVED_FROM/TO reflejos I-DERIVED_FROM/TO osteotendíneos I-DERIVED_FROM/TO exacerbados, I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO focalidad I-DERIVED_FROM/TO neurológica, I-DERIVED_FROM/TO signos I-DERIVED_FROM/TO meníngeos I-DERIVED_FROM/TO o I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO embólicas I-DERIVED_FROM/TO sistémicas I-DERIVED_FROM/TO o I-DERIVED_FROM/TO cutáneas. I-DERIVED_FROM/TO Se B-EXPLORATION repitió I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION LCR, I-EXPLORATION en I-EXPLORATION cuyo I-EXPLORATION citoquímico I-EXPLORATION las I-EXPLORATION proteínas I-EXPLORATION disminuyeron I-EXPLORATION a I-EXPLORATION 81 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION la I-EXPLORATION pleocitosis I-EXPLORATION a I-EXPLORATION 40 I-EXPLORATION céls/mm3. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION para I-EXPLORATION tuberculosis I-EXPLORATION (adenosina I-EXPLORATION deaminasa, I-EXPLORATION baciloscopia I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION Koch), I-EXPLORATION enterovirus I-EXPLORATION (RPC) I-EXPLORATION y I-EXPLORATION hongos I-EXPLORATION (tinta I-EXPLORATION china I-EXPLORATION y I-EXPLORATION cultivo) I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION y/o I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION también I-EXPLORATION una I-EXPLORATION neumonía I-EXPLORATION por I-EXPLORATION imágenes I-EXPLORATION y I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION se B-TREATMENT logró I-TREATMENT desconectar I-TREATMENT del I-TREATMENT ventilador I-TREATMENT mecánico I-TREATMENT a I-TREATMENT las I-TREATMENT 24 I-TREATMENT h I-TREATMENT de I-TREATMENT su I-TREATMENT ingreso, I-TREATMENT sin B-EVOLUTION demostrar I-EVOLUTION focalización I-EVOLUTION neurológica I-EVOLUTION alguna I-EVOLUTION y I-EVOLUTION recuperando I-EVOLUTION totalmente I-EVOLUTION sus I-EVOLUTION funciones I-EVOLUTION cerebrales I-EVOLUTION superiores. I-EVOLUTION Los B-TREATMENT antimicrobianos I-TREATMENT fueron I-TREATMENT suspendidos I-TREATMENT a I-TREATMENT las I-TREATMENT 72 I-TREATMENT h. I-TREATMENT Al B-EXPLORATION interrogatorio I-EXPLORATION dirigido, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION refirió I-EXPLORATION ningún I-EXPLORATION síntoma I-EXPLORATION respiratorio I-EXPLORATION alto I-EXPLORATION o I-EXPLORATION bajo I-EXPLORATION (rinorrea, I-EXPLORATION tos, I-EXPLORATION odinofagia I-EXPLORATION o I-EXPLORATION disfonía) I-EXPLORATION que I-EXPLORATION justificara I-EXPLORATION la I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION respiratorios. I-EXPLORATION Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso. I-EVOLUTION I-EVOLUTION Se B-PAST_MEDICAL_HISTORY obtuvieron I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY meningoencefalitis I-PAST_MEDICAL_HISTORY ocurrida I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY según I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY epicrisis. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY internado I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY días, I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ventilación I-PAST_MEDICAL_HISTORY mecánica. I-PAST_MEDICAL_HISTORY El B-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION indicó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION bacterias I-EXPLORATION a I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram, I-EXPLORATION pleocitosis I-EXPLORATION de I-EXPLORATION 70 I-EXPLORATION céls/mm3 I-EXPLORATION (60% I-EXPLORATION mononuclear), I-EXPLORATION proteínas I-EXPLORATION de I-EXPLORATION 68 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION glucosa I-EXPLORATION de I-EXPLORATION 135 I-EXPLORATION mg/dL. I-EXPLORATION El B-TREATMENT cuadro I-TREATMENT se I-TREATMENT interpretó I-TREATMENT como I-TREATMENT viral, I-TREATMENT tratándose I-TREATMENT con I-TREATMENT aciclovir I-TREATMENT i.v. I-TREATMENT por I-TREATMENT 10 I-TREATMENT días, I-TREATMENT sin I-TREATMENT realizarse I-TREATMENT estudio I-TREATMENT viral I-TREATMENT del I-TREATMENT LCR. I-TREATMENT I-TREATMENT En B-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY dirigida I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY rescató I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vacunación I-PAST_MEDICAL_HISTORY anual I-PAST_MEDICAL_HISTORY contra I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY influenza I-PAST_MEDICAL_HISTORY (vacuna I-PAST_MEDICAL_HISTORY trivalente) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY consecutivos I-PAST_MEDICAL_HISTORY (2011 I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY 2015). I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2014, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY vacuna I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY administrada I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY meningoencefalitis I-PAST_MEDICAL_HISTORY (Vaxigrip®, I-PAST_MEDICAL_HISTORY Sanofi, I-PAST_MEDICAL_HISTORY lote I-PAST_MEDICAL_HISTORY K7375-2) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY episodio, I-PAST_MEDICAL_HISTORY producido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2015, I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY (Influval®, I-PAST_MEDICAL_HISTORY Abbott, I-PAST_MEDICAL_HISTORY lote I-PAST_MEDICAL_HISTORY HY01N). I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY análisis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY causalidad, I-PAST_MEDICAL_HISTORY según I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY puntuación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Naranjo I-PAST_MEDICAL_HISTORY dio I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY puntos18. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY clínicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS °C I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS escalofríos, I-PRESENT_ILLNESS palidez I-PRESENT_ILLNESS de I-PRESENT_ILLNESS piel, I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS cervicales I-PRESENT_ILLNESS bilaterales, I-PRESENT_ILLNESS decaimiento I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inapetencia. I-PRESENT_ILLNESS Había I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS tratado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS azitromicina I-PRESENT_ILLNESS 500 I-PRESENT_ILLNESS mg I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS días. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION sistólico I-EXPLORATION grado I-EXPLORATION II/III I-EXPLORATION en I-EXPLORATION el I-EXPLORATION foco I-EXPLORATION auscultatorio I-EXPLORATION correspondiente I-EXPLORATION al I-EXPLORATION ventrículo I-EXPLORATION izquierdo. I-EXPLORATION El I-EXPLORATION electroencefalograma I-EXPLORATION y I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION no I-EXPLORATION evidenciaron I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION inflamatorios: I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 10.500 I-EXPLORATION céls/ml, I-EXPLORATION una I-EXPLORATION neutrofilia I-EXPLORATION de I-EXPLORATION 70% I-EXPLORATION y I-EXPLORATION una I-EXPLORATION PCR I-EXPLORATION elevada I-EXPLORATION (119 I-EXPLORATION mg/L). I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cefotaxima I-TREATMENT i.v. I-TREATMENT 200 I-TREATMENT mg/kg/día I-TREATMENT previa I-TREATMENT toma I-TREATMENT de I-TREATMENT hemocultivos I-TREATMENT seriados I-TREATMENT en I-TREATMENT dos I-TREATMENT días I-TREATMENT consecutivos. I-TREATMENT A B-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION incubación, I-EXPLORATION ambos I-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION positivos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION bacilos I-EXPLORATION grampositivos I-EXPLORATION pleomórficos I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION "V". I-EXPLORATION La I-EXPLORATION identificación I-EXPLORATION directa I-EXPLORATION del I-EXPLORATION microorganismo I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION positivos I-EXPLORATION mediante I-EXPLORATION espectrometría I-EXPLORATION de I-EXPLORATION masas I-EXPLORATION MALDI-TOF I-EXPLORATION fue I-EXPLORATION C. I-EXPLORATION pseudodiphtheriticum. I-EXPLORATION En I-EXPLORATION este I-EXPLORATION contexto, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION vegetativa I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION lado I-EXPLORATION ventricular I-EXPLORATION izquierdo, I-EXPLORATION provocando I-EXPLORATION insuficiencia I-EXPLORATION moderada, I-EXPLORATION sin I-EXPLORATION repercusión I-EXPLORATION en I-EXPLORATION la I-EXPLORATION hemodinamia I-EXPLORATION y I-EXPLORATION función I-EXPLORATION cardíaca. I-EXPLORATION Asimismo, I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION valvulopatía I-EXPLORATION aórtica I-EXPLORATION bicúspide. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT una I-TREATMENT endocarditis I-TREATMENT infecciosa I-TREATMENT se I-TREATMENT agregó I-TREATMENT gentamicina I-TREATMENT (6 I-TREATMENT mg/kg/día) I-TREATMENT a I-TREATMENT la I-TREATMENT terapia I-TREATMENT a I-TREATMENT la I-TREATMENT espera I-TREATMENT de I-TREATMENT la I-TREATMENT identificación I-TREATMENT definitiva I-TREATMENT del I-TREATMENT microorganismo I-TREATMENT y I-TREATMENT su I-TREATMENT perfil I-TREATMENT de I-TREATMENT susceptibilidad I-TREATMENT antimicrobiana. I-TREATMENT A B-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION incubación I-EXPLORATION en I-EXPLORATION medios I-EXPLORATION de I-EXPLORATION cultivo I-EXPLORATION sólidos I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION el I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION colonias I-EXPLORATION grises I-EXPLORATION en I-EXPLORATION placas I-EXPLORATION de I-EXPLORATION agar I-EXPLORATION sangre, I-EXPLORATION catalasa I-EXPLORATION positivas. I-EXPLORATION La I-EXPLORATION identificación I-EXPLORATION mediante I-EXPLORATION secuenciación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION ARN I-EXPLORATION 16S I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION aislamiento I-EXPLORATION de I-EXPLORATION C. I-EXPLORATION pseudodiphtheriticum. I-EXPLORATION El I-EXPLORATION antibiograma I-EXPLORATION con I-EXPLORATION epsilometría I-EXPLORATION (E-test) I-EXPLORATION mostró I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION azitromicina I-EXPLORATION (CIM I-EXPLORATION > I-EXPLORATION 256 I-EXPLORATION μg/ml) I-EXPLORATION y I-EXPLORATION sensibilidad I-EXPLORATION (CIM) I-EXPLORATION a I-EXPLORATION amoxicilina/ác. I-EXPLORATION clavulánico I-EXPLORATION (0, I-EXPLORATION 016 I-EXPLORATION μg/ml), I-EXPLORATION cefotaxima I-EXPLORATION (0, I-EXPLORATION 38 I-EXPLORATION μg/ml), I-EXPLORATION ciprofloxacina I-EXPLORATION (0, I-EXPLORATION 5 I-EXPLORATION μg/ I-EXPLORATION ml), I-EXPLORATION linezolid I-EXPLORATION (0, I-EXPLORATION 016 I-EXPLORATION μg/ml), I-EXPLORATION penicilina I-EXPLORATION G I-EXPLORATION (0, I-EXPLORATION 25 I-EXPLORATION μg/ml) I-EXPLORATION y I-EXPLORATION vancomicina I-EXPLORATION (0, I-EXPLORATION 38 I-EXPLORATION μg/ml). I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION favorable, I-EVOLUTION remitiendo I-EVOLUTION su I-EVOLUTION cuadro I-EVOLUTION febril I-EVOLUTION antes I-EVOLUTION de I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION iniciada I-EVOLUTION la I-EVOLUTION terapia I-EVOLUTION antimicrobiana I-EVOLUTION combinada. I-EVOLUTION Dada B-TREATMENT su I-TREATMENT buena I-TREATMENT evolución, I-TREATMENT habiendo I-TREATMENT negativizado I-TREATMENT los I-TREATMENT hemocultivos I-TREATMENT y I-TREATMENT sin I-TREATMENT cambios I-TREATMENT imagenológicos I-TREATMENT no I-TREATMENT se I-TREATMENT planteó I-TREATMENT una I-TREATMENT cirugía I-TREATMENT cardíaca I-TREATMENT en I-TREATMENT ese I-TREATMENT momento, I-TREATMENT salvo I-TREATMENT que I-TREATMENT hubiera I-TREATMENT algún I-TREATMENT deterioro I-TREATMENT clínico. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 16 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION internación, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION nuevamente I-EVOLUTION fiebre I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION cefalea I-EVOLUTION frontal, I-EVOLUTION desorientación I-EVOLUTION y I-EVOLUTION escaso I-EVOLUTION tono I-EVOLUTION motor I-EVOLUTION que I-EVOLUTION evolucionó I-EVOLUTION a I-EVOLUTION una I-EVOLUTION paresia I-EVOLUTION braquial I-EVOLUTION derecha, I-EVOLUTION hemicara I-EVOLUTION derecha I-EVOLUTION y I-EVOLUTION afasia. I-EVOLUTION El I-EVOLUTION cuadro I-EVOLUTION se I-EVOLUTION interpretó I-EVOLUTION como I-EVOLUTION una I-EVOLUTION embolia I-EVOLUTION séptica I-EVOLUTION cerebral. I-EVOLUTION Se B-TREATMENT agregó I-TREATMENT linezolid I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT por I-TREATMENT una I-TREATMENT eventual I-TREATMENT sobreinfección I-TREATMENT por I-TREATMENT microorganismos I-TREATMENT resistentes I-TREATMENT en I-TREATMENT algún I-TREATMENT otro I-TREATMENT foco. I-TREATMENT Ante I-TREATMENT el I-TREATMENT riesgo I-TREATMENT de I-TREATMENT un I-TREATMENT nuevo I-TREATMENT embolismo, I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT cirugía I-TREATMENT cardíaca I-TREATMENT sobre I-TREATMENT el I-TREATMENT territorio I-TREATMENT valvular I-TREATMENT aórtico I-TREATMENT (procedimiento I-TREATMENT Ross) I-TREATMENT que I-TREATMENT fue I-TREATMENT superada I-TREATMENT con I-TREATMENT éxito. I-TREATMENT En B-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION post-operatorio I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION hipertensión I-EVOLUTION intracraneal. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION cerebral I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION isquémico I-EXPLORATION por I-EXPLORATION oclusión I-EXPLORATION en I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION media I-EXPLORATION izquierda. I-EXPLORATION Debido B-EVOLUTION a I-EVOLUTION su I-EVOLUTION gravedad, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores. I-EVOLUTION Los B-EXPLORATION resultados I-EXPLORATION microbiológicos I-EXPLORATION finales I-EXPLORATION confirmaron I-EXPLORATION nuevamente I-EXPLORATION el I-EXPLORATION aislamiento I-EXPLORATION de I-EXPLORATION C. I-EXPLORATION pseudodiphtheriticum I-EXPLORATION en I-EXPLORATION los I-EXPLORATION hemocultivos. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY (DM-2) I-PAST_MEDICAL_HISTORY mal I-PAST_MEDICAL_HISTORY controlada, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY (ERC) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY etapa I-PAST_MEDICAL_HISTORY V I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY fístula I-PAST_MEDICAL_HISTORY arterio-venosa I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pie I-PAST_MEDICAL_HISTORY diabético I-PAST_MEDICAL_HISTORY izquierdo, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY amputación I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY ortejo, I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY mes I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY consulta. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS erupciones I-PRESENT_ILLNESS cutáneas I-PRESENT_ILLNESS inicialmente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS se I-PRESENT_ILLNESS extendieron I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS y I-PRESENT_ILLNESS las I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS superiores. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION confusa, I-EXPLORATION somnolienta, I-EXPLORATION con I-EXPLORATION mala I-EXPLORATION perfusión I-EXPLORATION distal I-EXPLORATION y I-EXPLORATION taquicárdica. I-EXPLORATION Los I-EXPLORATION signos I-EXPLORATION vitales I-EXPLORATION eran: I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION 118 I-EXPLORATION latidos/ I-EXPLORATION min, I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION 112/72 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION axilar I-EXPLORATION 37, I-EXPLORATION 5 I-EXPLORATION °C. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION adenopatías I-EXPLORATION cervicales I-EXPLORATION múltiples I-EXPLORATION dolorosas I-EXPLORATION y I-EXPLORATION seis I-EXPLORATION pústulas I-EXPLORATION con I-EXPLORATION base I-EXPLORATION eritematosa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mejilla I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION témporo-occipital I-EXPLORATION del I-EXPLORATION cuero I-EXPLORATION cabelludo I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION placa I-EXPLORATION costrosa I-EXPLORATION con I-EXPLORATION secreción I-EXPLORATION purulenta I-EXPLORATION de I-EXPLORATION mal I-EXPLORATION olor, I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION brazo I-EXPLORATION derecho I-EXPLORATION presentaba I-EXPLORATION dos I-EXPLORATION bulas I-EXPLORATION tensas, I-EXPLORATION que I-EXPLORATION posteriormente I-EXPLORATION se I-EXPLORATION ulceraron, I-EXPLORATION evolucionando I-EXPLORATION con I-EXPLORATION necrosis. I-EXPLORATION No I-EXPLORATION tenía I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION mucosas I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron: I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 3 I-EXPLORATION mg/dL, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION 27.500/mm3, I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION 513.000/mm3, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR): I-EXPLORATION 78 I-EXPLORATION mg/dL I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 5 I-EXPLORATION mg/dL), I-EXPLORATION nitrógeno I-EXPLORATION ureico I-EXPLORATION 98 I-EXPLORATION mg/ I-EXPLORATION dL, I-EXPLORATION pH I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION 7, I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION bicarbonato I-EXPLORATION sérico I-EXPLORATION 13, I-EXPLORATION 8 I-EXPLORATION mEq/L. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT el I-TREATMENT escenario I-TREATMENT clínico I-TREATMENT de I-TREATMENT una I-TREATMENT sepsis I-TREATMENT con I-TREATMENT foco I-TREATMENT de I-TREATMENT entrada I-TREATMENT cutánea, I-TREATMENT recibió I-TREATMENT volumen I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT antimicrobiana I-TREATMENT empírica I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT y I-TREATMENT clindamicina I-TREATMENT i.v., I-TREATMENT previa I-TREATMENT toma I-TREATMENT de I-TREATMENT cultivos. I-TREATMENT Evaluada I-TREATMENT por I-TREATMENT infectología I-TREATMENT y I-TREATMENT dermatología, I-TREATMENT se I-TREATMENT cambió I-TREATMENT antibioterapia I-TREATMENT a I-TREATMENT piperacilina/ I-TREATMENT tazobactam, I-TREATMENT debido I-TREATMENT la I-TREATMENT sospecha I-TREATMENT clínica I-TREATMENT de I-TREATMENT EG. I-TREATMENT Los B-EXPLORATION he-mocultivos I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cutánea I-EXPLORATION realizándose I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram, I-EXPLORATION cultivo I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION histopatológico. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION cocáceas I-EXPLORATION grampositivas I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Staphylococcus I-EXPLORATION aureus I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION meticilina I-EXPLORATION (SARM). I-EXPLORATION El I-EXPLORATION antibiograma I-EXPLORATION mostró I-EXPLORATION sensibilidad I-EXPLORATION a I-EXPLORATION vancomicina I-EXPLORATION (concentración I-EXPLORATION inhibitoria I-EXPLORATION mínima I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 75 I-EXPLORATION ug/mL), I-EXPLORATION rifampicina I-EXPLORATION y I-EXPLORATION cotrimoxazol, I-EXPLORATION y I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION β I-EXPLORATION lactámicos, I-EXPLORATION clindamicina, I-EXPLORATION ciprofloxacina I-EXPLORATION y I-EXPLORATION eritromicina. I-EXPLORATION Se B-TREATMENT ajustó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT adicionándose I-TREATMENT vancomicina I-TREATMENT i.v. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION un I-EXPLORATION EG, I-EXPLORATION evidenciándose I-EXPLORATION una I-EXPLORATION inflamación I-EXPLORATION dérmica I-EXPLORATION supurativa I-EXPLORATION y I-EXPLORATION necrosante I-EXPLORATION con I-EXPLORATION vasculitis I-EXPLORATION neutrofílica. I-EXPLORATION I-EXPLORATION Evolucionó B-EVOLUTION en I-EVOLUTION forma I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION lesiones I-EVOLUTION costrosas I-EVOLUTION no I-EVOLUTION exudativas, I-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION durante I-EVOLUTION su I-EVOLUTION estadía I-EVOLUTION hospitalaria I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION necrosis I-EVOLUTION del I-EVOLUTION segundo I-EVOLUTION ortejo I-EVOLUTION del I-EVOLUTION pie I-EVOLUTION izquierdo I-EVOLUTION realizándose B-TREATMENT una I-TREATMENT amputación I-TREATMENT transmetatarsiana I-TREATMENT que I-TREATMENT obligó I-TREATMENT a I-TREATMENT prolongar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibacteriano I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT y I-TREATMENT piperacilina/tazobactam I-TREATMENT por I-TREATMENT 30 I-TREATMENT días. I-TREATMENT Tras I-TREATMENT una I-TREATMENT semana I-TREATMENT de I-TREATMENT cotrimoxazol I-TREATMENT oral, I-TREATMENT la B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION generales, I-EVOLUTION afebril I-EVOLUTION y I-EVOLUTION con I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION cutáneas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY radiculo-patía I-PAST_MEDICAL_HISTORY lumbar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY depresivo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY carbamazepina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY clomipramina I-PAST_MEDICAL_HISTORY iniciado I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ingreso. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS días I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS °C I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS calofríos, I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS intensa, I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS principalmente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS A B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION estaba I-EXPLORATION lúcido, I-EXPLORATION febril, I-EXPLORATION taquicárdico I-EXPLORATION e I-EXPLORATION hipertenso. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION facial, I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION oral, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION un I-EXPLORATION púrpura I-EXPLORATION no I-EXPLORATION palpable I-EXPLORATION en I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION tórax, I-EXPLORATION con I-EXPLORATION sensibilidad I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION ade-nopatías I-EXPLORATION cervicales, I-EXPLORATION axilares I-EXPLORATION o I-EXPLORATION inguinales I-EXPLORATION palpables. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION discreto I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION eosinófilos I-EXPLORATION (6% I-EXPLORATION de I-EXPLORATION 3.300 I-EXPLORATION leucocitos) I-EXPLORATION y I-EXPLORATION escasos I-EXPLORATION linfocitos I-EXPLORATION atípicos I-EXPLORATION (menos I-EXPLORATION de I-EXPLORATION 1%), I-EXPLORATION creatinina I-EXPLORATION 1 I-EXPLORATION mg/dL, I-EXPLORATION LDH I-EXPLORATION 172 I-EXPLORATION U/L, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION mixto I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION colestásico I-EXPLORATION (GPT: I-EXPLORATION 215 I-EXPLORATION U/L, I-EXPLORATION GOT: I-EXPLORATION 64 I-EXPLORATION U/L, I-EXPLORATION GGT: I-EXPLORATION 598 I-EXPLORATION U/L, I-EXPLORATION FA: I-EXPLORATION 257 I-EXPLORATION U/L, I-EXPLORATION bilirrubina I-EXPLORATION total: I-EXPLORATION 0, I-EXPLORATION 72 I-EXPLORATION mg/dL, I-EXPLORATION INR: I-EXPLORATION 1, I-EXPLORATION 5) I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva: I-EXPLORATION 22, I-EXPLORATION 2 I-EXPLORATION mg/dL I-EXPLORATION (Valor I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 5). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION hepato-esplenomegalia I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION una I-EXPLORATION hiperecogenicidad I-EXPLORATION de I-EXPLORATION espacios I-EXPLORATION portales. I-EXPLORATION Una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION corroboró I-EXPLORATION la I-EXPLORATION hepato-esplenomegalia I-EXPLORATION y I-EXPLORATION evidenció I-EXPLORATION adenopatías I-EXPLORATION peri-portales. I-EXPLORATION Se I-EXPLORATION ingresó I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hepatitis I-EXPLORATION en I-EXPLORATION estudio; I-EXPLORATION probablemente I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION medicamentos I-EXPLORATION o I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION infecciosa. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION estudio I-EXPLORATION etiológico. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION urocultivo I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION IgM I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION antígeno I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION B, I-EXPLORATION anticuerpos I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION C, I-EXPLORATION IgM I-EXPLORATION VCA I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein I-EXPLORATION Barr I-EXPLORATION (VEB), I-EXPLORATION citomegalovirus I-EXPLORATION y I-EXPLORATION VIH, I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION RPR, I-EXPLORATION IgM I-EXPLORATION Toxoplasma I-EXPLORATION gondii, I-EXPLORATION IgM I-EXPLORATION e I-EXPLORATION IgG I-EXPLORATION Leptospira I-EXPLORATION spp., I-EXPLORATION IgM I-EXPLORATION sarampión, I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION aglutinación I-EXPLORATION para I-EXPLORATION Brucella I-EXPLORATION abortus/melitensis, I-EXPLORATION IgG I-EXPLORATION Brucella I-EXPLORATION canis, I-EXPLORATION IgG I-EXPLORATION Bartonella I-EXPLORATION hensenlae, I-EXPLORATION IgG I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION Borrelia I-EXPLORATION burgorferi, I-EXPLORATION IgM I-EXPLORATION Myco-plasma I-EXPLORATION pneumoniae I-EXPLORATION fueron I-EXPLORATION todas I-EXPLORATION negativas. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION panel I-EXPLORATION molecular I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION respiratorios I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativo. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION reumatológico I-EXPLORATION con I-EXPLORATION anticuerpos I-EXPLORATION anti-nucleares, I-EXPLORATION anti-citoplasmáticos, I-EXPLORATION anti-músculo I-EXPLORATION liso, I-EXPLORATION anti-mitocondriales, I-EXPLORATION anti-endomisio, I-EXPLORATION factor I-EXPLORATION reumatoideo, I-EXPLORATION y I-EXPLORATION antitransglutaminasa I-EXPLORATION tisular I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION estabilidad I-EVOLUTION clínica, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION hepática, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION persistente I-EVOLUTION y I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION cefalea I-EVOLUTION y I-EVOLUTION un I-EVOLUTION exantema I-EVOLUTION máculo-papular I-EVOLUTION morbiliforme I-EVOLUTION de I-EVOLUTION predominio I-EVOLUTION perifolicular, I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION y I-EVOLUTION el I-EVOLUTION cuello, I-EVOLUTION con I-EVOLUTION posterior I-EVOLUTION extensión I-EVOLUTION hacia I-EVOLUTION el I-EVOLUTION tórax, I-EVOLUTION dorso, I-EVOLUTION abdomen I-EVOLUTION y I-EVOLUTION extremidades, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION púrpura I-EVOLUTION no I-EVOLUTION palpable I-EVOLUTION en I-EVOLUTION extremidades I-EVOLUTION inferiores. I-EVOLUTION Dado B-EXPLORATION que I-EXPLORATION durante I-EXPLORATION su I-EXPLORATION evolución I-EXPLORATION la I-EXPLORATION cefalea I-EXPLORATION se I-EXPLORATION fue I-EXPLORATION intensificando, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION lumbar, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION dio I-EXPLORATION salida I-EXPLORATION a I-EXPLORATION un I-EXPLORATION líquido I-EXPLORATION cefalo-raquídeo I-EXPLORATION (LCR) I-EXPLORATION incoloro, I-EXPLORATION transparente, I-EXPLORATION en I-EXPLORATION cuyo I-EXPLORATION análisis I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION 30 I-EXPLORATION células/mm3, I-EXPLORATION 100% I-EXPLORATION mononucleares, I-EXPLORATION con I-EXPLORATION glucosa I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION normales, I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION sin I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION látex I-EXPLORATION bacteriano I-EXPLORATION negativo. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION corriente I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION para I-EXPLORATION enterovirus, I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simplex I-EXPLORATION 1-2 I-EXPLORATION y I-EXPLORATION virus I-EXPLORATION varicela I-EXPLORATION zoster I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Con I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION RPC I-EXPLORATION cualitativa I-EXPLORATION para I-EXPLORATION VHH-6 I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION LCR, I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION ambas I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION VHH-6. I-EXPLORATION Para I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio, I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION cutáneas. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION dermatitis I-EXPLORATION perivascular I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION perifolicular I-EXPLORATION liquenoide I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION eosinófilos, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION reacción I-EXPLORATION adversa I-EXPLORATION a I-EXPLORATION medicamentos. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION presentación I-EXPLORATION clínica, I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION y I-EXPLORATION el I-EXPLORATION antecedente I-EXPLORATION de I-EXPLORATION uso I-EXPLORATION reciente I-EXPLORATION de I-EXPLORATION carbamazepina, I-EXPLORATION fármaco I-EXPLORATION frecuentemente I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION cuadros I-EXPLORATION de I-EXPLORATION hipersensibilidad, I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION DRESS I-EXPLORATION en I-EXPLORATION concomitancia I-EXPLORATION con I-EXPLORATION una I-EXPLORATION meningoencefalitis I-EXPLORATION aguda I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION VHH-6. I-EXPLORATION En I-EXPLORATION este I-EXPLORATION caso I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION un I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION de I-EXPLORATION DRESS I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION a I-EXPLORATION criterios I-EXPLORATION RegiSCAR I-EXPLORATION y I-EXPLORATION DRESS I-EXPLORATION atípico I-EXPLORATION según I-EXPLORATION criterios I-EXPLORATION JSCAR. I-EXPLORATION Tras B-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION del I-EVOLUTION fármaco I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION espontáneamente I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cefalea. I-EVOLUTION El B-TREATMENT compromiso I-TREATMENT cutáneo I-TREATMENT disminuyó I-TREATMENT con I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT hidrocortisona I-TREATMENT tópica, I-TREATMENT sin I-TREATMENT requerir I-TREATMENT corticoesteroides I-TREATMENT sistémicos. I-TREATMENT Los B-EVOLUTION exámenes I-EVOLUTION de I-EVOLUTION laboratorio I-EVOLUTION fueron I-EVOLUTION mejorando I-EVOLUTION gradualmente, I-EVOLUTION llegando I-EVOLUTION a I-EVOLUTION tener I-EVOLUTION pruebas I-EVOLUTION hepáticas I-EVOLUTION normales I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION cuadro. I-EVOLUTION No I-EVOLUTION se I-EVOLUTION encontró I-EVOLUTION eosinofilia I-EVOLUTION ni I-EVOLUTION linfoci-tosis I-EVOLUTION atípica I-EVOLUTION > I-EVOLUTION 5%. I-EVOLUTION Debido B-TREATMENT a I-TREATMENT su I-TREATMENT buena I-TREATMENT evolución I-TREATMENT y I-TREATMENT siendo I-TREATMENT inmunocompetente I-TREATMENT se I-TREATMENT decidió I-TREATMENT no I-TREATMENT dar I-TREATMENT tratamiento I-TREATMENT antiviral, I-TREATMENT siendo B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION tras I-EVOLUTION nueve I-EVOLUTION días I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION para I-EVOLUTION ser I-EVOLUTION observado I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION ambulatoria. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION su I-EVOLUTION alta, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION permanecido I-EVOLUTION estable, I-EVOLUTION sin I-EVOLUTION recurrencia I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS residente I-PRESENT_ILLNESS en B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Buenos I-PAST_MEDICAL_HISTORY Aires, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY paludismo I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY viaje I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY amazónica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Bolivia, I-PAST_MEDICAL_HISTORY Perú, I-PAST_MEDICAL_HISTORY Ecuador I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Brasil, I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mefloquina I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY institución. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY regresó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY área I-PAST_MEDICAL_HISTORY endémica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tres B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS completado I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION un I-EXPLORATION peso I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 72 I-EXPLORATION kg, I-EXPLORATION palidez I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION esplenomegalia I-EXPLORATION leve. I-EXPLORATION Entre I-EXPLORATION los I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 14.300/mm3 I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fórmula I-EXPLORATION leucocitaria I-EXPLORATION conservada, I-EXPLORATION plaquetas I-EXPLORATION 84.000/mm3. I-EXPLORATION La I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION hepática I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION frotis I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION (FSP) I-EXPLORATION observándose I-EXPLORATION trofozoítos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION P. I-EXPLORATION vivax, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION parasitemia I-EXPLORATION < I-EXPLORATION 2%. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION fue I-EXPLORATION realizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Referencia I-EXPLORATION en I-EXPLORATION Parasitología I-EXPLORATION del I-EXPLORATION Hospital I-EXPLORATION de I-EXPLORATION Enfermedades I-EXPLORATION Infecciosas I-EXPLORATION "Francisco I-EXPLORATION J. I-EXPLORATION Muñiz". I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cloroquina I-TREATMENT (CQ) I-TREATMENT 1.500 I-TREATMENT mg I-TREATMENT de I-TREATMENT dosis I-TREATMENT total, I-TREATMENT constatándose B-EVOLUTION una I-EVOLUTION remisión I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION parasitemia I-EVOLUTION negativa I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h. I-EVOLUTION El B-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION glucosa-6-fosfato I-EXPLORATION deshidrogenasa I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 266 I-EXPLORATION mg/dl I-EXPLORATION (rango I-EXPLORATION normal), I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION recibió I-EXPLORATION PQ I-EXPLORATION 15 I-EXPLORATION mg I-EXPLORATION al I-EXPLORATION día I-EXPLORATION durante I-EXPLORATION 15 I-EXPLORATION días, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION adherencia. I-EXPLORATION Se B-EVOLUTION realizaron I-EVOLUTION parasitemias I-EVOLUTION de I-EVOLUTION control I-EVOLUTION en I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION y I-EVOLUTION cuarta I-EVOLUTION semana I-EVOLUTION después I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION resultando I-EVOLUTION negativas. I-EVOLUTION I-EVOLUTION Posteriormente I-EVOLUTION presentó I-EVOLUTION dos I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION recaída I-EVOLUTION por I-EVOLUTION P. I-EVOLUTION vivax. I-EVOLUTION Siete I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION fiebre I-EVOLUTION de I-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION calofríos, I-EVOLUTION cefalea I-EVOLUTION holocraneana, I-EVOLUTION artralgias I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION abdominal. I-EVOLUTION Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas, I-EXPLORATION ictericia I-EXPLORATION en I-EXPLORATION conjuntivas I-EXPLORATION y I-EXPLORATION petequias I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION recuento I-EXPLORATION plaquetario I-EXPLORATION normales, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION bilirrubina I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION indirecto. I-EXPLORATION El I-EXPLORATION FSP I-EXPLORATION informó I-EXPLORATION una I-EXPLORATION parasitemia I-EXPLORATION < I-EXPLORATION 2%. I-EXPLORATION Completó B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT CQ I-TREATMENT 1.500 I-TREATMENT mg I-TREATMENT de I-TREATMENT dosis I-TREATMENT total I-TREATMENT y I-TREATMENT PQ I-TREATMENT 30 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días, I-TREATMENT con B-EVOLUTION una I-EVOLUTION buena I-EVOLUTION adherencia I-EVOLUTION y I-EVOLUTION parasitemia I-EVOLUTION negativa I-EVOLUTION a I-EVOLUTION las I-EVOLUTION cuatro I-EVOLUTION semanas. I-EVOLUTION I-EVOLUTION Cinco I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION consultó I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION fiebre I-EVOLUTION intermitente I-EVOLUTION de I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION cefalea I-EVOLUTION y I-EVOLUTION astenia. I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION y I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION no I-EXPLORATION presentaron I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION una I-EXPLORATION parasitemia I-EXPLORATION < I-EXPLORATION 2%. I-EXPLORATION Reinició B-TREATMENT el I-TREATMENT mismo I-TREATMENT esquema I-TREATMENT con B-EVOLUTION buena I-EVOLUTION adherencia I-EVOLUTION y I-EVOLUTION con I-EVOLUTION parasitemia I-EVOLUTION negativa I-EVOLUTION a I-EVOLUTION las I-EVOLUTION cuatro I-EVOLUTION semanas. I-EVOLUTION No I-EVOLUTION presentó I-EVOLUTION nuevas I-EVOLUTION recaídas I-EVOLUTION durante I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY departamento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY San I-PAST_MEDICAL_HISTORY Martín I-PAST_MEDICAL_HISTORY (Amazonía I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Perú), I-PAST_MEDICAL_HISTORY agricultor. I-PAST_MEDICAL_HISTORY Tenía I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY malaria, I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY relevancia. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS inició I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ingreso, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mesogastrio, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS falta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS apetito, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Finalmente I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS intensificación I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS extendía I-PRESENT_ILLNESS a I-PRESENT_ILLNESS todo I-PRESENT_ILLNESS el I-PRESENT_ILLNESS abdomen, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS incoercibles, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ausencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS eliminación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gases I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deposiciones. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION quejumbroso, I-EXPLORATION taquicárdico I-EXPLORATION y I-EXPLORATION con I-EXPLORATION ictericia I-EXPLORATION de I-EXPLORATION escleras. I-EXPLORATION La I-EXPLORATION auscultación I-EXPLORATION reveló I-EXPLORATION ruidos I-EXPLORATION cardíacos I-EXPLORATION arrítmicos, I-EXPLORATION de I-EXPLORATION intensidad I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION abdominal I-EXPLORATION los I-EXPLORATION ruidos I-EXPLORATION hidroaéreos I-EXPLORATION estaban I-EXPLORATION disminuidos, I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION blanda, I-EXPLORATION depresible I-EXPLORATION y I-EXPLORATION dolorosa I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION difusa. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION visceromegalia. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION fue I-EXPLORATION considerado I-EXPLORATION no I-EXPLORATION contributorio. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION posible I-EXPLORATION obstrucción I-EXPLORATION intestinal, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION pie I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION intestinales I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION niveles I-EXPLORATION hidroaéreos. I-EXPLORATION I-EXPLORATION Entre I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION hemoglobina I-EXPLORATION 15, I-EXPLORATION 3 I-EXPLORATION g/dL, I-EXPLORATION hematocrito I-EXPLORATION 44%, I-EXPLORATION 11.570 I-EXPLORATION leucocitos/mm3, I-EXPLORATION segmentados I-EXPLORATION 81%, I-EXPLORATION sin I-EXPLORATION baciliformes I-EXPLORATION ni I-EXPLORATION eosinófilos, I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 386 I-EXPLORATION mg/L, I-EXPLORATION hiperbilirrubinemia I-EXPLORATION directa I-EXPLORATION (bilirrubina I-EXPLORATION total I-EXPLORATION 3, I-EXPLORATION 3 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION directa I-EXPLORATION 2, I-EXPLORATION 7 I-EXPLORATION mg/dL), I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION GGT I-EXPLORATION 181 I-EXPLORATION U/L I-EXPLORATION (GOT I-EXPLORATION y I-EXPLORATION GPT I-EXPLORATION normales), I-EXPLORATION hipoalbuminemia I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 4 I-EXPLORATION g/dL, I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION urea: I-EXPLORATION 61 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION creatinina: I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION mg/dL. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION VIH, I-EXPLORATION HTLV I-EXPLORATION 1-2 I-EXPLORATION y I-EXPLORATION VHC I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION El I-EXPLORATION HBsAg I-EXPLORATION y I-EXPLORATION RPR I-EXPLORATION también I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION exploratoria I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION por I-EXPLORATION una I-EXPLORATION probable I-EXPLORATION obstrucción I-EXPLORATION intestinal I-EXPLORATION mecánica. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION intraoperatorios I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION que I-EXPLORATION demarcaban I-EXPLORATION en I-EXPLORATION su I-EXPLORATION superficie I-EXPLORATION formas I-EXPLORATION lineares I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION ejemplares I-EXPLORATION de I-EXPLORATION A. I-EXPLORATION lumbricoides. I-EXPLORATION En B-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT decidió I-TREATMENT el I-TREATMENT manejo I-TREATMENT médico, I-TREATMENT procediendo I-TREATMENT al I-TREATMENT cierre I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT abdominal. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION posquirúrgica I-EVOLUTION fue I-EVOLUTION desfavorable. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION hacia I-EVOLUTION un I-EVOLUTION shock I-EVOLUTION hipovolémico, I-EVOLUTION observándose I-EVOLUTION la I-EVOLUTION salida I-EVOLUTION espontánea I-EVOLUTION y I-EVOLUTION masiva I-EVOLUTION de I-EVOLUTION gusanos I-EVOLUTION adultos I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cavidad I-EVOLUTION oral I-EVOLUTION y I-EVOLUTION fosas I-EVOLUTION nasales. I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT una I-TREATMENT re-intervención I-TREATMENT quirúrgica I-TREATMENT de I-TREATMENT urgencia, I-TREATMENT en I-TREATMENT que I-TREATMENT se I-TREATMENT evidenció I-TREATMENT una I-TREATMENT gran I-TREATMENT dilatación I-TREATMENT de I-TREATMENT asas I-TREATMENT intestinales, I-TREATMENT con I-TREATMENT abundante I-TREATMENT cantidad I-TREATMENT de I-TREATMENT ejemplares I-TREATMENT adultos, I-TREATMENT con I-TREATMENT múltiples I-TREATMENT zonas I-TREATMENT de I-TREATMENT aglomeración I-TREATMENT en I-TREATMENT forma I-TREATMENT de I-TREATMENT ovillos, I-TREATMENT que I-TREATMENT obstruían I-TREATMENT la I-TREATMENT totalidad I-TREATMENT del I-TREATMENT lumen I-TREATMENT intestinal. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT enterotomía I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT íleon, I-TREATMENT a I-TREATMENT 40 I-TREATMENT cm I-TREATMENT de I-TREATMENT la I-TREATMENT válvula I-TREATMENT ileocecal, I-TREATMENT con I-TREATMENT extracción I-TREATMENT de I-TREATMENT 20 I-TREATMENT gusanos. I-TREATMENT Se I-TREATMENT ordeñaron I-TREATMENT las I-TREATMENT asas I-TREATMENT intestinales, I-TREATMENT desde I-TREATMENT el I-TREATMENT ángulo I-TREATMENT de I-TREATMENT Treitz I-TREATMENT hasta I-TREATMENT la I-TREATMENT enterotomía, I-TREATMENT eliminando I-TREATMENT abundante I-TREATMENT cantidad I-TREATMENT de I-TREATMENT deposiciones I-TREATMENT con I-TREATMENT parásitos. I-TREATMENT En B-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION líquido I-EXPLORATION seroso I-EXPLORATION claro. I-EXPLORATION El I-EXPLORATION apéndice I-EXPLORATION cecal I-EXPLORATION y I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION características I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Luego B-TREATMENT de I-TREATMENT la I-TREATMENT primera I-TREATMENT cirugía, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antiparasitario I-TREATMENT con I-TREATMENT albendazol. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION insatisfactoria, I-EVOLUTION requiriendo I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION intervención I-EVOLUTION quirúrgica, I-EVOLUTION soporte I-EVOLUTION ventilatorio I-EVOLUTION y I-EVOLUTION manejo I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos I-EVOLUTION (UCI). I-EVOLUTION Durante B-EXPLORATION su I-EXPLORATION estadía I-EXPLORATION en I-EXPLORATION UCI, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION cursó I-EXPLORATION con I-EXPLORATION una I-EXPLORATION neumonía I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION ventilador I-EXPLORATION mecánico I-EXPLORATION por I-EXPLORATION Pseudomonas I-EXPLORATION aeru-ginosa I-EXPLORATION y I-EXPLORATION una I-EXPLORATION bacteriemia I-EXPLORATION por I-EXPLORATION Acinetobacter I-EXPLORATION baumannii I-EXPLORATION multiresistentes. I-EXPLORATION La B-EVOLUTION eliminación I-EVOLUTION de I-EVOLUTION gusanos I-EVOLUTION adultos I-EVOLUTION por I-EVOLUTION la I-EVOLUTION cavidad I-EVOLUTION oral I-EVOLUTION continuó I-EVOLUTION hasta I-EVOLUTION varios I-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION a I-EVOLUTION la I-EVOLUTION última I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS residente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS área I-PRESENT_ILLNESS urbana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Santiago I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cali I-PRESENT_ILLNESS (Valle I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Cauca, I-PRESENT_ILLNESS Colombia), I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estrato I-PRESENT_ILLNESS socioeconómico I-PRESENT_ILLNESS bajo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ocupación I-PRESENT_ILLNESS "vendedora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dulces" I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS calle. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY gastritis I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY desnutrición I-PAST_MEDICAL_HISTORY grave, I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY embarazos I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY hijos I-PAST_MEDICAL_HISTORY vivos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ligadura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trompas I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY tabaquismo. I-PAST_MEDICAL_HISTORY Presentaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY hábito I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ingerir I-PAST_MEDICAL_HISTORY agua I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY potable. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS inició I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS hospitalario, I-PRESENT_ILLNESS consistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mesogastrio, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores, I-PRESENT_ILLNESS evolucionando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS fétida, I-PRESENT_ILLNESS emesis, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS apetito I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS hemoptoica. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS periférico I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS evidenciaron I-PRESENT_ILLNESS larvas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS S. I-PRESENT_ILLNESS stercolaris I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS examen I-PRESENT_ILLNESS directo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS con I-PRESENT_ILLNESS solución I-PRESENT_ILLNESS salina I-PRESENT_ILLNESS fisiológica I-PRESENT_ILLNESS al I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 9% I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lugol. I-PRESENT_ILLNESS Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT con I-TREATMENT ivermectina I-TREATMENT durante I-TREATMENT dos I-TREATMENT días I-TREATMENT (200 I-TREATMENT μg/kg/día) I-TREATMENT y I-TREATMENT albendazol I-TREATMENT (400 I-TREATMENT mg/día). I-TREATMENT Entre B-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION albúmina I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION g/dL, I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION para I-EXPLORATION HTLV I-EXPLORATION I-II I-EXPLORATION positiva. I-EXPLORATION La I-EXPLORATION TSH I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION normal. I-EXPLORATION Siete I-EXPLORATION días I-EXPLORATION después I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION remitió I-EXPLORATION a I-EXPLORATION una I-EXPLORATION Unidad I-EXPLORATION de I-EXPLORATION Cuidados I-EXPLORATION Intensivos I-EXPLORATION (UCI) I-EXPLORATION extrainstitucional I-EXPLORATION por I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION dificultad I-EXPLORATION respiratoria. I-EXPLORATION Los I-EXPLORATION diagnósticos I-EXPLORATION presuntivos I-EXPLORATION fueron I-EXPLORATION un I-EXPLORATION trombo-embolismo I-EXPLORATION pulmonar I-EXPLORATION (TEP), I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Lóeffler I-EXPLORATION o I-EXPLORATION una I-EXPLORATION neumonía I-EXPLORATION bacteriana. I-EXPLORATION I-EXPLORATION Ingresó B-EVOLUTION a I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION consciente, I-EVOLUTION con I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION dificultad I-EVOLUTION respiratoria, I-EVOLUTION taquicárdica, I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION saturación I-EVOLUTION arterial I-EVOLUTION de I-EVOLUTION oxígeno I-EVOLUTION (SaO2) I-EVOLUTION por I-EVOLUTION oximetría I-EVOLUTION de I-EVOLUTION pulso I-EVOLUTION de I-EVOLUTION 87%, I-EVOLUTION con I-EVOLUTION soporte I-EVOLUTION de I-EVOLUTION oxígeno I-EVOLUTION (FiO2 I-EVOLUTION 50%). I-EVOLUTION Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacaba I-EXPLORATION estertores I-EXPLORATION finos I-EXPLORATION pulmonares I-EXPLORATION bibasales, I-EXPLORATION abdomen I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal, I-EXPLORATION edema I-EXPLORATION grado I-EXPLORATION III I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION y, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION eritematosas, I-EXPLORATION pruriginosas, I-EXPLORATION no I-EXPLORATION descamativas I-EXPLORATION en I-EXPLORATION piel, I-EXPLORATION predominantemente I-EXPLORATION en I-EXPLORATION los I-EXPLORATION muslos. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION evidenciaban I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 26.200/mm3, I-EXPLORATION hemoglobina I-EXPLORATION 9, I-EXPLORATION 1 I-EXPLORATION g/dL, I-EXPLORATION neutrófilos I-EXPLORATION 86%, I-EXPLORATION eosinófilos I-EXPLORATION 2%, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION 18 I-EXPLORATION mg/dL, I-EXPLORATION electrolitos I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales, I-EXPLORATION hipoxemia I-EXPLORATION grave I-EXPLORATION sin I-EXPLORATION trastorno I-EXPLORATION ácido-base. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION infiltrados I-EXPLORATION mixtos I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION alveolar I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION difusa. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION dificultad I-EVOLUTION respiratoria I-EVOLUTION progresiva, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT requirió I-TREATMENT finalmente I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasora, I-TREATMENT sin I-TREATMENT necesidad I-TREATMENT de I-TREATMENT parámetros I-TREATMENT ventilatorios I-TREATMENT altos. I-TREATMENT Además I-TREATMENT requirió I-TREATMENT soporte I-TREATMENT vasoactivo I-TREATMENT con I-TREATMENT norepinefrina I-TREATMENT por I-TREATMENT una I-TREATMENT hipotensión I-TREATMENT arterial I-TREATMENT persistente. I-TREATMENT En B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION presentó I-EVOLUTION secreciones I-EVOLUTION respiratorias I-EVOLUTION hemáticas I-EVOLUTION constantes I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION significativo I-EVOLUTION I-EVOLUTION de I-EVOLUTION la I-EVOLUTION hemoglobina, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT requirió I-TREATMENT transfusión I-TREATMENT de I-TREATMENT glóbulos I-TREATMENT rojos. I-TREATMENT Ante I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT una I-TREATMENT neumonía I-TREATMENT bacteriana I-TREATMENT se I-TREATMENT inició I-TREATMENT cobertura I-TREATMENT antibacteriana I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro I-TREATMENT con I-TREATMENT piperacilina/tazobactam. I-TREATMENT Posteriormente B-EXPLORATION se I-EXPLORATION informaron I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION urocultivo I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Escherichia I-EXPLORATION coli I-EXPLORATION productora I-EXPLORATION de I-EXPLORATION betalactamasas I-EXPLORATION de I-EXPLORATION espectro I-EXPLORATION extendido I-EXPLORATION (BLEE), I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT cambió I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT meropenem. I-TREATMENT Ante B-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION estrongiloidosis I-EXPLORATION pulmonar I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION microscopía I-EXPLORATION en I-EXPLORATION fresco I-EXPLORATION de I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION secreción I-EXPLORATION orotraqueal, I-EXPLORATION observándose I-EXPLORATION larvas I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION stercoralis, I-EXPLORATION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT administró I-TREATMENT una I-TREATMENT nueva I-TREATMENT dosis I-TREATMENT de I-TREATMENT ivermectina I-TREATMENT (200 I-TREATMENT μg/kg) I-TREATMENT y I-TREATMENT se I-TREATMENT continuó I-TREATMENT con I-TREATMENT albendazol I-TREATMENT oral I-TREATMENT (400 I-TREATMENT mg, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día). I-TREATMENT También B-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION una I-EXPLORATION tuberculosis I-EXPLORATION pulmonar I-EXPLORATION con I-EXPLORATION baciloscopias I-EXPLORATION seriadas I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colonoscopia, I-EXPLORATION cuyo I-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION una I-EXPLORATION colitis I-EXPLORATION crónica I-EXPLORATION leve I-EXPLORATION inespecífica. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION pruebas I-EXPLORATION inmunológicas I-EXPLORATION para I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION estrongiloidosis. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT el I-TREATMENT proceso I-TREATMENT de I-TREATMENT desvinculación I-TREATMENT progresiva I-TREATMENT del I-TREATMENT soporte I-TREATMENT ventilatorio, I-TREATMENT logrando I-TREATMENT la I-TREATMENT extubación I-TREATMENT al I-TREATMENT quinto I-TREATMENT día I-TREATMENT de I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasora. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION completó I-EVOLUTION una I-EVOLUTION estancia I-EVOLUTION hospitalaria I-EVOLUTION de I-EVOLUTION 12 I-EVOLUTION días, I-EVOLUTION período I-EVOLUTION en I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION presentó I-EVOLUTION episodios I-EVOLUTION repetitivos I-EVOLUTION de I-EVOLUTION tos I-EVOLUTION seca. I-EVOLUTION En I-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION clínico I-EVOLUTION el I-EVOLUTION estudio I-EVOLUTION coproscópico I-EVOLUTION no I-EVOLUTION evidenció I-EVOLUTION parásitos I-EVOLUTION intestinales, I-EVOLUTION y I-EVOLUTION la I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION tórax I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION evidenció I-EVOLUTION una I-EVOLUTION resolución I-EVOLUTION significativa I-EVOLUTION del I-EVOLUTION infiltrado I-EVOLUTION pulmonar. I-EVOLUTION Completó B-TREATMENT 10 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antihelmíntico I-TREATMENT con I-TREATMENT albendazol. I-TREATMENT La B-EVOLUTION hemoglobina I-EVOLUTION de I-EVOLUTION egreso I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 9, I-EVOLUTION 9 I-EVOLUTION g/dL. I-EVOLUTION I-EVOLUTION Durante B-TREATMENT la I-TREATMENT permanencia I-TREATMENT en I-TREATMENT la I-TREATMENT institución I-TREATMENT la I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT manejo I-TREATMENT de I-TREATMENT fisioterapia, I-TREATMENT donde B-EVOLUTION se I-EVOLUTION observó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable I-EVOLUTION de I-EVOLUTION su I-EVOLUTION condición I-EVOLUTION cardiorrespiratoria I-EVOLUTION y I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION funcionalidad. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY triplanar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tobillo I-PAST_MEDICAL_HISTORY derecho, I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY quirúrgicamente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY material I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY osteosíntesis I-PAST_MEDICAL_HISTORY (MOS) I-PAST_MEDICAL_HISTORY retirado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY cuya I-PAST_MEDICAL_HISTORY herida I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY cicatrizó. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después I-PRESENT_ILLNESS del I-PRESENT_ILLNESS retiro I-PRESENT_ILLNESS del I-PRESENT_ILLNESS MOS I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS inflamatorios I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS salida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS material I-PRESENT_ILLNESS purulento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS olor. I-PRESENT_ILLNESS No B-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION respuesta I-EXPLORATION inflamatoria I-EXPLORATION sistémica I-EXPLORATION y I-EXPLORATION había I-EXPLORATION permanecido I-EXPLORATION afebril. I-EXPLORATION Recibió B-TREATMENT un I-TREATMENT curso I-TREATMENT de I-TREATMENT dicloxacilina I-TREATMENT empírica I-TREATMENT sin I-TREATMENT mejoría. I-TREATMENT Por I-TREATMENT este I-TREATMENT motivo I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT aseo I-TREATMENT y I-TREATMENT desbridamiento I-TREATMENT quirúrgico I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT encontró I-TREATMENT un I-TREATMENT defecto I-TREATMENT de I-TREATMENT continuidad I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT cm I-TREATMENT x I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT cm I-TREATMENT en I-TREATMENT la I-TREATMENT región I-TREATMENT maleolar I-TREATMENT medial, I-TREATMENT con I-TREATMENT drenaje I-TREATMENT de I-TREATMENT un I-TREATMENT material I-TREATMENT óseo I-TREATMENT friable I-TREATMENT y I-TREATMENT necrótico. I-TREATMENT Se B-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION para I-EXPLORATION cultivo I-EXPLORATION y B-TREATMENT se I-TREATMENT inició I-TREATMENT cefazolina I-TREATMENT intravenosa I-TREATMENT en I-TREATMENT forma I-TREATMENT empírica. I-TREATMENT La B-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION mostró I-EXPLORATION bacilos I-EXPLORATION grampositivos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION demostró I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION Bacillus I-EXPLORATION spp., I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION considerado I-EXPLORATION como I-EXPLORATION contaminación I-EXPLORATION y I-EXPLORATION se I-EXPLORATION continuó I-EXPLORATION con I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION prescrito. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT persistió I-TREATMENT con I-TREATMENT drenaje I-TREATMENT de I-TREATMENT secreción I-TREATMENT sero-hemática I-TREATMENT por I-TREATMENT la I-TREATMENT herida I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT nuevo I-TREATMENT desbridamiento I-TREATMENT quirúrgico I-TREATMENT y I-TREATMENT se I-TREATMENT cambió I-TREATMENT la I-TREATMENT terapia I-TREATMENT a I-TREATMENT clindamicina I-TREATMENT intravenosa. I-TREATMENT En B-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION y I-EXPLORATION hueso I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION bacilos I-EXPLORATION grampositivos I-EXPLORATION identificados I-EXPLORATION como I-EXPLORATION Bacillus I-EXPLORATION spp. I-EXPLORATION sin I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION especie I-EXPLORATION ni I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION susceptibilidad I-EXPLORATION antimicrobiana I-EXPLORATION por I-EXPLORATION el I-EXPLORATION método I-EXPLORATION disponible I-EXPLORATION (sistema I-EXPLORATION VITEK I-EXPLORATION 2). I-EXPLORATION El I-EXPLORATION antibiograma I-EXPLORATION realizado I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Kirby I-EXPLORATION Bauer I-EXPLORATION mostró I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION clindamicina, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION iniciar I-EXPLORATION vancomicina I-EXPLORATION intravenosa. I-EXPLORATION La I-EXPLORATION cepa I-EXPLORATION finalmente I-EXPLORATION fue I-EXPLORATION identificada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION metodología I-EXPLORATION MALDI-TOF I-EXPLORATION MS I-EXPLORATION (matrix-assisted I-EXPLORATION laser I-EXPLORATION desorption/ionization I-EXPLORATION time-of-flight I-EXPLORATION mass I-EXPLORATION spectrometry) I-EXPLORATION como I-EXPLORATION Corynebacterium I-EXPLORATION striatum. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION vancomicina I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION persistía I-EVOLUTION con I-EVOLUTION secreción. I-EVOLUTION La B-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION del I-EXPLORATION tobillo I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION blandos, I-EXPLORATION edema I-EXPLORATION perióseo, I-EXPLORATION irregularidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION del I-EXPLORATION hueso I-EXPLORATION con I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION fistuloso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION piel. I-EXPLORATION En B-TREATMENT la I-TREATMENT tercera I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT se I-TREATMENT corrigió I-TREATMENT la I-TREATMENT fístula I-TREATMENT fibrótica I-TREATMENT y B-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION nuevas I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION cultivos, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION crecimiento I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION microorganismo, I-EXPLORATION identificado I-EXPLORATION igualmente I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION MALDI-TOF I-EXPLORATION como I-EXPLORATION Corynebacterium I-EXPLORATION striatum. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION antibiograma I-EXPLORATION manual I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION susceptibilidad I-EXPLORATION a I-EXPLORATION vancomicina, I-EXPLORATION linezolid, I-EXPLORATION daptomicina I-EXPLORATION e I-EXPLORATION imipenem, I-EXPLORATION y I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION clindamicina, I-EXPLORATION cefalosporinas, I-EXPLORATION rifampicina, I-EXPLORATION levofloxacina I-EXPLORATION y I-EXPLORATION cotrimoxazol. I-EXPLORATION Las B-TREATMENT dosis I-TREATMENT de I-TREATMENT vancomicina I-TREATMENT se I-TREATMENT aumentaron I-TREATMENT hasta I-TREATMENT alcanzar I-TREATMENT niveles I-TREATMENT valle I-TREATMENT de I-TREATMENT 10 I-TREATMENT ug/ml. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION última I-EVOLUTION cirugía I-EVOLUTION y I-EVOLUTION el I-EVOLUTION ajuste I-EVOLUTION de I-EVOLUTION la I-EVOLUTION dosis I-EVOLUTION fue I-EVOLUTION satisfactoria, I-EVOLUTION con I-EVOLUTION término I-EVOLUTION de I-EVOLUTION la I-EVOLUTION secreción I-EVOLUTION y I-EVOLUTION cicatrización I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION herida. I-EVOLUTION Se B-TREATMENT continuó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT por I-TREATMENT 28 I-TREATMENT días I-TREATMENT y I-TREATMENT se I-TREATMENT completó I-TREATMENT tratamiento I-TREATMENT ambulatorio I-TREATMENT dos I-TREATMENT semanas I-TREATMENT más I-TREATMENT con I-TREATMENT linezolid I-TREATMENT oral. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION evaluada I-EVOLUTION un I-EVOLUTION mes I-EVOLUTION después I-EVOLUTION del I-EVOLUTION egreso I-EVOLUTION y I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION quirúrgica I-EVOLUTION se I-EVOLUTION encontró I-EVOLUTION completamente I-EVOLUTION sana, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION inflamatorios I-EVOLUTION y I-EVOLUTION con I-EVOLUTION reactantes I-EVOLUTION de I-EVOLUTION fase I-EVOLUTION aguda I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION Preescolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sana, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY calendario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vacunación I-PAST_MEDICAL_HISTORY PNI I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY incluyendo I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vacuna I-PAST_MEDICAL_HISTORY conjugada I-PAST_MEDICAL_HISTORY ACWY-CRM197 I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Plan I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Acción I-PAST_MEDICAL_HISTORY W135. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS caracterizó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS coriza I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS °C, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS epistaxis. I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS oportunidades I-PRESENT_ILLNESS en I-PRESENT_ILLNESS SAPU, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS indicó I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS sintomático I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS antiinflamatorio I-PRESENT_ILLNESS no I-PRESENT_ILLNESS esteroidal. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS día I-PRESENT_ILLNESS siguiente I-PRESENT_ILLNESS aparecieron I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS violáceas I-PRESENT_ILLNESS puntiformes I-PRESENT_ILLNESS generalizadas, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS llevado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia. I-PRESENT_ILLNESS Ingresó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS paro I-PRESENT_ILLNESS cardio-respiratorio, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS exantema I-PRESENT_ILLNESS purpúrico I-PRESENT_ILLNESS generalizado. I-PRESENT_ILLNESS Se B-TREATMENT inició I-TREATMENT reanimación I-TREATMENT con I-TREATMENT masaje I-TREATMENT cardíaco, I-TREATMENT adrenalina I-TREATMENT e I-TREATMENT intubación I-TREATMENT orotraqueal, I-TREATMENT además I-TREATMENT de I-TREATMENT ceftriaxona I-TREATMENT 100 I-TREATMENT mg/kg I-TREATMENT y I-TREATMENT vancomicina I-TREATMENT 15 I-TREATMENT mg/kg/dosis I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT vía I-TREATMENT intraósea. I-TREATMENT Falleció B-EVOLUTION a I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION una I-EVOLUTION fibrilación I-EVOLUTION ventricular, I-EVOLUTION sin I-EVOLUTION respuesta I-EVOLUTION a I-EVOLUTION cardioversión I-EVOLUTION eléctrica I-EVOLUTION y I-EVOLUTION dosis I-EVOLUTION sucesivas I-EVOLUTION de I-EVOLUTION adrenalina. I-EVOLUTION La B-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION fue I-EXPLORATION una I-EXPLORATION meningococcemia I-EXPLORATION fulminante. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION su I-EXPLORATION gravedad I-EXPLORATION no I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION realizar I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION LCR. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION tomados I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION reanimación I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION alta I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION meningocócica, I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION remanente I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION RPC, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION confirmó I-EXPLORATION N. I-EXPLORATION meningitidis I-EXPLORATION serogrupo I-EXPLORATION B. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY residido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY transitoria I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Ovalle, I-PAST_MEDICAL_HISTORY Región I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Coquimbo, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY motivos I-PAST_MEDICAL_HISTORY laborales I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY parálisis I-PAST_MEDICAL_HISTORY facial I-PAST_MEDICAL_HISTORY periférica I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS repetidos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS trastorno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS equilibrio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vértigo. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso, I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION enflaquecido, I-EXPLORATION consciente I-EXPLORATION y I-EXPLORATION orientado, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION general. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION sin I-EXPLORATION afasia, I-EXPLORATION con I-EXPLORATION prueba I-EXPLORATION positiva I-EXPLORATION de I-EXPLORATION mínima I-EXPLORATION paresia, I-EXPLORATION dismetría I-EXPLORATION y I-EXPLORATION disdiadococinesia I-EXPLORATION izquierdas. I-EXPLORATION Entre I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION tenía I-EXPLORATION un I-EXPLORATION hemograma, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION perfil I-EXPLORATION hepático, I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION orina I-EXPLORATION completa I-EXPLORATION normales, I-EXPLORATION salvo I-EXPLORATION una I-EXPLORATION albuminemia I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 4 I-EXPLORATION g/dl. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION cerebral I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION edema I-EXPLORATION vasogénico I-EXPLORATION con I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION tipo I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION frontal I-EXPLORATION derecho; I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION imagen I-EXPLORATION parietal I-EXPLORATION con I-EXPLORATION impregnación I-EXPLORATION de I-EXPLORATION contomos I-EXPLORATION irregulares I-EXPLORATION al I-EXPLORATION contraste. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION tres I-EXPLORATION lesiones I-EXPLORATION hipointensas I-EXPLORATION con I-EXPLORATION impregnación I-EXPLORATION marginal I-EXPLORATION con I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION y I-EXPLORATION significativo I-EXPLORATION edema I-EXPLORATION perilesional I-EXPLORATION de I-EXPLORATION ubicación I-EXPLORATION frontal, I-EXPLORATION con I-EXPLORATION características I-EXPLORATION de I-EXPLORATION granulomas, I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION similares I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION frontoparietal I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cerebelar I-EXPLORATION izquierdo, I-EXPLORATION menores I-EXPLORATION a I-EXPLORATION 2, I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION una I-EXPLORATION probable I-EXPLORATION toxoplasmosis I-EXPLORATION cerebral. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION segmentario I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION candidiasis I-EXPLORATION orofaríngea I-EXPLORATION y I-EXPLORATION leucoplaquia I-EXPLORATION vellosa I-EXPLORATION y B-TREATMENT por I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT una I-TREATMENT toxoplasmosis I-TREATMENT cerebral I-TREATMENT se I-TREATMENT inició I-TREATMENT terapia I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT en I-TREATMENT dosis I-TREATMENT 8-10 I-TREATMENT mg/kg/día I-TREATMENT (en I-TREATMENT base I-TREATMENT a I-TREATMENT trimetoprim), I-TREATMENT corticoesteroides I-TREATMENT sistémicos I-TREATMENT (dexametasona I-TREATMENT 12-16 I-TREATMENT mg/día) I-TREATMENT y I-TREATMENT fluconazol I-TREATMENT oral I-TREATMENT (150 I-TREATMENT mg/día I-TREATMENT v.o. I-TREATMENT por I-TREATMENT 10 I-TREATMENT días). I-TREATMENT Las B-EXPLORATION serologías I-EXPLORATION por I-EXPLORATION quimioluminiscencia I-EXPLORATION de I-EXPLORATION VIH I-EXPLORATION y I-EXPLORATION ELISA I-EXPLORATION de I-EXPLORATION T. I-EXPLORATION cruzi I-EXPLORATION resultaron I-EXPLORATION reactivas, I-EXPLORATION siendo I-EXPLORATION ambas I-EXPLORATION confirmadas I-EXPLORATION posteriormente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION nacional I-EXPLORATION (ELISA I-EXPLORATION e I-EXPLORATION IFI I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION Chagas) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION además I-EXPLORATION serología I-EXPLORATION positiva I-EXPLORATION IgG I-EXPLORATION para I-EXPLORATION Toxoplasma I-EXPLORATION gondii. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION sífilis, I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION fueron I-EXPLORATION negativas, I-EXPLORATION sin I-EXPLORATION detectar I-EXPLORATION anomalías I-EXPLORATION al I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION sus I-EXPLORATION valores I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION para I-EXPLORATION sífilis, I-EXPLORATION bacterias, I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION tuberculosis I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION en I-EXPLORATION esta I-EXPLORATION primera I-EXPLORATION punción I-EXPLORATION lumbar. I-EXPLORATION Posteriormente, I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION CD4 I-EXPLORATION de I-EXPLORATION 73 I-EXPLORATION cél/mm3 I-EXPLORATION y I-EXPLORATION una I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION VIH I-EXPLORATION de I-EXPLORATION 54.438 I-EXPLORATION copias/ml I-EXPLORATION (log I-EXPLORATION 4, I-EXPLORATION 74). I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION por I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION adenopatías, I-EXPLORATION visceromegalias I-EXPLORATION ni I-EXPLORATION lesiones I-EXPLORATION residuales I-EXPLORATION de I-EXPLORATION tuberculosis. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION rechazo I-EVOLUTION alimentario, I-EVOLUTION ánimo I-EVOLUTION bajo I-EVOLUTION y I-EVOLUTION labilidad I-EVOLUTION emocional. I-EVOLUTION Se I-EVOLUTION diagnosticó I-EVOLUTION un I-EVOLUTION trastorno I-EVOLUTION depresivo/adaptativo I-EVOLUTION grave, I-EVOLUTION que B-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT mirtazapina I-TREATMENT y I-TREATMENT olanzapina. I-TREATMENT A I-TREATMENT los I-TREATMENT 10 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT y I-TREATMENT 26 I-TREATMENT de I-TREATMENT hospitalización I-TREATMENT se I-TREATMENT inicio I-TREATMENT terapia I-TREATMENT antiretroviral I-TREATMENT (TARV) I-TREATMENT con I-TREATMENT abacavir, I-TREATMENT lamivudina I-TREATMENT y I-TREATMENT raltegravir, I-TREATMENT que I-TREATMENT toleró I-TREATMENT en I-TREATMENT forma I-TREATMENT adecuada I-TREATMENT y I-TREATMENT con I-TREATMENT estudio I-TREATMENT previo I-TREATMENT genotípico I-TREATMENT para I-TREATMENT HLA*B5701 I-TREATMENT negativo. I-TREATMENT Se I-TREATMENT desestimó I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT inhibidores I-TREATMENT de I-TREATMENT proteasa I-TREATMENT por I-TREATMENT eventuales I-TREATMENT interacciones I-TREATMENT con I-TREATMENT psicofármacos I-TREATMENT y I-TREATMENT de I-TREATMENT efavirenz I-TREATMENT por I-TREATMENT la I-TREATMENT depresión I-TREATMENT concurrente. I-TREATMENT Durante B-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION días I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION TARV I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION diplopía, I-EVOLUTION nistagmus I-EVOLUTION y I-EVOLUTION estrabismo I-EVOLUTION convergente I-EVOLUTION del I-EVOLUTION ojo I-EVOLUTION derecho, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION una I-EVOLUTION marcada I-EVOLUTION agresividad. I-EVOLUTION Se B-EXPLORATION controló I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION RM I-EXPLORATION cerebral I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 15 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION terapia I-EXPLORATION con I-EXPLORATION cotrimoxazol I-EXPLORATION (+31 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION hospitalización), I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION significativa I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION frontales I-EXPLORATION y I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION lesiones I-EXPLORATION cerebelares I-EXPLORATION estacionarias I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION edema I-EXPLORATION perilesional. I-EXPLORATION Se I-EXPLORATION planteó I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones, I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION primario I-EXPLORATION de I-EXPLORATION SNC I-EXPLORATION y I-EXPLORATION otros I-EXPLORATION diagnósticos I-EXPLORATION diferenciales. I-EXPLORATION No I-EXPLORATION obstante, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION dichas I-EXPLORATION lesiones I-EXPLORATION radiológicamente I-EXPLORATION no I-EXPLORATION empeoraron, I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION Neurocirugía I-EXPLORATION desestimó I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION abierta. I-EXPLORATION I-EXPLORATION Durante B-EVOLUTION la I-EVOLUTION cuarta I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION terapia I-EVOLUTION con I-EVOLUTION cotrimoxazol I-EVOLUTION y I-EVOLUTION tercera I-EVOLUTION de I-EVOLUTION TARV, I-EVOLUTION inició I-EVOLUTION fiebre I-EVOLUTION hasta I-EVOLUTION 38°C, I-EVOLUTION somnolencia I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION sopor I-EVOLUTION profundo, I-EVOLUTION paresia I-EVOLUTION de I-EVOLUTION hemicuerpo I-EVOLUTION izquierdo, I-EVOLUTION del I-EVOLUTION velo I-EVOLUTION palatino I-EVOLUTION izquierdo I-EVOLUTION y I-EVOLUTION disartria I-EVOLUTION intensa, I-EVOLUTION objetivándose I-EVOLUTION una I-EVOLUTION infección I-EVOLUTION del I-EVOLUTION tracto I-EVOLUTION urinario I-EVOLUTION por I-EVOLUTION Klebsiella I-EVOLUTION pneumoniae I-EVOLUTION multiresistente. I-EVOLUTION Un B-EXPLORATION nuevo I-EXPLORATION control I-EXPLORATION de I-EXPLORATION RM I-EXPLORATION cerebral, I-EXPLORATION al I-EXPLORATION mes I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION cotrimoxazol, I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION progresión I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION cerebrales, I-EXPLORATION especialmente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION posterior I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION frontal I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION nuevas I-EXPLORATION lesiones I-EXPLORATION supra I-EXPLORATION e I-EXPLORATION infratentoriales, I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION y I-EXPLORATION herniación I-EXPLORATION subfalcina I-EXPLORATION a I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION Se B-TREATMENT planteó I-TREATMENT un I-TREATMENT probable I-TREATMENT compromiso I-TREATMENT de I-TREATMENT SNC I-TREATMENT por I-TREATMENT enfermedad I-TREATMENT de I-TREATMENT Chagas I-TREATMENT o I-TREATMENT un I-TREATMENT síndrome I-TREATMENT inflamatorio I-TREATMENT de I-TREATMENT reconstitución I-TREATMENT inmune I-TREATMENT (SIRI), I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT trasladar I-TREATMENT a I-TREATMENT UCI I-TREATMENT ese I-TREATMENT mismo I-TREATMENT día I-TREATMENT para I-TREATMENT protección I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea I-TREATMENT (escala I-TREATMENT Glasgow I-TREATMENT de I-TREATMENT coma I-TREATMENT 5-6 I-TREATMENT puntos) I-TREATMENT con I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasora I-TREATMENT y I-TREATMENT monitorización, I-TREATMENT manteniéndose I-TREATMENT la I-TREATMENT TARV, I-TREATMENT cotrimoxazol I-TREATMENT y I-TREATMENT corticoesteroides. I-TREATMENT Se I-TREATMENT inició I-TREATMENT empíricamente I-TREATMENT nifurtimox I-TREATMENT 8 I-TREATMENT mg/kg/día I-TREATMENT (120 I-TREATMENT mg I-TREATMENT fraccionado I-TREATMENT cada I-TREATMENT 6 I-TREATMENT horas I-TREATMENT por I-TREATMENT SNG), I-TREATMENT asociado I-TREATMENT a I-TREATMENT meropenem I-TREATMENT i.v. I-TREATMENT para I-TREATMENT el I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT infección I-TREATMENT urinaria. I-TREATMENT Se B-EXPLORATION amplió I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION con I-EXPLORATION una I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION para I-EXPLORATION citomegalovirus I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION indetectable I-EXPLORATION y I-EXPLORATION hemocultivos I-EXPLORATION para I-EXPLORATION micobacterias I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativo. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION punción I-EXPLORATION lumbar, I-EXPLORATION con I-EXPLORATION cultivo I-EXPLORATION corriente, I-EXPLORATION de I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION tinta I-EXPLORATION china I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION nuevamente I-EXPLORATION negativos, I-EXPLORATION pero I-EXPLORATION apareció I-EXPLORATION una I-EXPLORATION proteinorraquia I-EXPLORATION de I-EXPLORATION 55 I-EXPLORATION mg/dL. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION complementario I-EXPLORATION del I-EXPLORATION LCR I-EXPLORATION con I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION tripomastigotes, I-EXPLORATION RPC I-EXPLORATION con I-EXPLORATION Xpert I-EXPLORATION MTB/RIF I-EXPLORATION para I-EXPLORATION Mycobacterium I-EXPLORATION tuberculosis I-EXPLORATION y I-EXPLORATION RPC I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simplex-1 I-EXPLORATION y I-EXPLORATION 2, I-EXPLORATION varicela I-EXPLORATION zoster, I-EXPLORATION Epstein-Barr I-EXPLORATION y I-EXPLORATION JC I-EXPLORATION también I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Además, I-EXPLORATION la I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION T. I-EXPLORATION gondii I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION y I-EXPLORATION LCR I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION teniendo I-EXPLORATION como I-EXPLORATION target I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION multicopia I-EXPLORATION B1 I-EXPLORATION 9. I-EXPLORATION Sin I-EXPLORATION embargo, I-EXPLORATION la I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION T. I-EXPLORATION cruzi I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION reveló I-EXPLORATION 1.400 I-EXPLORATION copias/mL, I-EXPLORATION y I-EXPLORATION 35.000 I-EXPLORATION copias/mL I-EXPLORATION en I-EXPLORATION el I-EXPLORATION LCR, I-EXPLORATION confirmándose I-EXPLORATION una I-EXPLORATION encefalitis I-EXPLORATION chagásica. I-EXPLORATION Los I-EXPLORATION targets I-EXPLORATION utilizados I-EXPLORATION para I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION T. I-EXPLORATION cruzi I-EXPLORATION fueron I-EXPLORATION para I-EXPLORATION el I-EXPLORATION minicírculo I-EXPLORATION contenido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ADN I-EXPLORATION de I-EXPLORATION kinetoplasto I-EXPLORATION (ADNk) I-EXPLORATION 10 I-EXPLORATION y I-EXPLORATION la I-EXPLORATION región I-EXPLORATION repetitiva I-EXPLORATION de I-EXPLORATION 195 I-EXPLORATION pb I-EXPLORATION contenida I-EXPLORATION en I-EXPLORATION el I-EXPLORATION núcleo, I-EXPLORATION denominado I-EXPLORATION ADN I-EXPLORATION satélite I-EXPLORATION (ADNsat). I-EXPLORATION 11 I-EXPLORATION En B-EVOLUTION su I-EVOLUTION quinta I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION TARV I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION control I-EVOLUTION de I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION de I-EVOLUTION VIH I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION indetectable I-EVOLUTION (con I-EVOLUTION reducción I-EVOLUTION > I-EVOLUTION 1 I-EVOLUTION log I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION basal), I-EVOLUTION sin I-EVOLUTION aumento I-EVOLUTION en I-EVOLUTION el I-EVOLUTION recuento I-EVOLUTION CD4 I-EVOLUTION (30 I-EVOLUTION céls/μL), I-EVOLUTION aunque I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION recibiendo I-EVOLUTION altas I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION corticoesteroides. I-EVOLUTION I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION extrema I-EVOLUTION gravedad, I-EVOLUTION necesidad I-EVOLUTION continua I-EVOLUTION de I-EVOLUTION VM I-EVOLUTION y I-EVOLUTION aminas I-EVOLUTION vasoactivas, I-EVOLUTION sin I-EVOLUTION mayor I-EVOLUTION respuesta I-EVOLUTION neurológica I-EVOLUTION a I-EVOLUTION terapias I-EVOLUTION instauradas. I-EVOLUTION Luego I-EVOLUTION de I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION falleció I-EVOLUTION por I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION hipertensión I-EVOLUTION intracraneal I-EVOLUTION y I-EVOLUTION falla I-EVOLUTION multiorgánica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-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 infección I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY VIH, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY tuberculosis 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 Recibió I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY anti-retroviral I-PAST_MEDICAL_HISTORY (TARV) I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY adherencia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ocho I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY respuesta I-PAST_MEDICAL_HISTORY inmunológica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY virológica I-PAST_MEDICAL_HISTORY favorable, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY abandonó, I-PAST_MEDICAL_HISTORY según I-PAST_MEDICAL_HISTORY refirió, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY mejoría I-PAST_MEDICAL_HISTORY clínica. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY abandono, I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY nuevamente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tuberculosis, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY ganglionar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY multirresistencia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY fármacos I-PAST_MEDICAL_HISTORY antituberculosos. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY recibido I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY régimen I-PAST_MEDICAL_HISTORY individualizado I-PAST_MEDICAL_HISTORY (amikacina, I-PAST_MEDICAL_HISTORY pirazinamida, I-PAST_MEDICAL_HISTORY cicloserina, I-PAST_MEDICAL_HISTORY etionamida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY levofloxacina) I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY siete I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY reinicio I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY TARV I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY (tenofovir, I-PAST_MEDICAL_HISTORY lamivudina, I-PAST_MEDICAL_HISTORY efavirenz). I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY embargo, I-PAST_MEDICAL_HISTORY finalmente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY abandonado I-PAST_MEDICAL_HISTORY ambos I-PAST_MEDICAL_HISTORY esquemas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY intolerancia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY medicación. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY empírica I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY encefalitis I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Toxoplasma I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cotrimoxazol I-PAST_MEDICAL_HISTORY (5 I-PAST_MEDICAL_HISTORY mg/kg/día I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trimetoprim, I-PAST_MEDICAL_HISTORY fraccionado I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY h) I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY semanas, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY respuesta I-PAST_MEDICAL_HISTORY favorable I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY imágenes I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY resonancia I-PAST_MEDICAL_HISTORY magnética I-PAST_MEDICAL_HISTORY (RM). I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY alta, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY reiniciado I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antituberculoso, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY continuado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cotrimoxazol, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mantención I-PAST_MEDICAL_HISTORY (160/800 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY 24 I-PAST_MEDICAL_HISTORY h); I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY adherencia I-PAST_MEDICAL_HISTORY regular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tres B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después I-PRESENT_ILLNESS reingresó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Emergencias I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS neurológico, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS paraparesia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores, I-PRESENT_ILLNESS retención I-PRESENT_ILLNESS urinaria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS sensitivo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS T8. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION y I-EXPLORATION médula I-EXPLORATION espinal I-EXPLORATION revelando I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION intramedular I-EXPLORATION captadora I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION en I-EXPLORATION anillo I-EXPLORATION (0, I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION x I-EXPLORATION 2, I-EXPLORATION 6 I-EXPLORATION cm) I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION perilesional, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION T8. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION (LCR) I-EXPLORATION mostró I-EXPLORATION 20 I-EXPLORATION células I-EXPLORATION a I-EXPLORATION predominio I-EXPLORATION linfomononuclear I-EXPLORATION (90%), I-EXPLORATION hiperproteinorraquia I-EXPLORATION (247 I-EXPLORATION mg/dL), I-EXPLORATION glucorraquia I-EXPLORATION y I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION ADA I-EXPLORATION (adenosina I-EXPLORATION deaminasa) I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION microbiológicos I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION para I-EXPLORATION bacterias I-EXPLORATION (tinción I-EXPLORATION Gram I-EXPLORATION y I-EXPLORATION cultivo), I-EXPLORATION hongos I-EXPLORATION (tinta I-EXPLORATION china I-EXPLORATION y I-EXPLORATION antígeno I-EXPLORATION para I-EXPLORATION Cryptococcus) I-EXPLORATION y I-EXPLORATION micobacterias I-EXPLORATION (baciloscopias I-EXPLORATION y I-EXPLORATION GeneXpert I-EXPLORATION MTB/RIF) I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION RPC I-EXPLORATION para I-EXPLORATION Toxoplasma I-EXPLORATION en I-EXPLORATION LCR, I-EXPLORATION y I-EXPLORATION las I-EXPLORATION cargas I-EXPLORATION virales I-EXPLORATION para I-EXPLORATION CMV I-EXPLORATION y I-EXPLORATION VEB I-EXPLORATION séricas I-EXPLORATION y I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION fueron I-EXPLORATION indetectables. I-EXPLORATION El I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION células I-EXPLORATION T I-EXPLORATION CD4+ I-EXPLORATION fue I-EXPLORATION 11 I-EXPLORATION céls/mm3, I-EXPLORATION con I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION VIH I-EXPLORATION de I-EXPLORATION 548.800 I-EXPLORATION copias I-EXPLORATION ARN/ml; I-EXPLORATION los I-EXPLORATION títulos I-EXPLORATION séricos I-EXPLORATION de I-EXPLORATION IgG I-EXPLORATION para I-EXPLORATION Toxoplasma I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION en I-EXPLORATION 4, I-EXPLORATION 37 I-EXPLORATION (< I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION = I-EXPLORATION negativo) I-EXPLORATION obtenidos I-EXPLORATION mediante I-EXPLORATION inmunoanálisis I-EXPLORATION quimioluminiscente I-EXPLORATION de I-EXPLORATION partículas I-EXPLORATION (CMIA). I-EXPLORATION I-EXPLORATION Se B-TREATMENT reinició I-TREATMENT terapia I-TREATMENT empírica, I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT pudo I-TREATMENT realizar I-TREATMENT una I-TREATMENT biopsia I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT intramedular, I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT i.v. I-TREATMENT (5 I-TREATMENT mg/kg I-TREATMENT de I-TREATMENT trimetoprim, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día), I-TREATMENT durante I-TREATMENT cuatro I-TREATMENT semanas I-TREATMENT asociado I-TREATMENT a I-TREATMENT dexametasona I-TREATMENT i.v. I-TREATMENT 8 I-TREATMENT mg, I-TREATMENT fraccionado I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h, I-TREATMENT por I-TREATMENT siete I-TREATMENT días. I-TREATMENT Posteriormente I-TREATMENT continuó I-TREATMENT dos I-TREATMENT semanas I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT a I-TREATMENT la I-TREATMENT misma I-TREATMENT dosis I-TREATMENT por I-TREATMENT vía I-TREATMENT oral, I-TREATMENT y I-TREATMENT reducción I-TREATMENT semanal I-TREATMENT progresiva I-TREATMENT de I-TREATMENT corticoesteroides I-TREATMENT con I-TREATMENT prednisona, I-TREATMENT hasta I-TREATMENT completar I-TREATMENT seis I-TREATMENT semanas. I-TREATMENT Tuvo B-EVOLUTION control I-EVOLUTION imagenológico I-EVOLUTION cuatro I-EVOLUTION semanas I-EVOLUTION después I-EVOLUTION del I-EVOLUTION tratamiento, I-EVOLUTION evidenciándose I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION lesión I-EVOLUTION intramedular, I-EVOLUTION con I-EVOLUTION evidente I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION tamaño I-EVOLUTION y I-EVOLUTION menor I-EVOLUTION realce I-EVOLUTION al I-EVOLUTION contraste. I-EVOLUTION Clínicamente I-EVOLUTION a I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION empírico, I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION evidenciarse I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sensibilidad I-EVOLUTION discriminatoria I-EVOLUTION y I-EVOLUTION la I-EVOLUTION fuerza I-EVOLUTION muscular; I-EVOLUTION sin I-EVOLUTION embargo, I-EVOLUTION persistió I-EVOLUTION con I-EVOLUTION compromiso I-EVOLUTION del I-EVOLUTION esfínter I-EVOLUTION urinario I-EVOLUTION (retención I-EVOLUTION urinaria). I-EVOLUTION Ante B-TREATMENT la I-TREATMENT mejoría I-TREATMENT inicial, I-TREATMENT se I-TREATMENT decidió I-TREATMENT continuar I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT para I-TREATMENT toxoplasmosis I-TREATMENT (durante I-TREATMENT seis I-TREATMENT semanas), I-TREATMENT y I-TREATMENT terapia I-TREATMENT de I-TREATMENT rehabilitación I-TREATMENT física. I-TREATMENT Previo I-TREATMENT al I-TREATMENT alta I-TREATMENT se I-TREATMENT reinició I-TREATMENT la I-TREATMENT TARV I-TREATMENT con I-TREATMENT mismo I-TREATMENT esquema I-TREATMENT recibido I-TREATMENT previamente. I-TREATMENT Finalmente, I-TREATMENT la I-TREATMENT paciente I-TREATMENT continuó I-TREATMENT la I-TREATMENT terapia I-TREATMENT antituberculosa I-TREATMENT de I-TREATMENT manera I-TREATMENT regular I-TREATMENT y I-TREATMENT con I-TREATMENT dosis I-TREATMENT de I-TREATMENT mantención I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT 160/800 I-TREATMENT mg, I-TREATMENT fraccionado I-TREATMENT cada I-TREATMENT 12 I-TREATMENT h. I-TREATMENT I-TREATMENT Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS chofer B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ambulancia, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY activo I-PAST_MEDICAL_HISTORY (5 I-PAST_MEDICAL_HISTORY cigarrillos/día) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY (IMC I-PAST_MEDICAL_HISTORY 31 I-PAST_MEDICAL_HISTORY kg/m2) I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mialgias, I-PAST_MEDICAL_HISTORY tos, I-PAST_MEDICAL_HISTORY odinofagia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY rinorrea. I-PAST_MEDICAL_HISTORY Un B-PRESENT_ILLNESS día I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS se I-PRESENT_ILLNESS agregó I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS cuantitativo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia. I-PRESENT_ILLNESS Ingresó B-EXPLORATION al I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Urgencia I-EXPLORATION comprometido I-EXPLORATION de I-EXPLORATION conciencia, I-EXPLORATION mal I-EXPLORATION perfundido, I-EXPLORATION hipotenso I-EXPLORATION (106/46 I-EXPLORATION mmHg), I-EXPLORATION taquicárdico I-EXPLORATION (106/min), I-EXPLORATION con I-EXPLORATION uso I-EXPLORATION de I-EXPLORATION musculatura I-EXPLORATION accesoria, I-EXPLORATION saturando I-EXPLORATION 60-67% I-EXPLORATION por I-EXPLORATION oximetría I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION a I-EXPLORATION Fi02 I-EXPLORATION ambiental I-EXPLORATION y I-EXPLORATION con I-EXPLORATION roncus I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION campos I-EXPLORATION pulmonares. I-EXPLORATION Se I-EXPLORATION administró I-EXPLORATION oxigenoterapia I-EXPLORATION con I-EXPLORATION mascarilla I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION flujo I-EXPLORATION sin I-EXPLORATION respuesta, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION intubó I-EXPLORATION y I-EXPLORATION se I-EXPLORATION trasladó I-EXPLORATION a I-EXPLORATION UCI. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION con I-EXPLORATION creatinina I-EXPLORATION plasmática I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 45 I-EXPLORATION mg/dL I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION y I-EXPLORATION NU I-EXPLORATION de I-EXPLORATION 47 I-EXPLORATION mg/dL. I-EXPLORATION Tenía I-EXPLORATION una I-EXPLORATION PCR I-EXPLORATION elevada I-EXPLORATION (200 I-EXPLORATION mg/L), I-EXPLORATION con I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos, I-EXPLORATION eritrocitos I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION normales. I-EXPLORATION Además, I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION LDH I-EXPLORATION plasmática I-EXPLORATION (1.500 I-EXPLORATION U/L) I-EXPLORATION y I-EXPLORATION lactato I-EXPLORATION arterial I-EXPLORATION 45 I-EXPLORATION mg/dL I-EXPLORATION (4,5-14,4). I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION confirmó I-EXPLORATION una I-EXPLORATION neumonía I-EXPLORATION multilobar I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION tratamiento I-EXPLORATION empírico I-EXPLORATION con I-EXPLORATION ceftriaxona, I-EXPLORATION moxifloxacino I-EXPLORATION y I-EXPLORATION oseltamivir. I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION evolucionó I-EXPLORATION con I-EXPLORATION un I-EXPLORATION shock I-EXPLORATION (con I-EXPLORATION requerimientos I-EXPLORATION de I-EXPLORATION noradrenalina I-EXPLORATION hasta I-EXPLORATION 0, I-EXPLORATION 15 I-EXPLORATION μg/kg/min) I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION respiratoria I-EXPLORATION catastrófica I-EXPLORATION en I-EXPLORATION VM, I-EXPLORATION decidiéndose I-EXPLORATION ventilar I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION prono. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION agentes I-EXPLORATION por I-EXPLORATION hemocultivos, I-EXPLORATION urocultivo, I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION aspirado I-EXPLORATION endotraqueal I-EXPLORATION o I-EXPLORATION panel I-EXPLORATION viral I-EXPLORATION por I-EXPLORATION inmunofluorescencia. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION y I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION una I-EXPLORATION influenza I-EXPLORATION A I-EXPLORATION H1N1 I-EXPLORATION pdm09 I-EXPLORATION por I-EXPLORATION RPC. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION complementario I-EXPLORATION por I-EXPLORATION RPC I-EXPLORATION reveló I-EXPLORATION además I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION ADV I-EXPLORATION y I-EXPLORATION VRS I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION aérea. I-EXPLORATION I-EXPLORATION Desde I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION h I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION disminuyeron I-EXPLORATION los I-EXPLORATION requerimientos I-EXPLORATION de I-EXPLORATION noradrenalina I-EXPLORATION (0, I-EXPLORATION 03 I-EXPLORATION μg/kg/min), I-EXPLORATION estabilizándose I-EXPLORATION su I-EXPLORATION insuficiencia I-EXPLORATION respiratoria I-EXPLORATION (PaFi I-EXPLORATION > I-EXPLORATION 250), I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION volvió I-EXPLORATION a I-EXPLORATION posición I-EXPLORATION supina. I-EXPLORATION No I-EXPLORATION obstante, I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION progresión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION IRA, I-EXPLORATION desde I-EXPLORATION oliguria I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION anuria, I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION hasta I-EXPLORATION 5, I-EXPLORATION 7 I-EXPLORATION mg/dL, I-EXPLORATION NU I-EXPLORATION hasta I-EXPLORATION 98 I-EXPLORATION mg/dL I-EXPLORATION e I-EXPLORATION hiperkalemia I-EXPLORATION grave. I-EXPLORATION Se I-EXPLORATION inició I-EXPLORATION soporte I-EXPLORATION dialítico I-EXPLORATION con I-EXPLORATION HD I-EXPLORATION intermitente I-EXPLORATION diaria. I-EXPLORATION La I-EXPLORATION evolución I-EXPLORATION de I-EXPLORATION oliguria I-EXPLORATION a I-EXPLORATION anuria I-EXPLORATION no I-EXPLORATION permitió I-EXPLORATION realizar I-EXPLORATION FENa; I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION había I-EXPLORATION sido I-EXPLORATION reanimado I-EXPLORATION y I-EXPLORATION estabilizado I-EXPLORATION hemodinámicamente I-EXPLORATION (con I-EXPLORATION mínimo I-EXPLORATION requerimiento I-EXPLORATION de I-EXPLORATION vasoactivos), I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION era I-EXPLORATION planteable I-EXPLORATION un I-EXPLORATION componente I-EXPLORATION pre-renal I-EXPLORATION en I-EXPLORATION ese I-EXPLORATION contexto. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION pudieron I-EXPLORATION efectuar I-EXPLORATION imágenes I-EXPLORATION abdominales I-EXPLORATION para I-EXPLORATION evaluar I-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION renal, I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION su I-EXPLORATION condición I-EXPLORATION inestable I-EXPLORATION impidió I-EXPLORATION su I-EXPLORATION realización. I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION deterioro I-EXPLORATION gasométrico I-EXPLORATION con I-EXPLORATION PaFi I-EXPLORATION menor I-EXPLORATION a I-EXPLORATION 150, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION hizo I-EXPLORATION necesario I-EXPLORATION volver I-EXPLORATION a I-EXPLORATION VM I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION prono. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION una I-EXPLORATION falla I-EXPLORATION ventricular I-EXPLORATION por I-EXPLORATION ecocardiografía I-EXPLORATION y I-EXPLORATION se I-EXPLORATION administraron I-EXPLORATION bolos I-EXPLORATION de I-EXPLORATION metilprednisolona I-EXPLORATION 62, I-EXPLORATION 5 I-EXPLORATION mg I-EXPLORATION por I-EXPLORATION 5 I-EXPLORATION días I-EXPLORATION en I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION un I-EXPLORATION SDRA I-EXPLORATION grave. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina, I-EXPLORATION al I-EXPLORATION recuperar I-EXPLORATION la I-EXPLORATION diuresis, I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION perfil I-EXPLORATION inflamatorio I-EXPLORATION con I-EXPLORATION una I-EXPLORATION proteinuria I-EXPLORATION de I-EXPLORATION 300 I-EXPLORATION mg/dL, I-EXPLORATION hematuria I-EXPLORATION con I-EXPLORATION eritrocitos I-EXPLORATION incontables I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION proteinuria/creatininuria I-EXPLORATION de I-EXPLORATION 7.384 I-EXPLORATION mg/g. I-EXPLORATION Por I-EXPLORATION su I-EXPLORATION parte, I-EXPLORATION los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION CK, I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION C4 I-EXPLORATION resultaron I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION autoinmune I-EXPLORATION con I-EXPLORATION ANCA-c, I-EXPLORATION ANCA-p I-EXPLORATION y I-EXPLORATION ANA I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION virales I-EXPLORATION de I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION mejoró I-EXPLORATION progresivamente I-EXPLORATION de I-EXPLORATION su I-EXPLORATION cuadro I-EXPLORATION respiratorio I-EXPLORATION extubándose I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 21 I-EXPLORATION días. I-EXPLORATION En B-TREATMENT total, I-TREATMENT se I-TREATMENT completaron I-TREATMENT 15 I-TREATMENT sesiones I-TREATMENT de I-TREATMENT HD I-TREATMENT recuperando I-TREATMENT la I-TREATMENT función I-TREATMENT renal, I-TREATMENT con I-TREATMENT mejoría I-TREATMENT de I-TREATMENT sedimento I-TREATMENT urinario I-TREATMENT inflamatorio I-TREATMENT (proteinuria I-TREATMENT de I-TREATMENT 30 I-TREATMENT mg/dL I-TREATMENT y I-TREATMENT eritrocitos I-TREATMENT 2-4 I-TREATMENT por I-TREATMENT campo) I-TREATMENT y I-TREATMENT normalización I-TREATMENT de I-TREATMENT la I-TREATMENT diuresis. I-TREATMENT Se B-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION de I-EVOLUTION internación. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION tenía I-EVOLUTION indicación I-EVOLUTION de I-EVOLUTION vacuna I-EVOLUTION influenza I-EVOLUTION por I-EVOLUTION su I-EVOLUTION obesidad I-EVOLUTION y I-EVOLUTION ser I-EVOLUTION personal I-EVOLUTION de I-EVOLUTION salud, I-EVOLUTION pero I-EVOLUTION no I-EVOLUTION la I-EVOLUTION había I-EVOLUTION recibido. I-EVOLUTION Se I-EVOLUTION efectuó I-EVOLUTION un I-EVOLUTION control I-EVOLUTION un I-EVOLUTION año I-EVOLUTION después, I-EVOLUTION que I-EVOLUTION mostró I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION y I-EVOLUTION un I-EVOLUTION sedimento I-EVOLUTION de I-EVOLUTION orina I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Estudios I-EVOLUTION moleculares I-EVOLUTION I-EVOLUTION En I-EVOLUTION el I-EVOLUTION Instituto I-EVOLUTION de I-EVOLUTION Salud I-EVOLUTION Pública I-EVOLUTION de I-EVOLUTION Chile I-EVOLUTION las I-EVOLUTION muestras I-EVOLUTION respiratorias I-EVOLUTION se I-EVOLUTION sometieron I-EVOLUTION a I-EVOLUTION extracción I-EVOLUTION de I-EVOLUTION ácidos I-EVOLUTION nucleicos I-EVOLUTION totales I-EVOLUTION en I-EVOLUTION el I-EVOLUTION equipo I-EVOLUTION automatizado I-EVOLUTION EASYMAG I-EVOLUTION de I-EVOLUTION Nuclisens. I-EVOLUTION Se I-EVOLUTION realizó I-EVOLUTION RT-RPC I-EVOLUTION usando I-EVOLUTION el I-EVOLUTION protocolo I-EVOLUTION estándar I-EVOLUTION del I-EVOLUTION CDC I-EVOLUTION para I-EVOLUTION la I-EVOLUTION detección I-EVOLUTION y I-EVOLUTION subtipificación I-EVOLUTION de I-EVOLUTION virus I-EVOLUTION influenza I-EVOLUTION (CDC I-EVOLUTION real I-EVOLUTION time I-EVOLUTION RT-PCR I-EVOLUTION protocol I-EVOLUTION for I-EVOLUTION detection I-EVOLUTION and I-EVOLUTION characterization I-EVOLUTION of I-EVOLUTION influenza, I-EVOLUTION 2012), I-EVOLUTION y I-EVOLUTION para I-EVOLUTION otros I-EVOLUTION virus I-EVOLUTION respiratorios I-EVOLUTION (Real-time I-EVOLUTION RT-PCR I-EVOLUTION assay I-EVOLUTION for I-EVOLUTION non-influenza I-EVOLUTION respiratory I-EVOLUTION viruses) I-EVOLUTION en I-EVOLUTION termociclador I-EVOLUTION 7500 I-EVOLUTION Fast I-EVOLUTION de I-EVOLUTION Applied I-EVOLUTION Biosystems. I-EVOLUTION Se I-EVOLUTION amplificó I-EVOLUTION un I-EVOLUTION panel I-EVOLUTION de I-EVOLUTION virus I-EVOLUTION respiratorios I-EVOLUTION que I-EVOLUTION incluyen I-EVOLUTION influenza, I-EVOLUTION virus I-EVOLUTION respiratorio I-EVOLUTION sincicial, I-EVOLUTION metapneumovirus, I-EVOLUTION parainfluenza I-EVOLUTION 1, I-EVOLUTION 2 I-EVOLUTION y I-EVOLUTION 3, I-EVOLUTION adenovirus I-EVOLUTION y I-EVOLUTION rinovirus, I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION el I-EVOLUTION que I-EVOLUTION permitió I-EVOLUTION detectar I-EVOLUTION las I-EVOLUTION co-infecciones I-EVOLUTION ya I-EVOLUTION descritas. I-EVOLUTION I-EVOLUTION Además, I-EVOLUTION para I-EVOLUTION explorar I-EVOLUTION la I-EVOLUTION existencia I-EVOLUTION de I-EVOLUTION mutaciones I-EVOLUTION que I-EVOLUTION pudieran I-EVOLUTION estar I-EVOLUTION potencialmente I-EVOLUTION asociadas I-EVOLUTION a I-EVOLUTION una I-EVOLUTION mayor I-EVOLUTION gravedad I-EVOLUTION clínica, I-EVOLUTION se I-EVOLUTION hizo I-EVOLUTION un I-EVOLUTION estudio I-EVOLUTION de I-EVOLUTION secuenciación I-EVOLUTION del I-EVOLUTION segmento I-EVOLUTION HA1 I-EVOLUTION de I-EVOLUTION la I-EVOLUTION hemaglutinina I-EVOLUTION viral, I-EVOLUTION mediante I-EVOLUTION secuenciación I-EVOLUTION por I-EVOLUTION el I-EVOLUTION método I-EVOLUTION de I-EVOLUTION Sanger I-EVOLUTION en I-EVOLUTION un I-EVOLUTION equipo I-EVOLUTION Applied I-EVOLUTION Biosystems/Genetic I-EVOLUTION analyzer I-EVOLUTION 3500. I-EVOLUTION Ambas I-EVOLUTION muestras I-EVOLUTION fueron I-EVOLUTION comparadas I-EVOLUTION con I-EVOLUTION un I-EVOLUTION grupo I-EVOLUTION de I-EVOLUTION 76 I-EVOLUTION muestras I-EVOLUTION de I-EVOLUTION distintas I-EVOLUTION regiones I-EVOLUTION del I-EVOLUTION país, I-EVOLUTION tanto I-EVOLUTION de I-EVOLUTION pacientes I-EVOLUTION ambulatorios I-EVOLUTION como I-EVOLUTION hospitalizados, I-EVOLUTION incluyendo I-EVOLUTION 11 I-EVOLUTION muestras I-EVOLUTION de I-EVOLUTION pacientes I-EVOLUTION fallecidos. I-EVOLUTION El I-EVOLUTION análisis I-EVOLUTION de I-EVOLUTION la I-EVOLUTION secuenciación I-EVOLUTION del I-EVOLUTION segmento I-EVOLUTION HA1 I-EVOLUTION de I-EVOLUTION virus I-EVOLUTION influenza I-EVOLUTION H1N1pdm09, I-EVOLUTION comparado I-EVOLUTION con I-EVOLUTION la I-EVOLUTION cepa I-EVOLUTION estándar I-EVOLUTION A/California/07/2009 I-EVOLUTION demostró I-EVOLUTION que I-EVOLUTION ambos I-EVOLUTION casos I-EVOLUTION presentaron I-EVOLUTION las I-EVOLUTION mismas I-EVOLUTION ocho I-EVOLUTION mutaciones I-EVOLUTION comunes I-EVOLUTION a I-EVOLUTION las I-EVOLUTION otras I-EVOLUTION 76 I-EVOLUTION muestras I-EVOLUTION analizadas I-EVOLUTION del I-EVOLUTION año I-EVOLUTION 2015, I-EVOLUTION indicando I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION las I-EVOLUTION mismas I-EVOLUTION cepas I-EVOLUTION circulantes I-EVOLUTION (datos I-EVOLUTION no I-EVOLUTION mostrados). I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION la I-EVOLUTION muestra I-EVOLUTION del I-EVOLUTION caso I-EVOLUTION 1 I-EVOLUTION evidenció I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION única I-EVOLUTION la I-EVOLUTION mutación I-EVOLUTION D222N I-EVOLUTION que I-EVOLUTION no I-EVOLUTION se I-EVOLUTION detectó I-EVOLUTION en I-EVOLUTION ninguna I-EVOLUTION de I-EVOLUTION las I-EVOLUTION otras I-EVOLUTION muestras I-EVOLUTION analizadas. I-EVOLUTION En I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION muestras I-EVOLUTION analizadas I-EVOLUTION y I-EVOLUTION en I-EVOLUTION el I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION las I-EVOLUTION muestras I-EVOLUTION de I-EVOLUTION esa I-EVOLUTION temporada, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION detectaron I-EVOLUTION otras I-EVOLUTION mutaciones I-EVOLUTION previamente I-EVOLUTION reportadas I-EVOLUTION como I-EVOLUTION A90S I-EVOLUTION ni I-EVOLUTION K180Q. I-EVOLUTION I-EVOLUTION Preescolar B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY esquema I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inmunizaciones I-PAST_MEDICAL_HISTORY completas I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY Tres B-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS respiratorio I-PRESENT_ILLNESS alto I-PRESENT_ILLNESS se I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Guillain I-PRESENT_ILLNESS Barré, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS terapia I-PRESENT_ILLNESS intensiva I-PRESENT_ILLNESS pediátrica. I-PRESENT_ILLNESS Recibió B-TREATMENT tratamientos I-TREATMENT antibacterianos I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro I-TREATMENT (piperacilina/tazobactam I-TREATMENT por I-TREATMENT ocho I-TREATMENT días I-TREATMENT por I-TREATMENT una I-TREATMENT neumonía I-TREATMENT asociada I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica, I-TREATMENT sin I-TREATMENT aislamiento I-TREATMENT microbiológico, I-TREATMENT y I-TREATMENT luego I-TREATMENT meropenem I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días I-TREATMENT por I-TREATMENT una I-TREATMENT bacteriemia I-TREATMENT asociada I-TREATMENT a I-TREATMENT un I-TREATMENT catéter I-TREATMENT venoso I-TREATMENT central I-TREATMENT (CVC) I-TREATMENT por I-TREATMENT Klebsiella I-TREATMENT pneumoniae. I-TREATMENT Durante I-TREATMENT su I-TREATMENT estancia I-TREATMENT en I-TREATMENT terapia I-TREATMENT intensiva I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT cateterización I-TREATMENT urinaria I-TREATMENT permanente I-TREATMENT y I-TREATMENT a I-TREATMENT una I-TREATMENT traqueostomía. I-TREATMENT I-TREATMENT Al B-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION meropenem, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION persistió I-EVOLUTION febril, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION sospechó I-EVOLUTION una I-EVOLUTION infección I-EVOLUTION fúngica. I-EVOLUTION En B-EXPLORATION orina I-EXPLORATION y I-EXPLORATION sangre I-EXPLORATION hubo I-EXPLORATION aislamiento I-EXPLORATION de I-EXPLORATION C. I-EXPLORATION tropicalis. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION de I-EXPLORATION la I-EXPLORATION orina I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION levaduras I-EXPLORATION y I-EXPLORATION el I-EXPLORATION urocultivo I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION con I-EXPLORATION 30.000 I-EXPLORATION ufc I-EXPLORATION de I-EXPLORATION C. I-EXPLORATION tropicalis I-EXPLORATION con I-EXPLORATION una I-EXPLORATION CIM I-EXPLORATION ≤ I-EXPLORATION 0, I-EXPLORATION 25 I-EXPLORATION μg/mL I-EXPLORATION para I-EXPLORATION anfotericina I-EXPLORATION B I-EXPLORATION y I-EXPLORATION caspofungina, I-EXPLORATION y I-EXPLORATION ≤ I-EXPLORATION 1 I-EXPLORATION μg/mL I-EXPLORATION para I-EXPLORATION fluconazol. I-EXPLORATION La I-EXPLORATION cepa I-EXPLORATION se I-EXPLORATION identificó I-EXPLORATION por I-EXPLORATION CHROMagar; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION asimilación I-EXPLORATION de I-EXPLORATION azúcares. I-EXPLORATION Se I-EXPLORATION confirmó I-EXPLORATION C. I-EXPLORATION tropicalis I-EXPLORATION por I-EXPLORATION Vitek I-EXPLORATION 2 I-EXPLORATION ® I-EXPLORATION 2 I-EXPLORATION compact I-EXPLORATION 60 I-EXPLORATION (Biomérieux) I-EXPLORATION y I-EXPLORATION los I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION para I-EXPLORATION CIM I-EXPLORATION se I-EXPLORATION obtuvieron I-EXPLORATION por I-EXPLORATION microdilución I-EXPLORATION en I-EXPLORATION caldo I-EXPLORATION según I-EXPLORATION CLSI. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT deoxicolato I-TREATMENT 1 I-TREATMENT mg/kg/día. I-TREATMENT La B-EVOLUTION fiebre I-EVOLUTION bajó I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION y B-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION se I-EXPLORATION negativizaron I-EXPLORATION al I-EXPLORATION cuarto I-EXPLORATION día I-EXPLORATION de I-EXPLORATION terapia. I-EXPLORATION Anfotericina B-EVOLUTION B I-EVOLUTION deoxicolato I-EVOLUTION fue I-EVOLUTION bien I-EVOLUTION tolerada, I-EVOLUTION manteniéndose I-EVOLUTION una I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Al B-EXPLORATION séptimo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecotomografía I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION vías I-EXPLORATION urinarias, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION ambos I-EXPLORATION riñones I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION inflamatorios I-EXPLORATION agudos: I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION medía I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 1 I-EXPLORATION cm, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION 8, I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 4, I-EXPLORATION 6 I-EXPLORATION cm. I-EXPLORATION La I-EXPLORATION vejiga I-EXPLORATION urinaria I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION engrosada I-EXPLORATION (4 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION espesor) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION se I-EXPLORATION identificó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION única I-EXPLORATION hiperecogénica I-EXPLORATION que I-EXPLORATION no I-EXPLORATION proyectaba I-EXPLORATION sombra I-EXPLORATION sónica I-EXPLORATION posterior, I-EXPLORATION y I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION vascularidad I-EXPLORATION central I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION fungoma, I-EXPLORATION imagen I-EXPLORATION que I-EXPLORATION persistía I-EXPLORATION al I-EXPLORATION día I-EXPLORATION 14 I-EXPLORATION de I-EXPLORATION tratamiento. I-EXPLORATION Habiendo B-TREATMENT completado I-TREATMENT 40 I-TREATMENT mg/kg I-TREATMENT de I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT deoxicolato, I-TREATMENT y I-TREATMENT por I-TREATMENT persistencia I-TREATMENT del I-TREATMENT fungoma I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT resección I-TREATMENT de I-TREATMENT éste I-TREATMENT por I-TREATMENT cistoscopia. I-TREATMENT Macroscópicamente B-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION tenía I-EXPLORATION un I-EXPLORATION color I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION blanda. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico, I-EXPLORATION con I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION hematoxilina-eosina, I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION mucosa I-EXPLORATION vesical I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION estromal, I-EXPLORATION erosiones I-EXPLORATION del I-EXPLORATION epitelio I-EXPLORATION transicional I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION y I-EXPLORATION macrófagos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION una I-EXPLORATION cistitis I-EXPLORATION crónica. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION tinciones I-EXPLORATION especiales I-EXPLORATION para I-EXPLORATION hongos. I-EXPLORATION El I-EXPLORATION urocultivo I-EXPLORATION se I-EXPLORATION negativizó I-EXPLORATION posterior I-EXPLORATION a I-EXPLORATION la I-EXPLORATION resección I-EXPLORATION del I-EXPLORATION fungoma, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION suspendió I-EXPLORATION el I-EXPLORATION antifúngico I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION h I-EXPLORATION después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía, I-EXPLORATION con I-EXPLORATION ecografía I-EXPLORATION post-quirúrgica I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION fungoma. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION terapia I-EVOLUTION intensiva I-EVOLUTION durante I-EVOLUTION 16 I-EVOLUTION días I-EVOLUTION y B-DERIVED_FROM/TO después I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO neurología I-DERIVED_FROM/TO pediátrica I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO permaneció I-DERIVED_FROM/TO tres I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO internado. I-DERIVED_FROM/TO Egresó B-EVOLUTION sin I-EVOLUTION traqueostomía I-EVOLUTION y I-EVOLUTION sigue I-EVOLUTION sus I-EVOLUTION controles I-EVOLUTION ambulatorios. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY área I-PAST_MEDICAL_HISTORY urbana I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Santiago I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Estero. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY epidemiológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS hemiparesia I-PRESENT_ILLNESS facio-braquio-crural I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS quística I-PRESENT_ILLNESS infratemporal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS TC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cerebro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS tuvo I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS hepático I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS pulmonar. I-PRESENT_ILLNESS La B-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION HAI I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION hidatidosis I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía. I-EXPLORATION No I-EXPLORATION tuvo I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION la I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION al I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION diagnóstico. I-EXPLORATION Inició B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT albendazol I-TREATMENT 30 I-TREATMENT días I-TREATMENT previos I-TREATMENT a I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION con I-EXPLORATION escólices I-EXPLORATION de I-EXPLORATION E. I-EXPLORATION granulosus I-EXPLORATION en I-EXPLORATION estadio I-EXPLORATION de I-EXPLORATION degeneración. I-EXPLORATION Presentó B-EVOLUTION como I-EVOLUTION complicación I-EVOLUTION una I-EVOLUTION hidrocefalia I-EVOLUTION transitoria I-EVOLUTION que B-TREATMENT no I-TREATMENT requirió I-TREATMENT tratamiento. I-TREATMENT Completó I-TREATMENT seis I-TREATMENT semanas I-TREATMENT post-quirúrgicas I-TREATMENT de I-TREATMENT albendazol I-TREATMENT con B-EVOLUTION resolución I-EVOLUTION ad I-EVOLUTION integrum I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION secuelas. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Río I-PAST_MEDICAL_HISTORY Negro. I-PAST_MEDICAL_HISTORY Vivía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY crianza I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ganado I-PAST_MEDICAL_HISTORY bovino, I-PAST_MEDICAL_HISTORY ovino I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vacuno I-PAST_MEDICAL_HISTORY cercano I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY domicilio. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS convulsiones I-PRESENT_ILLNESS tónico-clónicas I-PRESENT_ILLNESS generalizadas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hemiparesia I-PRESENT_ILLNESS braquio-crural I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aparición. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION supratentorial I-EXPLORATION expansivo I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION subcortical I-EXPLORATION temporo-parietal I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION colapsaba I-EXPLORATION ventrículos I-EXPLORATION y I-EXPLORATION desplazaba I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media. I-EXPLORATION Imágenes I-EXPLORATION complementarias I-EXPLORATION descartaron I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION órganos. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION hidatidosis I-EXPLORATION por I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION HAI I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION No I-EXPLORATION tuvo I-EXPLORATION eosinofilia I-EXPLORATION ni I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION general. I-EXPLORATION Inició B-TREATMENT tratamiento I-TREATMENT previo I-TREATMENT a I-TREATMENT la I-TREATMENT cirugía I-TREATMENT con I-TREATMENT albendazol I-TREATMENT por I-TREATMENT sospecha I-TREATMENT clínica I-TREATMENT e I-TREATMENT imagenológica I-TREATMENT de I-TREATMENT hidatidosis. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT exéresis I-TREATMENT total I-TREATMENT del I-TREATMENT quiste. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION con I-EXPLORATION pared I-EXPLORATION membranosa I-EXPLORATION acelular, I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION ácido I-EXPLORATION peryódico I-EXPLORATION de I-EXPLORATION Schiff I-EXPLORATION (PAS) I-EXPLORATION positiva, I-EXPLORATION en I-EXPLORATION una I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION caras, I-EXPLORATION con I-EXPLORATION calcoforitos I-EXPLORATION y I-EXPLORATION restos I-EXPLORATION celulares. I-EXPLORATION Además, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION escólices I-EXPLORATION con I-EXPLORATION variables I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION y I-EXPLORATION degeneración. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION como I-EVOLUTION secuela I-EVOLUTION una I-EVOLUTION hemiparesia I-EVOLUTION facio-braquio-crural I-EVOLUTION derecha I-EVOLUTION que I-EVOLUTION le I-EVOLUTION dificultaba I-EVOLUTION la I-EVOLUTION deambulación. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS proveniente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Buenos I-PAST_MEDICAL_HISTORY Aires, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cría I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY animales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY granja I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY faenamiento. I-PAST_MEDICAL_HISTORY Fue B-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tumor I-DERIVED_FROM/TO quístico I-DERIVED_FROM/TO supratentorial. I-DERIVED_FROM/TO Tenía B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vómitos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cefalea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION que I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION con I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION supratentorial I-EXPLORATION periventricular I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION por I-EXPLORATION HAI I-EXPLORATION para I-EXPLORATION hidatidosis I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION alteración I-EXPLORATION significativa. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT pre I-TREATMENT y I-TREATMENT postquirúrgico I-TREATMENT con I-TREATMENT albendazol. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT del I-TREATMENT quiste I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION describió I-EXPLORATION una I-EXPLORATION estructura I-EXPLORATION quística I-EXPLORATION con I-EXPLORATION una I-EXPLORATION pared I-EXPLORATION con I-EXPLORATION capa I-EXPLORATION celular I-EXPLORATION eosinófila I-EXPLORATION (cutícula), I-EXPLORATION germinativa I-EXPLORATION y I-EXPLORATION abundantes I-EXPLORATION escólices. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS dueña B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY casa, I-PAST_MEDICAL_HISTORY profesional, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ánimo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY contexto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY separación I-PAST_MEDICAL_HISTORY conyugal. I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY señalaba I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY gustaba I-PAST_MEDICAL_HISTORY realizar I-PAST_MEDICAL_HISTORY actividades I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY jardinería I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY domicilio. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refirió I-PRESENT_ILLNESS expulsar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS "lombriz" I-PRESENT_ILLNESS en I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS deposiciones. I-PRESENT_ILLNESS Fue B-TREATMENT evaluada I-TREATMENT por I-TREATMENT un I-TREATMENT médico I-TREATMENT internista I-TREATMENT quien I-TREATMENT la I-TREATMENT trató I-TREATMENT en I-TREATMENT forma I-TREATMENT empírica I-TREATMENT con I-TREATMENT albendazol I-TREATMENT 400 I-TREATMENT mg I-TREATMENT por I-TREATMENT día, I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días. I-TREATMENT I-TREATMENT El I-TREATMENT EPSD I-TREATMENT y I-TREATMENT test I-TREATMENT de I-TREATMENT Graham I-TREATMENT fueron I-TREATMENT negativos. I-TREATMENT El B-EXPLORATION examen I-EXPLORATION macroscópico I-EXPLORATION del I-EXPLORATION verme I-EXPLORATION llevado I-EXPLORATION a I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION por I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION correspondió I-EXPLORATION a I-EXPLORATION una I-EXPLORATION lombriz I-EXPLORATION de I-EXPLORATION tierra I-EXPLORATION o I-EXPLORATION Lombricus I-EXPLORATION terrarius. I-EXPLORATION Un B-EVOLUTION mes I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION consultar I-EVOLUTION por I-EVOLUTION haber I-EVOLUTION eliminado I-EVOLUTION por I-EVOLUTION las I-EVOLUTION deposiciones I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION "lombriz". I-EVOLUTION Fue B-TREATMENT tratada I-TREATMENT con I-TREATMENT albendazol I-TREATMENT por I-TREATMENT 15 I-TREATMENT días, I-TREATMENT con I-TREATMENT un I-TREATMENT nuevo I-TREATMENT estudio I-TREATMENT parasitológico I-TREATMENT sin I-TREATMENT hallazgos. I-TREATMENT El B-EXPLORATION verme I-EXPLORATION fue I-EXPLORATION analizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION Pública I-EXPLORATION y I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION inicial. I-EXPLORATION I-EXPLORATION Dos B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refirió I-EVOLUTION que I-EVOLUTION al I-EVOLUTION ducharse I-EVOLUTION notó I-EVOLUTION la I-EVOLUTION expulsión I-EVOLUTION de I-EVOLUTION una I-EVOLUTION lombriz I-EVOLUTION por I-EVOLUTION el I-EVOLUTION ano, I-EVOLUTION que I-EVOLUTION resultó I-EVOLUTION ser I-EVOLUTION similar I-EVOLUTION a I-EVOLUTION las I-EVOLUTION anteriores. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION parasitología I-EXPLORATION del I-EXPLORATION espécimen I-EXPLORATION informó I-EXPLORATION nuevamente I-EXPLORATION una I-EXPLORATION lombriz I-EXPLORATION de I-EXPLORATION tierra. I-EXPLORATION La B-EVOLUTION paciente, I-EVOLUTION muy I-EVOLUTION molesta, I-EVOLUTION reclamó I-EVOLUTION que I-EVOLUTION nadie I-EVOLUTION encontraba I-EVOLUTION una I-EVOLUTION solución I-EVOLUTION a I-EVOLUTION su I-EVOLUTION mal I-EVOLUTION en I-EVOLUTION Chile, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION consultaría I-EVOLUTION en I-EVOLUTION otro I-EVOLUTION país. I-EVOLUTION Se I-EVOLUTION le I-EVOLUTION recomendó I-EVOLUTION la I-EVOLUTION evaluación I-EVOLUTION por I-EVOLUTION psiquiatría, I-EVOLUTION sin I-EVOLUTION embargo, I-EVOLUTION se I-EVOLUTION negó I-EVOLUTION a I-EVOLUTION considerar I-EVOLUTION esta I-EVOLUTION alternativa. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS residente B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Santiago, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY leucemia I-PAST_MEDICAL_HISTORY mieloide I-PAST_MEDICAL_HISTORY aguda I-PAST_MEDICAL_HISTORY (LMA) I-PAST_MEDICAL_HISTORY M4, I-PAST_MEDICAL_HISTORY sometido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY precursores I-PAST_MEDICAL_HISTORY hematopoyéticos I-PAST_MEDICAL_HISTORY (TPH) I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY rinitis I-PAST_MEDICAL_HISTORY alérgica. I-PAST_MEDICAL_HISTORY Evolucionó B-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS recaída I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS leucemia I-PRESENT_ILLNESS tras B-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT administró I-TREATMENT un I-TREATMENT ciclo I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT en I-TREATMENT preparación I-TREATMENT a I-TREATMENT un I-TREATMENT nuevo I-TREATMENT TPH. I-TREATMENT Ocho B-EVOLUTION días I-EVOLUTION después I-EVOLUTION se I-EVOLUTION hospitalizó I-EVOLUTION por I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION neutropenia I-EVOLUTION febril, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT vancomicina, I-TREATMENT ceftazidima I-TREATMENT y I-TREATMENT amikacina. I-TREATMENT Refirió B-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION fosa I-EVOLUTION nasal I-EVOLUTION derecha I-EVOLUTION e I-EVOLUTION incisivo I-EVOLUTION superior, I-EVOLUTION constatándose I-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso, I-EVOLUTION una I-EVOLUTION erosión I-EVOLUTION leve I-EVOLUTION en I-EVOLUTION la I-EVOLUTION fosa I-EVOLUTION nasal I-EVOLUTION derecha I-EVOLUTION (FND) I-EVOLUTION con I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION reciente I-EVOLUTION y I-EVOLUTION una I-EVOLUTION costra I-EVOLUTION dolorosa I-EVOLUTION en I-EVOLUTION la I-EVOLUTION porción I-EVOLUTION antero-inferior I-EVOLUTION del I-EVOLUTION tabique I-EVOLUTION nasal I-EVOLUTION izquierdo I-EVOLUTION (FNI). I-EVOLUTION Esta B-EXPLORATION última I-EXPLORATION se I-EXPLORATION removió I-EXPLORATION y I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION a I-EXPLORATION cultivo I-EXPLORATION bacteriano I-EXPLORATION y I-EXPLORATION de I-EXPLORATION hongos. I-EXPLORATION Bajo I-EXPLORATION la I-EXPLORATION costra I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION del I-EXPLORATION cartílago I-EXPLORATION septal I-EXPLORATION más I-EXPLORATION adherida I-EXPLORATION y I-EXPLORATION negruzca, I-EXPLORATION cuya I-EXPLORATION superficie I-EXPLORATION se I-EXPLORATION removió I-EXPLORATION sin I-EXPLORATION presentar I-EXPLORATION sangrado. I-EXPLORATION Se I-EXPLORATION envió I-EXPLORATION a I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION calcoflúor, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION evidenció I-EXPLORATION hifas I-EXPLORATION septadas I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT voriconazol I-TREATMENT iv I-TREATMENT 9 I-TREATMENT mg/kg/dosis, I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT La B-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION cavidades I-EXPLORATION paranasales I-EXPLORATION evidenció I-EXPLORATION cambios I-EXPLORATION inflamatorios I-EXPLORATION pansinusales I-EXPLORATION sin I-EXPLORATION extensión I-EXPLORATION extrasinusal. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT precozmente I-TREATMENT una I-TREATMENT cirugía I-TREATMENT endoscópica I-TREATMENT nasal, I-TREATMENT consistente I-TREATMENT en I-TREATMENT una I-TREATMENT esfenoidotomía I-TREATMENT derecha, I-TREATMENT con I-TREATMENT resección I-TREATMENT de I-TREATMENT tabique I-TREATMENT nasal I-TREATMENT necrótico I-TREATMENT y I-TREATMENT del I-TREATMENT cartílago I-TREATMENT septal I-TREATMENT izquierdo. I-TREATMENT Se B-EXPLORATION enviaron I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION cornete I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION esfenoides I-EXPLORATION derecho, I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION tabique I-EXPLORATION nasal I-EXPLORATION y I-EXPLORATION cartílago I-EXPLORATION septal I-EXPLORATION izquierdo I-EXPLORATION a I-EXPLORATION biopsia. I-EXPLORATION Las I-EXPLORATION dos I-EXPLORATION primeras I-EXPLORATION se I-EXPLORATION enviaron I-EXPLORATION además I-EXPLORATION a I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION calcoflúor I-EXPLORATION resultando I-EXPLORATION negativas I-EXPLORATION y I-EXPLORATION a I-EXPLORATION cultivo I-EXPLORATION bacteriano. I-EXPLORATION Las I-EXPLORATION muestras I-EXPLORATION fueron I-EXPLORATION sembradas I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION Sabouraud I-EXPLORATION dextrosa I-EXPLORATION a I-EXPLORATION temperatura I-EXPLORATION ambiente I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 35 I-EXPLORATION °C. I-EXPLORATION I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION quirúrgica I-EXPLORATION de I-EXPLORATION tabique I-EXPLORATION nasal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION de I-EXPLORATION cartílago I-EXPLORATION septal I-EXPLORATION mostraron I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION h I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION colonias I-EXPLORATION de I-EXPLORATION 4-6 I-EXPLORATION mm, I-EXPLORATION algodonosas, I-EXPLORATION laxas I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION polvo I-EXPLORATION de I-EXPLORATION hollín, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blanco I-EXPLORATION grisáceo, I-EXPLORATION y I-EXPLORATION color I-EXPLORATION oliváceo I-EXPLORATION por I-EXPLORATION el I-EXPLORATION reverso. I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION del I-EXPLORATION esfenoides I-EXPLORATION derecho I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION microscopia I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION hifas I-EXPLORATION dematiáceas, I-EXPLORATION con I-EXPLORATION conidióforos I-EXPLORATION color I-EXPLORATION café I-EXPLORATION claro, I-EXPLORATION septados, I-EXPLORATION solitarios I-EXPLORATION y I-EXPLORATION geniculados, I-EXPLORATION zigzageantes I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION apical, I-EXPLORATION desde I-EXPLORATION donde I-EXPLORATION brotaban I-EXPLORATION conidios I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION simpodial. I-EXPLORATION Éstos I-EXPLORATION eran I-EXPLORATION color I-EXPLORATION marrón, I-EXPLORATION cilíndricos, I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION pigmentadas I-EXPLORATION gruesas, I-EXPLORATION con I-EXPLORATION tres I-EXPLORATION distoseptos I-EXPLORATION y I-EXPLORATION cuatro I-EXPLORATION células, I-EXPLORATION con I-EXPLORATION cicatrices I-EXPLORATION de I-EXPLORATION color I-EXPLORATION marrón I-EXPLORATION oscuro I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lugar I-EXPLORATION de I-EXPLORATION unión I-EXPLORATION a I-EXPLORATION la I-EXPLORATION hifa I-EXPLORATION conidiogénica. I-EXPLORATION Basados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION macroscopia I-EXPLORATION y I-EXPLORATION microscopia I-EXPLORATION se I-EXPLORATION identificó I-EXPLORATION el I-EXPLORATION agente I-EXPLORATION como I-EXPLORATION una I-EXPLORATION Curvularia I-EXPLORATION spicifera. I-EXPLORATION Para I-EXPLORATION confirmación I-EXPLORATION de I-EXPLORATION género, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (RPC) I-EXPLORATION universal I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION secuenciación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION génicos I-EXPLORATION ITS1, I-EXPLORATION ITS4 I-EXPLORATION y I-EXPLORATION 5, I-EXPLORATION 6S I-EXPLORATION ARNr, I-EXPLORATION a I-EXPLORATION las I-EXPLORATION colonias I-EXPLORATION desarrolladas, I-EXPLORATION identificándose I-EXPLORATION Curvularia I-EXPLORATION spp. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION del I-EXPLORATION tabique I-EXPLORATION nasal I-EXPLORATION y I-EXPLORATION del I-EXPLORATION cartílago I-EXPLORATION septal I-EXPLORATION izquierdo I-EXPLORATION mostró I-EXPLORATION extensas I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION destrucción, I-EXPLORATION necrosis, I-EXPLORATION ulceración I-EXPLORATION y I-EXPLORATION hemorragia I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION abundantes I-EXPLORATION elementos I-EXPLORATION micóticos I-EXPLORATION filamentosos I-EXPLORATION histo I-EXPLORATION y I-EXPLORATION angioinvasores. I-EXPLORATION Los I-EXPLORATION elementos I-EXPLORATION micóticos I-EXPLORATION correspondían I-EXPLORATION a I-EXPLORATION filamentos I-EXPLORATION hialinos I-EXPLORATION tabicados I-EXPLORATION con I-EXPLORATION algunas I-EXPLORATION dilataciones I-EXPLORATION globosas I-EXPLORATION y I-EXPLORATION crecimiento I-EXPLORATION variable I-EXPLORATION de I-EXPLORATION 45° I-EXPLORATION a I-EXPLORATION 90°, I-EXPLORATION con I-EXPLORATION caracteres I-EXPLORATION de I-EXPLORATION hialohifomicetes. I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION ósteo-condro-mucosa I-EXPLORATION de I-EXPLORATION comete I-EXPLORATION y I-EXPLORATION esfenoides I-EXPLORATION derecho I-EXPLORATION sólo I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION inflamación I-EXPLORATION crónica I-EXPLORATION activa I-EXPLORATION inespecífica. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION sensibilidad I-EXPLORATION antifúngica I-EXPLORATION las I-EXPLORATION colonias I-EXPLORATION obtenidas I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION Sabouraud I-EXPLORATION fueron I-EXPLORATION sembradas I-EXPLORATION en I-EXPLORATION agar I-EXPLORATION agua I-EXPLORATION para I-EXPLORATION aumentar I-EXPLORATION la I-EXPLORATION producción I-EXPLORATION de I-EXPLORATION conidias. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION micro I-EXPLORATION dilución I-EXPLORATION según I-EXPLORATION la I-EXPLORATION norma I-EXPLORATION CLSI, I-EXPLORATION documento I-EXPLORATION M38-A2, I-EXPLORATION resultando I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION antifúngicos I-EXPLORATION estudiados, I-EXPLORATION con I-EXPLORATION CIM I-EXPLORATION a I-EXPLORATION anfotericina I-EXPLORATION B I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION μg/ml, I-EXPLORATION posaconazol I-EXPLORATION 0, I-EXPLORATION 25 I-EXPLORATION μg/ml I-EXPLORATION y I-EXPLORATION voriconazol I-EXPLORATION 0, I-EXPLORATION 25 I-EXPLORATION μg/ml. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT la I-TREATMENT identificación I-TREATMENT etiológica, I-TREATMENT se I-TREATMENT ajustó I-TREATMENT el I-TREATMENT esquema I-TREATMENT antifúngico I-TREATMENT asociando I-TREATMENT anfotericina I-TREATMENT liposomal I-TREATMENT 5 I-TREATMENT mg/kg/día I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT nuevo I-TREATMENT aseo I-TREATMENT quirúrgico I-TREATMENT dos I-TREATMENT días I-TREATMENT después, I-TREATMENT observándose I-TREATMENT la I-TREATMENT mucosa I-TREATMENT nasal I-TREATMENT sin I-TREATMENT necrosis, I-TREATMENT con I-TREATMENT tinción I-TREATMENT de I-TREATMENT calcoflúor I-TREATMENT y I-TREATMENT cultivo I-TREATMENT negativos. I-TREATMENT Las B-EVOLUTION detecciones I-EVOLUTION de I-EVOLUTION galactomanano I-EVOLUTION en I-EVOLUTION sangre I-EVOLUTION se I-EVOLUTION mantuvieron I-EVOLUTION negativas I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION evolución. I-EVOLUTION Recibió B-TREATMENT voriconazol I-TREATMENT por I-TREATMENT 40 I-TREATMENT días, I-TREATMENT con I-TREATMENT concentraciones I-TREATMENT plasmáticas I-TREATMENT variables I-TREATMENT entre I-TREATMENT 0, I-TREATMENT 2-1, I-TREATMENT 6 I-TREATMENT mg/L I-TREATMENT (rango I-TREATMENT terapéutico I-TREATMENT 1-5 I-TREATMENT mg/L) I-TREATMENT y I-TREATMENT anfotericina I-TREATMENT liposomal I-TREATMENT por I-TREATMENT 25 I-TREATMENT días I-TREATMENT (dosis I-TREATMENT acumulada I-TREATMENT 125 I-TREATMENT mg/kg). I-TREATMENT Evolucionó B-EVOLUTION en I-EVOLUTION forma I-EVOLUTION satisfactoria I-EVOLUTION del I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION otorrinológico. I-EVOLUTION Recibió B-TREATMENT un I-TREATMENT segundo I-TREATMENT TPH, I-TREATMENT sin B-EVOLUTION presentar I-EVOLUTION lesiones I-EVOLUTION cutáneas I-EVOLUTION ni I-EVOLUTION síntomas I-EVOLUTION nasales I-EVOLUTION en I-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION meses. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION no I-EVOLUTION logró I-EVOLUTION reconstitución I-EVOLUTION inmune, I-EVOLUTION falleciendo I-EVOLUTION por I-EVOLUTION otras I-EVOLUTION complicaciones I-EVOLUTION infecciosas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO por I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO en I-DERIVED_FROM/TO hipocondrio I-DERIVED_FROM/TO izquierdo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO seis I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO y I-DERIVED_FROM/TO crecimiento I-DERIVED_FROM/TO progresivo. I-DERIVED_FROM/TO A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION pétrea, I-EXPLORATION discretamente I-EXPLORATION dolorosa. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION no I-EXPLORATION aportaba I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION retroperitoneal I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 20 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION desplazaba I-EXPLORATION hacia I-EXPLORATION delante I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION del I-EXPLORATION páncreas. I-EXPLORATION Radiológicamente I-EXPLORATION su I-EXPLORATION estructura I-EXPLORATION era I-EXPLORATION compleja, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION y I-EXPLORATION de I-EXPLORATION calcificación, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION malignidad. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT esplenopancreatectomía I-TREATMENT distal I-TREATMENT con I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración, I-TREATMENT que I-TREATMENT presentaba I-TREATMENT un I-TREATMENT diámetro I-TREATMENT máximo I-TREATMENT de I-TREATMENT 24 I-TREATMENT cm, I-TREATMENT y I-TREATMENT estaba I-TREATMENT adherida I-TREATMENT al I-TREATMENT hilio I-TREATMENT esplénico, I-TREATMENT bazo, I-TREATMENT epiplon I-TREATMENT mayor I-TREATMENT y I-TREATMENT gastrocólico, I-TREATMENT sin I-TREATMENT aparente I-TREATMENT fijación I-TREATMENT al I-TREATMENT páncreas. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION se I-EXPLORATION describió I-EXPLORATION como I-EXPLORATION neoplasia I-EXPLORATION epitelial I-EXPLORATION papilar I-EXPLORATION sólida-quística I-EXPLORATION del I-EXPLORATION páncreas. I-EXPLORATION Inmunohistoquímica: I-EXPLORATION vimentina I-EXPLORATION positivo; I-EXPLORATION cromogranina I-EXPLORATION y I-EXPLORATION marcadores I-EXPLORATION epiteliales I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION controles I-EVOLUTION normales I-EVOLUTION a I-EVOLUTION los I-EVOLUTION cuatro I-EVOLUTION años I-EVOLUTION de I-EVOLUTION su I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS reflujo I-PRESENT_ILLNESS gastroesofágico I-PRESENT_ILLNESS severo I-PRESENT_ILLNESS resistente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS altas I-PRESENT_ILLNESS dosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS omeprazol I-PRESENT_ILLNESS (60 I-PRESENT_ILLNESS mg/día) I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY habitual I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cocaína I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY grandes I-PAST_MEDICAL_HISTORY cantidades I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY fines I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY semana. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION de I-EXPLORATION tracto I-EXPLORATION digestivo I-EXPLORATION superior I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION esofagitis I-EXPLORATION grave I-EXPLORATION e I-EXPLORATION imágenes I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION un I-EXPLORATION esófago I-EXPLORATION de I-EXPLORATION Barret. I-EXPLORATION La I-EXPLORATION pHmetría I-EXPLORATION esofágica I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION intenso I-EXPLORATION RGE I-EXPLORATION con I-EXPLORATION una I-EXPLORATION puntuación I-EXPLORATION de I-EXPLORATION DeMeester I-EXPLORATION de I-EXPLORATION 193 I-EXPLORATION (rango I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 14, I-EXPLORATION 72) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION manometría I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION esfínter I-EXPLORATION esofágico I-EXPLORATION inferior I-EXPLORATION hipotónico I-EXPLORATION con I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION mmHg I-EXPLORATION (rango I-EXPLORATION normal I-EXPLORATION 8-25 I-EXPLORATION mmHg). I-EXPLORATION I-EXPLORATION Con B-TREATMENT estas I-TREATMENT pruebas I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT propuesto I-TREATMENT para I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT funduplicatura I-TREATMENT de I-TREATMENT Nissen I-TREATMENT laparoscópica. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT profilaxis I-TREATMENT del I-TREATMENT tromboembolismo I-TREATMENT con I-TREATMENT 2.500 I-TREATMENT U.I. I-TREATMENT de I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT (Clexane®, I-TREATMENT Aventis I-TREATMENT Pharma, I-TREATMENT España) I-TREATMENT una I-TREATMENT dosis I-TREATMENT 2 I-TREATMENT horas I-TREATMENT antes I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT y I-TREATMENT una I-TREATMENT dosis I-TREATMENT diaria I-TREATMENT en I-TREATMENT los I-TREATMENT tres I-TREATMENT primeros I-TREATMENT días I-TREATMENT postoperatorios. I-TREATMENT El I-TREATMENT neumoperitoneo I-TREATMENT se I-TREATMENT realizó I-TREATMENT con I-TREATMENT CO2 I-TREATMENT a I-TREATMENT una I-TREATMENT presión I-TREATMENT máxima I-TREATMENT controlada I-TREATMENT de I-TREATMENT 14 I-TREATMENT mmHg. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT funduplicatura I-TREATMENT de I-TREATMENT Nissen I-TREATMENT con I-TREATMENT material I-TREATMENT irreabsorbible, I-TREATMENT suturándose I-TREATMENT los I-TREATMENT pilares I-TREATMENT diafragmáticos. I-TREATMENT No I-TREATMENT hubo I-TREATMENT incidencias I-TREATMENT durante I-TREATMENT la I-TREATMENT intervención I-TREATMENT que I-TREATMENT duró I-TREATMENT 105 I-TREATMENT minutos. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION transcurrió I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION durante I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 72 I-EVOLUTION horas, I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION En I-EVOLUTION el I-EVOLUTION séptimo I-EVOLUTION día I-EVOLUTION postoperatorio, I-EVOLUTION tras I-EVOLUTION una I-EVOLUTION ingesta I-EVOLUTION copiosa I-EVOLUTION de I-EVOLUTION alcohol, I-EVOLUTION bebidas I-EVOLUTION gaseosas I-EVOLUTION y I-EVOLUTION alimentos, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION desarrolló I-EVOLUTION repentinamente I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION de I-EVOLUTION espalda I-EVOLUTION brusco I-EVOLUTION e I-EVOLUTION intenso, I-EVOLUTION hipertermia, I-EVOLUTION distensión I-EVOLUTION abdominal I-EVOLUTION e I-EVOLUTION inestabilidad I-EVOLUTION hemodinámica. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION presentaba I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION 12% I-EXPLORATION de I-EXPLORATION cayados, I-EXPLORATION acidosis I-EXPLORATION metabólica I-EXPLORATION (pH: I-EXPLORATION 7, I-EXPLORATION 27) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION del I-EXPLORATION 52%. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION dilatadas, I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION intraabdominal, I-EXPLORATION hígado I-EXPLORATION de I-EXPLORATION estasis I-EXPLORATION y I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION mesentérica I-EXPLORATION y I-EXPLORATION portal. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT abdomen I-TREATMENT agudo I-TREATMENT se I-TREATMENT intervino I-TREATMENT quirúrgicamente I-TREATMENT hallándose I-TREATMENT isquemia I-TREATMENT intestinal I-TREATMENT masiva I-TREATMENT de I-TREATMENT todo I-TREATMENT el I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT y I-TREATMENT parte I-TREATMENT de I-TREATMENT colon, I-TREATMENT trombosis I-TREATMENT portal, I-TREATMENT hígado I-TREATMENT de I-TREATMENT estasis I-TREATMENT y I-TREATMENT una I-TREATMENT arteria I-TREATMENT mesentérica I-TREATMENT superior I-TREATMENT espástica I-TREATMENT de I-TREATMENT la I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT extrajo I-TREATMENT ningún I-TREATMENT trombo I-TREATMENT en I-TREATMENT la I-TREATMENT exploración I-TREATMENT mediante I-TREATMENT sonda I-TREATMENT de I-TREATMENT Fogarty. I-TREATMENT La B-EXPLORATION ecografía I-EXPLORATION Doppler I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION trombosis I-EXPLORATION completa I-EXPLORATION y I-EXPLORATION neumatosis I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION principal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION porta, I-EXPLORATION y I-EXPLORATION gas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION intestinal. I-EXPLORATION Las I-EXPLORATION arterias I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION mesentérica I-EXPLORATION eran I-EXPLORATION permeables. I-EXPLORATION No B-TREATMENT se I-TREATMENT consideró I-TREATMENT indicada I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT ningún I-TREATMENT gesto I-TREATMENT quirúrgico I-TREATMENT añadido. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION hipercoagulabilidad I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION posible I-EXPLORATION obtener I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION fiable I-EXPLORATION para I-EXPLORATION detectar I-EXPLORATION cocaína. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION rápidamente I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION desfavorable, I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION terapia I-EVOLUTION anticoagulante I-EVOLUTION con I-EVOLUTION heparina, I-EVOLUTION con I-EVOLUTION inestabilidad I-EVOLUTION hemodinámica I-EVOLUTION y I-EVOLUTION acidosis I-EVOLUTION irreversible I-EVOLUTION falleciendo I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica. I-EVOLUTION La B-EXPLORATION necropsia I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION masiva I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION mesentérica I-EXPLORATION inferior I-EXPLORATION y I-EXPLORATION vena I-EXPLORATION porta I-EXPLORATION con I-EXPLORATION infarto I-EXPLORATION hemorrágico I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION y I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION úlceras I-EXPLORATION agudas I-EXPLORATION mucosas I-EXPLORATION y I-EXPLORATION contenido I-EXPLORATION hemático I-EXPLORATION en I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION intestinal. I-EXPLORATION Infarto I-EXPLORATION hemorrágico I-EXPLORATION submasivo I-EXPLORATION hepático, I-EXPLORATION hipertrofia I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION microcalcificaciones I-EXPLORATION focales I-EXPLORATION en I-EXPLORATION parénquima I-EXPLORATION pulmonar I-EXPLORATION (típico I-EXPLORATION hallazgo I-EXPLORATION en I-EXPLORATION consumidores I-EXPLORATION crónicos I-EXPLORATION de I-EXPLORATION cocaína I-EXPLORATION inhalada). I-EXPLORATION Se I-EXPLORATION estableció I-EXPLORATION como I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION muerte I-EXPLORATION el I-EXPLORATION shock I-EXPLORATION hipovolémico I-EXPLORATION y I-EXPLORATION hemorrágico I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION la I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION mesentérica I-EXPLORATION y I-EXPLORATION portal. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés), I-PAST_MEDICAL_HISTORY derivada B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO por I-DERIVED_FROM/TO prurito I-DERIVED_FROM/TO generalizado, I-DERIVED_FROM/TO tinte I-DERIVED_FROM/TO ictérico, I-DERIVED_FROM/TO coluria I-DERIVED_FROM/TO y I-DERIVED_FROM/TO heces I-DERIVED_FROM/TO acólicas. I-DERIVED_FROM/TO La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION mostraba I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION ictericia I-EXPLORATION cutaneomucosa, I-EXPLORATION y I-EXPLORATION hepatomegalia I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION traveses. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anamnesis I-EXPLORATION por I-EXPLORATION aparatos I-EXPLORATION resultó I-EXPLORATION normal. I-EXPLORATION Bioquímica: I-EXPLORATION bilirrubina I-EXPLORATION directa I-EXPLORATION 22, I-EXPLORATION 13 I-EXPLORATION mg/dl, I-EXPLORATION GOT I-EXPLORATION 66 I-EXPLORATION UI/l, I-EXPLORATION GPT I-EXPLORATION 91 I-EXPLORATION UI/l, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION 1838 I-EXPLORATION UI/l, I-EXPLORATION GGT I-EXPLORATION 37 I-EXPLORATION UI/l. I-EXPLORATION Antígeno I-EXPLORATION CA I-EXPLORATION 19-9 I-EXPLORATION 86 I-EXPLORATION UI/l I-EXPLORATION (0-37), I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION bioquímicos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intra-extrahepática I-EXPLORATION sin I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION litiasis. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION y I-EXPLORATION colangio I-EXPLORATION RMN I-EXPLORATION mostraron I-EXPLORATION hepatomegalia, I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intra-extrahepática, I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION de I-EXPLORATION Wirsung, I-EXPLORATION desestructuración I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION del I-EXPLORATION proceso I-EXPLORATION uncinado I-EXPLORATION y I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION páncreas, I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION neoplasia. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT colocar I-TREATMENT percutáneamente I-TREATMENT un I-TREATMENT drenaje I-TREATMENT biliar I-TREATMENT externo-interno I-TREATMENT para I-TREATMENT resolver I-TREATMENT la I-TREATMENT ictericia I-TREATMENT obstructiva. I-TREATMENT Bajo I-TREATMENT sospecha I-TREATMENT de I-TREATMENT neoplasia I-TREATMENT pancreática, I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT intervino I-TREATMENT quirúrgicamente; I-TREATMENT la I-TREATMENT exploración I-TREATMENT intraoperatoria I-TREATMENT mostraba I-TREATMENT induración I-TREATMENT de I-TREATMENT la I-TREATMENT cabeza I-TREATMENT del I-TREATMENT páncreas I-TREATMENT y I-TREATMENT adenopatías I-TREATMENT hiliares; I-TREATMENT de B-EXPLORATION ambas, I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION intraoperatorias I-EXPLORATION que I-EXPLORATION informaron I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION intersticial I-EXPLORATION y I-EXPLORATION negativas I-EXPLORATION para I-EXPLORATION neoplasia I-EXPLORATION respectivamente. I-EXPLORATION Fue B-TREATMENT practicada I-TREATMENT duodenopancreatectomía I-TREATMENT cefálica I-TREATMENT con I-TREATMENT preservación I-TREATMENT pilórica. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION crónica I-EXPLORATION obstructiva I-EXPLORATION fibrosante I-EXPLORATION e I-EXPLORATION hiperplasia I-EXPLORATION ductal I-EXPLORATION inflamatoria I-EXPLORATION de I-EXPLORATION conducto I-EXPLORATION pancreático. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION duodécimo I-EVOLUTION día I-EVOLUTION postoperatorio I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION Fue B-EXPLORATION realizado, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION 6º I-EXPLORATION mes I-EXPLORATION postoperatorio, I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION N34S I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION SPINK1, I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativa. I-EXPLORATION Dos B-EVOLUTION años I-EVOLUTION después I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION La B-EXPLORATION IFP I-EXPLORATION es I-EXPLORATION una I-EXPLORATION rara I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION crónica I-EXPLORATION en I-EXPLORATION niños. I-EXPLORATION El I-EXPLORATION rango I-EXPLORATION de I-EXPLORATION edad I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION meses I-EXPLORATION a I-EXPLORATION 20 I-EXPLORATION años I-EXPLORATION con I-EXPLORATION una I-EXPLORATION edad I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION años I-EXPLORATION (1). I-EXPLORATION Hasta I-EXPLORATION la I-EXPLORATION fecha I-EXPLORATION sólo I-EXPLORATION 44 I-EXPLORATION casos I-EXPLORATION han I-EXPLORATION sido I-EXPLORATION publicados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION literatura. I-EXPLORATION La I-EXPLORATION etiología I-EXPLORATION es I-EXPLORATION desconocida, I-EXPLORATION aunque I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION determinadas I-EXPLORATION alteraciones I-EXPLORATION genéticas I-EXPLORATION (CFTR, I-EXPLORATION PRSS1), I-EXPLORATION destacando I-EXPLORATION por I-EXPLORATION su I-EXPLORATION frecuencia I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION N34S I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION SPINK1, I-EXPLORATION que I-EXPLORATION también I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION relacionado I-EXPLORATION con I-EXPLORATION la I-EXPLORATION pancreatitis I-EXPLORATION juvenil I-EXPLORATION tropical I-EXPLORATION (1,3,4). I-EXPLORATION A I-EXPLORATION diferencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pancreatitis I-EXPLORATION hereditaria I-EXPLORATION autonómica I-EXPLORATION dominante, I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION con I-EXPLORATION IFP I-EXPLORATION no I-EXPLORATION presentan I-EXPLORATION antecedentes I-EXPLORATION familiares. I-EXPLORATION La I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION presentación I-EXPLORATION más I-EXPLORATION frecuente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION IFP I-EXPLORATION es I-EXPLORATION la I-EXPLORATION ictericia I-EXPLORATION obstructiva I-EXPLORATION y I-EXPLORATION las I-EXPLORATION crisis I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION recidivante I-EXPLORATION (1,2,5,6,). I-EXPLORATION Analíticamente, I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION con I-EXPLORATION IFP, I-EXPLORATION presentan I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION colestásico, I-EXPLORATION citolítico I-EXPLORATION y, I-EXPLORATION ocasionalmente, I-EXPLORATION una I-EXPLORATION leve I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION amilasa I-EXPLORATION sérica I-EXPLORATION y I-EXPLORATION urinaria. I-EXPLORATION Respecto I-EXPLORATION al I-EXPLORATION diagnóstico, I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION son I-EXPLORATION útiles I-EXPLORATION para I-EXPLORATION objetivar I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION pancreático I-EXPLORATION de I-EXPLORATION la I-EXPLORATION obstrucción I-EXPLORATION de I-EXPLORATION vía I-EXPLORATION biliar. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION y I-EXPLORATION colangioRMN I-EXPLORATION permiten, I-EXPLORATION como I-EXPLORATION sucedió I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION caso, I-EXPLORATION visualizar I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION nitidez I-EXPLORATION el I-EXPLORATION páncreas, I-EXPLORATION cuya I-EXPLORATION cabeza I-EXPLORATION usualmente I-EXPLORATION estará I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION desestructurada. I-EXPLORATION El I-EXPLORATION Wirsung I-EXPLORATION puede I-EXPLORATION presentar I-EXPLORATION dilatación I-EXPLORATION preestenótica. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION se I-EXPLORATION consigue I-EXPLORATION por I-EXPLORATION exclusión I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION patologías I-EXPLORATION más I-EXPLORATION frecuentes I-EXPLORATION y I-EXPLORATION con I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION (biopsia I-EXPLORATION o I-EXPLORATION cirugía). I-EXPLORATION Histológicamente I-EXPLORATION el I-EXPLORATION páncreas I-EXPLORATION muestra I-EXPLORATION bandas I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION colagenizado I-EXPLORATION envolviendo I-EXPLORATION acinos I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION normal. I-EXPLORATION El I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION acompañante I-EXPLORATION de I-EXPLORATION la I-EXPLORATION proliferación I-EXPLORATION fibrosante I-EXPLORATION no I-EXPLORATION suele I-EXPLORATION ser I-EXPLORATION prominente I-EXPLORATION (1,6,). I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT debe I-TREATMENT comenzar I-TREATMENT por, I-TREATMENT en I-TREATMENT caso I-TREATMENT de I-TREATMENT existir, I-TREATMENT resolver I-TREATMENT la I-TREATMENT ictericia I-TREATMENT obstructiva, I-TREATMENT en I-TREATMENT espera I-TREATMENT del I-TREATMENT procedimiento I-TREATMENT quirúrgico I-TREATMENT definitivo. I-TREATMENT El I-TREATMENT drenaje I-TREATMENT percutáneo I-TREATMENT de I-TREATMENT vía I-TREATMENT biliar I-TREATMENT o I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT stent I-TREATMENT por I-TREATMENT CPRE I-TREATMENT son I-TREATMENT las I-TREATMENT técnicas I-TREATMENT de I-TREATMENT elección I-TREATMENT (1,6,). I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT es I-TREATMENT controvertido I-TREATMENT y I-TREATMENT podemos I-TREATMENT clasificarlos I-TREATMENT en I-TREATMENT derivativos I-TREATMENT y I-TREATMENT resectivos. I-TREATMENT Los I-TREATMENT primeros I-TREATMENT (coledocoduodenostomía I-TREATMENT y I-TREATMENT coledocoyeyunostomía I-TREATMENT en I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux) I-TREATMENT se I-TREATMENT encuentran I-TREATMENT en I-TREATMENT desuso I-TREATMENT porque I-TREATMENT no I-TREATMENT resuelven I-TREATMENT la I-TREATMENT obstrucción I-TREATMENT del I-TREATMENT Wirsung, I-TREATMENT persistiendo I-TREATMENT el I-TREATMENT dolor I-TREATMENT abdominal I-TREATMENT o I-TREATMENT la I-TREATMENT evolución I-TREATMENT a I-TREATMENT insuficiencia I-TREATMENT pancreática I-TREATMENT exo-endocrina I-TREATMENT (1). I-TREATMENT Entre I-TREATMENT los I-TREATMENT procedimientos I-TREATMENT resectivos I-TREATMENT destaca I-TREATMENT la I-TREATMENT DPC I-TREATMENT con I-TREATMENT preservación I-TREATMENT pilórica. I-TREATMENT Algunos I-TREATMENT autores I-TREATMENT la I-TREATMENT desanconsejan I-TREATMENT por I-TREATMENT la I-TREATMENT alta I-TREATMENT frecuencia I-TREATMENT de I-TREATMENT diabetes I-TREATMENT y I-TREATMENT mala I-TREATMENT digestión I-TREATMENT posoperatoria, I-TREATMENT así I-TREATMENT como I-TREATMENT el I-TREATMENT escaso I-TREATMENT alivio I-TREATMENT del I-TREATMENT dolor I-TREATMENT a I-TREATMENT largo I-TREATMENT plazo. I-TREATMENT Fue I-TREATMENT la I-TREATMENT técnica I-TREATMENT utilizada I-TREATMENT en I-TREATMENT nuestro I-TREATMENT caso I-TREATMENT y B-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION no I-EVOLUTION podemos I-EVOLUTION apoyar I-EVOLUTION dicha I-EVOLUTION afirmación. I-EVOLUTION La B-TREATMENT pancreatectomía I-TREATMENT cefálica I-TREATMENT con I-TREATMENT preservación I-TREATMENT duodenal I-TREATMENT (DPPHR) I-TREATMENT elimina I-TREATMENT las I-TREATMENT complicaciones I-TREATMENT de I-TREATMENT las I-TREATMENT pancreatitis I-TREATMENT crónicas I-TREATMENT y I-TREATMENT proporciona I-TREATMENT alivio I-TREATMENT del I-TREATMENT dolor I-TREATMENT a I-TREATMENT largo I-TREATMENT plazo I-TREATMENT en I-TREATMENT más I-TREATMENT del I-TREATMENT 80% I-TREATMENT de I-TREATMENT los I-TREATMENT pacientes I-TREATMENT (1). I-TREATMENT I-TREATMENT G. I-TREATMENT Suárez I-TREATMENT Artacho, I-TREATMENT J. I-TREATMENT Rodríguez I-TREATMENT Muñoz, I-TREATMENT M. I-TREATMENT A. I-TREATMENT Gómez I-TREATMENT Bravo, I-TREATMENT F. I-TREATMENT Docobo I-TREATMENT Durántez, I-TREATMENT R. I-TREATMENT García I-TREATMENT Lozano I-TREATMENT y I-TREATMENT S. I-TREATMENT P. I-TREATMENT Alconchel I-TREATMENT Gonzaga I-TREATMENT I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Cirugía I-TREATMENT General I-TREATMENT y I-TREATMENT Aparato I-TREATMENT Digestivo. I-TREATMENT Hospital I-TREATMENT Universitario I-TREATMENT Virgen I-TREATMENT del I-TREATMENT Rocío. I-TREATMENT Sevilla. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS ex-fumadora B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bebedora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 70 I-PAST_MEDICAL_HISTORY g I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día. I-PAST_MEDICAL_HISTORY Menopausia I-PAST_MEDICAL_HISTORY precoz I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY estrógenos I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS en I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hidrotórax I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hidrotórax I-PRESENT_ILLNESS hepático I-PRESENT_ILLNESS con I-PRESENT_ILLNESS biopsia I-PRESENT_ILLNESS hepática I-PRESENT_ILLNESS diagnóstica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cirrosis I-PRESENT_ILLNESS macro-micronodular I-PRESENT_ILLNESS poco I-PRESENT_ILLNESS evolucionada, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS moderada I-PRESENT_ILLNESS actividad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS esteatosis I-PRESENT_ILLNESS focal. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS viral, I-PRESENT_ILLNESS metabólico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS autoinmune I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hepatopatía I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS negativo. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS descartó I-PRESENT_ILLNESS patología I-PRESENT_ILLNESS cardiopulmonar I-PRESENT_ILLNESS como I-PRESENT_ILLNESS causante I-PRESENT_ILLNESS del I-PRESENT_ILLNESS derrame I-PRESENT_ILLNESS pleural, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS patología I-PRESENT_ILLNESS infecciosa I-PRESENT_ILLNESS o I-PRESENT_ILLNESS tuberculosa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS neoplásica I-PRESENT_ILLNESS pleuropulmonar. I-PRESENT_ILLNESS Ante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS falta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS restricción I-PRESENT_ILLNESS hidrosalina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS al I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS diurético, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS sometida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS toracocentesis I-PRESENT_ILLNESS evacuadoras I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS colocación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tubo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tórax I-PRESENT_ILLNESS para I-PRESENT_ILLNESS alivio I-PRESENT_ILLNESS sintomático. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS más I-PRESENT_ILLNESS tarde I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hidrotórax I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS recidivante. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION hipoventilación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION 2/3 I-EXPLORATION inferiores I-EXPLORATION del I-EXPLORATION campo I-EXPLORATION pulmonar I-EXPLORATION derecho. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 20.500/µL I-EXPLORATION con I-EXPLORATION 77% I-EXPLORATION de I-EXPLORATION PMN, I-EXPLORATION sin I-EXPLORATION anemia I-EXPLORATION ni I-EXPLORATION trombopenia. I-EXPLORATION La I-EXPLORATION bioquímica I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION creatinina I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 9 I-EXPLORATION mg/dl, I-EXPLORATION con I-EXPLORATION sodio I-EXPLORATION 129 I-EXPLORATION mEq/litro; I-EXPLORATION potasio I-EXPLORATION 5, I-EXPLORATION 4 I-EXPLORATION mEq/litro; I-EXPLORATION proteínas I-EXPLORATION totales: I-EXPLORATION 5, I-EXPLORATION 68 I-EXPLORATION g/dl; I-EXPLORATION albúmina: I-EXPLORATION 2, I-EXPLORATION 44 I-EXPLORATION g/dl; I-EXPLORATION GOT: I-EXPLORATION 107 I-EXPLORATION UI/L; I-EXPLORATION GPT: I-EXPLORATION 52 I-EXPLORATION UI/L; I-EXPLORATION LDH: I-EXPLORATION 157UI/L; I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 81 I-EXPLORATION mg/dl; I-EXPLORATION GGT I-EXPLORATION 370 I-EXPLORATION UI/L, I-EXPLORATION F.A. I-EXPLORATION 278 I-EXPLORATION UI/L; I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 69%; I-EXPLORATION TTPA I-EXPLORATION 30'', I-EXPLORATION fibrinógeno I-EXPLORATION 283 I-EXPLORATION mg/dl. I-EXPLORATION AFP I-EXPLORATION 6 I-EXPLORATION ng/ml, I-EXPLORATION serologías I-EXPLORATION de I-EXPLORATION VHB, I-EXPLORATION VHC, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein-Barr I-EXPLORATION y I-EXPLORATION sífilis I-EXPLORATION negativas; I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION a I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION era I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION exudado I-EXPLORATION (proteínas I-EXPLORATION totales I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 34 I-EXPLORATION g/dl; I-EXPLORATION LDH I-EXPLORATION 427 I-EXPLORATION UI/L; I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 073, I-EXPLORATION glucosa I-EXPLORATION 62 I-EXPLORATION mg/dl; I-EXPLORATION albúmina I-EXPLORATION 1, I-EXPLORATION 82 I-EXPLORATION mg/Dl, I-EXPLORATION leucocitos I-EXPLORATION 648 I-EXPLORATION cel/mm3 I-EXPLORATION con I-EXPLORATION 50% I-EXPLORATION PMN) I-EXPLORATION con I-EXPLORATION cultivo I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Staphylococcus I-EXPLORATION aureus I-EXPLORATION coagulasa I-EXPLORATION positivo I-EXPLORATION oxacilin I-EXPLORATION sensible. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION tuberculosis I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION bacilos I-EXPLORATION ácido-alcohol I-EXPLORATION resistentes I-EXPLORATION y I-EXPLORATION de I-EXPLORATION gamma-interferón I-EXPLORATION en I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION y I-EXPLORATION por I-EXPLORATION la I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION Mantoux. I-EXPLORATION Asímismo I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION malignidad I-EXPLORATION mediante I-EXPLORATION citologías I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION pleural I-EXPLORATION y I-EXPLORATION biopsias I-EXPLORATION pleurales. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION doppler I-EXPLORATION abdominal I-EXPLORATION mostraba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION crónica I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION morfológicos I-EXPLORATION ni I-EXPLORATION hemodinámicos I-EXPLORATION de I-EXPLORATION hipertensión I-EXPLORATION portal, I-EXPLORATION con I-EXPLORATION ascitis I-EXPLORATION mínima I-EXPLORATION y I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho. I-EXPLORATION Tras B-TREATMENT comprobar I-TREATMENT que I-TREATMENT no I-TREATMENT había I-TREATMENT respuesta I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT restricción I-TREATMENT hidrosalina I-TREATMENT y I-TREATMENT diuréticos, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT tubo I-TREATMENT torácico I-TREATMENT como I-TREATMENT tratamiento I-TREATMENT sintomático I-TREATMENT del I-TREATMENT hidrotórax I-TREATMENT drenando I-TREATMENT 2000-2500 I-TREATMENT cc I-TREATMENT de I-TREATMENT líquido I-TREATMENT al I-TREATMENT día. I-TREATMENT Como B-EVOLUTION complicaciones I-EVOLUTION del I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION presentó I-EVOLUTION insuficiencia I-EVOLUTION renal I-EVOLUTION prerrenal I-EVOLUTION por I-EVOLUTION alto I-EVOLUTION débito I-EVOLUTION e I-EVOLUTION hipoproteinemia I-EVOLUTION con I-EVOLUTION hipoalbuminemia. I-EVOLUTION En B-TREATMENT un I-TREATMENT intento I-TREATMENT de I-TREATMENT controlar I-TREATMENT la I-TREATMENT producción I-TREATMENT de I-TREATMENT líquido I-TREATMENT pleural I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT minitoracotomía I-TREATMENT con I-TREATMENT pleurodesis I-TREATMENT con I-TREATMENT talco I-TREATMENT que I-TREATMENT no I-TREATMENT fue I-TREATMENT efectiva. I-TREATMENT Ante I-TREATMENT el I-TREATMENT fracaso I-TREATMENT de I-TREATMENT la I-TREATMENT pleurodesis I-TREATMENT se I-TREATMENT decidió I-TREATMENT colocar I-TREATMENT una I-TREATMENT DPPI, I-TREATMENT tras I-TREATMENT hallar I-TREATMENT en I-TREATMENT las I-TREATMENT medidas I-TREATMENT de I-TREATMENT presión I-TREATMENT datos I-TREATMENT de I-TREATMENT hipertensión I-TREATMENT portal I-TREATMENT leve I-TREATMENT (gradiente I-TREATMENT de I-TREATMENT presión I-TREATMENT enclavamiento-libre: I-TREATMENT 13 I-TREATMENT mmHg) I-TREATMENT sugestivo I-TREATMENT de I-TREATMENT hidrotórax I-TREATMENT de I-TREATMENT origen I-TREATMENT hepático. I-TREATMENT Con I-TREATMENT ello I-TREATMENT se I-TREATMENT consiguió I-TREATMENT un I-TREATMENT descenso I-TREATMENT transitorio I-TREATMENT (2-3 I-TREATMENT días) I-TREATMENT del I-TREATMENT débito I-TREATMENT torácico. I-TREATMENT Se B-EXPLORATION descartó I-EXPLORATION disfunción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION DPPI I-EXPLORATION mediante I-EXPLORATION eco-doppler. I-EXPLORATION Se B-TREATMENT desestimó I-TREATMENT el I-TREATMENT trasplante I-TREATMENT hepático I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT ingesta I-TREATMENT reciente I-TREATMENT de I-TREATMENT alcohol. I-TREATMENT Ante I-TREATMENT la I-TREATMENT gravedad I-TREATMENT del I-TREATMENT cuadro I-TREATMENT y I-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT otras I-TREATMENT opciones I-TREATMENT terapéuticas, I-TREATMENT quince I-TREATMENT días I-TREATMENT más I-TREATMENT tarde I-TREATMENT se I-TREATMENT decidió I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT octreótido I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 25 I-TREATMENT µg/h I-TREATMENT i.v. I-TREATMENT el I-TREATMENT primer I-TREATMENT día, I-TREATMENT 50 I-TREATMENT el I-TREATMENT segundo I-TREATMENT y I-TREATMENT 100 I-TREATMENT durante I-TREATMENT otros I-TREATMENT 5 I-TREATMENT días. I-TREATMENT La I-TREATMENT paciente I-TREATMENT presentó I-TREATMENT muy I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT a I-TREATMENT dicho I-TREATMENT tratamiento, I-TREATMENT con I-TREATMENT disminución I-TREATMENT progresiva I-TREATMENT del I-TREATMENT débito I-TREATMENT por I-TREATMENT el I-TREATMENT tubo I-TREATMENT de I-TREATMENT tórax, I-TREATMENT lo I-TREATMENT que I-TREATMENT permitió I-TREATMENT la I-TREATMENT retirada I-TREATMENT del I-TREATMENT mismo I-TREATMENT sin I-TREATMENT posterior I-TREATMENT recidiva I-TREATMENT del I-TREATMENT derrame I-TREATMENT pleural. I-TREATMENT Se I-TREATMENT pautó I-TREATMENT una I-TREATMENT dosis I-TREATMENT 10 I-TREATMENT mg I-TREATMENT de I-TREATMENT octreótido I-TREATMENT subcutáneo I-TREATMENT antes I-TREATMENT del I-TREATMENT alta. I-TREATMENT En B-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION siguientes, I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION ni I-EVOLUTION ascitis I-EVOLUTION bajo I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION 25 I-EVOLUTION mg I-EVOLUTION de I-EVOLUTION aldactone I-EVOLUTION al I-EVOLUTION día. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS institución I-PRESENT_ILLNESS por I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS irradia I-PRESENT_ILLNESS al I-PRESENT_ILLNESS dorso, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS sub-ictericia, I-PRESENT_ILLNESS coluria, I-PRESENT_ILLNESS hipocolia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS escalofríos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presenta: I-EXPLORATION dolor I-EXPLORATION y I-EXPLORATION defensa I-EXPLORATION leve I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION distensión I-EXPLORATION abdominal I-EXPLORATION e I-EXPLORATION ictericia. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION evaluar I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION vesicular I-EXPLORATION que I-EXPLORATION atribuye I-EXPLORATION al I-EXPLORATION meteorismo I-EXPLORATION existente I-EXPLORATION y I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION con I-EXPLORATION paredes I-EXPLORATION engrosadas I-EXPLORATION y I-EXPLORATION con I-EXPLORATION sombras I-EXPLORATION acústicas I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION litiasis. I-EXPLORATION No I-EXPLORATION puede I-EXPLORATION evaluar I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION ni I-EXPLORATION páncreas. I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION franca I-EXPLORATION leucocitosis, I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bilirrubina I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION directa, I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION cinco I-EXPLORATION veces I-EXPLORATION lo I-EXPLORATION normal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION e I-EXPLORATION importante I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION transaminasas. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION coledociano, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION sometida I-EXPLORATION a I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION una I-EXPLORATION minuciosa I-EXPLORATION exploración, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION hallar I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar. I-EXPLORATION Se I-EXPLORATION libera I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extra-hepática I-EXPLORATION en I-EXPLORATION todo I-EXPLORATION su I-EXPLORATION recorrido I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION colangiografía I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION excepto I-EXPLORATION por I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION y I-EXPLORATION una I-EXPLORATION panlitiasis I-EXPLORATION coledociana I-EXPLORATION no I-EXPLORATION puede I-EXPLORATION objetivarse I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar. I-EXPLORATION I-EXPLORATION Se B-TREATMENT efectúa I-TREATMENT coledocotomía, I-TREATMENT extracción I-TREATMENT de I-TREATMENT 8 I-TREATMENT litos I-TREATMENT de I-TREATMENT diferentes I-TREATMENT tamaños I-TREATMENT y I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT una I-TREATMENT coledocoduodenostomía. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION alta. I-EVOLUTION Asintomática I-EVOLUTION a I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION operada. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 89 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 HTA, I-PAST_MEDICAL_HISTORY DM I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY accidentes I-PAST_MEDICAL_HISTORY cerebrovasculares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY consecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY hemiplejía I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alteraciones I-PAST_MEDICAL_HISTORY deglutorias I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY habían I-PAST_MEDICAL_HISTORY requerido I-PAST_MEDICAL_HISTORY nutrición I-PAST_MEDICAL_HISTORY enteral I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY través I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sonda I-PAST_MEDICAL_HISTORY nasogástrica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY De B-PRESENT_ILLNESS acuerdo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS geriatra I-PRESENT_ILLNESS habitual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS indicó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS colocación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sonda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gastrostomía I-PRESENT_ILLNESS percutánea I-PRESENT_ILLNESS con I-PRESENT_ILLNESS control I-PRESENT_ILLNESS endoscópico. I-PRESENT_ILLNESS El B-TREATMENT procedimiento I-TREATMENT fue I-TREATMENT realizado I-TREATMENT bajo I-TREATMENT sedación I-TREATMENT profunda I-TREATMENT por I-TREATMENT un I-TREATMENT anestesiólogo I-TREATMENT y I-TREATMENT siguiendo I-TREATMENT las I-TREATMENT pautas I-TREATMENT de I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT recomendadas I-TREATMENT actualmente. I-TREATMENT La I-TREATMENT técnica I-TREATMENT de I-TREATMENT colocación I-TREATMENT por I-TREATMENT tracción I-TREATMENT se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT con I-TREATMENT set I-TREATMENT comercializado I-TREATMENT por I-TREATMENT dos I-TREATMENT endoscopistas I-TREATMENT expertos. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT estricta I-TREATMENT desinfección I-TREATMENT de I-TREATMENT la I-TREATMENT zona, I-TREATMENT colocando I-TREATMENT la I-TREATMENT presilla I-TREATMENT externa I-TREATMENT de I-TREATMENT la I-TREATMENT sonda I-TREATMENT a I-TREATMENT una I-TREATMENT distancia I-TREATMENT entre I-TREATMENT 2-3 I-TREATMENT cm I-TREATMENT de I-TREATMENT la I-TREATMENT superficie I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT incisión I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 1 I-TREATMENT cm. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 12 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION se I-EVOLUTION inició I-EVOLUTION alimentación I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION la I-EVOLUTION PEG I-EVOLUTION y I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION aconsejándose I-EVOLUTION los I-EVOLUTION cuidados I-EVOLUTION domiciliarios I-EVOLUTION habituales. I-EVOLUTION Transcurridas I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ingresa I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION de I-EVOLUTION nuestro I-EVOLUTION hospital I-EVOLUTION por I-EVOLUTION deterioro I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general; I-EVOLUTION eritema, I-EVOLUTION edema I-EVOLUTION e I-EVOLUTION induración I-EVOLUTION en I-EVOLUTION pared I-EVOLUTION abdominal I-EVOLUTION con I-EVOLUTION supuración I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION purulento I-EVOLUTION a I-EVOLUTION través I-EVOLUTION y I-EVOLUTION alrededor I-EVOLUTION del I-EVOLUTION orificio I-EVOLUTION de I-EVOLUTION gastrostomía. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaban I-EXPLORATION un I-EXPLORATION claro I-EXPLORATION empeoramiento I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION tiraje I-EXPLORATION intercostal I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hipoperfusión I-EXPLORATION periférica. I-EXPLORATION La I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION presentaba I-EXPLORATION extensa I-EXPLORATION crepitación, I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION eritema I-EXPLORATION en I-EXPLORATION región I-EXPLORATION perigastrostomía I-EXPLORATION con I-EXPLORATION supuración I-EXPLORATION espontánea I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION material I-EXPLORATION purulento I-EXPLORATION por I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION gastrostomía. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION mostraba I-EXPLORATION intensa I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda, I-EXPLORATION plaquetopenia I-EXPLORATION y I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION los I-EXPLORATION tiempos I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION y I-EXPLORATION cefalina. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION urgente I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION extenso I-EXPLORATION enfisema I-EXPLORATION subcutáneo I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION : I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION abscesificación I-EXPLORATION en I-EXPLORATION región I-EXPLORATION subyacente I-EXPLORATION a I-EXPLORATION gastrostomía; I-EXPLORATION importante I-EXPLORATION íleo I-EXPLORATION paralítico I-EXPLORATION y I-EXPLORATION pneumoperitoneo. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro, I-TREATMENT desbridamiento I-TREATMENT quirúrgico I-TREATMENT del I-TREATMENT absceso I-TREATMENT abdominal I-TREATMENT y I-TREATMENT estrictos I-TREATMENT cuidados I-TREATMENT locales I-TREATMENT de I-TREATMENT la I-TREATMENT herida. I-TREATMENT Pese B-EVOLUTION a I-EVOLUTION todo I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION después I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento. I-EVOLUTION El B-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION tomada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION resultó I-EXPLORATION positivo I-EXPLORATION a I-EXPLORATION los I-EXPLORATION diez I-EXPLORATION días I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION para I-EXPLORATION Pseudomonas I-EXPLORATION putrida I-EXPLORATION y I-EXPLORATION Acinetobacter. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS gastrectomía I-PRESENT_ILLNESS total I-PRESENT_ILLNESS con I-PRESENT_ILLNESS reconstrucción I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Roux I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS adenocarcinoma I-PRESENT_ILLNESS gástrico I-PRESENT_ILLNESS pobremente I-PRESENT_ILLNESS diferenciado I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS antes. I-PRESENT_ILLNESS Se B-TREATMENT asoció I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT la I-TREATMENT pauta I-TREATMENT cisplatino I-TREATMENT e I-TREATMENT iridotecán, I-TREATMENT y I-TREATMENT se I-TREATMENT administraron I-TREATMENT 12 I-TREATMENT ciclos. I-TREATMENT Requirió I-TREATMENT cirugía I-TREATMENT de I-TREATMENT rescate I-TREATMENT 18 I-TREATMENT meses I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT 1ª I-TREATMENT cirugía I-TREATMENT por I-TREATMENT recidiva I-TREATMENT tumoral I-TREATMENT extraluminal I-TREATMENT local: I-TREATMENT anastomosis I-TREATMENT terminolateral I-TREATMENT con I-TREATMENT nueva I-TREATMENT reconstrucción I-TREATMENT en I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux I-TREATMENT y I-TREATMENT colectomía I-TREATMENT subtotal I-TREATMENT con I-TREATMENT anastomosis I-TREATMENT ileocólica I-TREATMENT terminolateral I-TREATMENT con I-TREATMENT ileostomía I-TREATMENT asociada. I-TREATMENT En B-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION comprobar I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION peritoneo, I-EXPLORATION colon, I-EXPLORATION asa I-EXPLORATION intestinal I-EXPLORATION ascendida I-EXPLORATION previamente I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION rodete I-EXPLORATION esofágico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION resección. I-EXPLORATION I-EXPLORATION Es B-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Aparato I-DERIVED_FROM/TO Digestivo I-DERIVED_FROM/TO por I-DERIVED_FROM/TO disfagia I-DERIVED_FROM/TO progresiva I-DERIVED_FROM/TO a I-DERIVED_FROM/TO los I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO cirugía, I-DERIVED_FROM/TO acompañada I-DERIVED_FROM/TO de I-DERIVED_FROM/TO pérdida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO peso. I-DERIVED_FROM/TO Se B-EXPLORATION realizó I-EXPLORATION esofagograma I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION estenosis I-EXPLORATION esofágica I-EXPLORATION distal I-EXPLORATION y I-EXPLORATION posteriormente, I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION una I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta: I-EXPLORATION estenosis I-EXPLORATION esofágica I-EXPLORATION distal I-EXPLORATION con I-EXPLORATION mucosa I-EXPLORATION normal, I-EXPLORATION con I-EXPLORATION biopsias I-EXPLORATION negativas I-EXPLORATION para I-EXPLORATION malignidad; I-EXPLORATION además I-EXPLORATION había I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION sutura I-EXPLORATION y I-EXPLORATION grapas I-EXPLORATION quirúrgicas. I-EXPLORATION Se B-TREATMENT optó I-TREATMENT por I-TREATMENT retirar I-TREATMENT los I-TREATMENT puntos I-TREATMENT de I-TREATMENT sutura I-TREATMENT y I-TREATMENT se I-TREATMENT hicieron I-TREATMENT 6 I-TREATMENT sesiones I-TREATMENT de I-TREATMENT dilatación I-TREATMENT neumática, I-TREATMENT siendo I-TREATMENT ineficaces. I-TREATMENT Ante I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT infiltración I-TREATMENT neoplásica I-TREATMENT transmural I-TREATMENT y I-TREATMENT el I-TREATMENT mantenimiento I-TREATMENT de I-TREATMENT la I-TREATMENT disfagia, I-TREATMENT se I-TREATMENT colocó I-TREATMENT una I-TREATMENT prótesis I-TREATMENT esofágica I-TREATMENT no I-TREATMENT recubierta I-TREATMENT de I-TREATMENT 7 I-TREATMENT cm. I-TREATMENT Al B-EXPLORATION expandirse I-EXPLORATION la I-EXPLORATION prótesis, I-EXPLORATION permitió I-EXPLORATION ver I-EXPLORATION la I-EXPLORATION infiltración I-EXPLORATION neoplásica. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION pudo I-EVOLUTION tomar I-EVOLUTION dieta I-EVOLUTION blanda, I-EVOLUTION y I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION franca I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION su I-EVOLUTION disfagia. I-EVOLUTION La B-TREATMENT paciente I-TREATMENT ha I-TREATMENT recibido I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT paliativos I-TREATMENT asociados. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION colocación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION prótesis, I-EVOLUTION aparece I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION disfagia I-EVOLUTION y I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION peso. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION realizada I-EXPLORATION se I-EXPLORATION vio I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neoplasia I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION prótesis I-EXPLORATION ; I-EXPLORATION se B-TREATMENT decidió I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT prótesis I-TREATMENT esofágica I-TREATMENT recubierta I-TREATMENT de I-TREATMENT 10 I-TREATMENT cm I-TREATMENT de I-TREATMENT longitud. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION reiniciar I-EVOLUTION la I-EVOLUTION alimentación I-EVOLUTION oral, I-EVOLUTION mejorando I-EVOLUTION su I-EVOLUTION disfagia. I-EVOLUTION Falleció I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION por I-EVOLUTION invasión I-EVOLUTION tumoral I-EVOLUTION sistémica. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 69 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS gastrectomía I-PRESENT_ILLNESS total I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Roux I-PRESENT_ILLNESS por I-PRESENT_ILLNESS adenocarcinoma I-PRESENT_ILLNESS gástrico I-PRESENT_ILLNESS pobremente I-PRESENT_ILLNESS diferenciado I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS Como B-TREATMENT tratamiento I-TREATMENT adyuvante I-TREATMENT recibió I-TREATMENT radioterapia I-TREATMENT y I-TREATMENT quimioterapia, I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT presentaba I-TREATMENT implantes I-TREATMENT peritoneales I-TREATMENT en I-TREATMENT el I-TREATMENT estudio I-TREATMENT histológico I-TREATMENT de I-TREATMENT la I-TREATMENT pieza I-TREATMENT quirúrgica. I-TREATMENT Se B-EXPLORATION realiza I-EXPLORATION endoscopia I-EXPLORATION alta I-EXPLORATION por I-EXPLORATION disfagia I-EXPLORATION progresiva I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION anillo I-EXPLORATION fibroso I-EXPLORATION en I-EXPLORATION anastomosis I-EXPLORATION esofagoenteral, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION yeyunal I-EXPLORATION próxima I-EXPLORATION a I-EXPLORATION la I-EXPLORATION anastomosis. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativas I-EXPLORATION para I-EXPLORATION malignidad. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT recidiva I-TREATMENT local I-TREATMENT por I-TREATMENT carcinomatosis I-TREATMENT peritoneal, I-TREATMENT se I-TREATMENT coloca I-TREATMENT prótesis I-TREATMENT esofágica I-TREATMENT expandible I-TREATMENT no I-TREATMENT recubierta I-TREATMENT de I-TREATMENT 10 I-TREATMENT cm I-TREATMENT de I-TREATMENT longitud. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION fallece I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION por I-EVOLUTION invasión I-EVOLUTION tumoral I-EVOLUTION sistémica. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY cigarrillos/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bebedor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY > I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY g I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol/día, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hepatopatía I-PAST_MEDICAL_HISTORY conocida, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS melenas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS "posos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS café". I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION el I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION nutricional, I-EXPLORATION los I-EXPLORATION estigmas I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION crónica, I-EXPLORATION una I-EXPLORATION hepatomegalia I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION edemas I-EXPLORATION bimaleolares I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION ascitis I-EXPLORATION grado I-EXPLORATION 2-3. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION normocítica-normocrómica I-EXPLORATION (Hb: I-EXPLORATION 9 I-EXPLORATION g/dl; I-EXPLORATION Hct: I-EXPLORATION 26, I-EXPLORATION 6%; I-EXPLORATION VCM: I-EXPLORATION 92 I-EXPLORATION fl) I-EXPLORATION y I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION transaminasas I-EXPLORATION (AST: I-EXPLORATION 145 I-EXPLORATION U/l; I-EXPLORATION ALT: I-EXPLORATION 75 I-EXPLORATION U/l; I-EXPLORATION GGT: I-EXPLORATION 166 I-EXPLORATION U/l) I-EXPLORATION con I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION bilirrubina, I-EXPLORATION albúmina I-EXPLORATION y I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION virales I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION cirrosis I-EXPLORATION e I-EXPLORATION hipertensión I-EXPLORATION portal, I-EXPLORATION con I-EXPLORATION ascitis I-EXPLORATION moderada. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION gastroscopia I-EXPLORATION urgente I-EXPLORATION con I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION hallazgos: I-EXPLORATION varices I-EXPLORATION esofágicas I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION moderado I-EXPLORATION ocupando I-EXPLORATION menos I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tercio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION esofágica, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION alarma I-EXPLORATION y I-EXPLORATION gastropatía I-EXPLORATION hipertensiva. I-EXPLORATION Dos I-EXPLORATION días I-EXPLORATION después I-EXPLORATION de I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION febrícula I-EXPLORATION y I-EXPLORATION malestar I-EXPLORATION abdominal, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION paracentesis I-EXPLORATION diagnóstica, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION resultado: I-EXPLORATION leucocitos: I-EXPLORATION 3.500/mm3 I-EXPLORATION (2.975 I-EXPLORATION PMN); I-EXPLORATION proteínas I-EXPLORATION totales: I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION g/dl; I-EXPLORATION albúmina: I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION g/dl; I-EXPLORATION glucosa: I-EXPLORATION 95 I-EXPLORATION mg/dl; I-EXPLORATION LDH: I-EXPLORATION 150 I-EXPLORATION U/l; I-EXPLORATION cultivo: I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Streptococcus I-EXPLORATION pneumoniae. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION los I-EXPLORATION hemocultivos I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS pluripatológico, B-PAST_MEDICAL_HISTORY acude B-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS persistentes. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION mostraba I-EXPLORATION ictericia I-EXPLORATION escleral I-EXPLORATION y I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION sin I-EXPLORATION peritonismo. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION Abdominal I-EXPLORATION evidenciaban I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION con I-EXPLORATION aerobilia, I-EXPLORATION vesícula I-EXPLORATION mal I-EXPLORATION delimitada I-EXPLORATION con I-EXPLORATION litiasis; I-EXPLORATION gran I-EXPLORATION cálculo I-EXPLORATION biliar I-EXPLORATION en I-EXPLORATION bulbo I-EXPLORATION duodenal I-EXPLORATION que I-EXPLORATION condiciona I-EXPLORATION obstrucción I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cámara I-EXPLORATION gástrica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION observando I-EXPLORATION contenido I-EXPLORATION líquido I-EXPLORATION en I-EXPLORATION cavidad I-EXPLORATION gástrica I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION bulbo I-EXPLORATION duodenal I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION cálculo I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION práctica I-EXPLORATION totalidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz. I-EXPLORATION Con B-TREATMENT ayuda I-TREATMENT del I-TREATMENT endoscopio I-TREATMENT lateral I-TREATMENT y I-TREATMENT litotriptor I-TREATMENT se I-TREATMENT realizó I-TREATMENT fragmentación I-TREATMENT parcial I-TREATMENT del I-TREATMENT cálculo, I-TREATMENT con I-TREATMENT extracción I-TREATMENT de I-TREATMENT los I-TREATMENT mismos, I-TREATMENT quedando I-TREATMENT en I-TREATMENT duodeno I-TREATMENT un I-TREATMENT fragmento I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 2 I-TREATMENT cm. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION notable I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ictericia I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION endoscopia I-EVOLUTION de I-EVOLUTION control I-EVOLUTION observando I-EVOLUTION imagen I-EVOLUTION sugestiva I-EVOLUTION de I-EVOLUTION fístula I-EVOLUTION bilio-duodenal I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION del I-EVOLUTION cálculo I-EVOLUTION descrito. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION en I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION notable I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION colestasis. I-EVOLUTION Dado I-EVOLUTION el I-EVOLUTION alto I-EVOLUTION riesgo I-EVOLUTION quirúrgico I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION actitud I-EVOLUTION expectante, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION sintomático I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS rectal I-PRESENT_ILLNESS que I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS nota I-PRESENT_ILLNESS por I-PRESENT_ILLNESS tacto I-PRESENT_ILLNESS rectal I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS estreñimiento I-PRESENT_ILLNESS crónico I-PRESENT_ILLNESS que I-PRESENT_ILLNESS requería I-PRESENT_ILLNESS alguna I-PRESENT_ILLNESS digitalización. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION anuscopia-rectoscopia, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION nodular I-EXPLORATION submucosa I-EXPLORATION única I-EXPLORATION a I-EXPLORATION 3-4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION margen I-EXPLORATION anal I-EXPLORATION de I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION móvil, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION amarillento I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION rectal. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT una I-TREATMENT exéresis I-TREATMENT local I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT respetando I-TREATMENT la I-TREATMENT muscular I-TREATMENT al I-TREATMENT no I-TREATMENT estar I-TREATMENT adherido I-TREATMENT a I-TREATMENT ella. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION carcinoide I-EXPLORATION rectal I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION bien I-EXPLORATION diferenciado, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION atipias, I-EXPLORATION desarrollado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION submucosa. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION invasión I-EXPLORATION vascular, I-EXPLORATION linfática I-EXPLORATION o I-EXPLORATION perineural. I-EXPLORATION En I-EXPLORATION superficie I-EXPLORATION aparece I-EXPLORATION cubierta I-EXPLORATION por I-EXPLORATION mucosa I-EXPLORATION rectal I-EXPLORATION bien I-EXPLORATION diferenciada. I-EXPLORATION En I-EXPLORATION su I-EXPLORATION base I-EXPLORATION muestra I-EXPLORATION escaso I-EXPLORATION margen I-EXPLORATION de I-EXPLORATION seguridad I-EXPLORATION afectando I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION bordes, I-EXPLORATION si I-EXPLORATION bien I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION invasión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muscular I-EXPLORATION propia. I-EXPLORATION I-EXPLORATION Con B-TREATMENT este I-TREATMENT hallazgo I-TREATMENT se I-TREATMENT propone I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT un I-TREATMENT seguimiento I-TREATMENT clínico I-TREATMENT y I-TREATMENT una I-TREATMENT biopsia I-TREATMENT de I-TREATMENT la I-TREATMENT cicatriz I-TREATMENT mucosa I-TREATMENT en I-TREATMENT tres I-TREATMENT meses. I-TREATMENT La B-EXPLORATION exéresis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION pericicatricial I-EXPLORATION no I-EXPLORATION evidencia I-EXPLORATION restos I-EXPLORATION tumorales. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION completó I-EXPLORATION con I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION que I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION otros I-EXPLORATION tumores. I-EXPLORATION Tras B-EVOLUTION 21 I-EVOLUTION meses I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS sana, I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diarrea, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS estaba I-PRESENT_ILLNESS tomando I-PRESENT_ILLNESS anovulatorios I-PRESENT_ILLNESS orales I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presenta I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION derecha. I-EXPLORATION Presentaba I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION importante I-EXPLORATION desviación I-EXPLORATION izquierda. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION y I-EXPLORATION radiológicos I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT apendicitis I-TREATMENT aguda I-TREATMENT se I-TREATMENT decide I-TREATMENT laparotomía I-TREATMENT de I-TREATMENT urgencia I-TREATMENT encontrándose I-TREATMENT una I-TREATMENT apendicitis I-TREATMENT aguda I-TREATMENT gangrenosa I-TREATMENT (anat. I-TREATMENT patológica: I-TREATMENT apendicitis I-TREATMENT aguda), I-TREATMENT realizándose I-TREATMENT apendicectomía. I-TREATMENT I-TREATMENT Se I-TREATMENT le I-TREATMENT administró I-TREATMENT empíricamente I-TREATMENT 1 I-TREATMENT g/8 I-TREATMENT h I-TREATMENT endovenoso I-TREATMENT de I-TREATMENT amoxicilina-clavulánico, I-TREATMENT en I-TREATMENT el I-TREATMENT en I-TREATMENT el I-TREATMENT 5º I-TREATMENT día I-TREATMENT postoperatorio I-TREATMENT empezó I-TREATMENT con I-TREATMENT fiebre I-TREATMENT "en I-TREATMENT picos" I-TREATMENT de I-TREATMENT hasta I-TREATMENT 40 I-TREATMENT ºC. I-TREATMENT Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION siendo I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION mesentérica I-EXPLORATION superior I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION a I-EXPLORATION las I-EXPLORATION ramas I-EXPLORATION ileocólicas, I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se B-TREATMENT la I-TREATMENT instauró I-TREATMENT sueroterapia, I-TREATMENT reposo I-TREATMENT intestinal I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT enoxiparina I-TREATMENT subcutánea I-TREATMENT 60 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT y I-TREATMENT meropenem I-TREATMENT endovenoso I-TREATMENT 1 I-TREATMENT g/8 I-TREATMENT h. I-TREATMENT Se B-EVOLUTION completan I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION antibiótico I-EVOLUTION y I-EVOLUTION ante I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION problemas I-EVOLUTION digestivos I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION causa I-EVOLUTION alta I-EVOLUTION el I-EVOLUTION 24º I-EVOLUTION día I-EVOLUTION del I-EVOLUTION postoperatorio I-EVOLUTION con I-EVOLUTION acenocumarol I-EVOLUTION oral. I-EVOLUTION I-EVOLUTION En B-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION intraoperatorios I-EXPLORATION crecieron I-EXPLORATION Proteus I-EXPLORATION mirabilis I-EXPLORATION y I-EXPLORATION Escherichia I-EXPLORATION coli I-EXPLORATION sensibles I-EXPLORATION a I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION antibióticos I-EXPLORATION testados. I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION intraoperatorio I-EXPLORATION para I-EXPLORATION gérmenes I-EXPLORATION anaerobios I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Dos I-EXPLORATION hemocultivos I-EXPLORATION resultaron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Bacteroides I-EXPLORATION fragilis I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION clindamicina I-EXPLORATION y I-EXPLORATION penicilina, I-EXPLORATION siendo I-EXPLORATION sensible I-EXPLORATION al I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION antibióticos I-EXPLORATION testados. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION para I-EXPLORATION anticuerpos I-EXPLORATION antifosfolípido I-EXPLORATION resultó I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION mes I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS ingresada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tromboembolismo I-PRESENT_ILLNESS pulmonar I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS terapia I-PRESENT_ILLNESS anticoagulante I-PRESENT_ILLNESS con I-PRESENT_ILLNESS enoxaparina, I-PRESENT_ILLNESS iniciándose B-TREATMENT a I-TREATMENT las I-TREATMENT 72 I-TREATMENT horas I-TREATMENT paso I-TREATMENT a I-TREATMENT anticoagulación I-TREATMENT oral I-TREATMENT con I-TREATMENT acenocumarol. I-TREATMENT Al B-EVOLUTION octavo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION ingreso, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION INR I-EVOLUTION de I-EVOLUTION 2, I-EVOLUTION 1, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION desarrolla, I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION emético I-EVOLUTION autolimitado, I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION malestar I-EVOLUTION general, I-EVOLUTION sudación, I-EVOLUTION tendencia I-EVOLUTION a I-EVOLUTION hipotensión I-EVOLUTION arterial I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION hipogástrico I-EVOLUTION sin I-EVOLUTION peritonismo, I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION practica I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION que I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION intraabdominal I-EXPLORATION hipogástrica I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION x I-EXPLORATION 11 I-EXPLORATION cm. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION hipogástrica I-EXPLORATION subperitoneal I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION x I-EXPLORATION 15 I-EXPLORATION x I-EXPLORATION 11 I-EXPLORATION cm, I-EXPLORATION dependiente I-EXPLORATION del I-EXPLORATION recto I-EXPLORATION abdominal I-EXPLORATION anterior I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION gran I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION pélvica. I-EXPLORATION Se I-EXPLORATION objetiva I-EXPLORATION importante I-EXPLORATION anemización I-EXPLORATION (descenso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 2 I-EXPLORATION g/dl I-EXPLORATION en I-EXPLORATION 72 I-EXPLORATION horas), I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION shock I-EXPLORATION hemorrágico I-EXPLORATION por I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION hematoma I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION se B-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT enérgico I-TREATMENT con I-TREATMENT reposición I-TREATMENT de I-TREATMENT volemia, I-TREATMENT se I-TREATMENT revierte I-TREATMENT la I-TREATMENT anticoagulación I-TREATMENT y I-TREATMENT se I-TREATMENT solicita I-TREATMENT valoración I-TREATMENT quirúrgica I-TREATMENT urgente. I-TREATMENT Ante B-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION inestabilidad I-EVOLUTION hemodinámica I-EVOLUTION con I-EVOLUTION el I-EVOLUTION manejo I-EVOLUTION conservador I-EVOLUTION inicial I-EVOLUTION y I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION semiología I-EVOLUTION de I-EVOLUTION abdomen I-EVOLUTION agudo, I-EVOLUTION se B-TREATMENT decide I-TREATMENT practicar I-TREATMENT laparotomía I-TREATMENT urgente I-TREATMENT que I-TREATMENT muestra I-TREATMENT "estallido" I-TREATMENT del I-TREATMENT peritoneo I-TREATMENT parietal I-TREATMENT y I-TREATMENT del I-TREATMENT músculo I-TREATMENT recto I-TREATMENT anterior I-TREATMENT derecho I-TREATMENT con I-TREATMENT gran I-TREATMENT hemoperitoneo I-TREATMENT secundario I-TREATMENT que I-TREATMENT diseca I-TREATMENT todo I-TREATMENT el I-TREATMENT espacio I-TREATMENT prevesical, I-TREATMENT objetivándose I-TREATMENT sangrado I-TREATMENT arterial I-TREATMENT por I-TREATMENT laceración I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT epigástrica I-TREATMENT derecha I-TREATMENT que I-TREATMENT se I-TREATMENT liga I-TREATMENT y I-TREATMENT sutura, I-TREATMENT procediéndose I-TREATMENT a I-TREATMENT evacuar I-TREATMENT aproximadamente I-TREATMENT 2 I-TREATMENT litros I-TREATMENT de I-TREATMENT hemoperitoneo I-TREATMENT con I-TREATMENT grandes I-TREATMENT coágulos I-TREATMENT prevesicales, I-TREATMENT y I-TREATMENT cierre I-TREATMENT con I-TREATMENT malla I-TREATMENT de I-TREATMENT polipropileno I-TREATMENT por I-TREATMENT defecto I-TREATMENT de I-TREATMENT músculo I-TREATMENT suprafascial. I-TREATMENT Tras I-TREATMENT soporte I-TREATMENT en I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Cuidados I-TREATMENT Intensivos I-TREATMENT e I-TREATMENT implantación I-TREATMENT de I-TREATMENT filtro I-TREATMENT temporal I-TREATMENT de I-TREATMENT vena I-TREATMENT cava I-TREATMENT inferior, I-TREATMENT la B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION reinstaurándose B-TREATMENT terapia I-TREATMENT anticoagulante I-TREATMENT con I-TREATMENT acenocumarol. I-TREATMENT I-TREATMENT El B-EXPLORATION hematoma I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION es I-EXPLORATION una I-EXPLORATION entidad I-EXPLORATION infrecuente I-EXPLORATION y I-EXPLORATION de I-EXPLORATION difícil I-EXPLORATION diagnóstico I-EXPLORATION que I-EXPLORATION generalmente I-EXPLORATION está I-EXPLORATION relacionada I-EXPLORATION con I-EXPLORATION la I-EXPLORATION anticoagulación I-EXPLORATION sistémica. I-EXPLORATION En I-EXPLORATION su I-EXPLORATION patogenia I-EXPLORATION se I-EXPLORATION involucra I-EXPLORATION la I-EXPLORATION anticoagulación I-EXPLORATION como I-EXPLORATION factor I-EXPLORATION predisponerte I-EXPLORATION y I-EXPLORATION la I-EXPLORATION contracción I-EXPLORATION vigorosa I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION rectos I-EXPLORATION del I-EXPLORATION abdomen I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION de I-EXPLORATION movimientos I-EXPLORATION de I-EXPLORATION Valsalva I-EXPLORATION enérgicos I-EXPLORATION y I-EXPLORATION bruscos I-EXPLORATION (tos, I-EXPLORATION vómitos, I-EXPLORATION estreñimiento) I-EXPLORATION como I-EXPLORATION factor I-EXPLORATION desencadenante. I-EXPLORATION En I-EXPLORATION varios I-EXPLORATION trabajos I-EXPLORATION previos I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION documentado I-EXPLORATION la I-EXPLORATION laceración I-EXPLORATION de I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION epigástricas I-EXPLORATION como I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION del I-EXPLORATION hematoma I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION (1-6). I-EXPLORATION I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION se I-EXPLORATION basa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION clínico I-EXPLORATION y I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION abdominal. I-EXPLORATION La I-EXPLORATION presentación I-EXPLORATION clínica I-EXPLORATION habitual I-EXPLORATION consiste I-EXPLORATION en I-EXPLORATION dolor I-EXPLORATION abdominal, I-EXPLORATION pudiendo I-EXPLORATION objetivarse I-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION o I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION y/o I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION superficial. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION suele I-EXPLORATION documentar I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION es I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION elección I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION permite I-EXPLORATION definir I-EXPLORATION y I-EXPLORATION precisar I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION del I-EXPLORATION proceso I-EXPLORATION y I-EXPLORATION la I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION vecinos. I-EXPLORATION I-EXPLORATION Su I-EXPLORATION manejo I-EXPLORATION es, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION general, I-EXPLORATION conservador, I-EXPLORATION incluso I-EXPLORATION ante I-EXPLORATION hallazgos I-EXPLORATION clínicos I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION agudo I-EXPLORATION (1,3), I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION el I-EXPLORATION propio I-EXPLORATION hematoma I-EXPLORATION ejerce I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION auto-taponamiento, I-EXPLORATION siendo I-EXPLORATION suficientes I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION sintomático I-EXPLORATION y I-EXPLORATION la I-EXPLORATION transfusión I-EXPLORATION sanguínea I-EXPLORATION en I-EXPLORATION casos I-EXPLORATION necesarios. I-EXPLORATION No B-TREATMENT obstante, I-TREATMENT existen I-TREATMENT situaciones I-TREATMENT en I-TREATMENT las I-TREATMENT que I-TREATMENT la I-TREATMENT hemorragia I-TREATMENT puede I-TREATMENT ser I-TREATMENT muy I-TREATMENT severa I-TREATMENT y I-TREATMENT llega I-TREATMENT a I-TREATMENT comprometer I-TREATMENT la I-TREATMENT vida, I-TREATMENT precisándose I-TREATMENT un I-TREATMENT abordaje I-TREATMENT quirúrgico I-TREATMENT para I-TREATMENT localizar I-TREATMENT el I-TREATMENT punto I-TREATMENT sangrante I-TREATMENT y I-TREATMENT drenar I-TREATMENT el I-TREATMENT hematoma. I-TREATMENT También I-TREATMENT se I-TREATMENT ha I-TREATMENT descrito I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT exitoso I-TREATMENT mediante I-TREATMENT embolización I-TREATMENT endovascular I-TREATMENT de I-TREATMENT los I-TREATMENT vasos I-TREATMENT sangrantes I-TREATMENT (1). I-TREATMENT La I-TREATMENT inestabilidad I-TREATMENT hemodinámica I-TREATMENT a I-TREATMENT pesar I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT intensivo I-TREATMENT y/o I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT complicaciones I-TREATMENT (hemoperitoneo, I-TREATMENT sobre-infección, I-TREATMENT etc.) I-TREATMENT son I-TREATMENT las I-TREATMENT principales I-TREATMENT indicaciones I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT quirúrgico, I-TREATMENT como I-TREATMENT ocurrió I-TREATMENT en I-TREATMENT el I-TREATMENT caso I-TREATMENT que I-TREATMENT presentamos. I-TREATMENT I-TREATMENT Nuestra B-EXPLORATION experiencia I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION importancia I-EXPLORATION del I-EXPLORATION diagnóstico I-EXPLORATION precoz I-EXPLORATION del I-EXPLORATION hematoma I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION necesidad I-EXPLORATION de I-EXPLORATION llevar I-EXPLORATION a I-EXPLORATION cabo I-EXPLORATION un I-EXPLORATION manejo I-EXPLORATION individualizado I-EXPLORATION del I-EXPLORATION mismo, I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION una I-EXPLORATION entidad I-EXPLORATION que, I-EXPLORATION aunque I-EXPLORATION generalmente I-EXPLORATION es I-EXPLORATION leve I-EXPLORATION y I-EXPLORATION autolimitada, I-EXPLORATION puede I-EXPLORATION presentar I-EXPLORATION complicaciones I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION magnitud I-EXPLORATION (shock I-EXPLORATION hemorrágico I-EXPLORATION refractario I-EXPLORATION a I-EXPLORATION soporte I-EXPLORATION médico, I-EXPLORATION hemoperitoneo, I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION vísceras I-EXPLORATION abdomino-pélvicas, I-EXPLORATION etc.) I-EXPLORATION que B-TREATMENT llegan I-TREATMENT a I-TREATMENT poner I-TREATMENT en I-TREATMENT peligro I-TREATMENT la I-TREATMENT vida I-TREATMENT del I-TREATMENT paciente I-TREATMENT y I-TREATMENT requieren I-TREATMENT un I-TREATMENT abordaje I-TREATMENT quirúrgico. I-TREATMENT I-TREATMENT J. B-EXPLORATION F. I-EXPLORATION Varona, I-EXPLORATION R. I-EXPLORATION Díaz-Conradi1, I-EXPLORATION M. I-EXPLORATION Valle, I-EXPLORATION F. I-EXPLORATION Muñoz2 I-EXPLORATION y I-EXPLORATION M. I-EXPLORATION A. I-EXPLORATION Bufalá I-EXPLORATION Departamentos I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION Interna, I-EXPLORATION 1Cirugía I-EXPLORATION General I-EXPLORATION y I-EXPLORATION 2Radiodiagnóstico. I-EXPLORATION Hospital I-EXPLORATION El I-EXPLORATION Escorial. I-EXPLORATION San I-EXPLORATION Lorenzo I-EXPLORATION del I-EXPLORATION Escorial, I-EXPLORATION Madrid I-EXPLORATION I-EXPLORATION MRB. B-PRESENT_ILLNESS Varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Hermano. B-FAMILY_HISTORY Casado I-FAMILY_HISTORY y I-FAMILY_HISTORY con I-FAMILY_HISTORY 2 I-FAMILY_HISTORY hijos, I-FAMILY_HISTORY uno I-FAMILY_HISTORY afecto I-FAMILY_HISTORY de I-FAMILY_HISTORY esclerosis I-FAMILY_HISTORY múltiple. I-FAMILY_HISTORY Rinitis B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY faringitis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY Lesiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY psoriasis I-PAST_MEDICAL_HISTORY generalizada, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY codos, I-PAST_MEDICAL_HISTORY rodillas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cuero I-PAST_MEDICAL_HISTORY cabelludo I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION leucopenia I-EXPLORATION mantenida I-EXPLORATION (3.700), I-EXPLORATION acompañada I-EXPLORATION de I-EXPLORATION ligero I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION ferritina I-EXPLORATION (21 I-EXPLORATION ng/ml) I-EXPLORATION sin I-EXPLORATION anemia I-EXPLORATION asociada I-EXPLORATION y I-EXPLORATION con I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION séricos I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION (177 I-EXPLORATION pg/ml). I-EXPLORATION La I-EXPLORATION TTG I-EXPLORATION estaba I-EXPLORATION discretamente I-EXPLORATION elevada I-EXPLORATION (1, I-EXPLORATION 74 I-EXPLORATION U/ml) I-EXPLORATION (N I-EXPLORATION ≤ I-EXPLORATION 1). I-EXPLORATION Es I-EXPLORATION DQ2 I-EXPLORATION (+) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION duodenal I-EXPLORATION fue I-EXPLORATION interpretada I-EXPLORATION como I-EXPLORATION normal I-EXPLORATION (estadio I-EXPLORATION 0 I-EXPLORATION de I-EXPLORATION Marsh). I-EXPLORATION Se B-TREATMENT le I-TREATMENT diagnosticó I-TREATMENT de I-TREATMENT EC I-TREATMENT hace I-TREATMENT 6 I-TREATMENT meses I-TREATMENT y I-TREATMENT se I-TREATMENT puso I-TREATMENT a I-TREATMENT DSG I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION analítica I-EVOLUTION al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION ellos. I-EVOLUTION I-EVOLUTION FGR. B-PRESENT_ILLNESS Mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Sobrina. B-PAST_MEDICAL_HISTORY Hija I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY JoRB I-PAST_MEDICAL_HISTORY (caso I-PAST_MEDICAL_HISTORY 4). I-PAST_MEDICAL_HISTORY Soltera. I-PAST_MEDICAL_HISTORY Nacida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY vuelta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cordón I-PAST_MEDICAL_HISTORY umbilical I-PAST_MEDICAL_HISTORY alrededor I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cuello I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY distócico. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY consecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ello, I-PAST_MEDICAL_HISTORY padece I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY parálisis I-PAST_MEDICAL_HISTORY cerebral I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY importante I-PAST_MEDICAL_HISTORY retraso I-PAST_MEDICAL_HISTORY mental I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY psicomotriz, I-PAST_MEDICAL_HISTORY camina I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dificultad I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY muletas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY utiliza I-PAST_MEDICAL_HISTORY parcialmente I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY silla I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ruedas. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY encuentra I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY hinchada I-PAST_MEDICAL_HISTORY habitualmente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY sientan I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY mal I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY comidas. I-PAST_MEDICAL_HISTORY Ardores I-PAST_MEDICAL_HISTORY epigástricos I-PAST_MEDICAL_HISTORY frecuentes, I-PAST_MEDICAL_HISTORY acompañados I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY reflujo. I-PAST_MEDICAL_HISTORY Hábito I-PAST_MEDICAL_HISTORY intestinal I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY estreñido, I-PAST_MEDICAL_HISTORY precisando I-PAST_MEDICAL_HISTORY empleo I-PAST_MEDICAL_HISTORY habitual I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY laxantes. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION descenso I-EXPLORATION persistente I-EXPLORATION de I-EXPLORATION ferritina I-EXPLORATION (6 I-EXPLORATION ng/ml) I-EXPLORATION y I-EXPLORATION del I-EXPLORATION IST I-EXPLORATION (13,4%) I-EXPLORATION sin I-EXPLORATION anemia I-EXPLORATION acompañante. I-EXPLORATION Presenta I-EXPLORATION anticuerpos I-EXPLORATION anti-tiroideos I-EXPLORATION ligeramente I-EXPLORATION positivos I-EXPLORATION (163 I-EXPLORATION U/ml), I-EXPLORATION con I-EXPLORATION normofunción I-EXPLORATION tiroidea. I-EXPLORATION La I-EXPLORATION TTG I-EXPLORATION es I-EXPLORATION ligeramente I-EXPLORATION positiva I-EXPLORATION (1,9), I-EXPLORATION el I-EXPLORATION DQ2 I-EXPLORATION es I-EXPLORATION negativo, I-EXPLORATION siendo I-EXPLORATION DQ8 I-EXPLORATION (+) I-EXPLORATION y I-EXPLORATION las I-EXPLORATION biopsias I-EXPLORATION duodenales I-EXPLORATION mostraron I-EXPLORATION un I-EXPLORATION claro I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION linfocitos I-EXPLORATION intraepiteliales I-EXPLORATION (estadio I-EXPLORATION 1 I-EXPLORATION de I-EXPLORATION Marsh). I-EXPLORATION I-EXPLORATION JRA. B-PRESENT_ILLNESS Varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Sobrino. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Asintomático. B-EXPLORATION Erupciones I-EXPLORATION cutáneas I-EXPLORATION generalizadas, I-EXPLORATION especialmente I-EXPLORATION en I-EXPLORATION cara, I-EXPLORATION brazos I-EXPLORATION y I-EXPLORATION piernas, I-EXPLORATION muy I-EXPLORATION pruriginosas I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION infancia, I-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION dermatitis I-EXPLORATION herpetiforme I-EXPLORATION (DH). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION leucopenia I-EXPLORATION (4.800), I-EXPLORATION con I-EXPLORATION descenso I-EXPLORATION del I-EXPLORATION colesterol I-EXPLORATION total I-EXPLORATION (116 I-EXPLORATION mg/dl). I-EXPLORATION La I-EXPLORATION TTG I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION (0, I-EXPLORATION 88 I-EXPLORATION U/ml). I-EXPLORATION Es I-EXPLORATION DQ2 I-EXPLORATION (-) I-EXPLORATION y I-EXPLORATION DQ8 I-EXPLORATION (+). I-EXPLORATION Las I-EXPLORATION biopsias I-EXPLORATION duodenales I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (estadio I-EXPLORATION 0 I-EXPLORATION de I-EXPLORATION Marsh). I-EXPLORATION Se B-TREATMENT le I-TREATMENT puso I-TREATMENT a I-TREATMENT DSG I-TREATMENT hace I-TREATMENT 10 I-TREATMENT meses, I-TREATMENT con B-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION analítica, I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION cutáneas. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS emesis I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS algunos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS arcadas. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hemorragias I-PAST_MEDICAL_HISTORY previas. I-PAST_MEDICAL_HISTORY Una B-EXPLORATION endoscopia I-EXPLORATION alta I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION desgarro I-EXPLORATION amplio I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION afectaba I-EXPLORATION a I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION y I-EXPLORATION la I-EXPLORATION submucosa I-EXPLORATION del I-EXPLORATION esófago I-EXPLORATION distal, I-EXPLORATION respetando I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION largo I-EXPLORATION proximal I-EXPLORATION a I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION Z. I-EXPLORATION La B-TREATMENT laceración I-TREATMENT presentaba I-TREATMENT una I-TREATMENT hemorragia I-TREATMENT rezumante I-TREATMENT lenta I-TREATMENT que I-TREATMENT se I-TREATMENT detuvo I-TREATMENT con I-TREATMENT la I-TREATMENT inyección I-TREATMENT de I-TREATMENT 6 I-TREATMENT cc I-TREATMENT de I-TREATMENT adrenalina I-TREATMENT al I-TREATMENT 1: I-TREATMENT 10000 I-TREATMENT y I-TREATMENT la I-TREATMENT aplicación I-TREATMENT de I-TREATMENT 17 I-TREATMENT endoclips I-TREATMENT para I-TREATMENT cerrar I-TREATMENT la I-TREATMENT laceración. I-TREATMENT La I-TREATMENT recurrencia I-TREATMENT de I-TREATMENT la I-TREATMENT hemorragia I-TREATMENT 8 I-TREATMENT días I-TREATMENT después I-TREATMENT se I-TREATMENT controló I-TREATMENT con I-TREATMENT la I-TREATMENT aplicación I-TREATMENT de I-TREATMENT otros I-TREATMENT 4 I-TREATMENT endoclips. I-TREATMENT No B-EVOLUTION hubo I-EVOLUTION ninguna I-EVOLUTION otra I-EVOLUTION recurrencia I-EVOLUTION hemorrágica I-EVOLUTION y I-EVOLUTION se I-EVOLUTION repitió I-EVOLUTION la I-EVOLUTION endoscopia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION 6 I-EVOLUTION y I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION 24, I-EVOLUTION no I-EVOLUTION observándose I-EVOLUTION lesión I-EVOLUTION alguna. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS hipogástrico, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 3 I-EXPLORATION ºC, I-EXPLORATION 115 I-EXPLORATION lat./min, I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION 130/80 I-EXPLORATION mmHg, I-EXPLORATION dolor I-EXPLORATION hipogástrico I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal. I-EXPLORATION Analítica: I-EXPLORATION leucocitos I-EXPLORATION 18.000µ/l I-EXPLORATION y I-EXPLORATION fibrinógeno I-EXPLORATION 939, I-EXPLORATION 9 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION TAC I-EXPLORATION abdominal: I-EXPLORATION el I-EXPLORATION duodeno I-EXPLORATION presenta I-EXPLORATION malrotación, I-EXPLORATION haciendo I-EXPLORATION un I-EXPLORATION tirabuzón I-EXPLORATION alrededor I-EXPLORATION del I-EXPLORATION eje I-EXPLORATION venoso I-EXPLORATION mesentérico. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION con I-EXPLORATION burbujas I-EXPLORATION de I-EXPLORATION gas I-EXPLORATION y I-EXPLORATION líquido I-EXPLORATION que I-EXPLORATION engloba I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION proximidad I-EXPLORATION al I-EXPLORATION fundus I-EXPLORATION uterino I-EXPLORATION y I-EXPLORATION receso I-EXPLORATION vesicouterino, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION apéndice I-EXPLORATION inflamado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION periapendicular I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuadrante I-EXPLORATION inferior I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenida I-TREATMENT quirúrgicamente, I-TREATMENT encontrándose I-TREATMENT la I-TREATMENT malrotación I-TREATMENT intestinal I-TREATMENT descrita I-TREATMENT con I-TREATMENT el I-TREATMENT duodeno I-TREATMENT en I-TREATMENT el I-TREATMENT lado I-TREATMENT derecho I-TREATMENT y I-TREATMENT el I-TREATMENT ciego I-TREATMENT descansando I-TREATMENT en I-TREATMENT el I-TREATMENT cuadrante I-TREATMENT superior I-TREATMENT izquierdo I-TREATMENT del I-TREATMENT abdomen. I-TREATMENT El I-TREATMENT apéndice I-TREATMENT se I-TREATMENT encuentra I-TREATMENT inflamado I-TREATMENT con I-TREATMENT un I-TREATMENT importante I-TREATMENT absceso I-TREATMENT pélvico I-TREATMENT asociado. I-TREATMENT Realizamos I-TREATMENT apendicectomía, I-TREATMENT drenaje I-TREATMENT de I-TREATMENT absceso I-TREATMENT pélvico I-TREATMENT y I-TREATMENT liberación I-TREATMENT de I-TREATMENT asas I-TREATMENT de I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT previa I-TREATMENT sección I-TREATMENT de I-TREATMENT las I-TREATMENT bandas I-TREATMENT de I-TREATMENT Ladd. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION recupera I-EVOLUTION satisfactoriamente I-EVOLUTION tras I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION con B-TREATMENT tratamiento I-TREATMENT antibiótico. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS ingresado I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ictericia. I-PRESENT_ILLNESS La B-EXPLORATION RMN I-EXPLORATION y I-EXPLORATION colangio-RMN I-EXPLORATION establecieron I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION colangiocarcinoma. I-EXPLORATION En B-TREATMENT el I-TREATMENT curso I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT consiguó I-TREATMENT la I-TREATMENT resección I-TREATMENT de I-TREATMENT una I-TREATMENT masa I-TREATMENT en I-TREATMENT el I-TREATMENT área I-TREATMENT de I-TREATMENT la I-TREATMENT bifurcación I-TREATMENT biliar I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT de I-TREATMENT la I-TREATMENT continuidad I-TREATMENT biliar I-TREATMENT mediante I-TREATMENT anastomosis I-TREATMENT segmentarias I-TREATMENT a I-TREATMENT un I-TREATMENT asa I-TREATMENT desfuncionalizada I-TREATMENT yeyunal I-TREATMENT en I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION reveló I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION carcinoide. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY hipertensa, I-PAST_MEDICAL_HISTORY dislipémica, I-PAST_MEDICAL_HISTORY apendicectomizada, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY practicó I-PAST_MEDICAL_HISTORY antrectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY reconstrucción I-PAST_MEDICAL_HISTORY Billroth-II I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY ulcerosa I-PAST_MEDICAL_HISTORY péptica. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Durante B-EXPLORATION su I-EXPLORATION exploración I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION ni I-EXPLORATION ictericia I-EXPLORATION ni I-EXPLORATION fiebre. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION la I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION (GGT I-EXPLORATION 386 I-EXPLORATION IU/L, I-EXPLORATION AP I-EXPLORATION 337 I-EXPLORATION IU/L, I-EXPLORATION AST I-EXPLORATION 245 I-EXPLORATION U/L, I-EXPLORATION ALT I-EXPLORATION 342 I-EXPLORATION U/L, I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 0, I-EXPLORATION 03 I-EXPLORATION g/l). I-EXPLORATION Se I-EXPLORATION detectaron I-EXPLORATION también I-EXPLORATION hiperamilasemia I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva; I-EXPLORATION además, I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION colecistitis, I-EXPLORATION colelitiasis, I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática. I-EXPLORATION Basándose I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION estos, I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION colecistopancreatitis I-EXPLORATION aguda I-EXPLORATION litiásica. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION por I-EXPLORATION contraste I-EXPLORATION oral I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION drenaje I-EXPLORATION biliar I-EXPLORATION al I-EXPLORATION asa I-EXPLORATION eferente. I-EXPLORATION Por I-EXPLORATION otra I-EXPLORATION parte, I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION endoscópicos I-EXPLORATION no I-EXPLORATION aportaron I-EXPLORATION nuevos I-EXPLORATION datos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (CT) I-EXPLORATION reveló I-EXPLORATION marcada I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION del I-EXPLORATION asa I-EXPLORATION yeyunal; I-EXPLORATION también I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION incremento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION colecistitis I-EXPLORATION mostrados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION inicial, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ictericia I-EXPLORATION obstructiva. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION otro I-EXPLORATION lado, I-EXPLORATION se I-EXPLORATION fueron I-EXPLORATION incrementando I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION hiperbilirrubinemia I-EXPLORATION (0, I-EXPLORATION 097 I-EXPLORATION g/l) I-EXPLORATION así I-EXPLORATION como I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepáticas I-EXPLORATION (AST I-EXPLORATION 600 I-EXPLORATION U/L) I-EXPLORATION tras I-EXPLORATION quince I-EXPLORATION días I-EXPLORATION de I-EXPLORATION hospitalización. I-EXPLORATION I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT laparotomía I-TREATMENT en I-TREATMENT base I-TREATMENT al I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT colecistitis I-TREATMENT aguda I-TREATMENT litiásica I-TREATMENT e I-TREATMENT ictericia I-TREATMENT obstructiva I-TREATMENT progresiva I-TREATMENT que I-TREATMENT involucraba I-TREATMENT al I-TREATMENT asa I-TREATMENT aferente I-TREATMENT de I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT Billroth-II. I-TREATMENT Se B-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION dilatada I-EXPLORATION y I-EXPLORATION necrótica, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION del I-EXPLORATION asa I-EXPLORATION aferente I-EXPLORATION volvulada I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION asa I-EXPLORATION eferente I-EXPLORATION provocando I-EXPLORATION la I-EXPLORATION ictericia I-EXPLORATION obstructiva. I-EXPLORATION Se B-TREATMENT resecó I-TREATMENT el I-TREATMENT asa I-TREATMENT aferente I-TREATMENT estenótica, I-TREATMENT se I-TREATMENT drenó I-TREATMENT el I-TREATMENT éstasis I-TREATMENT biliar I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT reconstrucción I-TREATMENT mediante I-TREATMENT Y-Roux I-TREATMENT yeyuno-yeyunal. I-TREATMENT Así I-TREATMENT mismo I-TREATMENT se I-TREATMENT practicó I-TREATMENT colecistectomía, I-TREATMENT y I-TREATMENT colangiografía I-TREATMENT intraoperatoria, I-TREATMENT obtenida I-TREATMENT a I-TREATMENT la I-TREATMENT finalización I-TREATMENT del I-TREATMENT procedimiento, I-TREATMENT mostrando I-TREATMENT un I-TREATMENT drenaje I-TREATMENT satisfactorio I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT papila I-TREATMENT de I-TREATMENT Vater I-TREATMENT hacia I-TREATMENT el I-TREATMENT duodeno I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT transanastomótico I-TREATMENT y I-TREATMENT a I-TREATMENT lo I-TREATMENT largo I-TREATMENT del I-TREATMENT yeyuno. I-TREATMENT I-TREATMENT Al B-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION postoperatorio I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION amilasemia I-EVOLUTION y I-EVOLUTION bilirrubina I-EVOLUTION se I-EVOLUTION normalizaron I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION exploración I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología. I-EVOLUTION La I-EVOLUTION ictericia I-EVOLUTION desapareció I-EVOLUTION completamente I-EVOLUTION antes I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION hospitalaria. I-EVOLUTION I-EVOLUTION El I-EVOLUTION estudio I-EVOLUTION histopatológico I-EVOLUTION del I-EVOLUTION espécimen I-EVOLUTION reveló I-EVOLUTION colecistitis I-EVOLUTION crónica, I-EVOLUTION colelitiasis, I-EVOLUTION y I-EVOLUTION el I-EVOLUTION asa I-EVOLUTION intestinal I-EVOLUTION presentó I-EVOLUTION signos I-EVOLUTION inespecíficos I-EVOLUTION inflamatorios I-EVOLUTION y I-EVOLUTION atrofia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mucosa. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS aquejado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS ponderal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS kg, I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS intensa, I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS estreñimiento I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS el I-PRESENT_ILLNESS transcurso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS además, I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemiabdomen I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS escasa I-PRESENT_ILLNESS mejoría I-PRESENT_ILLNESS a I-PRESENT_ILLNESS analgésicos I-PRESENT_ILLNESS habituales. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destaca I-EXPLORATION aceptable I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION palidez I-EXPLORATION mucocutánea, I-EXPLORATION auscultación I-EXPLORATION cardiorrespiratoria I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 5-6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION cuadrante I-EXPLORATION inferior I-EXPLORATION izdo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION ingreso, I-EXPLORATION destaca: I-EXPLORATION Hb: I-EXPLORATION 10.8 I-EXPLORATION g, I-EXPLORATION Hcto: I-EXPLORATION 38%, I-EXPLORATION VCM: I-EXPLORATION 78, I-EXPLORATION leucocitos: I-EXPLORATION 13.600/μl, I-EXPLORATION con I-EXPLORATION neutrofilia, I-EXPLORATION Fe: I-EXPLORATION 8, I-EXPLORATION úrico: I-EXPLORATION 9, I-EXPLORATION 6, I-EXPLORATION LDH: I-EXPLORATION 876 I-EXPLORATION y I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION I-EXPLORATION A B-EVOLUTION las I-EVOLUTION 8 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso, I-EVOLUTION se I-EVOLUTION agudiza I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION importante I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION fosa I-EVOLUTION ilíaca I-EVOLUTION izquierda, I-EVOLUTION irradiándose I-EVOLUTION este I-EVOLUTION a I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION centroabdominal. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presenta, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION referida I-EXPLORATION sensación I-EXPLORATION de I-EXPLORATION masa, I-EXPLORATION una I-EXPLORATION crepitación I-EXPLORATION difusa I-EXPLORATION en I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION peritonismo. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION urgente, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION : I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION intestinales I-EXPLORATION producida I-EXPLORATION por I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo, I-EXPLORATION situada I-EXPLORATION en I-EXPLORATION pelvis I-EXPLORATION izquierda, I-EXPLORATION que I-EXPLORATION condiciona I-EXPLORATION estenosis I-EXPLORATION y I-EXPLORATION obstrucción I-EXPLORATION intestinal I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION sigma. I-EXPLORATION La I-EXPLORATION masa, I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION mamelonados I-EXPLORATION infiltra I-EXPLORATION el I-EXPLORATION músculo I-EXPLORATION ilíaco I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION su I-EXPLORATION porción I-EXPLORATION superior I-EXPLORATION parece I-EXPLORATION ulcerada I-EXPLORATION y I-EXPLORATION fistulizada I-EXPLORATION a I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION anterior, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION está I-EXPLORATION marcadamente I-EXPLORATION engrosada, I-EXPLORATION con I-EXPLORATION aire I-EXPLORATION y I-EXPLORATION colección I-EXPLORATION líquida, I-EXPLORATION más I-EXPLORATION evidente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Diagnóstico: I-EXPLORATION neoplasia I-EXPLORATION de I-EXPLORATION sigma I-EXPLORATION fistulizada I-EXPLORATION a I-EXPLORATION pared I-EXPLORATION abdominal, I-EXPLORATION con I-EXPLORATION abscesificación. I-EXPLORATION Enfisema I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION abdominal. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION desfavorablemente, I-EVOLUTION presentando I-EVOLUTION un I-EVOLUTION shock I-EVOLUTION séptico I-EVOLUTION refractario I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica, I-EVOLUTION falleciendo I-EVOLUTION horas I-EVOLUTION después. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION necropsia I-EVOLUTION se I-EVOLUTION corroboran I-EVOLUTION los I-EVOLUTION diagnósticos I-EVOLUTION realizados I-EVOLUTION con I-EVOLUTION la I-EVOLUTION prueba I-EVOLUTION de I-EVOLUTION imagen, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION la I-EVOLUTION neoplasia I-EVOLUTION de I-EVOLUTION colon I-EVOLUTION que I-EVOLUTION resultó I-EVOLUTION ser I-EVOLUTION un I-EVOLUTION adenocarcinoma. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ileítis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Crohn I-PAST_MEDICAL_HISTORY desapareciendo I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY esteroides. I-PAST_MEDICAL_HISTORY Cinco B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después, I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS anemia I-PRESENT_ILLNESS ferropénica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS desnutrición I-PRESENT_ILLNESS severa. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS TAC B-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tránsito I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION trayectos I-EXPLORATION extraluminares I-EXPLORATION desde I-EXPLORATION ciego/íleon I-EXPLORATION terminal I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION posteriores I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION fístulas. I-EXPLORATION Se B-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT nutrición I-TREATMENT enteral, I-TREATMENT metronidazol I-TREATMENT y I-TREATMENT corticoides I-TREATMENT a I-TREATMENT bajas I-TREATMENT dosis. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION evolución, I-EVOLUTION pero I-EVOLUTION diez I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION acude I-EVOLUTION por I-EVOLUTION supuración I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION del I-EVOLUTION glúteo I-EVOLUTION y I-EVOLUTION absceso I-EVOLUTION retroperitoneal I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT resección I-TREATMENT ileocecal I-TREATMENT y I-TREATMENT anastomosis I-TREATMENT ileocólica I-TREATMENT látero-lateral. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT EC I-TREATMENT se I-TREATMENT han I-TREATMENT descrito I-TREATMENT tres I-TREATMENT enfoques I-TREATMENT en I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT los I-TREATMENT abscesos: I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT y I-TREATMENT esteroides, I-TREATMENT drenaje I-TREATMENT percutáneo I-TREATMENT y I-TREATMENT cirugía I-TREATMENT con I-TREATMENT resección I-TREATMENT de I-TREATMENT los I-TREATMENT segmentos I-TREATMENT intestinales I-TREATMENT afectados. I-TREATMENT I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT inicial I-TREATMENT estaría I-TREATMENT basado I-TREATMENT en I-TREATMENT la I-TREATMENT utilización I-TREATMENT de I-TREATMENT 5-ASA, I-TREATMENT antibióticos I-TREATMENT y I-TREATMENT corticosteroides, I-TREATMENT azatioprina I-TREATMENT o I-TREATMENT 6-mercaptopurina I-TREATMENT en I-TREATMENT caso I-TREATMENT de I-TREATMENT refractariedad I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT convencional I-TREATMENT (2). I-TREATMENT La I-TREATMENT siguiente I-TREATMENT línea I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT basa I-TREATMENT en I-TREATMENT la I-TREATMENT utilización I-TREATMENT de I-TREATMENT infliximab I-TREATMENT (anticuerpo I-TREATMENT monoclonal I-TREATMENT anti I-TREATMENT TNF-a) I-TREATMENT habiéndose I-TREATMENT observado I-TREATMENT una I-TREATMENT reducción I-TREATMENT en I-TREATMENT el I-TREATMENT número I-TREATMENT de I-TREATMENT intervenciones I-TREATMENT quirúrgicas I-TREATMENT en I-TREATMENT este I-TREATMENT grupo I-TREATMENT de I-TREATMENT pacientes. I-TREATMENT Una I-TREATMENT alternativa I-TREATMENT terapéutica I-TREATMENT para I-TREATMENT los I-TREATMENT pacientes I-TREATMENT con I-TREATMENT enfermedad I-TREATMENT de I-TREATMENT Crohn I-TREATMENT fistulizante I-TREATMENT refractaria I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anti-TNF-a I-TREATMENT sería I-TREATMENT la I-TREATMENT utilización I-TREATMENT de I-TREATMENT inmunosupresores I-TREATMENT anticalcineurínicos I-TREATMENT como I-TREATMENT el I-TREATMENT tacrolimus I-TREATMENT con I-TREATMENT remisiones I-TREATMENT completas I-TREATMENT de I-TREATMENT hasta I-TREATMENT un I-TREATMENT 40% I-TREATMENT y I-TREATMENT parciales I-TREATMENT del I-TREATMENT 50% I-TREATMENT (3). I-TREATMENT I-TREATMENT El I-TREATMENT drenaje I-TREATMENT percutáneo I-TREATMENT guiado I-TREATMENT radiológicamente I-TREATMENT en I-TREATMENT su I-TREATMENT momento I-TREATMENT se I-TREATMENT convirtió I-TREATMENT en I-TREATMENT la I-TREATMENT principal I-TREATMENT alternativa I-TREATMENT terapéutica I-TREATMENT llegando I-TREATMENT incluso I-TREATMENT a I-TREATMENT obviar I-TREATMENT la I-TREATMENT necesidad I-TREATMENT de I-TREATMENT resección I-TREATMENT intestinal. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT pueden I-TREATMENT llegar I-TREATMENT a I-TREATMENT presentar I-TREATMENT hasta I-TREATMENT un I-TREATMENT 100% I-TREATMENT de I-TREATMENT recidivas I-TREATMENT (4). I-TREATMENT Hay I-TREATMENT autores I-TREATMENT que I-TREATMENT defienden I-TREATMENT que I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT definitivo I-TREATMENT de I-TREATMENT un I-TREATMENT absceso I-TREATMENT de I-TREATMENT psoas I-TREATMENT debe I-TREATMENT incluir I-TREATMENT además, I-TREATMENT la I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT porción I-TREATMENT de I-TREATMENT tubo I-TREATMENT digestivo I-TREATMENT afectada I-TREATMENT (5). I-TREATMENT I-TREATMENT En I-TREATMENT los I-TREATMENT dos I-TREATMENT casos I-TREATMENT de I-TREATMENT EC I-TREATMENT fistulizante I-TREATMENT con I-TREATMENT abscesos I-TREATMENT intraabdominales I-TREATMENT presentados I-TREATMENT hemos I-TREATMENT podido I-TREATMENT observar I-TREATMENT dos I-TREATMENT tipos I-TREATMENT de I-TREATMENT experiencias I-TREATMENT en I-TREATMENT cuanto I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT En I-TREATMENT el I-TREATMENT primer I-TREATMENT caso I-TREATMENT se I-TREATMENT pudo I-TREATMENT resolver I-TREATMENT el I-TREATMENT absceso I-TREATMENT tras I-TREATMENT drenaje I-TREATMENT quirúrgico I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT conservador. I-TREATMENT En I-TREATMENT el I-TREATMENT segundo I-TREATMENT caso I-TREATMENT no I-TREATMENT tuvimos I-TREATMENT la I-TREATMENT oportunidad I-TREATMENT de I-TREATMENT tratar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT con I-TREATMENT anti-TNF I-TREATMENT dado I-TREATMENT que I-TREATMENT el I-TREATMENT cuadro I-TREATMENT clínico I-TREATMENT se I-TREATMENT presentó I-TREATMENT en I-TREATMENT 1999 I-TREATMENT y I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT fue I-TREATMENT la I-TREATMENT mejor I-TREATMENT opción, I-TREATMENT tras I-TREATMENT el I-TREATMENT fracaso I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT conservador. I-TREATMENT I-TREATMENT En I-TREATMENT conclusión, I-TREATMENT los I-TREATMENT pacientes I-TREATMENT con I-TREATMENT EC I-TREATMENT fistulizante I-TREATMENT con I-TREATMENT presencia I-TREATMENT de I-TREATMENT abscesos I-TREATMENT intraabdominales I-TREATMENT pueden I-TREATMENT ser I-TREATMENT tratados I-TREATMENT de I-TREATMENT forma I-TREATMENT conservadora I-TREATMENT inicialmente I-TREATMENT llegando I-TREATMENT a I-TREATMENT resolverse I-TREATMENT en I-TREATMENT algunos I-TREATMENT casos, I-TREATMENT ya I-TREATMENT sea I-TREATMENT con I-TREATMENT drenaje I-TREATMENT radiológico, I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT anti-TNF I-TREATMENT o I-TREATMENT con I-TREATMENT los I-TREATMENT nuevos I-TREATMENT inmunosupresores I-TREATMENT (tacrolimus). I-TREATMENT La I-TREATMENT resección I-TREATMENT quirúrgica I-TREATMENT del I-TREATMENT asa I-TREATMENT intestinal I-TREATMENT enferma I-TREATMENT se I-TREATMENT reservaría I-TREATMENT para I-TREATMENT los I-TREATMENT casos I-TREATMENT con I-TREATMENT fracaso I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT conservador I-TREATMENT o I-TREATMENT recurrencia I-TREATMENT de I-TREATMENT la I-TREATMENT EC I-TREATMENT fistulosa I-TREATMENT (6). I-TREATMENT I-TREATMENT M. I-TREATMENT Valdés I-TREATMENT Mas, I-TREATMENT J. I-TREATMENT A. I-TREATMENT Pons I-TREATMENT Miñano I-TREATMENT y I-TREATMENT F. I-TREATMENT Carballo I-TREATMENT Álvarez I-TREATMENT I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Aparato I-TREATMENT Digestivo. I-TREATMENT Hospital I-TREATMENT Universitario I-TREATMENT Virgen I-TREATMENT de I-TREATMENT la I-TREATMENT Arrixaca. I-TREATMENT Murcia I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS primípara I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS no I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Presentaba B-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION del I-EXPLORATION 29%, I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 109/L I-EXPLORATION con I-EXPLORATION 89, I-EXPLORATION 7% I-EXPLORATION de I-EXPLORATION neutrófilos, I-EXPLORATION amilasemia I-EXPLORATION de I-EXPLORATION 1.684 I-EXPLORATION UI/L, I-EXPLORATION AST I-EXPLORATION de I-EXPLORATION 41 I-EXPLORATION UI/L, I-EXPLORATION ALT I-EXPLORATION de I-EXPLORATION 75 I-EXPLORATION UI/L, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION de I-EXPLORATION 81 I-EXPLORATION UI/L I-EXPLORATION y I-EXPLORATION una I-EXPLORATION bGT I-EXPLORATION de I-EXPLORATION 28 I-EXPLORATION UI/L. I-EXPLORATION Una I-EXPLORATION ecografía I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION colecistitis I-EXPLORATION litiásica, I-EXPLORATION una I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION y I-EXPLORATION extrahepática I-EXPLORATION y I-EXPLORATION páncreas I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Una I-EXPLORATION ecografía I-EXPLORATION fetal I-EXPLORATION comprobó I-EXPLORATION una I-EXPLORATION gestación I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION semanas I-EXPLORATION sin I-EXPLORATION complicaciones. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT ingresó I-TREATMENT bajo I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT antibiótico I-TREATMENT pero I-TREATMENT con I-TREATMENT persistencia I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT horas. I-TREATMENT Se I-TREATMENT decidió I-TREATMENT CL I-TREATMENT electiva. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT CL I-TREATMENT hallando I-TREATMENT una I-TREATMENT colelitiasis I-TREATMENT simple I-TREATMENT con I-TREATMENT mínimos I-TREATMENT signos I-TREATMENT de I-TREATMENT colecistitis, I-TREATMENT con I-TREATMENT una I-TREATMENT presión I-TREATMENT intraabdominal I-TREATMENT inferior I-TREATMENT a I-TREATMENT 12 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT en I-TREATMENT un I-TREATMENT tiempo I-TREATMENT de I-TREATMENT 40 I-TREATMENT minutos. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION y I-EVOLUTION el I-EVOLUTION embarazo I-EVOLUTION transcurrieron I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS gestante B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY semanas, I-PAST_MEDICAL_HISTORY que B-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO por I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cinco I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución I-DERIVED_FROM/TO de I-DERIVED_FROM/TO náuseas, I-DERIVED_FROM/TO vómitos I-DERIVED_FROM/TO y I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO en I-DERIVED_FROM/TO hemiabdomen I-DERIVED_FROM/TO superior. I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION murphy I-EXPLORATION positivo. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION x I-EXPLORATION 109/L, I-EXPLORATION amilasemia I-EXPLORATION de I-EXPLORATION 1.300 I-EXPLORATION UI/L, I-EXPLORATION AST I-EXPLORATION de I-EXPLORATION 78 I-EXPLORATION UI/L, I-EXPLORATION ALT I-EXPLORATION de I-EXPLORATION 272 I-EXPLORATION UI/L, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION de I-EXPLORATION 288 I-EXPLORATION UI/L I-EXPLORATION y I-EXPLORATION una I-EXPLORATION bGT I-EXPLORATION de I-EXPLORATION 108 I-EXPLORATION UI/L. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION halla I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION litiasis I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION no I-EXPLORATION dilatada. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION claros I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION y I-EXPLORATION el I-EXPLORATION área I-EXPLORATION pancreática I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION El B-EVOLUTION estado I-EVOLUTION clínico I-EVOLUTION se I-EVOLUTION deterioró I-EVOLUTION y I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION estar I-EVOLUTION en I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION trimestre, I-EVOLUTION se B-TREATMENT decidió I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT realizándose I-TREATMENT CL I-TREATMENT con I-TREATMENT una I-TREATMENT presión I-TREATMENT intraabdominal I-TREATMENT inferior I-TREATMENT a I-TREATMENT 12 I-TREATMENT mmHg I-TREATMENT en I-TREATMENT un I-TREATMENT tiempo I-TREATMENT de I-TREATMENT 55 I-TREATMENT minutos. I-TREATMENT Una B-EXPLORATION colangiografía I-EXPLORATION intraoperatoria I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION la I-EVOLUTION gestación I-EVOLUTION transcurrió I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION I-EVOLUTION Durante I-EVOLUTION la I-EVOLUTION gestación, I-EVOLUTION al I-EVOLUTION igual I-EVOLUTION que I-EVOLUTION las I-EVOLUTION pacientes I-EVOLUTION que I-EVOLUTION toman I-EVOLUTION anticonceptivos I-EVOLUTION orales I-EVOLUTION o I-EVOLUTION estrógenos I-EVOLUTION en I-EVOLUTION el I-EVOLUTION periodo I-EVOLUTION menopáusico, I-EVOLUTION la I-EVOLUTION incidencia I-EVOLUTION de I-EVOLUTION colelitiasis I-EVOLUTION está I-EVOLUTION aumentada I-EVOLUTION por I-EVOLUTION el I-EVOLUTION estímulo I-EVOLUTION estrogénico I-EVOLUTION hormonal I-EVOLUTION (2). I-EVOLUTION Las I-EVOLUTION gestantes I-EVOLUTION no I-EVOLUTION escapan I-EVOLUTION a I-EVOLUTION la I-EVOLUTION posibilidad I-EVOLUTION de I-EVOLUTION sufrir I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION colecistitis I-EVOLUTION o I-EVOLUTION colelitiasis I-EVOLUTION y I-EVOLUTION su I-EVOLUTION manejo I-EVOLUTION es I-EVOLUTION similar I-EVOLUTION al I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION gestante, I-EVOLUTION incluyendo I-EVOLUTION una I-EVOLUTION monitorización I-EVOLUTION fetal. I-EVOLUTION La I-EVOLUTION CL I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION gestación I-EVOLUTION no I-EVOLUTION está I-EVOLUTION exenta I-EVOLUTION de I-EVOLUTION riesgos I-EVOLUTION para I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION el I-EVOLUTION feto I-EVOLUTION pese I-EVOLUTION a I-EVOLUTION su I-EVOLUTION gran I-EVOLUTION aceptación. I-EVOLUTION Así, I-EVOLUTION el I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION dióxido I-EVOLUTION de I-EVOLUTION carbono I-EVOLUTION para I-EVOLUTION realizar I-EVOLUTION el I-EVOLUTION pneumoperitoneo I-EVOLUTION puede I-EVOLUTION producir I-EVOLUTION una I-EVOLUTION acidosis I-EVOLUTION respiratoria I-EVOLUTION en I-EVOLUTION la I-EVOLUTION madre I-EVOLUTION y I-EVOLUTION el I-EVOLUTION feto, I-EVOLUTION y I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION propuesto I-EVOLUTION el I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION óxido I-EVOLUTION nitroso I-EVOLUTION (3). I-EVOLUTION Aun I-EVOLUTION así, I-EVOLUTION los I-EVOLUTION efectos I-EVOLUTION a I-EVOLUTION corto I-EVOLUTION plazo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION acidosis I-EVOLUTION fetal I-EVOLUTION severa I-EVOLUTION en I-EVOLUTION animales I-EVOLUTION no I-EVOLUTION han I-EVOLUTION demostrado I-EVOLUTION efectos I-EVOLUTION adversos I-EVOLUTION (4). I-EVOLUTION Además, I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION presión I-EVOLUTION intraabdominal I-EVOLUTION y I-EVOLUTION la I-EVOLUTION presión I-EVOLUTION del I-EVOLUTION útero I-EVOLUTION sobre I-EVOLUTION la I-EVOLUTION vena I-EVOLUTION cava I-EVOLUTION inferior I-EVOLUTION pueden I-EVOLUTION disminuir I-EVOLUTION el I-EVOLUTION flujo I-EVOLUTION del I-EVOLUTION retorno I-EVOLUTION venoso I-EVOLUTION y I-EVOLUTION disminuir I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION consiguiente I-EVOLUTION el I-EVOLUTION gasto I-EVOLUTION cardiaco, I-EVOLUTION el I-EVOLUTION riego I-EVOLUTION uterino I-EVOLUTION y I-EVOLUTION aparecer I-EVOLUTION hipoxia I-EVOLUTION fetal. I-EVOLUTION Algunos I-EVOLUTION autores I-EVOLUTION usan I-EVOLUTION presiones I-EVOLUTION intraabdominales I-EVOLUTION mínimas I-EVOLUTION y I-EVOLUTION una I-EVOLUTION posición I-EVOLUTION de I-EVOLUTION decúbito I-EVOLUTION lateral I-EVOLUTION izquierdo I-EVOLUTION con I-EVOLUTION una I-EVOLUTION mínima I-EVOLUTION posición I-EVOLUTION de I-EVOLUTION anti-Trendelenberg I-EVOLUTION (4). I-EVOLUTION Algún I-EVOLUTION estudio I-EVOLUTION demuestra I-EVOLUTION que I-EVOLUTION se I-EVOLUTION puede I-EVOLUTION trabajar I-EVOLUTION con I-EVOLUTION presiones I-EVOLUTION de I-EVOLUTION aire I-EVOLUTION mínimas, I-EVOLUTION pero I-EVOLUTION el I-EVOLUTION riesgo I-EVOLUTION de I-EVOLUTION reconversión I-EVOLUTION es I-EVOLUTION mayor I-EVOLUTION (5). I-EVOLUTION Se I-EVOLUTION recomienda I-EVOLUTION colocar I-EVOLUTION primero I-EVOLUTION un I-EVOLUTION trocar I-EVOLUTION epigástrico I-EVOLUTION (6). I-EVOLUTION La I-EVOLUTION colangiografía I-EVOLUTION intraoperatoria I-EVOLUTION no I-EVOLUTION está I-EVOLUTION recomendada I-EVOLUTION de I-EVOLUTION rutina I-EVOLUTION y I-EVOLUTION solo I-EVOLUTION en I-EVOLUTION pacientes I-EVOLUTION con I-EVOLUTION factores I-EVOLUTION de I-EVOLUTION riesgo I-EVOLUTION para I-EVOLUTION desarrollar I-EVOLUTION coledocolitiasis I-EVOLUTION (historia I-EVOLUTION de I-EVOLUTION pancreatitis, I-EVOLUTION de I-EVOLUTION ictericia I-EVOLUTION o I-EVOLUTION de I-EVOLUTION dilatación I-EVOLUTION coledocal) I-EVOLUTION (7). I-EVOLUTION Hay I-EVOLUTION un I-EVOLUTION mayor I-EVOLUTION riesgo I-EVOLUTION de I-EVOLUTION complicaciones I-EVOLUTION obstétricas I-EVOLUTION como I-EVOLUTION el I-EVOLUTION aborto I-EVOLUTION espontáneo I-EVOLUTION en I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION trimestre I-EVOLUTION (7). I-EVOLUTION La I-EVOLUTION CL I-EVOLUTION en I-EVOLUTION gestantes I-EVOLUTION debería I-EVOLUTION de I-EVOLUTION ser I-EVOLUTION pospuesta I-EVOLUTION al I-EVOLUTION segundo I-EVOLUTION trimestre I-EVOLUTION (4). I-EVOLUTION I-EVOLUTION Existe I-EVOLUTION una I-EVOLUTION amplia I-EVOLUTION experiencia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION CL I-EVOLUTION y I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION demostrado I-EVOLUTION una I-EVOLUTION menor I-EVOLUTION tasa I-EVOLUTION de I-EVOLUTION complicaciones I-EVOLUTION en I-EVOLUTION la I-EVOLUTION madre I-EVOLUTION y I-EVOLUTION el I-EVOLUTION feto I-EVOLUTION en I-EVOLUTION el I-EVOLUTION grupo I-EVOLUTION de I-EVOLUTION pacientes I-EVOLUTION intervenidos I-EVOLUTION respecto I-EVOLUTION al I-EVOLUTION grupo I-EVOLUTION de I-EVOLUTION gestantes I-EVOLUTION con I-EVOLUTION un I-EVOLUTION manejo I-EVOLUTION conservador I-EVOLUTION de I-EVOLUTION la I-EVOLUTION patología I-EVOLUTION biliar I-EVOLUTION (8). I-EVOLUTION La I-EVOLUTION CL I-EVOLUTION ofrece I-EVOLUTION ventajas I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION colecistectomía I-EVOLUTION abierta I-EVOLUTION y I-EVOLUTION debe I-EVOLUTION de I-EVOLUTION plantearse I-EVOLUTION como I-EVOLUTION primera I-EVOLUTION opción I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION gestación I-EVOLUTION (9). I-EVOLUTION Requiere I-EVOLUTION de I-EVOLUTION una I-EVOLUTION experiencia I-EVOLUTION quirúrgica I-EVOLUTION para I-EVOLUTION conseguir I-EVOLUTION un I-EVOLUTION tiempo I-EVOLUTION quirúrgico I-EVOLUTION menor I-EVOLUTION y I-EVOLUTION debe I-EVOLUTION de I-EVOLUTION acompañarse I-EVOLUTION de I-EVOLUTION una I-EVOLUTION serie I-EVOLUTION de I-EVOLUTION medidas I-EVOLUTION encaminadas I-EVOLUTION a I-EVOLUTION disminuir I-EVOLUTION las I-EVOLUTION posibles I-EVOLUTION complicaciones I-EVOLUTION maternofetales I-EVOLUTION (10). I-EVOLUTION I-EVOLUTION R. I-EVOLUTION Vilallonga, I-EVOLUTION J. I-EVOLUTION J. I-EVOLUTION Olsina, I-EVOLUTION C. I-EVOLUTION Margarit† I-EVOLUTION y I-EVOLUTION J. I-EVOLUTION Balsells I-EVOLUTION I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cirugía I-EVOLUTION Hepatobiliopancreática I-EVOLUTION y I-EVOLUTION Trasplante I-EVOLUTION Hepático. I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Cirugía I-EVOLUTION General I-EVOLUTION y I-EVOLUTION del I-EVOLUTION Aparato I-EVOLUTION Digestivo. I-EVOLUTION Hospital I-EVOLUTION Vall I-EVOLUTION d´Hebron. I-EVOLUTION Universidad I-EVOLUTION Autónoma I-EVOLUTION de I-EVOLUTION Barcelona I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 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 parálisis I-PAST_MEDICAL_HISTORY facial I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY once I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY habitual, I-PAST_MEDICAL_HISTORY dispepsia I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY ulcerosa, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY ansioso-depresivo, I-PAST_MEDICAL_HISTORY menstruaciones I-PAST_MEDICAL_HISTORY irregulares, I-PAST_MEDICAL_HISTORY multípara I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY sexuales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY veces I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Urgencias I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY doloroso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY hipocondrio I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY lumbar I-PAST_MEDICAL_HISTORY irradiado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY genitales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY miccional, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY veces I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cólico I-PAST_MEDICAL_HISTORY nefrítico. I-PAST_MEDICAL_HISTORY Desde B-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS dispareunia, I-PRESENT_ILLNESS leucorrea, I-PRESENT_ILLNESS disuria, I-PRESENT_ILLNESS orinas I-PRESENT_ILLNESS oscuras I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mugüet I-PRESENT_ILLNESS oral. I-PRESENT_ILLNESS Presentando I-PRESENT_ILLNESS además I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS anorexia, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS transtornos I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hábito I-PRESENT_ILLNESS intestinal. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION presenta I-EXPLORATION abdomen I-EXPLORATION doloroso I-EXPLORATION con I-EXPLORATION puño-percusión I-EXPLORATION renal I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION oleada I-EXPLORATION ascítica. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION anamnesis I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION se I-EXPLORATION pensó I-EXPLORATION en I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION diagnósticos I-EXPLORATION diferenciales I-EXPLORATION tales I-EXPLORATION como: I-EXPLORATION carcimomatosis I-EXPLORATION peritoneal, I-EXPLORATION hepatopatía, I-EXPLORATION neoplasia I-EXPLORATION ovárica, I-EXPLORATION celiaquía, I-EXPLORATION tuberculosis I-EXPLORATION intestinal I-EXPLORATION y I-EXPLORATION EPI I-EXPLORATION con I-EXPLORATION infección I-EXPLORATION perihepática I-EXPLORATION (síndrome I-EXPLORATION de I-EXPLORATION Fitz-Hugh-Curtis) I-EXPLORATION por I-EXPLORATION gonococos I-EXPLORATION o I-EXPLORATION chlamidias, I-EXPLORATION entre I-EXPLORATION otras I-EXPLORATION entidades I-EXPLORATION patológicas. I-EXPLORATION I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION presentó I-EXPLORATION neutrofilia I-EXPLORATION sin I-EXPLORATION leucocitosis, I-EXPLORATION linfopenia, I-EXPLORATION anemia I-EXPLORATION microcítica I-EXPLORATION hipocrómica, I-EXPLORATION plaquetas I-EXPLORATION disminuidas, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION VSG I-EXPLORATION (111 I-EXPLORATION mm/h, I-EXPLORATION n I-EXPLORATION < I-EXPLORATION 10) I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION PCR I-EXPLORATION (182 I-EXPLORATION mg/l, I-EXPLORATION n I-EXPLORATION < I-EXPLORATION 5). I-EXPLORATION Además I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION hipoalbuminemia I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION g/l, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION globulinas, I-EXPLORATION aumento I-EXPLORATION discreto I-EXPLORATION de I-EXPLORATION bilirrubina. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION sometió I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION ginecológico, I-EXPLORATION resultando I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION fue I-EXPLORATION negativa, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION Brucella, I-EXPLORATION Retrovirus, I-EXPLORATION VHC I-EXPLORATION y I-EXPLORATION VHB. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION elevado I-EXPLORATION el I-EXPLORATION ADA I-EXPLORATION (25, I-EXPLORATION 8 I-EXPLORATION U/l, I-EXPLORATION n I-EXPLORATION < I-EXPLORATION 18, I-EXPLORATION 2) I-EXPLORATION y I-EXPLORATION muy I-EXPLORATION elevado I-EXPLORATION el I-EXPLORATION antígeno I-EXPLORATION neoplásico I-EXPLORATION Ca-125 I-EXPLORATION (714 I-EXPLORATION U/ml, I-EXPLORATION n I-EXPLORATION < I-EXPLORATION 35). I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION un I-EXPLORATION exudado I-EXPLORATION faríngeo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION S. I-EXPLORATION aureus. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION antigliadina I-EXPLORATION y I-EXPLORATION antiendomisio I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION A I-EXPLORATION su I-EXPLORATION vez I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION orina I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION bilirrubina I-EXPLORATION moderado, I-EXPLORATION indicio I-EXPLORATION de I-EXPLORATION cuerpos I-EXPLORATION cetónicos, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION urocultivo I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION heces I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION Ziehl-Neelsen I-EXPLORATION para I-EXPLORATION BAAR I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION ocasiones, I-EXPLORATION y I-EXPLORATION negativo I-EXPLORATION también I-EXPLORATION para I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION Lowenstein. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION paracentesis I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION ascítico I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION un I-EXPLORATION líquido I-EXPLORATION claro I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 1.476 I-EXPLORATION células/ml, I-EXPLORATION siendo I-EXPLORATION un I-EXPLORATION 80% I-EXPLORATION polimorfos I-EXPLORATION nucleares I-EXPLORATION (n I-EXPLORATION < I-EXPLORATION 20%), I-EXPLORATION LDH I-EXPLORATION muy I-EXPLORATION elevada, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION S. I-EXPLORATION haemoliticus, I-EXPLORATION resultando I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Ziehl-Neelsen I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiología I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION podemos I-EXPLORATION comprobar I-EXPLORATION una I-EXPLORATION distribución I-EXPLORATION de I-EXPLORATION gas I-EXPLORATION normal I-EXPLORATION aunque I-EXPLORATION con I-EXPLORATION cierta I-EXPLORATION tendencia I-EXPLORATION a I-EXPLORATION situarse I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION centro, I-EXPLORATION no I-EXPLORATION pudiendo I-EXPLORATION valorarse I-EXPLORATION adecuadamente I-EXPLORATION al I-EXPLORATION no I-EXPLORATION poder I-EXPLORATION visualizarse I-EXPLORATION los I-EXPLORATION flancos. I-EXPLORATION En I-EXPLORATION pelvis I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION signos I-EXPLORATION que I-EXPLORATION indican I-EXPLORATION la I-EXPLORATION presentación I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION libre. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION nos I-EXPLORATION muestra I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION peritoneal, I-EXPLORATION no I-EXPLORATION existiendo I-EXPLORATION hallazgos I-EXPLORATION significativos I-EXPLORATION en I-EXPLORATION vísceras I-EXPLORATION abdominales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION baritado I-EXPLORATION gastroduodenal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION alteración I-EXPLORATION del I-EXPLORATION tránsito I-EXPLORATION intestinal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION abominal I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION abundante I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION y I-EXPLORATION engrosamiento I-EXPLORATION peritoneal I-EXPLORATION como I-EXPLORATION signos I-EXPLORATION más I-EXPLORATION llamativos. I-EXPLORATION I-EXPLORATION Sin I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION clara I-EXPLORATION de I-EXPLORATION la I-EXPLORATION patología I-EXPLORATION principal I-EXPLORATION que I-EXPLORATION originó I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION y I-EXPLORATION teniendo I-EXPLORATION en I-EXPLORATION mente I-EXPLORATION la I-EXPLORATION carcinomatosis I-EXPLORATION peritoneal, I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION difusa I-EXPLORATION intraperitoneal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION propia I-EXPLORATION tuberculosis I-EXPLORATION peritoneal, I-EXPLORATION se I-EXPLORATION ingresó I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION para I-EXPLORATION ser I-EXPLORATION sometida I-EXPLORATION a I-EXPLORATION una I-EXPLORATION laparoscopia I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION reglada. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION entrar I-EXPLORATION en I-EXPLORATION cavidad I-EXPLORATION nos I-EXPLORATION encontramos I-EXPLORATION multitud I-EXPLORATION de I-EXPLORATION adherencias I-EXPLORATION y I-EXPLORATION septos I-EXPLORATION intraperitoneales I-EXPLORATION y I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION distintos I-EXPLORATION órganos I-EXPLORATION abdominales, I-EXPLORATION destacando I-EXPLORATION las I-EXPLORATION adherencias I-EXPLORATION hepáticas. I-EXPLORATION Además I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION siembra I-EXPLORATION peritoneal I-EXPLORATION muy I-EXPLORATION extensa I-EXPLORATION de I-EXPLORATION tuberculomas. I-EXPLORATION Se I-EXPLORATION tomó I-EXPLORATION biopsia I-EXPLORATION peritoneal I-EXPLORATION de I-EXPLORATION tuberculomas I-EXPLORATION y I-EXPLORATION hepática, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION liberaron I-EXPLORATION las I-EXPLORATION adherencias I-EXPLORATION más I-EXPLORATION llamativas. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION dieron I-EXPLORATION a I-EXPLORATION conocer I-EXPLORATION una I-EXPLORATION granulomatosis I-EXPLORATION peritoneal I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION sugestivamente I-EXPLORATION tuberculosa I-EXPLORATION con I-EXPLORATION hígado I-EXPLORATION con I-EXPLORATION granulomatosis I-EXPLORATION capsular I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION sugestivamente I-EXPLORATION tuberculosa I-EXPLORATION de I-EXPLORATION alteraciones I-EXPLORATION inflamatorias I-EXPLORATION parenquimatosas I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION reactivo. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS y 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 y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS postprandrial, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS diarrea. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION estaba I-EXPLORATION pálida I-EXPLORATION y I-EXPLORATION presentaba I-EXPLORATION dolor I-EXPLORATION epigástrico I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION abdominal. I-EXPLORATION Analítica: I-EXPLORATION Hb I-EXPLORATION 8, I-EXPLORATION 6 I-EXPLORATION g/dl, I-EXPLORATION Htco I-EXPLORATION 28%, I-EXPLORATION VCM I-EXPLORATION 64, I-EXPLORATION Fe I-EXPLORATION 6 I-EXPLORATION mcg/dl, I-EXPLORATION ferritina I-EXPLORATION 1 I-EXPLORATION ng/ml, I-EXPLORATION saturación I-EXPLORATION transferrina I-EXPLORATION 1, I-EXPLORATION 5%, I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION fólico I-EXPLORATION normales. I-EXPLORATION Anticuerpos I-EXPLORATION antigliadina I-EXPLORATION 24, I-EXPLORATION 5 I-EXPLORATION (0-20 I-EXPLORATION UI/ml) I-EXPLORATION y I-EXPLORATION antiendomisio I-EXPLORATION > I-EXPLORATION 20. I-EXPLORATION Resto I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION biológicos I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Ca19.9, I-EXPLORATION CEA, I-EXPLORATION alfafetoproteína I-EXPLORATION normales. I-EXPLORATION Hemólisis I-EXPLORATION negativo. I-EXPLORATION Rx I-EXPLORATION gastroduodenal-tránsito I-EXPLORATION intestinal: I-EXPLORATION varias I-EXPLORATION estenosis I-EXPLORATION duodenales, I-EXPLORATION con I-EXPLORATION ulceración I-EXPLORATION e I-EXPLORATION imágenes I-EXPLORATION diverticulares I-EXPLORATION en I-EXPLORATION duodeno I-EXPLORATION distal-yeyuno. I-EXPLORATION Esofagogastroscopia: I-EXPLORATION mucosa I-EXPLORATION duodenal I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION atrófico I-EXPLORATION y I-EXPLORATION ulceraciones I-EXPLORATION lineales I-EXPLORATION postbulbares. I-EXPLORATION Anatomía I-EXPLORATION patológica: I-EXPLORATION atrofia I-EXPLORATION vellositaria I-EXPLORATION severa I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION extensa I-EXPLORATION inflamatoria. I-EXPLORATION No I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION granulomas, I-EXPLORATION tejido I-EXPLORATION linfoide I-EXPLORATION ni I-EXPLORATION carcinoma. I-EXPLORATION Biopsia I-EXPLORATION con I-EXPLORATION cápsula I-EXPLORATION de I-EXPLORATION Crosby I-EXPLORATION dirigida I-EXPLORATION a I-EXPLORATION zona I-EXPLORATION estenótica: I-EXPLORATION hallazgos I-EXPLORATION histológicos I-EXPLORATION similares. I-EXPLORATION TAC I-EXPLORATION abdominal: I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT dieta I-TREATMENT sin I-TREATMENT gluten I-TREATMENT con B-EVOLUTION mejoría I-EVOLUTION analítica I-EVOLUTION y I-EVOLUTION clínica I-EVOLUTION progresiva I-EVOLUTION y I-EVOLUTION posterior I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION parámetros. I-EVOLUTION Ocho I-EVOLUTION años I-EVOLUTION después I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION asintomática I-EVOLUTION con I-EVOLUTION controles I-EVOLUTION anuales. I-EVOLUTION La B-EXPLORATION endoscopia I-EXPLORATION y I-EXPLORATION la I-EXPLORATION histología I-EXPLORATION objetivaron I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION intestinal I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION analítica, I-EXPLORATION incluidos I-EXPLORATION anticuerpos I-EXPLORATION de I-EXPLORATION celiaquia, I-EXPLORATION no I-EXPLORATION presenta I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION estenosis I-EXPLORATION del I-EXPLORATION duodeno I-EXPLORATION es I-EXPLORATION una I-EXPLORATION forma I-EXPLORATION inusual I-EXPLORATION del I-EXPLORATION presentación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION celiaca I-EXPLORATION (3). I-EXPLORATION La I-EXPLORATION ulceración I-EXPLORATION intestinal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION estenosis I-EXPLORATION se I-EXPLORATION cree I-EXPLORATION que I-EXPLORATION aparecen I-EXPLORATION en I-EXPLORATION zonas I-EXPLORATION con I-EXPLORATION mucosa I-EXPLORATION inflamatoria. I-EXPLORATION Estas I-EXPLORATION lesiones I-EXPLORATION típicamente I-EXPLORATION se I-EXPLORATION localizan I-EXPLORATION en I-EXPLORATION el I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION proximal I-EXPLORATION y I-EXPLORATION generalmente I-EXPLORATION se I-EXPLORATION describen I-EXPLORATION en I-EXPLORATION fases I-EXPLORATION avanzadas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION celiaca I-EXPLORATION (1,2). I-EXPLORATION Más I-EXPLORATION recientemente, I-EXPLORATION Schweger I-EXPLORATION y I-EXPLORATION Murray I-EXPLORATION (3) I-EXPLORATION han I-EXPLORATION descrito I-EXPLORATION 5 I-EXPLORATION casos I-EXPLORATION más I-EXPLORATION indicando I-EXPLORATION que I-EXPLORATION estas I-EXPLORATION complicaciones, I-EXPLORATION si I-EXPLORATION bien I-EXPLORATION raras, I-EXPLORATION pueden I-EXPLORATION presentarse I-EXPLORATION más I-EXPLORATION frecuentemente I-EXPLORATION que I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION pensaba I-EXPLORATION y I-EXPLORATION parece I-EXPLORATION que I-EXPLORATION podrían I-EXPLORATION aparecer I-EXPLORATION más I-EXPLORATION temprano I-EXPLORATION en I-EXPLORATION el I-EXPLORATION curso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad. I-EXPLORATION Las I-EXPLORATION erosiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION duodenal I-EXPLORATION en I-EXPLORATION pacientes I-EXPLORATION celiacos I-EXPLORATION han I-EXPLORATION sido I-EXPLORATION descritas I-EXPLORATION recientemente I-EXPLORATION endoscópicamente I-EXPLORATION (4). I-EXPLORATION Nuestra I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION clínica I-EXPLORATION típica I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION celiaca, I-EXPLORATION presentando I-EXPLORATION estreñimiento I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION epigástrico. I-EXPLORATION La I-EXPLORATION radiología I-EXPLORATION objetivó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION estenosis I-EXPLORATION duodenal I-EXPLORATION y I-EXPLORATION ulceración, I-EXPLORATION y I-EXPLORATION tuvimos I-EXPLORATION que I-EXPLORATION realizar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION entre I-EXPLORATION enfermedad I-EXPLORATION celiaca I-EXPLORATION y I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn, I-EXPLORATION linfoma, I-EXPLORATION carcinoma I-EXPLORATION intestinal, I-EXPLORATION y I-EXPLORATION yeyunitis I-EXPLORATION ulcerativa. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION analíticos, I-EXPLORATION endoscópicos I-EXPLORATION e I-EXPLORATION histológicos, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION dieta I-EXPLORATION sin I-EXPLORATION gluten, I-EXPLORATION confirmaron I-EXPLORATION la I-EXPLORATION enfermedad. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION celiaca I-EXPLORATION debe I-EXPLORATION ser I-EXPLORATION tenido I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION el I-EXPLORATION desarrollo I-EXPLORATION temprano I-EXPLORATION de I-EXPLORATION estenosis I-EXPLORATION duodenal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION ulceraciones, I-EXPLORATION y I-EXPLORATION más I-EXPLORATION en I-EXPLORATION aquellos I-EXPLORATION pacientes I-EXPLORATION con I-EXPLORATION síntomas I-EXPLORATION no I-EXPLORATION típicos I-EXPLORATION o I-EXPLORATION con I-EXPLORATION hallazgos I-EXPLORATION radiológicos I-EXPLORATION inespecíficos, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION que I-EXPLORATION los I-EXPLORATION cambios I-EXPLORATION radiológicos I-EXPLORATION antes I-EXPLORATION mencionados I-EXPLORATION pueden I-EXPLORATION preceder I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad. I-EXPLORATION I-EXPLORATION A. I-EXPLORATION Castiella, I-EXPLORATION I. I-EXPLORATION Aramberri1, I-EXPLORATION J. I-EXPLORATION Fernández, I-EXPLORATION C. I-EXPLORATION Carrera1, I-EXPLORATION L. I-EXPLORATION Legasa2, I-EXPLORATION I. I-EXPLORATION Ruiz3 I-EXPLORATION y I-EXPLORATION E. I-EXPLORATION Zapata I-EXPLORATION I-EXPLORATION Unidad I-EXPLORATION de I-EXPLORATION Gastroenterología, I-EXPLORATION 1Medicina I-EXPLORATION de I-EXPLORATION Familia, I-EXPLORATION 2Servicios I-EXPLORATION de I-EXPLORATION Radiología I-EXPLORATION y I-EXPLORATION 3Anatomía I-EXPLORATION Patológica. I-EXPLORATION Hospital I-EXPLORATION Mendaro. I-EXPLORATION Gipuzkoa I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diagnosticada B-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 14 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY PQH I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY poliquistosis I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sometida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY drenaje I-PAST_MEDICAL_HISTORY percutáneo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY quistes I-PAST_MEDICAL_HISTORY hepáticos. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS es I-PRESENT_ILLNESS incluida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS lista I-PRESENT_ILLNESS de I-PRESENT_ILLNESS espera I-PRESENT_ILLNESS (LE) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS trasplante I-PRESENT_ILLNESS hepático I-PRESENT_ILLNESS (TH) I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS PQH I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS los I-PRESENT_ILLNESS criterios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hepatomegalia I-PRESENT_ILLNESS gigantesca, I-PRESENT_ILLNESS caquexia, I-PRESENT_ILLNESS hipertensión I-PRESENT_ILLNESS portal, I-PRESENT_ILLNESS ascitis, I-PRESENT_ILLNESS minusvalía I-PRESENT_ILLNESS física I-PRESENT_ILLNESS y I-PRESENT_ILLNESS social I-PRESENT_ILLNESS e I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS grado I-PRESENT_ILLNESS II I-PRESENT_ILLNESS (creatinemia I-PRESENT_ILLNESS 2, I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mg/dl). I-PRESENT_ILLNESS La B-EXPLORATION puntuación I-EXPLORATION MELD I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 23. I-EXPLORATION El B-TREATMENT TH I-TREATMENT se I-TREATMENT realizó I-TREATMENT con I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT la I-TREATMENT preservación I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT cava I-TREATMENT inferior I-TREATMENT (técnica I-TREATMENT de I-TREATMENT piggy-back), I-TREATMENT sin I-TREATMENT by-pass I-TREATMENT veno-venoso I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT biliar I-TREATMENT mediante I-TREATMENT colédoco-yeyunostomía I-TREATMENT sobre I-TREATMENT asa I-TREATMENT desfuncionalizada I-TREATMENT en I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux. I-TREATMENT El I-TREATMENT injerto I-TREATMENT se I-TREATMENT perfundió I-TREATMENT y I-TREATMENT almacenó I-TREATMENT con I-TREATMENT la I-TREATMENT solución I-TREATMENT de I-TREATMENT preservación I-TREATMENT de I-TREATMENT Celsior. I-TREATMENT Tiempo I-TREATMENT de I-TREATMENT isquemia I-TREATMENT fría: I-TREATMENT 5 I-TREATMENT h I-TREATMENT 50 I-TREATMENT min. I-TREATMENT Peso I-TREATMENT de I-TREATMENT la I-TREATMENT pieza I-TREATMENT de I-TREATMENT hepatectomía: I-TREATMENT 14 I-TREATMENT kg. I-TREATMENT No I-TREATMENT se I-TREATMENT presentó I-TREATMENT síndrome I-TREATMENT de I-TREATMENT reperfusión. I-TREATMENT Duración I-TREATMENT de I-TREATMENT la I-TREATMENT intervención: I-TREATMENT 6 I-TREATMENT h I-TREATMENT 25 I-TREATMENT min. I-TREATMENT Transfusión: I-TREATMENT 2.620 I-TREATMENT cc I-TREATMENT de I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes I-TREATMENT y I-TREATMENT 2.370 I-TREATMENT cc I-TREATMENT de I-TREATMENT plasma. I-TREATMENT Debido I-TREATMENT a I-TREATMENT la I-TREATMENT insuficiencia I-TREATMENT renal, I-TREATMENT la I-TREATMENT inducción I-TREATMENT de I-TREATMENT la I-TREATMENT inmunosupresión I-TREATMENT se I-TREATMENT realizó I-TREATMENT con I-TREATMENT basiliximab I-TREATMENT y I-TREATMENT corticoides; I-TREATMENT al I-TREATMENT 4º I-TREATMENT día I-TREATMENT del I-TREATMENT trasplante, I-TREATMENT siendo I-TREATMENT normal I-TREATMENT la I-TREATMENT creatinina I-TREATMENT (1 I-TREATMENT mg/dl), I-TREATMENT se I-TREATMENT introdujo I-TREATMENT tacrolimus. I-TREATMENT La B-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION UCI I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION días. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION TH I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION hospitalaria. I-EVOLUTION Actualmente I-EVOLUTION han I-EVOLUTION transcurrido I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION TH, I-EVOLUTION la I-EVOLUTION enferma I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION bien, I-EVOLUTION hace I-EVOLUTION vida I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION función I-EVOLUTION hepática I-EVOLUTION son I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION Una B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS es B-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO ante I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hallazgo I-DERIVED_FROM/TO ambulatorio I-DERIVED_FROM/TO en I-DERIVED_FROM/TO TAC I-DERIVED_FROM/TO abdominal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO lesión I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 7 I-DERIVED_FROM/TO cm I-DERIVED_FROM/TO en I-DERIVED_FROM/TO lóbulo I-DERIVED_FROM/TO hepático I-DERIVED_FROM/TO izquierdo. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-PAST_MEDICAL_HISTORY trata I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY sana I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS había I-PRESENT_ILLNESS acudido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cabecera I-PRESENT_ILLNESS a I-PRESENT_ILLNESS realizarse I-PRESENT_ILLNESS un I-PRESENT_ILLNESS chequeo I-PRESENT_ILLNESS rutinario I-PRESENT_ILLNESS y I-PRESENT_ILLNESS este I-PRESENT_ILLNESS detectó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS analítica I-PRESENT_ILLNESS convencional I-PRESENT_ILLNESS una I-PRESENT_ILLNESS discreta I-PRESENT_ILLNESS elevación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS transaminasas, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS decidió I-PRESENT_ILLNESS completar I-PRESENT_ILLNESS el I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS prueba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS imagen. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS ninguna I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS reseñable I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aparatos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION llamando I-EXPLORATION únicamente I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION discreta I-EXPLORATION molestia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION A I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION nuestra I-EXPLORATION unidad I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION pruebas I-EXPLORATION complementarias: I-EXPLORATION I-EXPLORATION Hemograma I-EXPLORATION y I-EXPLORATION coagulación: I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Bioquímica: I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 12, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION 690 I-EXPLORATION (n I-EXPLORATION < I-EXPLORATION 258), I-EXPLORATION LDH I-EXPLORATION 359, I-EXPLORATION GOT I-EXPLORATION (AST) I-EXPLORATION 185 I-EXPLORATION (n I-EXPLORATION < I-EXPLORATION 40), I-EXPLORATION GPT I-EXPLORATION (ALT) I-EXPLORATION 211 I-EXPLORATION (n I-EXPLORATION < I-EXPLORATION 40), I-EXPLORATION GGT I-EXPLORATION 673 I-EXPLORATION (n I-EXPLORATION < I-EXPLORATION 36), I-EXPLORATION resto I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Marcadores I-EXPLORATION tumorales: I-EXPLORATION CA I-EXPLORATION 19.9, I-EXPLORATION 10.9, I-EXPLORATION alfafetoproteína I-EXPLORATION 386, I-EXPLORATION 9 I-EXPLORATION (n I-EXPLORATION < I-EXPLORATION 10), I-EXPLORATION CEA I-EXPLORATION 1.12. I-EXPLORATION I-EXPLORATION EKG: I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION TAC I-EXPLORATION abdominal: I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION delimitados, I-EXPLORATION centrada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION medial I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION al I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION masa I-EXPLORATION produce I-EXPLORATION compresión I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION principal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION porta I-EXPLORATION y, I-EXPLORATION sobre I-EXPLORATION todo, I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION discreta I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION biliar I-EXPLORATION izquierdo. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION está I-EXPLORATION poco I-EXPLORATION vascularizada I-EXPLORATION y I-EXPLORATION muestra I-EXPLORATION importantes I-EXPLORATION áreas I-EXPLORATION necróticas. I-EXPLORATION I-EXPLORATION Biopsia I-EXPLORATION hepática: I-EXPLORATION cambios I-EXPLORATION de I-EXPLORATION hiperplasia I-EXPLORATION nodular I-EXPLORATION con I-EXPLORATION marcada I-EXPLORATION esteatosis, I-EXPLORATION no I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION malignidad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION material I-EXPLORATION remitido. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION discordancia I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION y I-EXPLORATION analíticas, I-EXPLORATION que I-EXPLORATION orientaban I-EXPLORATION hacia I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION neoplásico, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION (no I-EXPLORATION concluyente I-EXPLORATION de I-EXPLORATION malignidad) I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION explicar I-EXPLORATION la I-EXPLORATION situación I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION ofreciéndole I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT acepta I-TREATMENT la I-TREATMENT intervención I-TREATMENT practicándosele I-TREATMENT una I-TREATMENT resección I-TREATMENT de I-TREATMENT los I-TREATMENT segmentos I-TREATMENT IV I-TREATMENT y I-TREATMENT V I-TREATMENT hepáticos. I-TREATMENT I-TREATMENT Durante B-EXPLORATION la I-EXPLORATION operación I-EXPLORATION se I-EXPLORATION envía I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION intraoperatoria I-EXPLORATION que I-EXPLORATION es I-EXPLORATION informada I-EXPLORATION nuevamente I-EXPLORATION como I-EXPLORATION biopsia I-EXPLORATION no I-EXPLORATION concluyente I-EXPLORATION de I-EXPLORATION malignidad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION material I-EXPLORATION remitido, I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION macroscópicamente I-EXPLORATION se I-EXPLORATION diferencia I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION bien I-EXPLORATION delimitado I-EXPLORATION y I-EXPLORATION encapsulado, I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION central I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño, I-EXPLORATION necrosado I-EXPLORATION y I-EXPLORATION multilobulado. I-EXPLORATION Microscópicamente I-EXPLORATION se I-EXPLORATION diferencian I-EXPLORATION áreas I-EXPLORATION extensas I-EXPLORATION sin I-EXPLORATION atipias, I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION vacuolas I-EXPLORATION lipídicas I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION muy I-EXPLORATION bajo I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION áreas I-EXPLORATION con I-EXPLORATION alta I-EXPLORATION celuraridad, I-EXPLORATION núcleos I-EXPLORATION atípicos, I-EXPLORATION mitosis I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION en I-EXPLORATION torno I-EXPLORATION al I-EXPLORATION 15%. I-EXPLORATION Finalmente I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION es I-EXPLORATION catalogado I-EXPLORATION como I-EXPLORATION hepatocarcinoma I-EXPLORATION bien I-EXPLORATION diferenciado I-EXPLORATION (grado I-EXPLORATION II) I-EXPLORATION rico I-EXPLORATION en I-EXPLORATION lípidos. I-EXPLORATION I-EXPLORATION En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION ninguna I-EVOLUTION complicación I-EVOLUTION reseñable I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION posterior I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION externas. I-EVOLUTION Actualmente B-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION asintomática I-EXPLORATION y I-EXPLORATION en I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION control I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION comprobado I-EXPLORATION la I-EXPLORATION normalización I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION las I-EXPLORATION transaminasas I-EXPLORATION como I-EXPLORATION de I-EXPLORATION la I-EXPLORATION alfafetoproteína. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diabético B-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II. I-PAST_MEDICAL_HISTORY Bebedor I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pancreatitis I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION es I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible, I-EXPLORATION no I-EXPLORATION presenta I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION ni I-EXPLORATION alteraciones I-EXPLORATION analíticas. I-EXPLORATION I-EXPLORATION Ingresa I-EXPLORATION en I-EXPLORATION observación I-EXPLORATION practicándose I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION pancreatitis I-EXPLORATION crónica I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION calcificaciones. I-EXPLORATION Existen I-EXPLORATION dos I-EXPLORATION formaciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION páncreas: I-EXPLORATION una I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION pseudoquiste I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION sólido I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION que I-EXPLORATION corresponde I-EXPLORATION a I-EXPLORATION un I-EXPLORATION pseudoaneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION gastroduodenal. I-EXPLORATION Evoluciona B-EVOLUTION favorablemente I-EVOLUTION mejorando I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION presentando I-EVOLUTION una I-EVOLUTION ligera I-EVOLUTION anemización. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION presenta I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION muy I-EVOLUTION intenso I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION hematemesis I-EVOLUTION y I-EVOLUTION rectorragia I-EVOLUTION masiva. I-EVOLUTION Se I-EVOLUTION produce I-EVOLUTION un I-EVOLUTION shock I-EVOLUTION hemodinámico I-EVOLUTION mejorando I-EVOLUTION posteriormente I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION persistiendo I-EVOLUTION el I-EVOLUTION sangrado. I-EVOLUTION Una B-EXPLORATION nueva I-EXPLORATION TC I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION desaparición I-EXPLORATION del I-EXPLORATION pseudoquiste I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION y I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION pancreática I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION arterial I-EXPLORATION activo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION El I-EXPLORATION cuadro I-EXPLORATION es I-EXPLORATION interpretado I-EXPLORATION como I-EXPLORATION un I-EXPLORATION drenaje I-EXPLORATION espontáneo I-EXPLORATION del I-EXPLORATION pseudoquiste I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION un I-EXPLORATION sangrado I-EXPLORATION digestivo I-EXPLORATION ocasionado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION pseudoaneurisma I-EXPLORATION en I-EXPLORATION comunicación I-EXPLORATION a I-EXPLORATION través I-EXPLORATION del I-EXPLORATION pseudoquiste I-EXPLORATION con I-EXPLORATION el I-EXPLORATION tubo I-EXPLORATION digestivo. I-EXPLORATION Ante B-TREATMENT tal I-TREATMENT situación I-TREATMENT se I-TREATMENT desaconseja I-TREATMENT el I-TREATMENT traslado I-TREATMENT y I-TREATMENT se I-TREATMENT interveniene I-TREATMENT quirúrgicamente. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT aprecia I-TREATMENT una I-TREATMENT masa I-TREATMENT del I-TREATMENT tamaño I-TREATMENT de I-TREATMENT un I-TREATMENT puño I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT cabeza I-TREATMENT pancreática. I-TREATMENT Se I-TREATMENT aborda I-TREATMENT la I-TREATMENT arteria I-TREATMENT gastroduodenal I-TREATMENT que I-TREATMENT se I-TREATMENT liga I-TREATMENT en I-TREATMENT el I-TREATMENT origen I-TREATMENT para I-TREATMENT detener I-TREATMENT la I-TREATMENT principal I-TREATMENT fuente I-TREATMENT de I-TREATMENT sangre I-TREATMENT que I-TREATMENT alimenta I-TREATMENT el I-TREATMENT aneurisma. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT una I-TREATMENT gastrotomía I-TREATMENT comprobando I-TREATMENT la I-TREATMENT comunicación I-TREATMENT del I-TREATMENT pseudoquiste I-TREATMENT de I-TREATMENT la I-TREATMENT cola I-TREATMENT con I-TREATMENT la I-TREATMENT pared I-TREATMENT gástrica I-TREATMENT posterior I-TREATMENT y I-TREATMENT comprobando I-TREATMENT que I-TREATMENT no I-TREATMENT existe I-TREATMENT sangrado. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION es I-EVOLUTION favorable. I-EVOLUTION A B-DERIVED_FROM/TO los I-DERIVED_FROM/TO pocos I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO intervención, I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO haber I-DERIVED_FROM/TO repuesto I-DERIVED_FROM/TO en I-DERIVED_FROM/TO las I-DERIVED_FROM/TO primeras I-DERIVED_FROM/TO horas I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hematocrito, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO aprecia I-DERIVED_FROM/TO una I-DERIVED_FROM/TO disminución I-DERIVED_FROM/TO progresiva I-DERIVED_FROM/TO de I-DERIVED_FROM/TO los I-DERIVED_FROM/TO valores I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hemoglobina, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO se I-DERIVED_FROM/TO remite I-DERIVED_FROM/TO al I-DERIVED_FROM/TO enfermo I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO radiología I-DERIVED_FROM/TO intervencionista. I-DERIVED_FROM/TO Se B-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION arteriografía I-EXPLORATION selectiva I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION no I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION acceder I-EXPLORATION al I-EXPLORATION pseudoaneurisma I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION principal I-EXPLORATION que I-EXPLORATION lo I-EXPLORATION nutre, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION la I-EXPLORATION gastroduodenal, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION accede I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION ramas I-EXPLORATION arteriales I-EXPLORATION secundarias I-EXPLORATION que I-EXPLORATION proceden I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pancreático-yeyunal. I-EXPLORATION Se B-TREATMENT consigue I-TREATMENT excluir I-TREATMENT por I-TREATMENT completo I-TREATMENT el I-TREATMENT pseudoaneurisma. I-TREATMENT En B-EVOLUTION los I-EVOLUTION días I-EVOLUTION siguientes I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION estable I-EVOLUTION y I-EVOLUTION no I-EVOLUTION se I-EVOLUTION evidencian I-EVOLUTION nuevos I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION sangrado. I-EVOLUTION Tras I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY histerectomía, I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY renales, I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY B, I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY megaloblástica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY biliares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION hemiabdomen I-EXPLORATION superior, I-EXPLORATION especialmente I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho. I-EXPLORATION Analítica I-EXPLORATION al I-EXPLORATION ingreso: I-EXPLORATION 17 I-EXPLORATION x I-EXPLORATION 109/l I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION 86% I-EXPLORATION de I-EXPLORATION neutrofilia; I-EXPLORATION amilasemia I-EXPLORATION 5.203 I-EXPLORATION U/l; I-EXPLORATION amilasuria I-EXPLORATION 43.703 I-EXPLORATION U/l; I-EXPLORATION LDH I-EXPLORATION 675 I-EXPLORATION U/l; I-EXPLORATION bilirubina I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 55 I-EXPLORATION mg/dl; I-EXPLORATION GOT I-EXPLORATION 111 I-EXPLORATION U/L; I-EXPLORATION GPT I-EXPLORATION 152 I-EXPLORATION U/l; I-EXPLORATION GGT I-EXPLORATION 203 I-EXPLORATION U/l; I-EXPLORATION PH I-EXPLORATION 7.222, I-EXPLORATION PCO2 I-EXPLORATION 28, I-EXPLORATION 8 I-EXPLORATION mmHg; I-EXPLORATION PO2 I-EXPLORATION 80 I-EXPLORATION mmHg; I-EXPLORATION bicarbonato I-EXPLORATION 13, I-EXPLORATION 7 I-EXPLORATION mmol/l; I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION normales. I-EXPLORATION A I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION horas I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION mantiene I-EXPLORATION cifras I-EXPLORATION similares I-EXPLORATION de I-EXPLORATION amilasemia I-EXPLORATION y I-EXPLORATION amilasuria I-EXPLORATION con I-EXPLORATION alteraciones I-EXPLORATION graves I-EXPLORATION de I-EXPLORATION la I-EXPLORATION coagulación: I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 50%; I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION cefalina I-EXPLORATION 48, I-EXPLORATION 2 I-EXPLORATION s. I-EXPLORATION Por I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION del I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION aprecia: I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION litiásica, I-EXPLORATION coledocolitiasis, I-EXPLORATION aumento I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION del I-EXPLORATION páncreas I-EXPLORATION y I-EXPLORATION ascitis, I-EXPLORATION apreciándose I-EXPLORATION en I-EXPLORATION bazo I-EXPLORATION múltiples I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION infarto. I-EXPLORATION A B-TREATMENT los I-TREATMENT tres I-TREATMENT días I-TREATMENT del I-TREATMENT ingreso I-TREATMENT se I-TREATMENT practica I-TREATMENT esfinterotomía I-TREATMENT endoscópica. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evoluciona I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION tórpida, I-EVOLUTION falleciendo I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 17 I-EVOLUTION días I-EVOLUTION por I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION shock I-EVOLUTION hemorrágico I-EVOLUTION de I-EVOLUTION origen I-EVOLUTION digestivo. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY quistes I-PAST_MEDICAL_HISTORY renales I-PAST_MEDICAL_HISTORY bilaterales, I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY úlcera I-PAST_MEDICAL_HISTORY duodenal, I-PAST_MEDICAL_HISTORY dislipemia, I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY I I-PAST_MEDICAL_HISTORY (índice I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY masa I-PAST_MEDICAL_HISTORY corporal I-PAST_MEDICAL_HISTORY 33, I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY kg/m2) I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY prolactinoma. I-PAST_MEDICAL_HISTORY Presenta B-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS suprarrenal I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS no I-PRESENT_ILLNESS funcionante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS tamaño, I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS TC I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS Se B-TREATMENT efectuó I-TREATMENT un I-TREATMENT abordaje I-TREATMENT laparoscópico, I-TREATMENT con I-TREATMENT liberación I-TREATMENT del I-TREATMENT ángulo I-TREATMENT esplénico I-TREATMENT del I-TREATMENT colon I-TREATMENT y I-TREATMENT movilización I-TREATMENT medial I-TREATMENT espleno-pancreática; I-TREATMENT sección I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT principal I-TREATMENT adrenal I-TREATMENT izquierda I-TREATMENT y I-TREATMENT de I-TREATMENT los I-TREATMENT vasos I-TREATMENT accesorios I-TREATMENT venosos I-TREATMENT y I-TREATMENT arteriales; I-TREATMENT exéresis I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT glándula I-TREATMENT adrenal I-TREATMENT tumoral, I-TREATMENT revisión I-TREATMENT de I-TREATMENT la I-TREATMENT hemostasia I-TREATMENT y I-TREATMENT extracción I-TREATMENT de I-TREATMENT la I-TREATMENT pieza I-TREATMENT en I-TREATMENT una I-TREATMENT bolsa I-TREATMENT preformada I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT minilaparotomía I-TREATMENT transversa. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION heterogéneo, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION hemorrágicas, I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION parduzcas, I-EXPLORATION áreas I-EXPLORATION amarillentas I-EXPLORATION y I-EXPLORATION extensas I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION hemorrágicas; I-EXPLORATION también I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION septos I-EXPLORATION con I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION calcificación. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION cortical I-EXPLORATION suprarrenal I-EXPLORATION (14 I-EXPLORATION x I-EXPLORATION 12 I-EXPLORATION x I-EXPLORATION 11, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro). I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS hospitalizada I-PRESENT_ILLNESS doce I-PRESENT_ILLNESS días I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuidado I-PRESENT_ILLNESS intensivo, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS epigastralgia I-PRESENT_ILLNESS no I-PRESENT_ILLNESS irradiada, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cede I-PRESENT_ILLNESS con I-PRESENT_ILLNESS administración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ranitidina, I-PRESENT_ILLNESS valorada I-PRESENT_ILLNESS inicialmente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias, I-PRESENT_ILLNESS donde B-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION hiperamilasemia I-EXPLORATION e I-EXPLORATION hipertrigliceridemia I-EXPLORATION (5.080 I-EXPLORATION mg/dl) I-EXPLORATION con I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION hígado I-EXPLORATION y I-EXPLORATION vías I-EXPLORATION biliares I-EXPLORATION más I-EXPLORATION colangiorresonancia I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Por I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION deshidratación I-EXPLORATION grado I-EXPLORATION III, I-EXPLORATION SIRS I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION severo, I-EXPLORATION se I-EXPLORATION manejó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION unidad I-EXPLORATION de I-EXPLORATION cuidado I-EXPLORATION intensivo. I-EXPLORATION Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dislipidemia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY manejo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lovastatina I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY gemfibrozilo I-PAST_MEDICAL_HISTORY irregularmente, I-PAST_MEDICAL_HISTORY adicionalmente I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY productos I-PAST_MEDICAL_HISTORY homeopáticos I-PAST_MEDICAL_HISTORY (espirulina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vinagre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY manzana), I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY G2P1C1 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY planifica I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anticonceptivos I-PAST_MEDICAL_HISTORY orales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION de I-EXPLORATION ingreso, I-EXPLORATION como I-EXPLORATION hallazgos I-EXPLORATION relevantes I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION paciente I-EXPLORATION somnolienta, I-EXPLORATION taquicárdica, I-EXPLORATION taquipneica, I-EXPLORATION deshidratada; I-EXPLORATION signos I-EXPLORATION vitales: I-EXPLORATION TA I-EXPLORATION 114/70; I-EXPLORATION FC: I-EXPLORATION 105 I-EXPLORATION por I-EXPLORATION minuto; I-EXPLORATION FR: I-EXPLORATION 28 I-EXPLORATION por I-EXPLORATION min: I-EXPLORATION SaO2: I-EXPLORATION 90% I-EXPLORATION con I-EXPLORATION FIO2 I-EXPLORATION 28%; I-EXPLORATION IMC I-EXPLORATION 32, I-EXPLORATION 5, I-EXPLORATION abdomen I-EXPLORATION blando I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION epigastrio I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal, I-EXPLORATION sin I-EXPLORATION otro I-EXPLORATION hallazgo I-EXPLORATION anormal I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico. I-EXPLORATION Se I-EXPLORATION hace I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION aguda I-EXPLORATION severa I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION hipertrigliceridemia, I-EXPLORATION con I-EXPLORATION puntuación I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION en I-EXPLORATION APACHE I-EXPLORATION inicial I-EXPLORATION y I-EXPLORATION 5 I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION TAC I-EXPLORATION contrastada I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION Baltazar I-EXPLORATION E I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION menos I-EXPLORATION del I-EXPLORATION 30%. I-EXPLORATION Se B-TREATMENT manejó I-TREATMENT multidisciplinariamente I-TREATMENT con I-TREATMENT los I-TREATMENT servicios I-TREATMENT de I-TREATMENT gastroenterología I-TREATMENT y I-TREATMENT soporte I-TREATMENT nutricional, I-TREATMENT se I-TREATMENT inició I-TREATMENT infusión I-TREATMENT de I-TREATMENT insulina I-TREATMENT con I-TREATMENT descenso I-TREATMENT significativo I-TREATMENT de I-TREATMENT triglicéridos I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT horas I-TREATMENT (valor I-TREATMENT inicial I-TREATMENT 5.080, I-TREATMENT control I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT h: I-TREATMENT 369), I-TREATMENT al I-TREATMENT séptimo I-TREATMENT día I-TREATMENT se I-TREATMENT observó I-TREATMENT aumento I-TREATMENT de I-TREATMENT leucocitos, I-TREATMENT persistencia I-TREATMENT de I-TREATMENT taquicardia I-TREATMENT y I-TREATMENT PCR I-TREATMENT mayor I-TREATMENT a I-TREATMENT 16 I-TREATMENT mg/dl, I-TREATMENT por I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT decidió I-TREATMENT iniciar I-TREATMENT cubrimiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT meropenem. I-TREATMENT Al B-EVOLUTION noveno I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION mostraba I-EVOLUTION una I-EVOLUTION apariencia I-EVOLUTION clínica I-EVOLUTION normal I-EVOLUTION sin I-EVOLUTION dolor, I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION leucocitosis I-EVOLUTION y I-EVOLUTION bandemia; I-EVOLUTION dada I-EVOLUTION su I-EVOLUTION evolución, I-EVOLUTION se I-EVOLUTION decide I-EVOLUTION traslado I-EVOLUTION a I-EVOLUTION planta. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS constitucional I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tenesmo I-PRESENT_ILLNESS rectal. I-PRESENT_ILLNESS Presentaba B-EXPLORATION molestias I-EXPLORATION abdominales I-EXPLORATION difusas I-EXPLORATION y, I-EXPLORATION al I-EXPLORATION tacto, I-EXPLORATION un I-EXPLORATION recto I-EXPLORATION rígido I-EXPLORATION a I-EXPLORATION punta I-EXPLORATION de I-EXPLORATION dedo. I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION metástasis I-EXPLORATION pulmonares I-EXPLORATION y I-EXPLORATION hepáticas. I-EXPLORATION La I-EXPLORATION rectocolonoscopia I-EXPLORATION mostró I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pliegues I-EXPLORATION mucosos I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION pseudopolipoide I-EXPLORATION y I-EXPLORATION duro I-EXPLORATION del I-EXPLORATION 7º I-EXPLORATION al I-EXPLORATION 15º I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION margen I-EXPLORATION anal I-EXPLORATION con I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION intacta. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION carcinomatosa I-EXPLORATION rectal I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION mamario I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION lobulillar, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico: I-EXPLORATION citoqueratina I-EXPLORATION 7 I-EXPLORATION +, I-EXPLORATION citoqueratina I-EXPLORATION 20 I-EXPLORATION -, I-EXPLORATION e-cadherina I-EXPLORATION - I-EXPLORATION y I-EXPLORATION receptores I-EXPLORATION estrogénicos I-EXPLORATION +. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION mamográfico I-EXPLORATION dirigido I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION espiculación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mama I-EXPLORATION izquierda, I-EXPLORATION cuya I-EXPLORATION biopsia I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION gruesa I-EXPLORATION (BAG) I-EXPLORATION remedó I-EXPLORATION la I-EXPLORATION rectal. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION (TAC) I-EXPLORATION abdominopélvica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION rectal I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION el I-EXPLORATION saco I-EXPLORATION de I-EXPLORATION Douglas I-EXPLORATION y I-EXPLORATION destruía I-EXPLORATION los I-EXPLORATION planos I-EXPLORATION "de I-EXPLORATION clivaje" I-EXPLORATION rectouterinos. I-EXPLORATION I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION al I-EXPLORATION alta I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION lobulillar I-EXPLORATION mamario I-EXPLORATION izquierdo I-EXPLORATION en I-EXPLORATION estadio I-EXPLORATION IV, I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION rectales. I-EXPLORATION En B-TREATMENT la I-TREATMENT actualidad I-TREATMENT sigue I-TREATMENT régimen I-TREATMENT quimioterápico I-TREATMENT ambulatorio I-TREATMENT con I-TREATMENT pobre I-TREATMENT respuesta I-TREATMENT clínica I-TREATMENT y I-TREATMENT mal I-TREATMENT tolerado. I-TREATMENT En B-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION sufrido I-EVOLUTION complicación I-EVOLUTION alguna I-EVOLUTION que I-EVOLUTION haya I-EVOLUTION requerido I-EVOLUTION cirugía I-EVOLUTION paliativa. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY penicilina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY características I-PAST_MEDICAL_HISTORY similares I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY actual. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS periumbilical I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS irradió I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS FID, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carácter I-PRESENT_ILLNESS continuo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS deambulación. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS días I-PRESENT_ILLNESS previos. I-PRESENT_ILLNESS Ausencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mareo. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hábito I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS miccional. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION afebril, I-EXPLORATION normotenso I-EXPLORATION y I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION Presentaba I-EXPLORATION abdomen I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible, I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION ni I-EXPLORATION megalias, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION FID I-EXPLORATION e I-EXPLORATION hipogastrio, I-EXPLORATION con I-EXPLORATION defensa I-EXPLORATION y I-EXPLORATION peritonismo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacaba I-EXPLORATION leucocitosis I-EXPLORATION (13.390 I-EXPLORATION x I-EXPLORATION 103/mcl) I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (66,7%). I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT apendicitis I-TREATMENT aguda I-TREATMENT se I-TREATMENT intervino I-TREATMENT de I-TREATMENT forma I-TREATMENT urgente I-TREATMENT encontrando I-TREATMENT divertículo I-TREATMENT en I-TREATMENT cara I-TREATMENT anterior I-TREATMENT de I-TREATMENT ciego I-TREATMENT inflamado I-TREATMENT y I-TREATMENT necrótico I-TREATMENT por I-TREATMENT fecalito I-TREATMENT impactado I-TREATMENT en I-TREATMENT su I-TREATMENT interior I-TREATMENT y I-TREATMENT apéndice I-TREATMENT ileocecal I-TREATMENT hiperémico. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT apendicectomía I-TREATMENT reglada I-TREATMENT y I-TREATMENT diverticulectomía I-TREATMENT con I-TREATMENT sutura I-TREATMENT manual I-TREATMENT transversal I-TREATMENT con I-TREATMENT Byosin® I-TREATMENT 2-0, I-TREATMENT dejando I-TREATMENT drenaje I-TREATMENT de I-TREATMENT Penrose. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION el I-EVOLUTION 12º I-EVOLUTION día I-EVOLUTION postoperatorio I-EVOLUTION completamente I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION reveló I-EXPLORATION apéndice I-EXPLORATION ileocecal, I-EXPLORATION periapendicitis, I-EXPLORATION fecalito I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION grueso I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION severa I-EXPLORATION inflamación I-EXPLORATION aguda. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS naturales B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Perú, I-PAST_MEDICAL_HISTORY sin I-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 acuden I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS doce I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS epigástrico, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS irradiado, I-PRESENT_ILLNESS continuo, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY referían I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY noche I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY ingesta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY comida I-PAST_MEDICAL_HISTORY típica I-PAST_MEDICAL_HISTORY peruana, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pescado I-PAST_MEDICAL_HISTORY crudo. I-PAST_MEDICAL_HISTORY El B-EXPLORATION abdomen I-EXPLORATION era I-EXPLORATION blando, I-EXPLORATION depresible I-EXPLORATION pero I-EXPLORATION doloroso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION epigastrio. I-EXPLORATION No I-EXPLORATION había I-EXPLORATION masas, I-EXPLORATION organomegalias I-EXPLORATION abdominales I-EXPLORATION ni I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal. I-EXPLORATION Se I-EXPLORATION observó I-EXPLORATION leucocitosis I-EXPLORATION importante I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (16.000 I-EXPLORATION L), I-EXPLORATION sin I-EXPLORATION eosinofilia. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION endoscópico I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION pacientes I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION incontables I-EXPLORATION AS I-EXPLORATION adheridos I-EXPLORATION a I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION duodenal, I-EXPLORATION la I-EXPLORATION mayoría I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION agrupados I-EXPLORATION en I-EXPLORATION nidos I-EXPLORATION con I-EXPLORATION más I-EXPLORATION de I-EXPLORATION diez I-EXPLORATION parásitos. I-EXPLORATION También I-EXPLORATION los I-EXPLORATION había I-EXPLORATION aislados I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION pliegues I-EXPLORATION mucosos, I-EXPLORATION donde I-EXPLORATION producían I-EXPLORATION intenso I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION erosiones I-EXPLORATION por I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION duodenal. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT extracción I-TREATMENT de I-TREATMENT los I-TREATMENT mismos I-TREATMENT mediante I-TREATMENT pinza I-TREATMENT de I-TREATMENT biopsia. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticada B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hiato I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intolerancia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY lactosa. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS porque I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS diarreico, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS con I-PRESENT_ILLNESS rectorragia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION estudio I-EXPLORATION bioquímico I-EXPLORATION y I-EXPLORATION hematológico I-EXPLORATION que I-EXPLORATION es I-EXPLORATION normal, I-EXPLORATION incluyendo I-EXPLORATION hormonas I-EXPLORATION tiroideas I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION hepático. I-EXPLORATION Los I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION CEA, I-EXPLORATION CA. I-EXPLORATION 125 I-EXPLORATION y I-EXPLORATION CA I-EXPLORATION 19.9 I-EXPLORATION fueron I-EXPLORATION también I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION que I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION izquierda, I-EXPLORATION existe I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION redondeada, I-EXPLORATION ligeramente I-EXPLORATION hiperecogénica, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 45 I-EXPLORATION mm, I-EXPLORATION que I-EXPLORATION pudiera I-EXPLORATION corresponder I-EXPLORATION a I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION intraluminal I-EXPLORATION o I-EXPLORATION un I-EXPLORATION artefacto I-EXPLORATION por I-EXPLORATION heces. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION fibrocolonoscopia I-EXPLORATION para I-EXPLORATION observar I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION del I-EXPLORATION sigma, I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION polipoide, I-EXPLORATION lisa I-EXPLORATION y I-EXPLORATION nacarada I-EXPLORATION en I-EXPLORATION superficie I-EXPLORATION y I-EXPLORATION azulada I-EXPLORATION en I-EXPLORATION profundidad, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION dura, I-EXPLORATION desplazable, I-EXPLORATION no I-EXPLORATION apreciándose I-EXPLORATION pedículo I-EXPLORATION tras I-EXPLORATION inyectar I-EXPLORATION contraste. I-EXPLORATION Dada B-DERIVED_FROM/TO la I-DERIVED_FROM/TO naturaleza I-DERIVED_FROM/TO inespecífica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO lesión I-DERIVED_FROM/TO y I-DERIVED_FROM/TO la I-DERIVED_FROM/TO no I-DERIVED_FROM/TO obstrucción I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO luz I-DERIVED_FROM/TO colónica I-DERIVED_FROM/TO no I-DERIVED_FROM/TO se I-DERIVED_FROM/TO procede I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO colocación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO stent I-DERIVED_FROM/TO colónico I-DERIVED_FROM/TO y I-DERIVED_FROM/TO se I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO remitir I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO a I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valorar I-DERIVED_FROM/TO intervención I-DERIVED_FROM/TO quirúrgica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO lesión. I-DERIVED_FROM/TO Previo B-EXPLORATION a I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION le I-EXPLORATION hace I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION tumoración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION descendente I-EXPLORATION con I-EXPLORATION el I-EXPLORATION sigma I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION y I-EXPLORATION reducción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION intestinal. I-EXPLORATION A B-TREATMENT la I-TREATMENT paciente I-TREATMENT finalmente I-TREATMENT se I-TREATMENT le I-TREATMENT practicó I-TREATMENT una I-TREATMENT hemicolectomía I-TREATMENT izquierda. I-TREATMENT A I-TREATMENT la I-TREATMENT apertura I-TREATMENT se I-TREATMENT identifica I-TREATMENT una I-TREATMENT neoformación I-TREATMENT excrecente, I-TREATMENT polipoidea; I-TREATMENT externamente I-TREATMENT es I-TREATMENT de I-TREATMENT superficie I-TREATMENT lisa, I-TREATMENT con I-TREATMENT un I-TREATMENT pedículo I-TREATMENT de I-TREATMENT 2 I-TREATMENT cm I-TREATMENT de I-TREATMENT diámetro I-TREATMENT máximo I-TREATMENT y I-TREATMENT ocupa I-TREATMENT la I-TREATMENT luz I-TREATMENT intestinal I-TREATMENT casi I-TREATMENT por I-TREATMENT completo. I-TREATMENT A I-TREATMENT los I-TREATMENT cortes, I-TREATMENT dicha I-TREATMENT neoformación I-TREATMENT es I-TREATMENT blanquecina, I-TREATMENT amarillenta I-TREATMENT de I-TREATMENT consistencia I-TREATMENT elástica, I-TREATMENT aspecto I-TREATMENT homogéneo I-TREATMENT y I-TREATMENT parece I-TREATMENT estar I-TREATMENT rodeado I-TREATMENT por I-TREATMENT una I-TREATMENT pared I-TREATMENT que I-TREATMENT lo I-TREATMENT delimita I-TREATMENT en I-TREATMENT su I-TREATMENT mayor I-TREATMENT parte. I-TREATMENT Fue I-TREATMENT informada I-TREATMENT como I-TREATMENT un I-TREATMENT lipoma I-TREATMENT submucoso I-TREATMENT infartado I-TREATMENT con I-TREATMENT ulceración I-TREATMENT epitelial I-TREATMENT y I-TREATMENT necrosis I-TREATMENT grasa. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alcoholismo I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pseudoquiste I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cabeza I-PRESENT_ILLNESS pancreática I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS pancreatitis I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS alcohólica. I-PRESENT_ILLNESS Amilasemia B-EXPLORATION normal. I-EXPLORATION Tras B-TREATMENT tratamiento I-TREATMENT sintomático, I-TREATMENT el B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION disnea I-EVOLUTION progresiva I-EVOLUTION y I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION derecho I-EVOLUTION que B-TREATMENT mejora I-TREATMENT tras I-TREATMENT drenaje I-TREATMENT pleural. I-TREATMENT Una B-EXPLORATION colangio-RM I-EXPLORATION verifica I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION y I-EXPLORATION revela I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION volumen I-EXPLORATION del I-EXPLORATION pseudoquiste I-EXPLORATION con I-EXPLORATION probable I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION comunicación I-EXPLORATION entre I-EXPLORATION ducto I-EXPLORATION pancreático I-EXPLORATION y I-EXPLORATION pseudoquiste. I-EXPLORATION Posteriormente, B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION su I-EVOLUTION disnea, I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION rotura I-EVOLUTION del I-EVOLUTION pseudoquiste I-EVOLUTION y I-EVOLUTION difusión I-EVOLUTION a I-EVOLUTION cavidad I-EVOLUTION pleural I-EVOLUTION izquierda I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION hiato I-EVOLUTION esofágico. I-EVOLUTION Se B-TREATMENT realizó I-TREATMENT drenaje I-TREATMENT pleural, I-TREATMENT evidenciándose I-TREATMENT líquido I-TREATMENT pleural I-TREATMENT de I-TREATMENT características I-TREATMENT hemorrágicas, I-TREATMENT compatible I-TREATMENT con I-TREATMENT comunicación I-TREATMENT pancreático-pleural. I-TREATMENT Tras B-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION inicial, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION su I-EVOLUTION disnea I-EVOLUTION y I-EVOLUTION recurrencia I-EVOLUTION del I-EVOLUTION derrame, I-EVOLUTION realizándose B-TREATMENT un I-TREATMENT tercer I-TREATMENT drenaje I-TREATMENT pleural I-TREATMENT y I-TREATMENT pleurodesis. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION se B-TREATMENT decide I-TREATMENT tratamiento I-TREATMENT quirúgico I-TREATMENT definitivo I-TREATMENT del I-TREATMENT pseudoquiste. I-TREATMENT I-TREATMENT A I-TREATMENT los I-TREATMENT 25 I-TREATMENT días I-TREATMENT de I-TREATMENT su I-TREATMENT ingreso I-TREATMENT el I-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenido, I-TREATMENT realizándosele I-TREATMENT una I-TREATMENT cistogastrostomía I-TREATMENT a I-TREATMENT cara I-TREATMENT posterior I-TREATMENT gástrica I-TREATMENT con B-EVOLUTION mejoría I-EVOLUTION definitiva I-EVOLUTION y I-EVOLUTION reducción I-EVOLUTION del I-EVOLUTION pseudoquiste. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con B-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION que I-EXPLORATION evidenciaba I-EXPLORATION anemia, I-EXPLORATION trombopenia I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bilirrubina I-EXPLORATION y I-EXPLORATION enzimas I-EXPLORATION de I-EXPLORATION colestasis. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 13 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION segmentos I-EXPLORATION IV, I-EXPLORATION V I-EXPLORATION y I-EXPLORATION VIII. I-EXPLORATION Al B-EVOLUTION mes I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION falleció I-EVOLUTION por I-EVOLUTION shock I-EVOLUTION hipovolémico I-EVOLUTION con I-EVOLUTION una I-EVOLUTION autopsia I-EVOLUTION compatible I-EVOLUTION con I-EVOLUTION ASH. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY C, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS constitucional I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION presentaba I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bilirrubina I-EXPLORATION y I-EXPLORATION enzimas I-EXPLORATION de I-EXPLORATION colestasis. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION mostró I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION hepáticos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION versus I-EXPLORATION hepatocarcinoma I-EXPLORATION multicéntrico I-EXPLORATION con I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION en I-EXPLORATION bazo. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION falleció I-EVOLUTION por I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION hepática I-EVOLUTION con I-EVOLUTION una I-EVOLUTION autopsia I-EVOLUTION compatible I-EVOLUTION con I-EVOLUTION ASH I-EVOLUTION con I-EVOLUTION metástasis I-EVOLUTION esplénicas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS analítica I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evidenciaba I-PRESENT_ILLNESS trombopenia, I-PRESENT_ILLNESS elevación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS bilirrubina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS enzimas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS colestasis. I-PRESENT_ILLNESS La B-EXPLORATION TC I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION nódulos I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION bazo. I-EXPLORATION Al B-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION falleció I-EVOLUTION por I-EVOLUTION un I-EVOLUTION shock I-EVOLUTION hipovolémico I-EVOLUTION con I-EVOLUTION una I-EVOLUTION autopsia I-EVOLUTION compatible I-EVOLUTION con I-EVOLUTION ASH I-EVOLUTION con I-EVOLUTION metástasis I-EVOLUTION esplénicas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY con B-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS inespecífica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS incremento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS constitucional. I-PRESENT_ILLNESS Intervenido B-DERIVED_FROM/TO de I-DERIVED_FROM/TO urgencia I-DERIVED_FROM/TO en I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO con I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO de I-DERIVED_FROM/TO apendicitis, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO diagnosticó I-DERIVED_FROM/TO de I-DERIVED_FROM/TO pseudomixoma, I-DERIVED_FROM/TO practicándole I-DERIVED_FROM/TO exclusivamente I-DERIVED_FROM/TO toma I-DERIVED_FROM/TO de I-DERIVED_FROM/TO biopsias, I-DERIVED_FROM/TO y I-DERIVED_FROM/TO remitiéndolo I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO atención. I-DERIVED_FROM/TO A B-TREATMENT pesar I-TREATMENT de I-TREATMENT que I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT comprometía I-TREATMENT todas I-TREATMENT las I-TREATMENT regiones I-TREATMENT abdominales I-TREATMENT y I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT presentaba I-TREATMENT un I-TREATMENT índice I-TREATMENT de I-TREATMENT carcinomatosis I-TREATMENT peritoneal I-TREATMENT de I-TREATMENT 32, I-TREATMENT acorde I-TREATMENT con I-TREATMENT la I-TREATMENT clasificación I-TREATMENT de I-TREATMENT Sugarbaker I-TREATMENT (4), I-TREATMENT se I-TREATMENT consiguió I-TREATMENT realizar I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT intención I-TREATMENT curativa I-TREATMENT mediante I-TREATMENT citorreducción I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT macroscópica I-TREATMENT tipo I-TREATMENT CC0, I-TREATMENT precisando I-TREATMENT las I-TREATMENT 6 I-TREATMENT peritonectomías I-TREATMENT parietales I-TREATMENT con I-TREATMENT omentectomía I-TREATMENT mayor I-TREATMENT y I-TREATMENT menor, I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT resección I-TREATMENT del I-TREATMENT tumor I-TREATMENT primario I-TREATMENT mediante I-TREATMENT apendicectomía I-TREATMENT con I-TREATMENT cequectomía. I-TREATMENT Se I-TREATMENT completó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT posible I-TREATMENT enfermedad I-TREATMENT microscópica I-TREATMENT residual I-TREATMENT con I-TREATMENT QIIH I-TREATMENT con I-TREATMENT mitomicina I-TREATMENT C I-TREATMENT a I-TREATMENT 12 I-TREATMENT mg/m2 I-TREATMENT disueltos I-TREATMENT en I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT l I-TREATMENT de I-TREATMENT solución I-TREATMENT de I-TREATMENT diálisis I-TREATMENT peritoneal I-TREATMENT de I-TREATMENT dianeal I-TREATMENT al I-TREATMENT 0, I-TREATMENT 33% I-TREATMENT a I-TREATMENT 42 I-TREATMENT ºC I-TREATMENT durante I-TREATMENT 60 I-TREATMENT min, I-TREATMENT con I-TREATMENT un I-TREATMENT flujo I-TREATMENT de I-TREATMENT perfusión I-TREATMENT continua I-TREATMENT de I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT l/min, I-TREATMENT mediante I-TREATMENT la I-TREATMENT técnica I-TREATMENT abierta I-TREATMENT o I-TREATMENT "técnica I-TREATMENT de I-TREATMENT coliseo". I-TREATMENT Durante I-TREATMENT su I-TREATMENT estancia I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT de I-TREATMENT cuidados I-TREATMENT intensivos, I-TREATMENT recibió I-TREATMENT QIPP I-TREATMENT los I-TREATMENT días I-TREATMENT 1º I-TREATMENT a I-TREATMENT 5º I-TREATMENT del I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT con I-TREATMENT 5-fluorouracilo I-TREATMENT 750 I-TREATMENT mg/m2 I-TREATMENT en I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT l I-TREATMENT de I-TREATMENT glucosado I-TREATMENT al I-TREATMENT 5% I-TREATMENT durante I-TREATMENT 23 I-TREATMENT horas. I-TREATMENT Su B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION satisfactoria I-EVOLUTION con I-EVOLUTION estancia I-EVOLUTION de I-EVOLUTION 19 I-EVOLUTION días I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION vivo I-EVOLUTION y I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION más I-EVOLUTION de I-EVOLUTION 10 I-EVOLUTION años I-EVOLUTION después, I-EVOLUTION habiendo I-EVOLUTION sufrido I-EVOLUTION un I-EVOLUTION AVC I-EVOLUTION por I-EVOLUTION HTA, I-EVOLUTION con I-EVOLUTION hemiplejía I-EVOLUTION residual. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS entre B-PAST_MEDICAL_HISTORY cuyos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY únicamente I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY amigdalectomizado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY neumonía I-PAST_MEDICAL_HISTORY adquirida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY comunidad. I-PAST_MEDICAL_HISTORY Es I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY crónico. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Presentaba I-PAST_MEDICAL_HISTORY dolores I-PAST_MEDICAL_HISTORY abdominales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY supuesto I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY hospitalarios I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY amilasa I-PAST_MEDICAL_HISTORY elevadas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pancreatitis I-PAST_MEDICAL_HISTORY aguda, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY pudiera I-PAST_MEDICAL_HISTORY alcanzar I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY etiológico. I-PAST_MEDICAL_HISTORY Por I-PAST_MEDICAL_HISTORY ello I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY realizando I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY consultas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gastroenterología. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizaron I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY analíticas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY plasmático I-PAST_MEDICAL_HISTORY rondaban I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY límites I-PAST_MEDICAL_HISTORY superiores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY normalidad I-PAST_MEDICAL_HISTORY (considerando I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY rangos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY normalidad I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY sérico I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 8, I-PAST_MEDICAL_HISTORY 4-10, I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY mg/dl), I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY llegar I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY francamente I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY caso. I-PAST_MEDICAL_HISTORY Es I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY destacar I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY pancreatitis I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY siempre I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS nuevamente I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS epigastrio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS irradiación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS hipocondrios. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS era I-PRESENT_ILLNESS continuo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS le I-PRESENT_ILLNESS limitaba I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta. I-PRESENT_ILLNESS Analíticamente B-EXPLORATION destacaba I-EXPLORATION a I-EXPLORATION su I-EXPLORATION recepción: I-EXPLORATION I-EXPLORATION -Hb: I-EXPLORATION 13, I-EXPLORATION 8 I-EXPLORATION g/dl; I-EXPLORATION Hcto: I-EXPLORATION 40%; I-EXPLORATION leucocitos: I-EXPLORATION 13400 I-EXPLORATION (81% I-EXPLORATION neutrófilos). I-EXPLORATION I-EXPLORATION -Glucosa: I-EXPLORATION 99 I-EXPLORATION mg/dl; I-EXPLORATION urea: I-EXPLORATION 33 I-EXPLORATION mg/dl; I-EXPLORATION creatinina: I-EXPLORATION 1, I-EXPLORATION 03 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION -Amilasa I-EXPLORATION plasmática: I-EXPLORATION 1980 I-EXPLORATION U/l; I-EXPLORATION lipasa: I-EXPLORATION 630 I-EXPLORATION U/l. I-EXPLORATION I-EXPLORATION -Colesterol: I-EXPLORATION 210 I-EXPLORATION mg/dl; I-EXPLORATION triglicéridos: I-EXPLORATION 98 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION -Proteínas: I-EXPLORATION 7, I-EXPLORATION 1 I-EXPLORATION g/dl; I-EXPLORATION albúmina: I-EXPLORATION 4, I-EXPLORATION 5 I-EXPLORATION g/dl. I-EXPLORATION I-EXPLORATION -Calcio: I-EXPLORATION 11, I-EXPLORATION 7 I-EXPLORATION mg I-EXPLORATION mg/dl; I-EXPLORATION ácido I-EXPLORATION úrico: I-EXPLORATION 6, I-EXPLORATION 9 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION aguda I-EXPLORATION se I-EXPLORATION realizan I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION primero, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecoendoscopia I-EXPLORATION posteriormente, I-EXPLORATION en I-EXPLORATION las I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION litiasis, I-EXPLORATION microlitiasis I-EXPLORATION ni I-EXPLORATION barro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION páncreas I-EXPLORATION edematoso I-EXPLORATION y I-EXPLORATION desestructurado, I-EXPLORATION sin I-EXPLORATION más I-EXPLORATION hallazgos. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION exploraciones I-EXPLORATION en I-EXPLORATION cuanto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION etiología I-EXPLORATION del I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION pancreatitis, I-EXPLORATION se I-EXPLORATION postuló I-EXPLORATION una I-EXPLORATION posible I-EXPLORATION relación I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION con I-EXPLORATION la I-EXPLORATION hipercalcemia I-EXPLORATION objetivada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION rutinaria I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION a I-EXPLORATION su I-EXPLORATION ingreso. I-EXPLORATION Así, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION calcio I-EXPLORATION plasmático I-EXPLORATION y I-EXPLORATION de I-EXPLORATION paratohormona I-EXPLORATION intacta I-EXPLORATION (PTHi), I-EXPLORATION cuyos I-EXPLORATION valores I-EXPLORATION fueron I-EXPLORATION respectivamente I-EXPLORATION de I-EXPLORATION 11, I-EXPLORATION 9 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION 451 I-EXPLORATION pg/ml I-EXPLORATION (valores I-EXPLORATION normales I-EXPLORATION por I-EXPLORATION debajo I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION pg/ml), I-EXPLORATION confirmándose I-EXPLORATION la I-EXPLORATION hipercalcemia I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION hiperparatiroidismo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION de I-EVOLUTION su I-EVOLUTION pancreatitis I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION ulteriores, I-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION amilasa I-EVOLUTION y I-EVOLUTION lipasa, I-EVOLUTION obtención I-EVOLUTION de I-EVOLUTION una I-EVOLUTION correcta I-EVOLUTION tolerancia I-EVOLUTION oral I-EVOLUTION y I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION dolor. I-EVOLUTION Cuando B-EXPLORATION se I-EXPLORATION hubo I-EXPLORATION resuelto I-EXPLORATION por I-EXPLORATION completo I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION gammagrafía I-EXPLORATION con I-EXPLORATION Tc99-Sestamibi, I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION captación I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION adenoma I-EXPLORATION paratiroideo I-EXPLORATION inferior I-EXPLORATION derecho. I-EXPLORATION Días B-TREATMENT más I-TREATMENT tarde I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT intervino I-TREATMENT quirúrgicamente, I-TREATMENT hallándose I-TREATMENT dicha I-TREATMENT lesión I-TREATMENT y I-TREATMENT procediéndose I-TREATMENT a I-TREATMENT su I-TREATMENT extirpación. I-TREATMENT Se B-EXPLORATION comprobó I-EXPLORATION intraoperatoriamente I-EXPLORATION el I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION PTHi. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION confirmó I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION un I-EXPLORATION adenoma I-EXPLORATION paratiroideo. I-EXPLORATION I-EXPLORATION Tras B-EVOLUTION este I-EVOLUTION episodio I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION referir I-EVOLUTION más I-EVOLUTION cuadros I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION en I-EVOLUTION las I-EVOLUTION revisiones I-EVOLUTION posteriores. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 73 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diabético B-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertenso I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY sigue I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico. I-PAST_MEDICAL_HISTORY Dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY tóxica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY amoxicilina-clavulánico. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY especialista I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Aparato I-PAST_MEDICAL_HISTORY Digestivo. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY discretamente I-PAST_MEDICAL_HISTORY elevadas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio I-PAST_MEDICAL_HISTORY plasmático, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY hubiera I-PAST_MEDICAL_HISTORY llegado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY filiar I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dicha I-PAST_MEDICAL_HISTORY alteración I-PAST_MEDICAL_HISTORY analítica. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY tratamientos I-PAST_MEDICAL_HISTORY crónicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pancreatitis I-PRESENT_ILLNESS aguda, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico, I-PRESENT_ILLNESS intolerancia I-PRESENT_ILLNESS oral, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS elevación I-PRESENT_ILLNESS significativa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS cifras I-PRESENT_ILLNESS de I-PRESENT_ILLNESS amilasa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lipasa, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS el I-PRESENT_ILLNESS resto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS datos I-PRESENT_ILLNESS analíticos I-PRESENT_ILLNESS anodinos. I-PRESENT_ILLNESS La B-EVOLUTION evolución I-EVOLUTION es I-EVOLUTION favorable I-EVOLUTION en I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION días, I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION reinstauración I-EVOLUTION de I-EVOLUTION la I-EVOLUTION dieta I-EVOLUTION oral. I-EVOLUTION No I-EVOLUTION obstante, I-EVOLUTION sufre I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION súbita I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION su I-EVOLUTION situación I-EVOLUTION clínica, I-EVOLUTION con I-EVOLUTION aparición I-EVOLUTION nuevamente I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION deterioro I-EVOLUTION progresivo I-EVOLUTION del I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION conciencia, I-EVOLUTION con I-EVOLUTION episodios I-EVOLUTION fluctuantes I-EVOLUTION de I-EVOLUTION desconexión I-EVOLUTION del I-EVOLUTION medio, I-EVOLUTION objetivándose I-EVOLUTION además, I-EVOLUTION en I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION analíticos I-EVOLUTION llevados I-EVOLUTION a I-EVOLUTION cabo I-EVOLUTION esos I-EVOLUTION días, I-EVOLUTION elevación I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION calcio I-EVOLUTION total, I-EVOLUTION alcanzándose I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION 15, I-EVOLUTION 5 I-EVOLUTION mg/dl I-EVOLUTION (rangos I-EVOLUTION de I-EVOLUTION normalidad I-EVOLUTION del I-EVOLUTION calcio I-EVOLUTION sérico I-EVOLUTION entre I-EVOLUTION 8, I-EVOLUTION 4-10, I-EVOLUTION 4 I-EVOLUTION mg/dl). I-EVOLUTION Se B-EXPLORATION determinaron I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION paratohormona I-EXPLORATION intacta I-EXPLORATION (PTHi): I-EXPLORATION 311, I-EXPLORATION 2 I-EXPLORATION pg/ml I-EXPLORATION (valores I-EXPLORATION de I-EXPLORATION normalidad I-EXPLORATION < I-EXPLORATION 9 I-EXPLORATION pg/ml) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION informaba I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION quístico I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION lóbulo I-EXPLORATION tiroideo I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION requirió I-EVOLUTION ingreso I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos, I-EVOLUTION con I-EVOLUTION mala I-EVOLUTION evolución I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores. I-EVOLUTION No I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION corregir I-EVOLUTION la I-EVOLUTION hipercalcemia I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION médico I-EVOLUTION intensivo I-EVOLUTION y I-EVOLUTION la I-EVOLUTION PTHi I-EVOLUTION alcanzó I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION 1.900 I-EVOLUTION pg/ml. I-EVOLUTION Se B-TREATMENT intervino I-TREATMENT quirúrgicamente, I-TREATMENT extirpándose I-TREATMENT un I-TREATMENT nódulo I-TREATMENT paratiroideo I-TREATMENT dependiente I-TREATMENT de I-TREATMENT la I-TREATMENT glándula I-TREATMENT superior I-TREATMENT izquierda, I-TREATMENT tras I-TREATMENT lo I-TREATMENT que I-TREATMENT la I-TREATMENT PTHi I-TREATMENT descendió I-TREATMENT a I-TREATMENT 324, I-TREATMENT 7 I-TREATMENT pg/ml, I-TREATMENT llegando I-TREATMENT a I-TREATMENT normalizarse I-TREATMENT en I-TREATMENT las I-TREATMENT horas I-TREATMENT siguientes. I-TREATMENT El B-EVOLUTION calcio I-EVOLUTION plasmático I-EVOLUTION ionizado I-EVOLUTION disminuyó I-EVOLUTION igualmente, I-EVOLUTION consiguiéndose I-EVOLUTION valores I-EVOLUTION en I-EVOLUTION el I-EVOLUTION límite I-EVOLUTION alto I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad. I-EVOLUTION No I-EVOLUTION obstante, I-EVOLUTION y I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION de I-EVOLUTION soporte, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION pudo I-EVOLUTION superar I-EVOLUTION un I-EVOLUTION shock I-EVOLUTION refractario I-EVOLUTION con I-EVOLUTION intensa I-EVOLUTION acidosis I-EVOLUTION metabólica I-EVOLUTION láctica, I-EVOLUTION falleciendo I-EVOLUTION por I-EVOLUTION asistolia I-EVOLUTION sin I-EVOLUTION respuesta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION maniobras I-EVOLUTION de I-EVOLUTION reanimación. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fallo I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS nutrición I-PRESENT_ILLNESS parenteral I-PRESENT_ILLNESS domiciliaria I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Presentaba B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY quirúrgicamente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2002. I-PAST_MEDICAL_HISTORY Tras B-TREATMENT cuatro I-TREATMENT años I-TREATMENT de I-TREATMENT buen I-TREATMENT estado I-TREATMENT general I-TREATMENT y I-TREATMENT una I-TREATMENT reducción I-TREATMENT importante I-TREATMENT de I-TREATMENT peso I-TREATMENT presentó I-TREATMENT un I-TREATMENT vólvulo I-TREATMENT intestinal, I-TREATMENT que I-TREATMENT obligó I-TREATMENT a I-TREATMENT la I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT totalidad I-TREATMENT del I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT y I-TREATMENT colon I-TREATMENT derecho. I-TREATMENT El B-EVOLUTION tracto I-EVOLUTION digestivo I-EVOLUTION quedó I-EVOLUTION cerrado I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cuarta I-EVOLUTION porción I-EVOLUTION duodenal I-EVOLUTION sin I-EVOLUTION continuidad I-EVOLUTION con I-EVOLUTION el I-EVOLUTION colon I-EVOLUTION transverso, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION era I-EVOLUTION portador I-EVOLUTION de I-EVOLUTION una I-EVOLUTION gastrostomía I-EVOLUTION de I-EVOLUTION descarga. I-EVOLUTION Debido I-EVOLUTION a I-EVOLUTION la I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION la I-EVOLUTION totalidad I-EVOLUTION del I-EVOLUTION intestino I-EVOLUTION delgado, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION con I-EVOLUTION nutrición I-EVOLUTION parenteral I-EVOLUTION domiciliaria, I-EVOLUTION sin I-EVOLUTION la I-EVOLUTION posibilidad I-EVOLUTION de I-EVOLUTION ningún I-EVOLUTION tipo I-EVOLUTION de I-EVOLUTION rehabilitación I-EVOLUTION intestinal. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION remitido I-EVOLUTION a I-EVOLUTION nuestro I-EVOLUTION centro I-EVOLUTION para I-EVOLUTION valorar I-EVOLUTION la I-EVOLUTION posibilidad I-EVOLUTION de I-EVOLUTION trasplante I-EVOLUTION intestinal. I-EVOLUTION Dadas I-EVOLUTION las I-EVOLUTION circunstancias I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION teniendo I-EVOLUTION en I-EVOLUTION cuenta I-EVOLUTION que I-EVOLUTION había I-EVOLUTION presentado I-EVOLUTION repetidos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION sepsis I-EVOLUTION por I-EVOLUTION catéter I-EVOLUTION en I-EVOLUTION el I-EVOLUTION último I-EVOLUTION año, I-EVOLUTION se I-EVOLUTION indicó I-EVOLUTION el I-EVOLUTION trasplante I-EVOLUTION intestinal I-EVOLUTION aislado. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION incluido I-EVOLUTION en I-EVOLUTION lista I-EVOLUTION de I-EVOLUTION espera I-EVOLUTION con I-EVOLUTION un I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 60 I-EVOLUTION kg, I-EVOLUTION 180 I-EVOLUTION cm I-EVOLUTION de I-EVOLUTION altura I-EVOLUTION y I-EVOLUTION 18, I-EVOLUTION 3 I-EVOLUTION de I-EVOLUTION índice I-EVOLUTION de I-EVOLUTION masa I-EVOLUTION corporal. I-EVOLUTION I-EVOLUTION A B-TREATMENT los I-TREATMENT 2 I-TREATMENT meses I-TREATMENT de I-TREATMENT su I-TREATMENT inclusión I-TREATMENT en I-TREATMENT lista I-TREATMENT de I-TREATMENT espera I-TREATMENT se I-TREATMENT realizó I-TREATMENT el I-TREATMENT trasplante I-TREATMENT intestinal I-TREATMENT con I-TREATMENT un I-TREATMENT donante I-TREATMENT isogrupo. I-TREATMENT Al I-TREATMENT donante I-TREATMENT se I-TREATMENT le I-TREATMENT administró I-TREATMENT timoglobulina I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 2 I-TREATMENT mg/kg I-TREATMENT con I-TREATMENT el I-TREATMENT objetivo I-TREATMENT de I-TREATMENT deplecionar I-TREATMENT al I-TREATMENT máximo I-TREATMENT el I-TREATMENT número I-TREATMENT de I-TREATMENT linfocitos I-TREATMENT y I-TREATMENT así I-TREATMENT disminuir I-TREATMENT la I-TREATMENT probabilidad I-TREATMENT de I-TREATMENT rechazo I-TREATMENT y I-TREATMENT de I-TREATMENT enfermedad I-TREATMENT de I-TREATMENT injerto I-TREATMENT contra I-TREATMENT huésped. I-TREATMENT El I-TREATMENT receptor I-TREATMENT presentaba I-TREATMENT una I-TREATMENT trasposición I-TREATMENT de I-TREATMENT los I-TREATMENT grandes I-TREATMENT vasos I-TREATMENT con I-TREATMENT la I-TREATMENT vena I-TREATMENT cava I-TREATMENT situada I-TREATMENT a I-TREATMENT la I-TREATMENT izquierda I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT aorta. I-TREATMENT Este I-TREATMENT problema I-TREATMENT se I-TREATMENT solucionó I-TREATMENT con I-TREATMENT una I-TREATMENT rotación I-TREATMENT del I-TREATMENT injerto I-TREATMENT de I-TREATMENT 180º I-TREATMENT sobre I-TREATMENT su I-TREATMENT eje I-TREATMENT mesentérico, I-TREATMENT con I-TREATMENT el I-TREATMENT objetivo I-TREATMENT de I-TREATMENT que I-TREATMENT la I-TREATMENT vena I-TREATMENT y I-TREATMENT la I-TREATMENT arteria I-TREATMENT mesentérica I-TREATMENT superior I-TREATMENT del I-TREATMENT injerto I-TREATMENT coincidieran I-TREATMENT con I-TREATMENT la I-TREATMENT vena I-TREATMENT cava I-TREATMENT y I-TREATMENT la I-TREATMENT arteria I-TREATMENT aorta I-TREATMENT del I-TREATMENT receptor. I-TREATMENT La I-TREATMENT primera I-TREATMENT asa I-TREATMENT yeyunal I-TREATMENT del I-TREATMENT injerto I-TREATMENT se I-TREATMENT anastomosó I-TREATMENT de I-TREATMENT forma I-TREATMENT latero-lateral I-TREATMENT a I-TREATMENT la I-TREATMENT cuarta I-TREATMENT porción I-TREATMENT duodenal I-TREATMENT y I-TREATMENT el I-TREATMENT íleon I-TREATMENT terminal I-TREATMENT del I-TREATMENT injerto I-TREATMENT al I-TREATMENT colon I-TREATMENT transverso I-TREATMENT de I-TREATMENT forma I-TREATMENT latero-terminal I-TREATMENT dejando I-TREATMENT una I-TREATMENT ileostomía I-TREATMENT en I-TREATMENT forma I-TREATMENT de I-TREATMENT "chimenea" I-TREATMENT para I-TREATMENT poder I-TREATMENT acceder I-TREATMENT con I-TREATMENT facilidad I-TREATMENT a I-TREATMENT la I-TREATMENT mucosa I-TREATMENT intestinal I-TREATMENT y I-TREATMENT realizar I-TREATMENT las I-TREATMENT biopsias I-TREATMENT de I-TREATMENT protocolo. I-TREATMENT Al I-TREATMENT girar I-TREATMENT el I-TREATMENT injerto I-TREATMENT 180º, I-TREATMENT la I-TREATMENT ileostomía I-TREATMENT quedó I-TREATMENT fijada I-TREATMENT en I-TREATMENT el I-TREATMENT flanco I-TREATMENT derecho I-TREATMENT del I-TREATMENT abdomen I-TREATMENT en I-TREATMENT lugar I-TREATMENT del I-TREATMENT izquierdo. I-TREATMENT Además, I-TREATMENT se I-TREATMENT dejó I-TREATMENT una I-TREATMENT yeyunostomía I-TREATMENT de I-TREATMENT alimentación I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT colecistectomía I-TREATMENT por I-TREATMENT barro I-TREATMENT biliar, I-TREATMENT muy I-TREATMENT frecuente I-TREATMENT en I-TREATMENT este I-TREATMENT tipo I-TREATMENT de I-TREATMENT pacientes. I-TREATMENT I-TREATMENT El I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT inducción I-TREATMENT con I-TREATMENT timoglobulina I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT mg/kg I-TREATMENT y I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT con I-TREATMENT vancomicina, I-TREATMENT aztreonam I-TREATMENT y I-TREATMENT anfotericina I-TREATMENT B I-TREATMENT lioposomal. I-TREATMENT Durante I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT el I-TREATMENT paciente I-TREATMENT siguió I-TREATMENT tratamiento I-TREATMENT inmunosupresor I-TREATMENT con I-TREATMENT triple I-TREATMENT terapia: I-TREATMENT timoglobulina I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT mg/kg/día I-TREATMENT (durante I-TREATMENT 5 I-TREATMENT días), I-TREATMENT tacrolimus I-TREATMENT 0, I-TREATMENT 15 I-TREATMENT mg/kg/día I-TREATMENT (administrado I-TREATMENT en I-TREATMENT dos I-TREATMENT dosis) I-TREATMENT por I-TREATMENT sonda I-TREATMENT nasogástrica, I-TREATMENT modificando I-TREATMENT la I-TREATMENT dosis I-TREATMENT hasta I-TREATMENT alcanzar I-TREATMENT niveles I-TREATMENT sanguíneos I-TREATMENT entre I-TREATMENT 15-20 I-TREATMENT ng/dl, I-TREATMENT y I-TREATMENT prednisolona I-TREATMENT 200 I-TREATMENT mg/día I-TREATMENT en I-TREATMENT pauta I-TREATMENT descendente I-TREATMENT hasta I-TREATMENT llegar I-TREATMENT a I-TREATMENT 20 I-TREATMENT mg I-TREATMENT el I-TREATMENT 6º I-TREATMENT día. I-TREATMENT Al I-TREATMENT no I-TREATMENT alcanzar I-TREATMENT niveles I-TREATMENT sanguíneos I-TREATMENT de I-TREATMENT tacrolimus I-TREATMENT adecuados I-TREATMENT al I-TREATMENT 3er I-TREATMENT día I-TREATMENT postoperatorio, I-TREATMENT se I-TREATMENT pasó I-TREATMENT a I-TREATMENT la I-TREATMENT administración I-TREATMENT intravenosa I-TREATMENT durante I-TREATMENT 4 I-TREATMENT días I-TREATMENT hasta I-TREATMENT que I-TREATMENT los I-TREATMENT niveles I-TREATMENT fueron I-TREATMENT correctos, I-TREATMENT volviendo I-TREATMENT de I-TREATMENT nuevo I-TREATMENT a I-TREATMENT la I-TREATMENT vía I-TREATMENT enteral. I-TREATMENT Además I-TREATMENT se I-TREATMENT administró I-TREATMENT PGE1 I-TREATMENT (Alprostadil®) I-TREATMENT en I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT mejorar I-TREATMENT la I-TREATMENT lesión I-TREATMENT de I-TREATMENT reperfusión I-TREATMENT (4). I-TREATMENT I-TREATMENT A I-TREATMENT las I-TREATMENT 72 I-TREATMENT horas I-TREATMENT del I-TREATMENT trasplante I-TREATMENT el I-TREATMENT paciente I-TREATMENT presentó I-TREATMENT una I-TREATMENT hemorragia I-TREATMENT digestiva I-TREATMENT secundaria I-TREATMENT a I-TREATMENT una I-TREATMENT úlcera I-TREATMENT cardial I-TREATMENT que I-TREATMENT fue I-TREATMENT tratada I-TREATMENT mediante I-TREATMENT "clip" I-TREATMENT por I-TREATMENT vía I-TREATMENT endoscópica. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION de I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION y I-EVOLUTION trasladado I-EVOLUTION a I-EVOLUTION la I-EVOLUTION planta I-EVOLUTION de I-EVOLUTION hospitalización. I-EVOLUTION Dentro I-EVOLUTION del I-EVOLUTION protocolo I-EVOLUTION para I-EVOLUTION el I-EVOLUTION control I-EVOLUTION del I-EVOLUTION rechazo, I-EVOLUTION se I-EVOLUTION realizaron I-EVOLUTION biopsias I-EVOLUTION 2 I-EVOLUTION veces I-EVOLUTION por I-EVOLUTION semana I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ileostomía I-EVOLUTION durante I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION mes, I-EVOLUTION y I-EVOLUTION 1 I-EVOLUTION vez I-EVOLUTION por I-EVOLUTION semana I-EVOLUTION durante I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION mes. I-EVOLUTION Durante I-EVOLUTION las I-EVOLUTION seis I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION sólo I-EVOLUTION una I-EVOLUTION biopsia I-EVOLUTION mostró I-EVOLUTION rechazo I-EVOLUTION indeterminado I-EVOLUTION y I-EVOLUTION otra I-EVOLUTION rechazo I-EVOLUTION leve, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION trató I-EVOLUTION con I-EVOLUTION 3 I-EVOLUTION bolus I-EVOLUTION de I-EVOLUTION 500 I-EVOLUTION mg I-EVOLUTION de I-EVOLUTION metil-prednisolona. I-EVOLUTION I-EVOLUTION Desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION nutricional, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION post-trasplante I-EVOLUTION se I-EVOLUTION inició I-EVOLUTION la I-EVOLUTION administración I-EVOLUTION de I-EVOLUTION agua I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION de I-EVOLUTION nutrición I-EVOLUTION enteral I-EVOLUTION por I-EVOLUTION la I-EVOLUTION sonda I-EVOLUTION de I-EVOLUTION yeyunostomía. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION tres I-EVOLUTION semanas I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION inició I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION oral I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION progresiva I-EVOLUTION hasta I-EVOLUTION ingerir I-EVOLUTION 2.100 I-EVOLUTION kcal I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION permitió I-EVOLUTION suspender I-EVOLUTION la I-EVOLUTION nutrición I-EVOLUTION parenteral. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION aumentó I-EVOLUTION 10 I-EVOLUTION kg I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION en I-EVOLUTION las I-EVOLUTION 6 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION a I-EVOLUTION la I-EVOLUTION séptima I-EVOLUTION semana I-EVOLUTION del I-EVOLUTION trasplante, I-EVOLUTION sin I-EVOLUTION requerir I-EVOLUTION nutrición I-EVOLUTION parenteral. I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION excelente I-EVOLUTION con I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION ponderal, I-EVOLUTION que I-EVOLUTION indica I-EVOLUTION la I-EVOLUTION viabilidad I-EVOLUTION y I-EVOLUTION buena I-EVOLUTION función I-EVOLUTION del I-EVOLUTION injerto I-EVOLUTION intestinal. 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 67 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY los I-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 diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY insulindependiente, 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 y I-PAST_MEDICAL_HISTORY gastritis I-PAST_MEDICAL_HISTORY atrófica I-PAST_MEDICAL_HISTORY autoinmune I-PAST_MEDICAL_HISTORY (con I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anticélulas I-PAST_MEDICAL_HISTORY parietales I-PAST_MEDICAL_HISTORY positivos I-PAST_MEDICAL_HISTORY 1/160, I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY agosto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2007), I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY colecistectomía I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY colelitiasis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY septiembre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2007. I-PAST_MEDICAL_HISTORY En B-EXPLORATION enero I-EXPLORATION de I-EXPLORATION 2008 I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION por I-EXPLORATION presentar I-EXPLORATION molestias I-EXPLORATION epigástricas I-EXPLORATION irradiadas I-EXPLORATION en I-EXPLORATION cinturón I-EXPLORATION así I-EXPLORATION como I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION kg I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION objetivándose I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION concéntrico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION gástricas, I-EXPLORATION motivo I-EXPLORATION por I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION gastroscopia, I-EXPLORATION ecoendoscopia I-EXPLORATION digestiva I-EXPLORATION alta, I-EXPLORATION analítica I-EXPLORATION y I-EXPLORATION marcadores I-EXPLORATION tumorales. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION tan I-EXPLORATION sólo I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION colestasis I-EXPLORATION disociada I-EXPLORATION con I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION y I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION gastroscopia I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION pólipo I-EXPLORATION sesil I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION fundus, I-EXPLORATION sobre I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION atrófico, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extirpó I-EXPLORATION y I-EXPLORATION cuyo I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION resultó I-EXPLORATION en I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION gástrico I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION difuso. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecoendoscopia I-EXPLORATION alta I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION adenopatías I-EXPLORATION locorregionales. I-EXPLORATION Dados B-TREATMENT los I-TREATMENT hallazgos I-TREATMENT de I-TREATMENT la I-TREATMENT anatomía I-TREATMENT patológica, I-TREATMENT se I-TREATMENT programó I-TREATMENT para I-TREATMENT gastrectomía I-TREATMENT total, I-TREATMENT durante I-TREATMENT la I-TREATMENT cual I-TREATMENT macroscópicamente I-TREATMENT no I-TREATMENT se I-TREATMENT evidenció I-TREATMENT aparentemente I-TREATMENT tumoración I-TREATMENT gástrica I-TREATMENT macroscópica, I-TREATMENT ni I-TREATMENT afectación I-TREATMENT ganglionar I-TREATMENT ni I-TREATMENT peritoneal. I-TREATMENT La B-EXPLORATION histopatología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION mostró I-EXPLORATION múltiples I-EXPLORATION tumores I-EXPLORATION neuroendocrinos I-EXPLORATION bien I-EXPLORATION diferenciados I-EXPLORATION tipo I-EXPLORATION I I-EXPLORATION (tumores I-EXPLORATION carcinoides) I-EXPLORATION en I-EXPLORATION cuerpo I-EXPLORATION y I-EXPLORATION fundus, I-EXPLORATION de I-EXPLORATION 1-5 I-EXPLORATION mm, I-EXPLORATION asociados I-EXPLORATION a I-EXPLORATION hiperplasia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION neuroendocrinas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION oxíntica I-EXPLORATION y I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION atrófica I-EXPLORATION de I-EXPLORATION cuerpo I-EXPLORATION y I-EXPLORATION fundus I-EXPLORATION con I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION displasia I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION y I-EXPLORATION márgenes I-EXPLORATION quirúrgicos I-EXPLORATION no I-EXPLORATION afectados. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 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 apendicectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY neurinoma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1986. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS de I-PRESENT_ILLNESS reciente I-PRESENT_ILLNESS comienzo, I-PRESENT_ILLNESS sin B-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION ni I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacaba I-EXPLORATION FA I-EXPLORATION 1499 I-EXPLORATION UI/l, I-EXPLORATION GGT I-EXPLORATION 1163 I-EXPLORATION UI/l, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 62 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION CA-19.9 I-EXPLORATION 533 I-EXPLORATION UI/ml I-EXPLORATION (normal I-EXPLORATION < I-EXPLORATION 37 I-EXPLORATION UI/ml). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ecografía-doppler I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostraban I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION situada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intra- I-EXPLORATION y I-EXPLORATION extrahepática. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION presentaba I-EXPLORATION zonas I-EXPLORATION quísticas, I-EXPLORATION con I-EXPLORATION septos I-EXPLORATION y I-EXPLORATION mamelones I-EXPLORATION sólidos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION alguno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION captaba I-EXPLORATION contraste I-EXPLORATION intensamente I-EXPLORATION ; I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION invasión I-EXPLORATION vascular I-EXPLORATION ni I-EXPLORATION adenopatías. I-EXPLORATION Con B-TREATMENT la I-TREATMENT impresión I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT neoplasia I-TREATMENT quística I-TREATMENT del I-TREATMENT páncreas I-TREATMENT sin I-TREATMENT contraindicación I-TREATMENT quirúrgica I-TREATMENT y I-TREATMENT resecable, I-TREATMENT se I-TREATMENT realizó I-TREATMENT duodeno-pancreatectomía I-TREATMENT cefálica. I-TREATMENT En B-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION blanquecina I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION elástica, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas, I-EXPLORATION no I-EXPLORATION encapsulada I-EXPLORATION pero I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION bien I-EXPLORATION delimitados, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION separaba I-EXPLORATION con I-EXPLORATION facilidad I-EXPLORATION del I-EXPLORATION páncreas I-EXPLORATION adyacente. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION inmunohistoquímica I-EXPLORATION mostró I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION el I-EXPLORATION marcador I-EXPLORATION vimentina, I-EXPLORATION y I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION citoqueratinas I-EXPLORATION (AE1-AE3), I-EXPLORATION S-100, I-EXPLORATION cromogranina, I-EXPLORATION CD I-EXPLORATION 34, I-EXPLORATION C-KIT I-EXPLORATION y I-EXPLORATION actina, I-EXPLORATION presentando I-EXPLORATION además I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION celular I-EXPLORATION (MIB-I) I-EXPLORATION muy I-EXPLORATION bajo I-EXPLORATION ; I-EXPLORATION siendo I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION un I-EXPLORATION sarcoma I-EXPLORATION fusocelular I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION malignidad. I-EXPLORATION Tras B-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION recidiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Analítica: B-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 17.500/mm3, I-EXPLORATION PMN I-EXPLORATION 75%, I-EXPLORATION amilasa I-EXPLORATION 1.956 I-EXPLORATION U/L, I-EXPLORATION AST: I-EXPLORATION 89U/L, I-EXPLORATION ALT I-EXPLORATION 120U/L. I-EXPLORATION Ecografía I-EXPLORATION abdominal: I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática I-EXPLORATION con I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION CPRE: I-EXPLORATION colédoco I-EXPLORATION dilatado I-EXPLORATION con I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION filiforme, I-EXPLORATION plegada I-EXPLORATION sobre I-EXPLORATION sí I-EXPLORATION misma I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT limpieza I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT biliar I-TREATMENT con I-TREATMENT balón I-TREATMENT Fogarty, I-TREATMENT extrayéndose I-TREATMENT un I-TREATMENT gusano I-TREATMENT cilíndrico I-TREATMENT de I-TREATMENT 23 I-TREATMENT cm, I-TREATMENT barro I-TREATMENT biliar I-TREATMENT y I-TREATMENT dos I-TREATMENT cálculos I-TREATMENT menores I-TREATMENT de I-TREATMENT 10 I-TREATMENT mm. I-TREATMENT Se I-TREATMENT lavó I-TREATMENT la I-TREATMENT vía I-TREATMENT biliar I-TREATMENT con I-TREATMENT suero I-TREATMENT fisiológico I-TREATMENT y I-TREATMENT se I-TREATMENT pautó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT 400 I-TREATMENT mg I-TREATMENT de I-TREATMENT albendazol I-TREATMENT vía I-TREATMENT oral I-TREATMENT durante I-TREATMENT 4 I-TREATMENT días. I-TREATMENT Fue B-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION asintomática, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION ingreso. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS deterioro I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY trabaja I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY auxiliar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY despacho I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY notario I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY seguido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY intermitente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY consultas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Digestivo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alteración I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY perfil I-PAST_MEDICAL_HISTORY hepático I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY predominio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colestasis I-PAST_MEDICAL_HISTORY leve. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY resto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY y B-FAMILY_HISTORY familiares I-FAMILY_HISTORY carecían I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY I-FAMILY_HISTORY Durante B-PAST_MEDICAL_HISTORY esos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizaron I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY analíticas, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY únicamente I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consabido I-PAST_MEDICAL_HISTORY patrón I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colestasis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY trombocitopenia I-PAST_MEDICAL_HISTORY leve I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY algunos I-PAST_MEDICAL_HISTORY controles. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY largo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY periodo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY GOT I-PAST_MEDICAL_HISTORY oscilaron I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 31-56 I-PAST_MEDICAL_HISTORY UI/l; I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY GPT, I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 27-75 I-PAST_MEDICAL_HISTORY UI/l; I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY GGT, I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 150-185 I-PAST_MEDICAL_HISTORY UI/l; I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY FA, I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 213-456 I-PAST_MEDICAL_HISTORY UI/l. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY bilirrubina I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY movió I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY 2-2, I-PAST_MEDICAL_HISTORY 56 I-PAST_MEDICAL_HISTORY mg/dl. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY autoinmunidad, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY negativo. I-PAST_MEDICAL_HISTORY Igual I-PAST_MEDICAL_HISTORY resultado I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY obtuvo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY serologías I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY virus I-PAST_MEDICAL_HISTORY hepatotropos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY VIH, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY marcadores I-PAST_MEDICAL_HISTORY tumorales I-PAST_MEDICAL_HISTORY (CEA, I-PAST_MEDICAL_HISTORY Ca I-PAST_MEDICAL_HISTORY 19.9 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY α-fetoproteína). I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY resto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY analíticos, I-PAST_MEDICAL_HISTORY incluyendo I-PAST_MEDICAL_HISTORY hemograma, I-PAST_MEDICAL_HISTORY bioquímica I-PAST_MEDICAL_HISTORY completa, I-PAST_MEDICAL_HISTORY coagulación, I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ferrocinética, I-PAST_MEDICAL_HISTORY proteinograma, I-PAST_MEDICAL_HISTORY hormonas I-PAST_MEDICAL_HISTORY tiroideas, I-PAST_MEDICAL_HISTORY ... I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY siempre I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY También I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY sometió I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY diversas I-PAST_MEDICAL_HISTORY pruebas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY imagen. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY esos I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY llevaron I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY cabo I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY ecografías I-PAST_MEDICAL_HISTORY abdominales, I-PAST_MEDICAL_HISTORY todas I-PAST_MEDICAL_HISTORY ellas I-PAST_MEDICAL_HISTORY normales I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY excepción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY realizada I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ingreso, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY informaba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY discreta I-PAST_MEDICAL_HISTORY esplenomegalia. I-PAST_MEDICAL_HISTORY Dos I-PAST_MEDICAL_HISTORY estudios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY TAC, I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY abdominal, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY abdómino-pélvico I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY siete I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY centro, I-PAST_MEDICAL_HISTORY habían I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY igualmente I-PAST_MEDICAL_HISTORY informados I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION su I-EXPLORATION recepción I-EXPLORATION en I-EXPLORATION nuestra I-EXPLORATION planta I-EXPLORATION de I-EXPLORATION hospitalización I-EXPLORATION se I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION ictericia I-EXPLORATION mucocutánea I-EXPLORATION franca I-EXPLORATION y I-EXPLORATION ascitis I-EXPLORATION no I-EXPLORATION a I-EXPLORATION tensión, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION deterioro I-EXPLORATION del I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION conciencia I-EXPLORATION del I-EXPLORATION paciente. I-EXPLORATION Analíticamente I-EXPLORATION destaca: I-EXPLORATION Hb: I-EXPLORATION 9, I-EXPLORATION 6 I-EXPLORATION g/dl; I-EXPLORATION Hcto: I-EXPLORATION 26, I-EXPLORATION 9%; I-EXPLORATION plaquetas: I-EXPLORATION 37000; I-EXPLORATION leucocitos: I-EXPLORATION 3800; I-EXPLORATION bilirrubina I-EXPLORATION total: I-EXPLORATION 27, I-EXPLORATION 5 I-EXPLORATION mg/dl; I-EXPLORATION GOT: I-EXPLORATION 88; I-EXPLORATION GPT: I-EXPLORATION 73; I-EXPLORATION GGT: I-EXPLORATION 243; I-EXPLORATION FA: I-EXPLORATION 305; I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION protrombina: I-EXPLORATION 33%; I-EXPLORATION INR: I-EXPLORATION 2, I-EXPLORATION 1; I-EXPLORATION creatinina: I-EXPLORATION 2, I-EXPLORATION 09 I-EXPLORATION mg/dl; I-EXPLORATION urea: I-EXPLORATION 172 I-EXPLORATION mg/dl; I-EXPLORATION α-fetoproteína: I-EXPLORATION 1 I-EXPLORATION ng/ml; I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION de I-EXPLORATION VHB, I-EXPLORATION VHC, I-EXPLORATION VIH, I-EXPLORATION CMV I-EXPLORATION y I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein I-EXPLORATION Barr I-EXPLORATION son I-EXPLORATION nuevamente I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION lleva I-EXPLORATION a I-EXPLORATION cabo I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION hígado I-EXPLORATION con I-EXPLORATION estigmas I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION crónica, I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION nódulos I-EXPLORATION de I-EXPLORATION regeneración I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior; I-EXPLORATION y I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear, I-EXPLORATION con I-EXPLORATION imágenes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION cirrosis I-EXPLORATION hepática I-EXPLORATION macronodular I-EXPLORATION y I-EXPLORATION ascitis I-EXPLORATION perihepática I-EXPLORATION y I-EXPLORATION periesplénica I-EXPLORATION en I-EXPLORATION escasa I-EXPLORATION cantidad. I-EXPLORATION Con I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION transyugular. I-EXPLORATION I-EXPLORATION No B-EVOLUTION obstante, I-EVOLUTION y I-EVOLUTION mientras I-EVOLUTION se I-EVOLUTION espera I-EVOLUTION el I-EVOLUTION resultado I-EVOLUTION histológico I-EVOLUTION de I-EVOLUTION dicha I-EVOLUTION biopsia, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sufre I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION brusco I-EVOLUTION de I-EVOLUTION su I-EVOLUTION situación I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION de I-EVOLUTION su I-EVOLUTION función I-EVOLUTION respiratoria, I-EVOLUTION requiriendo B-TREATMENT ventilación I-TREATMENT mecánica, I-TREATMENT intubación I-TREATMENT orotraqueal I-TREATMENT e I-TREATMENT ingreso I-TREATMENT en I-TREATMENT UCI I-TREATMENT por I-TREATMENT cuadro I-TREATMENT de I-TREATMENT distrés I-TREATMENT respiratorio. I-TREATMENT Fallece B-EVOLUTION 36 I-EVOLUTION horas I-EVOLUTION después. I-EVOLUTION I-EVOLUTION La B-EXPLORATION biopsia I-EXPLORATION hepática, I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION se I-EXPLORATION recibió I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION fallecimiento I-EXPLORATION del I-EXPLORATION enfermo, I-EXPLORATION es I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION dilatación I-EXPLORATION irregular I-EXPLORATION de I-EXPLORATION los I-EXPLORATION sinusoides I-EXPLORATION (peliosis) I-EXPLORATION y I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION células I-EXPLORATION endoteliales, I-EXPLORATION sin I-EXPLORATION que I-EXPLORATION estas I-EXPLORATION presenten I-EXPLORATION mitosis. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION necropsia, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION macroscópicamente I-EXPLORATION hígado I-EXPLORATION con I-EXPLORATION superficie I-EXPLORATION externa I-EXPLORATION macronodular, I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION al I-EXPLORATION corte I-EXPLORATION áreas I-EXPLORATION peliótico-esponjosas, I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION que I-EXPLORATION se I-EXPLORATION sitúan I-EXPLORATION zonas I-EXPLORATION con I-EXPLORATION parénquima I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION sano I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION macroscópicos I-EXPLORATION de I-EXPLORATION colestasis. I-EXPLORATION Al I-EXPLORATION microscopio I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION proliferación I-EXPLORATION neoplásica I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION sinusoidal, I-EXPLORATION configurando I-EXPLORATION espacios I-EXPLORATION cavernosos I-EXPLORATION tapizados I-EXPLORATION por I-EXPLORATION células I-EXPLORATION atípicas. I-EXPLORATION La I-EXPLORATION afectación I-EXPLORATION hepática I-EXPLORATION es I-EXPLORATION difusa I-EXPLORATION y I-EXPLORATION parcheada, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION algunas I-EXPLORATION zonas I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION crecimiento I-EXPLORATION intravascular I-EXPLORATION neoplásico, I-EXPLORATION a I-EXPLORATION veces I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION mitosis, I-EXPLORATION algunas I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION atípicas. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION intensamente I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION marcadores I-EXPLORATION endoteliales I-EXPLORATION CD-31 I-EXPLORATION y I-EXPLORATION CD-34. I-EXPLORATION Todo I-EXPLORATION ello I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION angiosarcoma I-EXPLORATION hepático I-EXPLORATION primario. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 73 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS entre B-PAST_MEDICAL_HISTORY cuyos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY únicamente I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY tuberculosis I-PAST_MEDICAL_HISTORY pasada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY juventud, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY dejó I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY secuela I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY importante I-PAST_MEDICAL_HISTORY fibrosis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY lóbulo I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY superior I-PAST_MEDICAL_HISTORY izquierdo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Sufre B-PRESENT_ILLNESS una I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS accidental, I-PRESENT_ILLNESS produciéndose I-PRESENT_ILLNESS una I-PRESENT_ILLNESS herida I-PRESENT_ILLNESS incisocontusa I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS sangra I-PRESENT_ILLNESS profusamente, I-PRESENT_ILLNESS llamando I-PRESENT_ILLNESS la I-PRESENT_ILLNESS atención I-PRESENT_ILLNESS al I-PRESENT_ILLNESS personal I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS que I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS atiende I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS dificultoso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hemostasia. I-PRESENT_ILLNESS Por B-EXPLORATION ello I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION analítica, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto: I-EXPLORATION Hb: I-EXPLORATION 10, I-EXPLORATION 6 I-EXPLORATION g/dl; I-EXPLORATION plaquetas: I-EXPLORATION 115.000; I-EXPLORATION leucocitos: I-EXPLORATION 3.450; I-EXPLORATION bilirrubina I-EXPLORATION total: I-EXPLORATION 7, I-EXPLORATION 1 I-EXPLORATION mg/dl; I-EXPLORATION GOT: I-EXPLORATION 45; I-EXPLORATION GPT: I-EXPLORATION 53; I-EXPLORATION GGT: I-EXPLORATION 293; I-EXPLORATION FA: I-EXPLORATION 286; I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION protrombina: I-EXPLORATION 61%. I-EXPLORATION Tras I-EXPLORATION esto I-EXPLORATION se I-EXPLORATION inicia I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION hepatopatía, I-EXPLORATION realizándose I-EXPLORATION serologías I-EXPLORATION virales, I-EXPLORATION proteinograma, I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION autoinmunidad I-EXPLORATION y I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION tumorales, I-EXPLORATION que I-EXPLORATION son I-EXPLORATION todos I-EXPLORATION negativos. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION hacen I-EXPLORATION varias I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen, I-EXPLORATION que I-EXPLORATION arrojan I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION datos: I-EXPLORATION TAC I-EXPLORATION abdominal: I-EXPLORATION hígado I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION imágenes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION hepáticas, I-EXPLORATION algunas I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño, I-EXPLORATION y I-EXPLORATION repartidas I-EXPLORATION por I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION del I-EXPLORATION hígado. I-EXPLORATION Escasa I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION ascitis I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION atípica I-EXPLORATION ; I-EXPLORATION colangio-RMN: I-EXPLORATION cirrosis I-EXPLORATION hepática I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION nódulos I-EXPLORATION de I-EXPLORATION regeneración I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartarse I-EXPLORATION otra I-EXPLORATION etiología I-EXPLORATION como I-EXPLORATION la I-EXPLORATION metastásica. I-EXPLORATION Ascitis; I-EXPLORATION PET-TAC: I-EXPLORATION captación I-EXPLORATION patológica I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION hepáticos I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION más I-EXPLORATION captación I-EXPLORATION patológica I-EXPLORATION extrahepática; I-EXPLORATION ecografía I-EXPLORATION abdominal: I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION ocupantes I-EXPLORATION de I-EXPLORATION espacio I-EXPLORATION (LOE) I-EXPLORATION hepáticas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION metastático. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos, I-EXPLORATION y I-EXPLORATION con I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION patología I-EXPLORATION neoplásica, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION PAAF I-EXPLORATION guiada I-EXPLORATION por I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION estas I-EXPLORATION lesiones, I-EXPLORATION cuyo I-EXPLORATION informe I-EXPLORATION reza: I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION estirpe I-EXPLORATION mesenquimal, I-EXPLORATION con I-EXPLORATION células I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION hipercromáticos, I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION diferentes I-EXPLORATION marcadores I-EXPLORATION endoteliales, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION angiosarcoma I-EXPLORATION hepático. I-EXPLORATION I-EXPLORATION Cuarenta B-EVOLUTION y I-EVOLUTION ocho I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION punción I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION precisa I-EVOLUTION ingreso I-EVOLUTION hospitalario I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION hemoperitoneo I-EVOLUTION secundario, I-EVOLUTION con I-EVOLUTION distensión I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION peritonismo. I-EVOLUTION El I-EVOLUTION sangrado I-EVOLUTION cede I-EVOLUTION espontáneamente I-EVOLUTION y I-EVOLUTION no I-EVOLUTION requiere I-EVOLUTION intervencionismo, I-EVOLUTION siendo I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION domicilio I-EVOLUTION varios I-EVOLUTION días I-EVOLUTION después I-EVOLUTION sin I-EVOLUTION más I-EVOLUTION complicaciones. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION en I-EVOLUTION las I-EVOLUTION semanas I-EVOLUTION siguientes I-EVOLUTION sufre I-EVOLUTION un I-EVOLUTION deterioro I-EVOLUTION progresivo I-EVOLUTION de I-EVOLUTION su I-EVOLUTION estado, I-EVOLUTION llegando I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION mixto I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION hepática, I-EVOLUTION encefalopatía, I-EVOLUTION e I-EVOLUTION insuficiencia I-EVOLUTION respiratoria, I-EVOLUTION que I-EVOLUTION no I-EVOLUTION responde I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION médico, I-EVOLUTION falleciendo I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION por I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION final I-EVOLUTION de I-EVOLUTION fracaso I-EVOLUTION multiorgánico. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS adicto I-PRESENT_ILLNESS a I-PRESENT_ILLNESS drogas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS parenteral, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS por I-PRESENT_ILLNESS VIH I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS dejado I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS antirretroviral I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS Ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS odinofagia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dudosa I-PRESENT_ILLNESS disfagia, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS deposiciones/día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS heces I-PRESENT_ILLNESS líquidas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION desnutrición I-EXPLORATION con I-EXPLORATION muguet I-EXPLORATION orofaríngeo. I-EXPLORATION Hepatomegalia I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho I-EXPLORATION sin I-EXPLORATION esplenomegalia. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION presentaba I-EXPLORATION 6.830 I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION 7, I-EXPLORATION 2% I-EXPLORATION linfocitos I-EXPLORATION y I-EXPLORATION 86, I-EXPLORATION 7% I-EXPLORATION neutrófilos. I-EXPLORATION CD4 I-EXPLORATION 10 I-EXPLORATION cel/µl. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION esofagogastrocopia I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION de I-EXPLORATION duodeno I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION velloso, I-EXPLORATION blanquecino, I-EXPLORATION irregular I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION oral I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION alteraciones. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Leishmania I-EXPLORATION amastigotes I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION histiocitos. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amfotericina I-TREATMENT B I-TREATMENT mejorando B-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION las I-EVOLUTION sucesivas I-EVOLUTION revisiones. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS trasplantado B-PAST_MEDICAL_HISTORY hepático I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY VHC I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY inmunosupresor I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY esteroides, I-PAST_MEDICAL_HISTORY tacrolimus I-PAST_MEDICAL_HISTORY (FK) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mofetil-micofenolato I-PAST_MEDICAL_HISTORY (MMF). I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY primeros I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY postrasplante I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY produjo I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY deterioro I-PAST_MEDICAL_HISTORY progresivo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY función I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aparición I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY relacionada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tacrolimus, I-PAST_MEDICAL_HISTORY planteándose I-PAST_MEDICAL_HISTORY sustituir I-PAST_MEDICAL_HISTORY FK I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY MMF I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY rapamicina I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY mg/día. I-PAST_MEDICAL_HISTORY Transcurridos B-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca I-PRESENT_ILLNESS y I-PRESENT_ILLNESS febrícula. I-PRESENT_ILLNESS En B-EXPLORATION ese I-EXPLORATION momento I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION plasmáticos I-EXPLORATION de I-EXPLORATION rapamicina I-EXPLORATION eran I-EXPLORATION 25 I-EXPLORATION ng/ml I-EXPLORATION (normal: I-EXPLORATION 9-19). I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION varios I-EXPLORATION infiltrados I-EXPLORATION alveolares I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION medio I-EXPLORATION y I-EXPLORATION segmento I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION pulmón I-EXPLORATION derecho I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION ipsilateral. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT empíricamente I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT levofloxacino I-TREATMENT por I-TREATMENT sospecha I-TREATMENT de I-TREATMENT bronconeumonía I-TREATMENT y I-TREATMENT se I-TREATMENT redujo I-TREATMENT la I-TREATMENT dosis I-TREATMENT 1 I-TREATMENT mg/día, I-TREATMENT presentando B-EVOLUTION evolución I-EVOLUTION desfavorable I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION costal I-EVOLUTION mecánico, I-EVOLUTION tos I-EVOLUTION irritativa, I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION febrícula I-EVOLUTION y I-EVOLUTION apareciendo I-EVOLUTION disnea. I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT cambiar I-TREATMENT a I-TREATMENT piperacilina-tazobactam, I-TREATMENT persistiendo I-TREATMENT la I-TREATMENT fiebre. I-TREATMENT La B-EXPLORATION gasometría I-EXPLORATION arterial I-EXPLORATION basal I-EXPLORATION mostró I-EXPLORATION hipoxia I-EXPLORATION leve. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION torácica I-EXPLORATION reveló I-EXPLORATION opacidades I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION basal I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION hemotórax, I-EXPLORATION cavitación I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION segmentos I-EXPLORATION anteriores I-EXPLORATION de I-EXPLORATION lóbulos I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION nodulares I-EXPLORATION múltiples, I-EXPLORATION realizándose I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF) I-EXPLORATION de I-EXPLORATION las I-EXPLORATION condensaciones. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION PAAF I-EXPLORATION mostraron I-EXPLORATION Ziehl I-EXPLORATION negativo, I-EXPLORATION anticuerpos I-EXPLORATION monoclonales I-EXPLORATION para I-EXPLORATION Pneumocystis I-EXPLORATION carinii I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION aerobios I-EXPLORATION estéril. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION fibrobroncoscopia I-EXPLORATION con I-EXPLORATION lavado I-EXPLORATION bronquioloalveolar I-EXPLORATION (LAB) I-EXPLORATION cuya I-EXPLORATION baciloscopia I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION fueron I-EXPLORATION estériles I-EXPLORATION para I-EXPLORATION bacterias, I-EXPLORATION virus, I-EXPLORATION hongos, I-EXPLORATION micobacterias I-EXPLORATION o I-EXPLORATION parásitos, I-EXPLORATION incluyendo I-EXPLORATION nocardia. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION micobacterias I-EXPLORATION en I-EXPLORATION esputo I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION micoplasma, I-EXPLORATION fiebre I-EXPLORATION Q, I-EXPLORATION clamidia I-EXPLORATION y I-EXPLORATION legionela I-EXPLORATION fueron I-EXPLORATION negativas, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION el I-EXPLORATION galactomanano, I-EXPLORATION la I-EXPLORATION antigenemia I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION citomegalovirus. I-EXPLORATION Debido B-TREATMENT a I-TREATMENT la I-TREATMENT inapropiada I-TREATMENT respuesta I-TREATMENT antibiótica, I-TREATMENT y I-TREATMENT sin I-TREATMENT aislarse I-TREATMENT ningún I-TREATMENT microorganismo, I-TREATMENT se I-TREATMENT decidió I-TREATMENT suspender I-TREATMENT la I-TREATMENT rapamicina. I-TREATMENT El B-EVOLUTION cuadro I-EVOLUTION clínico I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION encontrándose I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION asintomático I-EVOLUTION en I-EVOLUTION posteriores I-EVOLUTION revisiones, I-EVOLUTION aunque I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION radiológicas I-EVOLUTION persistieron I-EVOLUTION en I-EVOLUTION la I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 12 I-EVOLUTION semanas, I-EVOLUTION normalizándose I-EVOLUTION transcurridos I-EVOLUTION 6 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS ingresada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS anémico I-PRESENT_ILLNESS (Hb I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS g/dl, I-PRESENT_ILLNESS Hto I-PRESENT_ILLNESS 30%) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS constitucional. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presentaba I-EXPLORATION manchas I-EXPLORATION "café I-EXPLORATION con I-EXPLORATION leche" I-EXPLORATION en I-EXPLORATION la I-EXPLORATION espalda I-EXPLORATION y I-EXPLORATION cuello, I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION neurofibromas. I-EXPLORATION El I-EXPLORATION abdomen I-EXPLORATION era I-EXPLORATION blando, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipogastrio I-EXPLORATION y I-EXPLORATION zona I-EXPLORATION periumbilical, I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION palpables I-EXPLORATION y I-EXPLORATION con I-EXPLORATION peristalsis I-EXPLORATION conservada. I-EXPLORATION El I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION refería I-EXPLORATION presentar I-EXPLORATION un I-EXPLORATION fenotipo I-EXPLORATION similar I-EXPLORATION a I-EXPLORATION su I-EXPLORATION padre. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION un I-EXPLORATION asa I-EXPLORATION intestinal I-EXPLORATION en I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm, I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION abdominal, I-EXPLORATION objetivándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION intraluminal I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION colon I-EXPLORATION ascendente. I-EXPLORATION Se B-TREATMENT intervino I-TREATMENT quirúrgicamente, I-TREATMENT hallándose I-TREATMENT 3 I-TREATMENT tumoraciones, I-TREATMENT la I-TREATMENT mayor I-TREATMENT de I-TREATMENT 12 I-TREATMENT cm, I-TREATMENT que I-TREATMENT englobaba I-TREATMENT íleon I-TREATMENT terminal I-TREATMENT y I-TREATMENT ciego, I-TREATMENT y I-TREATMENT otras I-TREATMENT dos I-TREATMENT de I-TREATMENT 3, I-TREATMENT 5 I-TREATMENT y I-TREATMENT 1, I-TREATMENT 2 I-TREATMENT cm, I-TREATMENT proximales I-TREATMENT a I-TREATMENT la I-TREATMENT primera. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION anatomopatológico, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION GIST, I-EXPLORATION describía I-EXPLORATION formación I-EXPLORATION nodular I-EXPLORATION fusiforme, I-EXPLORATION con I-EXPLORATION marcada I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION CD I-EXPLORATION 117, I-EXPLORATION CD I-EXPLORATION 34, I-EXPLORATION y I-EXPLORATION negatividad I-EXPLORATION para I-EXPLORATION S-100. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY meningitis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY gestacional I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY colestasis I-PAST_MEDICAL_HISTORY gravídica. I-PAST_MEDICAL_HISTORY Diagnosticada B-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS pancreatitis I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS idiopática, I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS localización I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS obstructiva. I-PRESENT_ILLNESS Se B-EXPLORATION realizada I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION helicoidal I-EXPLORATION con I-EXPLORATION contraste, I-EXPLORATION identificándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION calcificaciones I-EXPLORATION pancreáticas, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas I-EXPLORATION (alcanza I-EXPLORATION los I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor), I-EXPLORATION con I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION los I-EXPLORATION planos I-EXPLORATION grasos I-EXPLORATION con I-EXPLORATION duodeno. I-EXPLORATION Existe I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION pancreático I-EXPLORATION principal, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION gran I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION adenopatías I-EXPLORATION periaorticocavas I-EXPLORATION y I-EXPLORATION mesentéricas. I-EXPLORATION Se I-EXPLORATION establece I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION inflamatoria I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION pancreatitis I-EXPLORATION crónica, I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartar I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION páncreas. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION USE, I-EXPLORATION confirmándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION cabeza I-EXPLORATION pancreática, I-EXPLORATION heteroecogénica, I-EXPLORATION irregular, I-EXPLORATION mal I-EXPLORATION delimitada, I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION calcificaciones I-EXPLORATION dispersas, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION como I-EXPLORATION en I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION parénquima I-EXPLORATION pancreático, I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION lobular, I-EXPLORATION con I-EXPLORATION puntos I-EXPLORATION y I-EXPLORATION bandas I-EXPLORATION hiperecogénicas I-EXPLORATION (característico I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION crónica). I-EXPLORATION El I-EXPLORATION conducto I-EXPLORATION pancreático I-EXPLORATION principal I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION dilatado, I-EXPLORATION con I-EXPLORATION pared I-EXPLORATION hiperecogénica, I-EXPLORATION patrón I-EXPLORATION irregular I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION colaterales. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION pancreática I-EXPLORATION afecta I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION principal, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION secundaria I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION Durante I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION USE I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION elastográfico. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION basal I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION heterogéneo I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION verde, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION elastográfico I-EXPLORATION de I-EXPLORATION segunda I-EXPLORATION generación I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION coeficiente I-EXPLORATION de I-EXPLORATION elasticidad I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 35 I-EXPLORATION y I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION A I-EXPLORATION (lesión I-EXPLORATION a I-EXPLORATION estudio) I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 12%. I-EXPLORATION Finalmente I-EXPLORATION se I-EXPLORATION rea-liza I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION de I-EXPLORATION 22G, I-EXPLORATION apreciándose I-EXPLORATION hallazgos I-EXPLORATION característicos I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION inflamatoria I-EXPLORATION en I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION pancreatitis I-EXPLORATION crónica I-EXPLORATION (18). I-EXPLORATION Finalmente B-TREATMENT se I-TREATMENT realiza I-TREATMENT una I-TREATMENT colangiopancreatografía I-TREATMENT retrógrada I-TREATMENT endoscópica I-TREATMENT con I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT prótesis I-TREATMENT de I-TREATMENT polietileno. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION satisfactoria, I-EVOLUTION encontrándose I-EVOLUTION tras I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION estable I-EVOLUTION y I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pancreatitis I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY alcohólica, I-PAST_MEDICAL_HISTORY ingresado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS respiratoria. I-PRESENT_ILLNESS Tras B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION y I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION un I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho. I-EXPLORATION Tras B-TREATMENT realizar I-TREATMENT una I-TREATMENT toracocentesis I-TREATMENT diagnóstica I-TREATMENT y I-TREATMENT evacuadora, I-TREATMENT el I-TREATMENT paciente I-TREATMENT experimentó I-TREATMENT disnea I-TREATMENT y I-TREATMENT síndrome I-TREATMENT de I-TREATMENT vena I-TREATMENT cava I-TREATMENT superior. I-TREATMENT En B-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ensanchamiento I-EXPLORATION mediastínico. I-EXPLORATION En I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION torácica I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION abdomen, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION drenó I-EXPLORATION mediante I-EXPLORATION un I-EXPLORATION tubo I-EXPLORATION torácico. I-EXPLORATION Este I-EXPLORATION líquido I-EXPLORATION contenía I-EXPLORATION una I-EXPLORATION elevada I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION amilasa I-EXPLORATION (104.000 I-EXPLORATION U/ml). I-EXPLORATION Además B-EVOLUTION apareció I-EVOLUTION en I-EVOLUTION la I-EVOLUTION región I-EVOLUTION cervical I-EVOLUTION lateral I-EVOLUTION derecha I-EVOLUTION un I-EVOLUTION área I-EVOLUTION de I-EVOLUTION abultamiento I-EVOLUTION con I-EVOLUTION signos I-EVOLUTION inflamatorios, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION drenó, I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION obtuvo I-EVOLUTION también I-EVOLUTION una I-EVOLUTION elevada I-EVOLUTION concentración I-EVOLUTION de I-EVOLUTION amilasa I-EVOLUTION (90.000 I-EVOLUTION U/ml). I-EVOLUTION Tras I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION de I-EVOLUTION las I-EVOLUTION colecciones I-EVOLUTION cervical I-EVOLUTION y I-EVOLUTION torácica, I-EVOLUTION mejoró I-EVOLUTION la I-EVOLUTION disnea I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION estabilizó. I-EVOLUTION A B-EXPLORATION fin I-EXPLORATION de I-EXPLORATION investigar I-EXPLORATION el I-EXPLORATION sospechado I-EXPLORATION origen I-EXPLORATION pancreático I-EXPLORATION de I-EXPLORATION las I-EXPLORATION colecciones, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION CPRE I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION que I-EXPLORATION el I-EXPLORATION conducto I-EXPLORATION de I-EXPLORATION Wirsung I-EXPLORATION era I-EXPLORATION irregular I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION dilataciones I-EXPLORATION y I-EXPLORATION que I-EXPLORATION comunicaba I-EXPLORATION con I-EXPLORATION la I-EXPLORATION pleura. I-EXPLORATION Se B-TREATMENT colocó I-TREATMENT una I-TREATMENT prótesis I-TREATMENT plástica, I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT la I-TREATMENT fístula I-TREATMENT se I-TREATMENT cerró. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION mejoró I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION cirugía. I-EVOLUTION La I-EVOLUTION prótesis I-EVOLUTION se I-EVOLUTION retiró I-EVOLUTION endoscópicamente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION bien, I-EVOLUTION sin I-EVOLUTION recidiva I-EVOLUTION del I-EVOLUTION pseudoquiste I-EVOLUTION después I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION años. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS intermitentes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS no I-PRESENT_ILLNESS advirtió I-PRESENT_ILLNESS rectorragia. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION alteraciones. I-EXPLORATION La I-EXPLORATION colonoscopia I-EXPLORATION evidenció I-EXPLORATION en I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION polipoide I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION casi I-EXPLORATION por I-EXPLORATION completo I-EXPLORATION la I-EXPLORATION luz, I-EXPLORATION y I-EXPLORATION mostraba I-EXPLORATION ulceraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza. I-EXPLORATION El I-EXPLORATION lugar I-EXPLORATION se I-EXPLORATION marcó I-EXPLORATION con I-EXPLORATION un I-EXPLORATION clip I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION mejor I-EXPLORATION la I-EXPLORATION localización I-EXPLORATION del I-EXPLORATION pólipo I-EXPLORATION mediante I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION simple. I-EXPLORATION Se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION informadas I-EXPLORATION como: I-EXPLORATION mucosa I-EXPLORATION colónica I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION ulceración I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION granulación I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION fibroso, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION malignidad. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION endoscópicos. I-EXPLORATION Tres B-TREATMENT semanas I-TREATMENT más I-TREATMENT tarde I-TREATMENT la I-TREATMENT paciente I-TREATMENT tuvo I-TREATMENT que I-TREATMENT ser I-TREATMENT operada I-TREATMENT de I-TREATMENT forma I-TREATMENT urgente I-TREATMENT al I-TREATMENT presentar I-TREATMENT un I-TREATMENT cuadro I-TREATMENT suboclusivo. I-TREATMENT En I-TREATMENT la I-TREATMENT intervención I-TREATMENT se I-TREATMENT objetivó I-TREATMENT una I-TREATMENT invaginación I-TREATMENT colónica I-TREATMENT asociada I-TREATMENT a I-TREATMENT un I-TREATMENT lipoma I-TREATMENT de I-TREATMENT 5, I-TREATMENT 5 I-TREATMENT cm, I-TREATMENT con I-TREATMENT origen I-TREATMENT en I-TREATMENT la I-TREATMENT submucosa. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT hemicolectomía I-TREATMENT derecha. I-TREATMENT Se I-TREATMENT aislaron I-TREATMENT varios I-TREATMENT ganglios I-TREATMENT reactivos. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 69 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS exfumador, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY aneurisma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aorta I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY infrarrenal I-PAST_MEDICAL_HISTORY 7, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anticoagulación I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY tromboembolismo I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY previo, I-PAST_MEDICAL_HISTORY recibió B-PRESENT_ILLNESS el I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pulmón I-PRESENT_ILLNESS no I-PRESENT_ILLNESS microcítico I-PRESENT_ILLNESS CPNM I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS epidermoide I-PRESENT_ILLNESS T3aN2M0 I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS lóbulo I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS Considerado B-TREATMENT irresecable, I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT 4 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT cisplatino-vinorelbina I-TREATMENT junto I-TREATMENT con I-TREATMENT radioterapia I-TREATMENT torácica; I-TREATMENT con I-TREATMENT moderada I-TREATMENT respuesta. I-TREATMENT Seis B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION diagnóstico, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION ingresó I-EVOLUTION por I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION difuso I-EVOLUTION de I-EVOLUTION seis I-EVOLUTION días I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION vómitos I-EVOLUTION esporádicos. I-EVOLUTION Presentaba B-EXPLORATION hipoalbuminemia I-EXPLORATION leve I-EXPLORATION y I-EXPLORATION anemia I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION g/dl I-EXPLORATION -precisando I-EXPLORATION concentrados I-EXPLORATION de I-EXPLORATION hematíes-. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION abdómino-pélvica I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION procedente I-EXPLORATION de I-EXPLORATION mesenterio I-EXPLORATION que I-EXPLORATION englobaba I-EXPLORATION varias I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino. I-EXPLORATION La I-EXPLORATION ultrasonografía I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION fistuloso I-EXPLORATION entre I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION y I-EXPLORATION un I-EXPLORATION área I-EXPLORATION flemonosa I-EXPLORATION con I-EXPLORATION pequeñas I-EXPLORATION burbujas I-EXPLORATION de I-EXPLORATION gas I-EXPLORATION extraluminal, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION instauró I-EXPLORATION tratamiento I-EXPLORATION antibiótico. I-EXPLORATION Al B-EVOLUTION 5o I-EVOLUTION día I-EVOLUTION desarrolló I-EVOLUTION un I-EVOLUTION franco I-EVOLUTION cuadro I-EVOLUTION obstructivo; I-EVOLUTION siendo B-TREATMENT entonces I-TREATMENT intervenido I-TREATMENT con I-TREATMENT carácter I-TREATMENT urgente. I-TREATMENT Se B-EXPLORATION halló I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mesenterio I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION promontorio I-EXPLORATION y I-EXPLORATION cercana I-EXPLORATION al I-EXPLORATION aneurisma. I-EXPLORATION Esta I-EXPLORATION englobaba I-EXPLORATION al I-EXPLORATION intestino I-EXPLORATION delgado, I-EXPLORATION dos I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION yeyuno, I-EXPLORATION una I-EXPLORATION de I-EXPLORATION íleon I-EXPLORATION -a I-EXPLORATION 30 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION cecal- I-EXPLORATION y I-EXPLORATION al I-EXPLORATION colon I-EXPLORATION sigmoideo I-EXPLORATION en I-EXPLORATION una I-EXPLORATION longitud I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT resección I-TREATMENT segmentaria I-TREATMENT de I-TREATMENT sigma I-TREATMENT y I-TREATMENT asas I-TREATMENT englobadas I-TREATMENT en I-TREATMENT el I-TREATMENT tumor I-TREATMENT mesentérico, I-TREATMENT reconstruyendo I-TREATMENT mediante I-TREATMENT tres I-TREATMENT anastomosis I-TREATMENT de I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT con I-TREATMENT autosutura I-TREATMENT mecánica I-TREATMENT latero-lateral, I-TREATMENT y I-TREATMENT una I-TREATMENT de I-TREATMENT sigma I-TREATMENT término-terminal. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION mesentérica I-EXPLORATION y I-EXPLORATION su I-EXPLORATION extensión I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION las I-EXPLORATION asas I-EXPLORATION intestinales I-EXPLORATION -alcanzando I-EXPLORATION la I-EXPLORATION mucosa-, I-EXPLORATION englobándolas, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION abscesificación I-EXPLORATION y I-EXPLORATION fistulización. I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION transcurrió I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION -recuperó I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION oral I-EVOLUTION y I-EVOLUTION el I-EVOLUTION tránsito I-EVOLUTION intestinal- I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION 8o I-EVOLUTION día, I-EVOLUTION cuando I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION pico I-EVOLUTION febril. I-EVOLUTION La B-EXPLORATION TC I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION -por I-EXPLORATION mínima I-EXPLORATION dehiscencia I-EXPLORATION de I-EXPLORATION sigma- I-EXPLORATION que I-EXPLORATION se I-EXPLORATION drenó I-EXPLORATION y I-EXPLORATION resolvió I-EXPLORATION radiológicamente. I-EXPLORATION Con B-EVOLUTION función I-EVOLUTION intestinal I-EVOLUTION normal, I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION En I-EVOLUTION las I-EVOLUTION semanas I-EVOLUTION posteriores, I-EVOLUTION experimentó I-EVOLUTION rápido I-EVOLUTION deterioro I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION y I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION tumoral I-EVOLUTION (linfangitis I-EVOLUTION carcinomatosa I-EVOLUTION pulmonar, I-EVOLUTION crecimiento I-EVOLUTION de I-EVOLUTION metástasis I-EVOLUTION subcutánea I-EVOLUTION en I-EVOLUTION pared I-EVOLUTION torácica, I-EVOLUTION hipercalcemia I-EVOLUTION tumoral). I-EVOLUTION No I-EVOLUTION estando I-EVOLUTION en I-EVOLUTION condiciones I-EVOLUTION de I-EVOLUTION iniciar I-EVOLUTION una I-EVOLUTION segunda I-EVOLUTION línea I-EVOLUTION de I-EVOLUTION quimioterapia, I-EVOLUTION falleció I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION exéresis I-EVOLUTION quirúrgica I-EVOLUTION de I-EVOLUTION la I-EVOLUTION metástasis I-EVOLUTION abdominal. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY diagnosticado B-PRESENT_ILLNESS de I-PRESENT_ILLNESS colitis I-PRESENT_ILLNESS ulcerosa I-PRESENT_ILLNESS e I-PRESENT_ILLNESS intervenido, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS colectomía I-PRESENT_ILLNESS total I-PRESENT_ILLNESS e I-PRESENT_ILLNESS ileostomía I-PRESENT_ILLNESS terminal, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS megacolon I-PRESENT_ILLNESS tóxico. I-PRESENT_ILLNESS Acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS líquidas I-PRESENT_ILLNESS inicialmente, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cierre I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION abdomen I-EXPLORATION distendido I-EXPLORATION y I-EXPLORATION doloroso, I-EXPLORATION con I-EXPLORATION ruidos I-EXPLORATION hidroaéreos I-EXPLORATION ausentes. I-EXPLORATION Ileostomía I-EXPLORATION terminal I-EXPLORATION iliaca I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION escaso I-EXPLORATION débito I-EXPLORATION y I-EXPLORATION hernia I-EXPLORATION paraileostómica I-EXPLORATION no I-EXPLORATION reductible. I-EXPLORATION Analíticamente, I-EXPLORATION presentaba I-EXPLORATION hemograma I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION bioquímica I-EXPLORATION con I-EXPLORATION glucosa I-EXPLORATION 388 I-EXPLORATION mg/dl, I-EXPLORATION urea I-EXPLORATION 98 I-EXPLORATION mg/dl, I-EXPLORATION GOT I-EXPLORATION 50 I-EXPLORATION U/l, I-EXPLORATION GPT I-EXPLORATION 52 I-EXPLORATION U/l, I-EXPLORATION LDH I-EXPLORATION 556 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 159 I-EXPLORATION U/l, I-EXPLORATION CK I-EXPLORATION 41 I-EXPLORATION U/l, I-EXPLORATION TG I-EXPLORATION 358 I-EXPLORATION mg/dl, I-EXPLORATION PT I-EXPLORATION 5, I-EXPLORATION 2 I-EXPLORATION g/l I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION 63 I-EXPLORATION mg/l. I-EXPLORATION La I-EXPLORATION gasometría I-EXPLORATION venosa, I-EXPLORATION ionograma I-EXPLORATION y I-EXPLORATION coagulación I-EXPLORATION eran I-EXPLORATION normales I-EXPLORATION con I-EXPLORATION fibrinógeno I-EXPLORATION de I-EXPLORATION 891 I-EXPLORATION mg/dl. I-EXPLORATION La I-EXPLORATION radiología I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION eran I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION oclusión I-EXPLORATION intestinal. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT falta I-TREATMENT de I-TREATMENT respuesta I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT médico, I-TREATMENT se I-TREATMENT decide I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT la I-TREATMENT hernia I-TREATMENT paraileostómica I-TREATMENT presentando B-EVOLUTION posteriormente I-EVOLUTION empeoramiento I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION sepsis I-EVOLUTION y I-EVOLUTION celulitis I-EVOLUTION de I-EVOLUTION piel I-EVOLUTION y I-EVOLUTION tejido I-EVOLUTION celular I-EVOLUTION subcutáneo I-EVOLUTION abdominal I-EVOLUTION circundante I-EVOLUTION al I-EVOLUTION ostoma, I-EVOLUTION reinterviniéndose B-TREATMENT en I-TREATMENT otras I-TREATMENT 2 I-TREATMENT ocasiones, I-TREATMENT con I-TREATMENT resección I-TREATMENT de I-TREATMENT 50 I-TREATMENT cm I-TREATMENT de I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT cada I-TREATMENT una, I-TREATMENT presentando I-TREATMENT ulceraciones I-TREATMENT profundas, I-TREATMENT perforaciones I-TREATMENT y I-TREATMENT pequeños I-TREATMENT abscesos I-TREATMENT adyacentes I-TREATMENT al I-TREATMENT ostoma. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION postoperatorio, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION comienza I-EVOLUTION con I-EVOLUTION sangrado I-EVOLUTION difuso I-EVOLUTION por I-EVOLUTION el I-EVOLUTION orificio I-EVOLUTION de I-EVOLUTION ileostomía I-EVOLUTION y I-EVOLUTION necrosis I-EVOLUTION en I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION centímetros I-EVOLUTION de I-EVOLUTION esta. I-EVOLUTION La B-EXPLORATION endoscopia I-EXPLORATION alta, I-EXPLORATION hasta I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION duodenal I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos, I-EXPLORATION se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION la I-EXPLORATION reapertura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION quirúrgica, I-EXPLORATION apreciándose I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION los I-EXPLORATION últimos I-EXPLORATION centímetros I-EXPLORATION del I-EXPLORATION asa I-EXPLORATION de I-EXPLORATION ileostomía, I-EXPLORATION sangrado I-EXPLORATION activo I-EXPLORATION de I-EXPLORATION ulceraciones I-EXPLORATION profundas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION y I-EXPLORATION perforaciones I-EXPLORATION cubiertas I-EXPLORATION con I-EXPLORATION coágulos I-EXPLORATION intraluminales, I-EXPLORATION resecándose I-EXPLORATION nuevamente I-EXPLORATION 50 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION afectado. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION resulta I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION continuó I-EVOLUTION con I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION persistente I-EVOLUTION y I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION inestabilidad I-EVOLUTION hemodinámica, I-EVOLUTION requiriendo B-TREATMENT transfusión I-TREATMENT de I-TREATMENT 10 I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes I-TREATMENT y I-TREATMENT 2 I-TREATMENT de I-TREATMENT fibrinógeno, I-TREATMENT sin I-TREATMENT respuesta I-TREATMENT a I-TREATMENT corticoterapia I-TREATMENT a I-TREATMENT dosis I-TREATMENT plenas, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT infliximab I-TREATMENT previa I-TREATMENT realización I-TREATMENT de I-TREATMENT placa I-TREATMENT de I-TREATMENT tórax, I-TREATMENT mantoux I-TREATMENT negativo I-TREATMENT y I-TREATMENT TAC I-TREATMENT toracoabdominal I-TREATMENT que I-TREATMENT descartó I-TREATMENT procesos I-TREATMENT infecciosos. I-TREATMENT Cinco B-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION infliximab, I-EVOLUTION el I-EVOLUTION sangrado I-EVOLUTION remite I-EVOLUTION y I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION terapia I-EVOLUTION de I-EVOLUTION mantenimiento I-EVOLUTION con I-EVOLUTION infliximab I-EVOLUTION y I-EVOLUTION en I-EVOLUTION la I-EVOLUTION enteroscopia I-EVOLUTION de I-EVOLUTION control, I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION mucosa I-EVOLUTION intestinal I-EVOLUTION sin I-EVOLUTION ulceraciones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 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 colecistectomía I-PAST_MEDICAL_HISTORY abierta I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro 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 dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS intermitente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS epigastrio I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS biliosos, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS consultado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS diversas I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS atención I-PRESENT_ILLNESS primaria I-PRESENT_ILLNESS realizándose I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS sintomático I-PRESENT_ILLNESS con I-PRESENT_ILLNESS omeprazol. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION afebril, I-EXPLORATION hemodinámicamente I-EXPLORATION estable I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION alteraciones. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION y, I-EXPLORATION posteriormente, I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION revelaba I-EXPLORATION una I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION hepática I-EXPLORATION propia I-EXPLORATION próxima I-EXPLORATION a I-EXPLORATION su I-EXPLORATION bifurcación I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION pseudoaneurisma, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION un I-EXPLORATION componente I-EXPLORATION mural I-EXPLORATION trombosado I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION condicionaba I-EXPLORATION una I-EXPLORATION compresión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION secundaria. I-EXPLORATION Al I-EXPLORATION día I-EXPLORATION siguiente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION por I-EXPLORATION vía I-EXPLORATION femoral I-EXPLORATION derecha I-EXPLORATION una I-EXPLORATION arteriografía I-EXPLORATION selectiva I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION celiaco, I-EXPLORATION arteria I-EXPLORATION hepática I-EXPLORATION común I-EXPLORATION y I-EXPLORATION mesentérica I-EXPLORATION superior I-EXPLORATION objetivando I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION sacular I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bifurcación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION hepática I-EXPLORATION propia, I-EXPLORATION con I-EXPLORATION vascularización I-EXPLORATION distal I-EXPLORATION intrahepática I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION relleno I-EXPLORATION retrógrado I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arcada I-EXPLORATION pancreatoduodenal. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT prótesis I-TREATMENT metálica I-TREATMENT autoexpandible I-TREATMENT y I-TREATMENT embolización I-TREATMENT del I-TREATMENT pseudoaneurisma I-TREATMENT mediante I-TREATMENT coils I-TREATMENT con I-TREATMENT una I-TREATMENT oclusión I-TREATMENT efectiva I-TREATMENT y I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT en I-TREATMENT el I-TREATMENT control. I-TREATMENT Al B-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION su I-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Reanimación, I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION e I-EVOLUTION hipotensión I-EVOLUTION brusca I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION rotura I-EVOLUTION del I-EVOLUTION aneurisma I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION cavidad I-EVOLUTION peritoneal I-EVOLUTION falleciendo I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS constitucional. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hiperuricemia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY metformina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alopurinol. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS apetito I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipercalcemia. I-PRESENT_ILLNESS En B-EXPLORATION analítica I-EXPLORATION destaca: I-EXPLORATION Hb I-EXPLORATION 9, I-EXPLORATION 9 I-EXPLORATION mg/dl, I-EXPLORATION eosinófilos I-EXPLORATION 7, I-EXPLORATION 5%, I-EXPLORATION GGT I-EXPLORATION 225 I-EXPLORATION U/l, I-EXPLORATION calcio I-EXPLORATION 11, I-EXPLORATION 8 I-EXPLORATION mg/dl, I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION 7, I-EXPLORATION 2 I-EXPLORATION g/dl, I-EXPLORATION creatinina I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION mg/dl. I-EXPLORATION ECA I-EXPLORATION 134.8. I-EXPLORATION Resto I-EXPLORATION normal. I-EXPLORATION Anticuerpos I-EXPLORATION antinucleares I-EXPLORATION negativos. I-EXPLORATION Serología I-EXPLORATION hepatitis, I-EXPLORATION CMV, I-EXPLORATION VEB, I-EXPLORATION toxoplasma, I-EXPLORATION Aspergillus I-EXPLORATION fumigatus, I-EXPLORATION Brucella, I-EXPLORATION Candida I-EXPLORATION negativos; I-EXPLORATION VEB I-EXPLORATION Ig I-EXPLORATION G I-EXPLORATION positivo, I-EXPLORATION Coxiella I-EXPLORATION Ig I-EXPLORATION G I-EXPLORATION positivo I-EXPLORATION 1/80, I-EXPLORATION Ig I-EXPLORATION M I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Endoscopia I-EXPLORATION alta, I-EXPLORATION colonoscopia, I-EXPLORATION broncoscopia, I-EXPLORATION gammagrafía, I-EXPLORATION proteinograma I-EXPLORATION y I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION en I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION toraco-abdominal I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION hepatopatía I-EXPLORATION difusa I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hipertensión I-EXPLORATION portal. I-EXPLORATION Tras B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT furosemida I-TREATMENT y I-TREATMENT sueroterapia I-TREATMENT presenta I-TREATMENT inicialmente I-TREATMENT empeoramiento I-TREATMENT de I-TREATMENT las I-TREATMENT cifras I-TREATMENT de I-TREATMENT calcemia I-TREATMENT hasta I-TREATMENT 14, I-TREATMENT 7 I-TREATMENT mg/dl. I-TREATMENT Se B-EXPLORATION realiza I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION objetivándose I-EXPLORATION granulomas I-EXPLORATION no I-EXPLORATION necrotizantes I-EXPLORATION con I-EXPLORATION células I-EXPLORATION epiteliodes I-EXPLORATION que I-EXPLORATION se I-EXPLORATION acompaña I-EXPLORATION de I-EXPLORATION fibrosis. I-EXPLORATION Está I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION células I-EXPLORATION epiteliodes, I-EXPLORATION gigantes I-EXPLORATION multinucleadas I-EXPLORATION (algunas I-EXPLORATION microvacuoladas) I-EXPLORATION con I-EXPLORATION componente I-EXPLORATION de I-EXPLORATION células I-EXPLORATION plasmáticas, I-EXPLORATION mononucleares I-EXPLORATION y I-EXPLORATION polimorfonucleares. I-EXPLORATION La I-EXPLORATION inflamación I-EXPLORATION sobrepasa I-EXPLORATION la I-EXPLORATION limitante I-EXPLORATION portal, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION esteatosis I-EXPLORATION macrovesicular, I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION eosinófilos. I-EXPLORATION Tinciones I-EXPLORATION para I-EXPLORATION hongos I-EXPLORATION y I-EXPLORATION Ziehl I-EXPLORATION negativa. I-EXPLORATION Dado B-TREATMENT que I-TREATMENT el I-TREATMENT cuadro I-TREATMENT clínico I-TREATMENT era I-TREATMENT compatible I-TREATMENT con I-TREATMENT granulomas I-TREATMENT secundarios I-TREATMENT a I-TREATMENT fármacos, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT retirada I-TREATMENT del I-TREATMENT alopurinol I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT furosemida. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 3 I-EVOLUTION semanas I-EVOLUTION persistía I-EVOLUTION hipercalcemia I-EVOLUTION leve I-EVOLUTION (10, I-EVOLUTION 7 I-EVOLUTION mg/dl) I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT pauta I-TREATMENT corta I-TREATMENT de I-TREATMENT corticoides, I-TREATMENT normalizándose I-TREATMENT la I-TREATMENT calcemia I-TREATMENT y I-TREATMENT las I-TREATMENT enzimas I-TREATMENT hepáticas I-TREATMENT a I-TREATMENT los I-TREATMENT 2 I-TREATMENT meses. I-TREATMENT La B-EVOLUTION ecografía I-EVOLUTION de I-EVOLUTION control I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION fue I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Antecedentes B-FAMILY_HISTORY familiares: I-FAMILY_HISTORY padres I-FAMILY_HISTORY y I-FAMILY_HISTORY ocho I-FAMILY_HISTORY hermanos I-FAMILY_HISTORY fallecidos I-FAMILY_HISTORY sin I-FAMILY_HISTORY patología I-FAMILY_HISTORY digestiva I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY Antecedentes B-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY alergias, I-PAST_MEDICAL_HISTORY hábito I-PAST_MEDICAL_HISTORY tabáquico I-PAST_MEDICAL_HISTORY (60 I-PAST_MEDICAL_HISTORY cigarrillos/día) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY etílico I-PAST_MEDICAL_HISTORY (80 I-PAST_MEDICAL_HISTORY g/día) I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY apendicectomizado, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY enfisematosa, I-PAST_MEDICAL_HISTORY hipertrofia I-PAST_MEDICAL_HISTORY benigna I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY artrosis I-PAST_MEDICAL_HISTORY generalizada. I-PAST_MEDICAL_HISTORY Diagnosticado I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY diverticular I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY enema I-PAST_MEDICAL_HISTORY opaco, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY referir I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY hipogástrico. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY practicó I-PAST_MEDICAL_HISTORY colonoscopia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY analítica I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY detectaron I-PAST_MEDICAL_HISTORY alteraciones I-PAST_MEDICAL_HISTORY significativas, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY normal I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cifra I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY proteínas I-PAST_MEDICAL_HISTORY totales. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY habitual I-PAST_MEDICAL_HISTORY con: I-PAST_MEDICAL_HISTORY tamsulosina, I-PAST_MEDICAL_HISTORY tartrato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY zolpidem, I-PAST_MEDICAL_HISTORY biotina, I-PAST_MEDICAL_HISTORY candesartán, I-PAST_MEDICAL_HISTORY fumarato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY formoterol, I-PAST_MEDICAL_HISTORY bromuro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ipratropio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY budesonida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY inhalatoria. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY ingesta I-PAST_MEDICAL_HISTORY habitual I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antiinflamatorios I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY esteroideos I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY antibióticos. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY mes, I-PAST_MEDICAL_HISTORY dada I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diarrea, I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY loperamida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ciprofloxacino, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY observarse I-PAST_MEDICAL_HISTORY mejoría. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY - I-PAST_MEDICAL_HISTORY Enfermedad B-PRESENT_ILLNESS actual: I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS progresiva: I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS anorexia, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS (10 I-PRESENT_ILLNESS kg), I-PRESENT_ILLNESS numerosas I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS precedidas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS hipogástrico, I-PRESENT_ILLNESS diurnas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS nocturnas, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS consistencia I-PRESENT_ILLNESS blanda I-PRESENT_ILLNESS o I-PRESENT_ILLNESS líquida, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS contenido I-PRESENT_ILLNESS hemático I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS abundante I-PRESENT_ILLNESS mucosidad. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS interés. I-PRESENT_ILLNESS I-PRESENT_ILLNESS - B-EXPLORATION Exploración I-EXPLORATION física: I-EXPLORATION deterioro I-EXPLORATION físico I-EXPLORATION atribuible I-EXPLORATION a I-EXPLORATION edad I-EXPLORATION avanzada I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION muscular. I-EXPLORATION Talla I-EXPLORATION 164 I-EXPLORATION cm. I-EXPLORATION Peso I-EXPLORATION 67 I-EXPLORATION kg. I-EXPLORATION Necesitaba I-EXPLORATION ayuda I-EXPLORATION para I-EXPLORATION la I-EXPLORATION deambulación. I-EXPLORATION Ausencia I-EXPLORATION de I-EXPLORATION ictericia I-EXPLORATION o I-EXPLORATION de I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas. I-EXPLORATION Presencia I-EXPLORATION de I-EXPLORATION máculas I-EXPLORATION hiperpigmentadas I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION superiores. I-EXPLORATION Escaso I-EXPLORATION vello I-EXPLORATION corporal. I-EXPLORATION No I-EXPLORATION adenopatías I-EXPLORATION periféricas. I-EXPLORATION Auscultación I-EXPLORATION cardiaca I-EXPLORATION normal. I-EXPLORATION Frecuencia I-EXPLORATION cardiaca: I-EXPLORATION 80 I-EXPLORATION sístoles/minuto. I-EXPLORATION Tensión I-EXPLORATION arterial: I-EXPLORATION 150/90 I-EXPLORATION mmHg. I-EXPLORATION Auscultación I-EXPLORATION respiratoria: I-EXPLORATION disminución I-EXPLORATION difusa I-EXPLORATION del I-EXPLORATION murmullo I-EXPLORATION vesicular I-EXPLORATION con I-EXPLORATION escasos I-EXPLORATION roncus I-EXPLORATION y I-EXPLORATION sibilantes. I-EXPLORATION Abdomen I-EXPLORATION con I-EXPLORATION auscultación I-EXPLORATION normal, I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipogastrio I-EXPLORATION y I-EXPLORATION ambas I-EXPLORATION fosas I-EXPLORATION iliacas, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION masas I-EXPLORATION o I-EXPLORATION visceromegalias. I-EXPLORATION Atrofia I-EXPLORATION muscular I-EXPLORATION en I-EXPLORATION extremidades, I-EXPLORATION pulsos I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION edemas. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Analítica: I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION hematocrito, I-EXPLORATION hemoglobina, I-EXPLORATION volumen I-EXPLORATION corpuscular I-EXPLORATION medio, I-EXPLORATION plaquetas, I-EXPLORATION glucosa, I-EXPLORATION urea, I-EXPLORATION sodio, I-EXPLORATION creatinina, I-EXPLORATION bilirrubina, I-EXPLORATION transaminasas, I-EXPLORATION fosfatasa I-EXPLORATION alcalina, I-EXPLORATION colesterol, I-EXPLORATION triglicéridos, I-EXPLORATION ácido I-EXPLORATION fólico, I-EXPLORATION ferritina I-EXPLORATION y I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION se I-EXPLORATION mantuvieron I-EXPLORATION en I-EXPLORATION el I-EXPLORATION rango I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION Elevación I-EXPLORATION progresiva I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION (13.900- I-EXPLORATION 30.900, I-EXPLORATION normal I-EXPLORATION 4.600-10.200/mm3), I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (70-90%), I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (16, I-EXPLORATION 9-93, I-EXPLORATION 4, I-EXPLORATION normal I-EXPLORATION 0-5 I-EXPLORATION mg/l); I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION (4, I-EXPLORATION 4-5, I-EXPLORATION 3, I-EXPLORATION normal I-EXPLORATION 6, I-EXPLORATION 6-8, I-EXPLORATION 7 I-EXPLORATION g/dl), I-EXPLORATION calcio I-EXPLORATION (4, I-EXPLORATION 7-7, I-EXPLORATION 0, I-EXPLORATION normal I-EXPLORATION 8, I-EXPLORATION 5-10, I-EXPLORATION 5 I-EXPLORATION mg/dl) I-EXPLORATION y I-EXPLORATION colinesterasa I-EXPLORATION (1.557-2.591, I-EXPLORATION normal I-EXPLORATION 5.300-12.900 I-EXPLORATION U/l). I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION normal. I-EXPLORATION Proteinograma: I-EXPLORATION hipoalbuminemia I-EXPLORATION (2, I-EXPLORATION 49, I-EXPLORATION normal I-EXPLORATION 4, I-EXPLORATION 0-4, I-EXPLORATION 7 I-EXPLORATION g/dl) I-EXPLORATION e I-EXPLORATION hipogammaglobulinemia I-EXPLORATION (0, I-EXPLORATION 39, I-EXPLORATION normal I-EXPLORATION 0, I-EXPLORATION 80-1, I-EXPLORATION 35 I-EXPLORATION g/dl), I-EXPLORATION con I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION 4, I-EXPLORATION 7 I-EXPLORATION g/dl. I-EXPLORATION Las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION potasio, I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION anodinas I-EXPLORATION durante I-EXPLORATION las I-EXPLORATION primeras I-EXPLORATION semanas I-EXPLORATION del I-EXPLORATION ingreso, I-EXPLORATION alcanzaron I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 3-1, I-EXPLORATION 9, I-EXPLORATION normal I-EXPLORATION 3, I-EXPLORATION 5-5 I-EXPLORATION mEq/l). I-EXPLORATION Elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION gastrina I-EXPLORATION (263, I-EXPLORATION normal I-EXPLORATION 13-115 I-EXPLORATION pg/ml) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION tirotropina I-EXPLORATION (TSH) I-EXPLORATION (33, I-EXPLORATION 9-17, I-EXPLORATION 3, I-EXPLORATION normal I-EXPLORATION 0, I-EXPLORATION 12-5 I-EXPLORATION uU/ml), I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tiroxina I-EXPLORATION (T4) I-EXPLORATION (0, I-EXPLORATION 56-0, I-EXPLORATION 27, I-EXPLORATION normal I-EXPLORATION 0, I-EXPLORATION 8-1, I-EXPLORATION 8 I-EXPLORATION ng/dl) I-EXPLORATION y I-EXPLORATION normalidad I-EXPLORATION de I-EXPLORATION cortisol I-EXPLORATION sérico. I-EXPLORATION Las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION TSH I-EXPLORATION y I-EXPLORATION T4 I-EXPLORATION eran I-EXPLORATION normales I-EXPLORATION al I-EXPLORATION ingreso. I-EXPLORATION Anticuerpos I-EXPLORATION anti-peroxidasa I-EXPLORATION tiroidea, I-EXPLORATION anti-tiroglobulina, I-EXPLORATION antinucleares I-EXPLORATION y I-EXPLORATION anti-transglutaminasa I-EXPLORATION negativos. I-EXPLORATION Sedimento I-EXPLORATION urinario I-EXPLORATION normal. I-EXPLORATION Elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario I-EXPLORATION (28, I-EXPLORATION 5-88, I-EXPLORATION 1, I-EXPLORATION normal I-EXPLORATION 0-5 I-EXPLORATION ng/ml) I-EXPLORATION y I-EXPLORATION del I-EXPLORATION antígeno I-EXPLORATION CA I-EXPLORATION 19., I-EXPLORATION 9 I-EXPLORATION (57, I-EXPLORATION 8, I-EXPLORATION normal I-EXPLORATION 0-37 I-EXPLORATION U/ml); I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION antígeno I-EXPLORATION específico I-EXPLORATION prostático, I-EXPLORATION alfa-fetoproteína I-EXPLORATION y I-EXPLORATION antígeno I-EXPLORATION CA I-EXPLORATION 125 I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Cuantificación I-EXPLORATION de I-EXPLORATION grasas I-EXPLORATION en I-EXPLORATION heces I-EXPLORATION no I-EXPLORATION valorable. I-EXPLORATION Microbiología: I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION coprocultivos, I-EXPLORATION urocultivos, I-EXPLORATION parásitos I-EXPLORATION en I-EXPLORATION heces, I-EXPLORATION toxina I-EXPLORATION de I-EXPLORATION Clostridium I-EXPLORATION difficile, I-EXPLORATION Mantoux I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION a I-EXPLORATION Helicobacter I-EXPLORATION pylori, I-EXPLORATION VIH, I-EXPLORATION citomegalovirus, I-EXPLORATION Salmonella I-EXPLORATION y I-EXPLORATION Yersinia I-EXPLORATION enterocolítica. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Exploraciones I-EXPLORATION complementarias: I-EXPLORATION I-EXPLORATION • I-EXPLORATION Colonoscopia I-EXPLORATION (practicada I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION ocasiones): I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa, I-EXPLORATION principalmente I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION rectosigmoidea I-EXPLORATION y I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION ileocecal, I-EXPLORATION numerosas I-EXPLORATION lesiones I-EXPLORATION nodulares I-EXPLORATION o I-EXPLORATION polipoides I-EXPLORATION sésiles, I-EXPLORATION de I-EXPLORATION variable I-EXPLORATION tamaño, I-EXPLORATION llegando I-EXPLORATION en I-EXPLORATION algunos I-EXPLORATION tramos I-EXPLORATION a I-EXPLORATION ocupar I-EXPLORATION casi I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION del I-EXPLORATION colon, I-EXPLORATION dificultando I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio. I-EXPLORATION Las I-EXPLORATION lesiones I-EXPLORATION muestran I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION enrojecida I-EXPLORATION con I-EXPLORATION lesiones I-EXPLORATION petequiales I-EXPLORATION y I-EXPLORATION equimóticas. I-EXPLORATION Se I-EXPLORATION obtuvieron I-EXPLORATION biopsias I-EXPLORATION a I-EXPLORATION distintos I-EXPLORATION niveles I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION exploración, I-EXPLORATION una I-EXPLORATION macrobiopsia I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION rectal I-EXPLORATION con I-EXPLORATION asa I-EXPLORATION de I-EXPLORATION polipectomía. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Gastroscopia: I-EXPLORATION esófago, I-EXPLORATION fundus I-EXPLORATION y I-EXPLORATION cuerpo I-EXPLORATION gástrico I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION antro I-EXPLORATION gástrico, I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION prepilórico, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION duodenal I-EXPLORATION mostraban, I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa, I-EXPLORATION nódulos I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Radiología I-EXPLORATION del I-EXPLORATION tórax: I-EXPLORATION bullas I-EXPLORATION enfisematosas I-EXPLORATION en I-EXPLORATION base I-EXPLORATION pulmonar I-EXPLORATION derecha. I-EXPLORATION No I-EXPLORATION derrame I-EXPLORATION pleural. I-EXPLORATION Sospecha I-EXPLORATION de I-EXPLORATION leve I-EXPLORATION derrame I-EXPLORATION pericárdico. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Radiología I-EXPLORATION baritada I-EXPLORATION de I-EXPLORATION esófago, I-EXPLORATION estómago I-EXPLORATION e I-EXPLORATION intestino I-EXPLORATION delgado: I-EXPLORATION pliegues I-EXPLORATION gástricos I-EXPLORATION antrales I-EXPLORATION engrosados, I-EXPLORATION irregulares I-EXPLORATION y I-EXPLORATION con I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción. I-EXPLORATION Engrosamiento I-EXPLORATION de I-EXPLORATION pliegues I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado, I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION nodular, I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION en I-EXPLORATION yeyuno, I-EXPLORATION y I-EXPLORATION dilución I-EXPLORATION del I-EXPLORATION contraste. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Enema I-EXPLORATION opaco: I-EXPLORATION divertículos I-EXPLORATION en I-EXPLORATION colon I-EXPLORATION sigmoideo I-EXPLORATION y I-EXPLORATION descendente. I-EXPLORATION Múltiples I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION en I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Tomografía I-EXPLORATION computarizada I-EXPLORATION abdominal: I-EXPLORATION quistes I-EXPLORATION en I-EXPLORATION riñón I-EXPLORATION izquierdo. I-EXPLORATION Probable I-EXPLORATION adenoma I-EXPLORATION suprarrenal I-EXPLORATION derecho. I-EXPLORATION Divertículos I-EXPLORATION en I-EXPLORATION colon I-EXPLORATION descendente I-EXPLORATION y I-EXPLORATION sigmoides. I-EXPLORATION Engrosamiento I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION Hipertrofia I-EXPLORATION prostática. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Ecografía I-EXPLORATION tiroidea: I-EXPLORATION tiroides I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION normal. I-EXPLORATION Pequeños I-EXPLORATION quistes I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION derecho. I-EXPLORATION Lóbulo I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION ecogenicidad I-EXPLORATION homogénea I-EXPLORATION y I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Ecocardiograma I-EXPLORATION transtorácico: I-EXPLORATION no I-EXPLORATION derrame I-EXPLORATION pericárdico, I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION conservada, I-EXPLORATION insuficiencia I-EXPLORATION valvular I-EXPLORATION mitral I-EXPLORATION y I-EXPLORATION aórtica. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Histología I-EXPLORATION de I-EXPLORATION biopsias I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION y I-EXPLORATION macrobiopsia I-EXPLORATION rectal: I-EXPLORATION mucosa I-EXPLORATION con I-EXPLORATION distorsión I-EXPLORATION intensa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arquitectura I-EXPLORATION glandular, I-EXPLORATION dilataciones I-EXPLORATION glandulares I-EXPLORATION microquísticas I-EXPLORATION y I-EXPLORATION colecciones I-EXPLORATION de I-EXPLORATION mucina, I-EXPLORATION lámina I-EXPLORATION propia I-EXPLORATION edematosa I-EXPLORATION con I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION moderado I-EXPLORATION a I-EXPLORATION severo I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION células I-EXPLORATION plasmáticas, I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION eosinófilos. I-EXPLORATION Las I-EXPLORATION alteraciones I-EXPLORATION detectadas I-EXPLORATION son I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION hamartomas I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION y I-EXPLORATION recto. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Histología I-EXPLORATION de I-EXPLORATION biopsias I-EXPLORATION gástricas I-EXPLORATION y I-EXPLORATION duodenales: I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION dilataciones I-EXPLORATION glandulares I-EXPLORATION e I-EXPLORATION intenso I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION mixto, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION hamartomas I-EXPLORATION de I-EXPLORATION estómago I-EXPLORATION y I-EXPLORATION duodeno. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Evolución B-EVOLUTION clínica: I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION diagnosticado I-EVOLUTION de I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Cronkhite-Canadá, I-EVOLUTION falleciendo I-EVOLUTION tras I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION hospitalario I-EVOLUTION sin I-EVOLUTION detectarse I-EVOLUTION en I-EVOLUTION ningún I-EVOLUTION momento I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION evidente I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION clínico I-EVOLUTION inicial. I-EVOLUTION Mantuvo I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION de I-EVOLUTION astenia I-EVOLUTION y I-EVOLUTION anorexia, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION número I-EVOLUTION variable I-EVOLUTION de I-EVOLUTION deposiciones I-EVOLUTION con I-EVOLUTION abundante I-EVOLUTION contenido I-EVOLUTION mucoso, I-EVOLUTION mayor I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION y I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION hipoproteinemia I-EVOLUTION con I-EVOLUTION edemas I-EVOLUTION en I-EVOLUTION miembros I-EVOLUTION inferiores. I-EVOLUTION Presencia I-EVOLUTION de I-EVOLUTION fiebre I-EVOLUTION (38 I-EVOLUTION oC) I-EVOLUTION en I-EVOLUTION días I-EVOLUTION aislados I-EVOLUTION con I-EVOLUTION hemocultivos I-EVOLUTION positivos I-EVOLUTION a I-EVOLUTION E. I-EVOLUTION coli I-EVOLUTION atribuible I-EVOLUTION a I-EVOLUTION flebitis I-EVOLUTION e I-EVOLUTION infecciones I-EVOLUTION urinarias, I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION tetania I-EVOLUTION hipocalcémica, I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION miembros I-EVOLUTION inferiores I-EVOLUTION de I-EVOLUTION probable I-EVOLUTION origen I-EVOLUTION neuropático I-EVOLUTION y I-EVOLUTION lesiones I-EVOLUTION ungueales I-EVOLUTION con I-EVOLUTION onicólisis I-EVOLUTION muy I-EVOLUTION evidente. I-EVOLUTION Es I-EVOLUTION destacable I-EVOLUTION el I-EVOLUTION desarrollo I-EVOLUTION de I-EVOLUTION hipotiroidismo I-EVOLUTION y I-EVOLUTION la I-EVOLUTION elevación I-EVOLUTION de I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION antígeno I-EVOLUTION carcinoembrionario. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION fallece I-EVOLUTION tras I-EVOLUTION presentar, I-EVOLUTION en I-EVOLUTION las I-EVOLUTION últimas I-EVOLUTION 24 I-EVOLUTION horas, I-EVOLUTION fiebre, I-EVOLUTION tos I-EVOLUTION con I-EVOLUTION expectoración I-EVOLUTION hemoptoica, I-EVOLUTION disnea, I-EVOLUTION datos I-EVOLUTION de I-EVOLUTION insuficiencia I-EVOLUTION respiratoria I-EVOLUTION en I-EVOLUTION la I-EVOLUTION gasometría I-EVOLUTION arterial I-EVOLUTION y I-EVOLUTION de I-EVOLUTION neumonía I-EVOLUTION de I-EVOLUTION base I-EVOLUTION izquierda I-EVOLUTION en I-EVOLUTION la I-EVOLUTION radiología I-EVOLUTION de I-EVOLUTION tórax. I-EVOLUTION Se B-EXPLORATION practicó I-EXPLORATION necropsia. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Tratamientos: B-TREATMENT el I-TREATMENT paciente I-TREATMENT durante I-TREATMENT su I-TREATMENT prolongada I-TREATMENT estancia I-TREATMENT hospitalaria I-TREATMENT recibió I-TREATMENT tratamiento, I-TREATMENT no I-TREATMENT de I-TREATMENT forma I-TREATMENT simultánea, I-TREATMENT con: I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT oral I-TREATMENT y I-TREATMENT por I-TREATMENT sonda, I-TREATMENT sueroterapia I-TREATMENT con I-TREATMENT aporte I-TREATMENT de I-TREATMENT cloruro I-TREATMENT potásico, I-TREATMENT calcio I-TREATMENT oral I-TREATMENT y I-TREATMENT sistémico, I-TREATMENT albúmina I-TREATMENT intravenosa, I-TREATMENT omeprazol I-TREATMENT 20 I-TREATMENT mg/día, I-TREATMENT mesalazina, I-TREATMENT complejos I-TREATMENT vitamínicos, I-TREATMENT loratadina I-TREATMENT 10 I-TREATMENT mg/día, I-TREATMENT corticoides I-TREATMENT orales I-TREATMENT y I-TREATMENT sistémicos, I-TREATMENT loperamida, I-TREATMENT octeótrida I-TREATMENT subcutánea I-TREATMENT 50 I-TREATMENT mcg/8 I-TREATMENT h, I-TREATMENT gabapentina I-TREATMENT 300 I-TREATMENT mg/8 I-TREATMENT h, I-TREATMENT antibióticos I-TREATMENT (piperacilina-tazobactam, I-TREATMENT amoxicilina-clavulámico, I-TREATMENT metronidazol I-TREATMENT y I-TREATMENT ciprofloxacino), I-TREATMENT levotiroxina I-TREATMENT y I-TREATMENT medicación I-TREATMENT para I-TREATMENT su I-TREATMENT patología I-TREATMENT previas: I-TREATMENT hipertensión I-TREATMENT arterial, I-TREATMENT broncopatía I-TREATMENT crónica I-TREATMENT e I-TREATMENT hipertrofia I-TREATMENT prostática. I-TREATMENT I-TREATMENT - B-EXPLORATION Informe I-EXPLORATION de I-EXPLORATION la I-EXPLORATION necropsia: I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION autópsicos I-EXPLORATION resultan I-EXPLORATION concordantes I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Cronkhite-Canadá. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Examen I-EXPLORATION externo: I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION vello I-EXPLORATION corporal I-EXPLORATION y I-EXPLORATION máculas I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION pardo-oscuras I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION superiores, I-EXPLORATION especialmente I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION dorsal I-EXPLORATION de I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION antebrazo I-EXPLORATION izquierdo. I-EXPLORATION Los I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION manos I-EXPLORATION presentan I-EXPLORATION onicólisis I-EXPLORATION con I-EXPLORATION coloración I-EXPLORATION ungueal I-EXPLORATION blanquecino-amarillenta. I-EXPLORATION Hidrocele I-EXPLORATION bilateral. I-EXPLORATION Edemas I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores. I-EXPLORATION I-EXPLORATION -Examen I-EXPLORATION interno: I-EXPLORATION derrame I-EXPLORATION pericárdico, I-EXPLORATION pleural I-EXPLORATION y I-EXPLORATION peritoneal. I-EXPLORATION Hipotrofia I-EXPLORATION tiroides. I-EXPLORATION Enfisema I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION neumonía I-EXPLORATION pulmón I-EXPLORATION izquierdo. I-EXPLORATION Hiperplasia I-EXPLORATION nodular I-EXPLORATION suprarrenal I-EXPLORATION bilateral. I-EXPLORATION Arterioesclerosis I-EXPLORATION moderada. I-EXPLORATION Adenocarcinoma I-EXPLORATION de I-EXPLORATION próstata I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION extracapsular I-EXPLORATION ni I-EXPLORATION metástasica. I-EXPLORATION Atrofia I-EXPLORATION testicular. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectan I-EXPLORATION alteraciones I-EXPLORATION destacables I-EXPLORATION en I-EXPLORATION hígado, I-EXPLORATION vías I-EXPLORATION biliares I-EXPLORATION o I-EXPLORATION páncreas. I-EXPLORATION Estudio I-EXPLORATION del I-EXPLORATION tubo I-EXPLORATION digestivo: I-EXPLORATION esófago I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION El I-EXPLORATION cuerpo I-EXPLORATION gástrico I-EXPLORATION muestra I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION pliegues. I-EXPLORATION El I-EXPLORATION antro I-EXPLORATION gástrico I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION rugosa, I-EXPLORATION "en I-EXPLORATION empedrado", I-EXPLORATION con I-EXPLORATION engrosamienro I-EXPLORATION nodular I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pliegues I-EXPLORATION y I-EXPLORATION equimosis I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie, I-EXPLORATION persistiendo I-EXPLORATION estas I-EXPLORATION alteraciones I-EXPLORATION hasta I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION duodenal, I-EXPLORATION donde I-EXPLORATION es I-EXPLORATION más I-EXPLORATION evidente I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION pólipos I-EXPLORATION sésiles. I-EXPLORATION En I-EXPLORATION yeyuno I-EXPLORATION e I-EXPLORATION íleon I-EXPLORATION no I-EXPLORATION aparecen I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION La I-EXPLORATION mucosa I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION muestra, I-EXPLORATION en I-EXPLORATION toda I-EXPLORATION su I-EXPLORATION extensión, I-EXPLORATION una I-EXPLORATION morfología I-EXPLORATION polipoidea, I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION prominencias I-EXPLORATION sésiles, I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION equimótica I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION friable. I-EXPLORATION Las I-EXPLORATION alteraciones I-EXPLORATION son I-EXPLORATION menos I-EXPLORATION evidentes I-EXPLORATION en I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION derecho. I-EXPLORATION Divertículos I-EXPLORATION en I-EXPLORATION colon I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Microscópicamente I-EXPLORATION lo I-EXPLORATION más I-EXPLORATION llamativo I-EXPLORATION era I-EXPLORATION la I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION antro, I-EXPLORATION duodeno, I-EXPLORATION colon I-EXPLORATION y I-EXPLORATION recto I-EXPLORATION (en I-EXPLORATION su I-EXPLORATION totalidad), I-EXPLORATION que I-EXPLORATION mostraban I-EXPLORATION una I-EXPLORATION histopatología I-EXPLORATION similar, I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION formaciones I-EXPLORATION polipoides, I-EXPLORATION algunos I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION hamartomatoso, I-EXPLORATION con I-EXPLORATION criptas I-EXPLORATION dilatadas I-EXPLORATION y I-EXPLORATION quísticas I-EXPLORATION que I-EXPLORATION disminuyen I-EXPLORATION en I-EXPLORATION número I-EXPLORATION y I-EXPLORATION que I-EXPLORATION presentan I-EXPLORATION hipersecreción I-EXPLORATION de I-EXPLORATION moco. I-EXPLORATION En I-EXPLORATION lámina I-EXPLORATION propia I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION edema I-EXPLORATION con I-EXPLORATION hiperplasia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION fibras I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muscularis I-EXPLORATION mucosa, I-EXPLORATION e I-EXPLORATION inflamación I-EXPLORATION crónica I-EXPLORATION leve-moderada. I-EXPLORATION Existe I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION las I-EXPLORATION vellosidades I-EXPLORATION intestinales I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION duodeno I-EXPLORATION como I-EXPLORATION de I-EXPLORATION colon, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pliegues I-EXPLORATION gástricos I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION y I-EXPLORATION cuerpo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION reconocen I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION displasia I-EXPLORATION en I-EXPLORATION ninguno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cortes I-EXPLORATION examinados. I-EXPLORATION I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION justificación I-EXPLORATION para I-EXPLORATION la I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario. I-EXPLORATION I-EXPLORATION Causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muerte: I-EXPLORATION malnutrición I-EXPLORATION grave I-EXPLORATION secundaria I-EXPLORATION al I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Cronkhite I-EXPLORATION Canada. I-EXPLORATION Neumonía I-EXPLORATION en I-EXPLORATION pulmón I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS con I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Presentaba I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cantidad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS consistencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS no I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS frecuencia. I-PRESENT_ILLNESS En B-FAMILY_HISTORY sus I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY personales I-FAMILY_HISTORY destacan: I-FAMILY_HISTORY alergia I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY penicilina, I-FAMILY_HISTORY hipertensa, I-FAMILY_HISTORY dislipémica I-FAMILY_HISTORY y I-FAMILY_HISTORY asma I-FAMILY_HISTORY intrínseco. I-FAMILY_HISTORY I-FAMILY_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION gran I-EXPLORATION tumoración I-EXPLORATION abdominal I-EXPLORATION palpable, I-EXPLORATION dura I-EXPLORATION y I-EXPLORATION dolorosa. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION los I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION abdómino-pélvica I-EXPLORATION mostraban I-EXPLORATION anejos I-EXPLORATION normales, I-EXPLORATION endometrio I-EXPLORATION lineal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION de I-EXPLORATION 17, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 17, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 11 I-EXPLORATION cm I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION precisar I-EXPLORATION origen. I-EXPLORATION I-EXPLORATION Se B-TREATMENT intervino I-TREATMENT de I-TREATMENT forma I-TREATMENT programada, I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Ginecología, I-TREATMENT realizando I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT infraumbilical, I-TREATMENT evidenciando I-TREATMENT una I-TREATMENT tumoración I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 20 I-TREATMENT cm I-TREATMENT dependiente I-TREATMENT de I-TREATMENT mesenterio I-TREATMENT adherida I-TREATMENT a I-TREATMENT un I-TREATMENT asa I-TREATMENT de I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT y I-TREATMENT a I-TREATMENT colon I-TREATMENT sigmoide. I-TREATMENT Se I-TREATMENT avisó I-TREATMENT al I-TREATMENT cirujano I-TREATMENT de I-TREATMENT guardia I-TREATMENT que I-TREATMENT realizó I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT con I-TREATMENT resección I-TREATMENT intestinal I-TREATMENT de I-TREATMENT 50 I-TREATMENT cm I-TREATMENT y I-TREATMENT sutura I-TREATMENT de I-TREATMENT área I-TREATMENT deserosada I-TREATMENT de I-TREATMENT colon I-TREATMENT sigmoide. I-TREATMENT Al I-TREATMENT 7o I-TREATMENT día I-TREATMENT postoperatorio I-TREATMENT se I-TREATMENT reintervino I-TREATMENT de I-TREATMENT urgencia I-TREATMENT por I-TREATMENT presentar I-TREATMENT abdomen I-TREATMENT agudo I-TREATMENT realizando I-TREATMENT resección I-TREATMENT de I-TREATMENT colon I-TREATMENT sigmoide I-TREATMENT perforado I-TREATMENT y I-TREATMENT anastomosis I-TREATMENT T-T. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION posteriormente I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION favorable I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 17 I-EVOLUTION día I-EVOLUTION postoperatorio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION mostró I-EXPLORATION proliferación I-EXPLORATION fusocelular I-EXPLORATION sin I-EXPLORATION atipias I-EXPLORATION y I-EXPLORATION con I-EXPLORATION alguna I-EXPLORATION mitosis I-EXPLORATION ocasional. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION son I-EXPLORATION positivas I-EXPLORATION con I-EXPLORATION vimentina I-EXPLORATION y I-EXPLORATION CD117 I-EXPLORATION (C-Kit). I-EXPLORATION Actualmente, B-EVOLUTION un I-EVOLUTION año I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION y B-TREATMENT en I-TREATMENT tratamiento I-TREATMENT adyuvante I-TREATMENT con I-TREATMENT mesilato I-TREATMENT de I-TREATMENT imatinib. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemofilia I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY severa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Cuba I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY (su I-PAST_MEDICAL_HISTORY país I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY residente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY España I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY años). I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY refería I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY enfermedad. I-FAMILY_HISTORY Durante B-PAST_MEDICAL_HISTORY estos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemartros I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY rodilla I-PAST_MEDICAL_HISTORY derecha, I-PAST_MEDICAL_HISTORY tratados I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY conservadora, I-PAST_MEDICAL_HISTORY precisando I-PAST_MEDICAL_HISTORY crioprecipitados. I-PAST_MEDICAL_HISTORY Previo I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY actual I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY asintomático I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY domiciliario. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipogastrio, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hematuria. I-PRESENT_ILLNESS Tras B-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION analíticas I-EXPLORATION y I-EXPLORATION radiológicas I-EXPLORATION fue I-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION cólico I-EXPLORATION nefrítico, I-EXPLORATION siendo I-EXPLORATION alta I-EXPLORATION con I-EXPLORATION tratamiento I-EXPLORATION analgésico. I-EXPLORATION I-EXPLORATION Cinco B-PRESENT_ILLNESS horas I-PRESENT_ILLNESS más I-PRESENT_ILLNESS tarde, I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS micción, I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síncope I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conocimiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS escasos I-PRESENT_ILLNESS segundos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION consciente I-EXPLORATION y I-EXPLORATION orientado, I-EXPLORATION con I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION e I-EXPLORATION intensa I-EXPLORATION palidez I-EXPLORATION mucocutánea. I-EXPLORATION La I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION sistólica I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 70 I-EXPLORATION mmHg I-EXPLORATION y I-EXPLORATION la I-EXPLORATION diastólica I-EXPLORATION de I-EXPLORATION 37 I-EXPLORATION mmHg, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 61 I-EXPLORATION latidos/min. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION abdominal I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION estaba I-EXPLORATION distendido, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa, I-EXPLORATION con I-EXPLORATION defensa I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION generalizada. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION realizada I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION del I-EXPLORATION 20%, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 7 I-EXPLORATION g/dl, I-EXPLORATION leucocitos I-EXPLORATION 12.270/ul I-EXPLORATION (84% I-EXPLORATION neutrófilos) I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION 358.000/ul. I-EXPLORATION Actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 100%, I-EXPLORATION TTPA I-EXPLORATION 46%. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION que I-EXPLORATION informaba I-EXPLORATION de I-EXPLORATION abundante I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION subdiafragmático I-EXPLORATION izquierdo, I-EXPLORATION subhepático I-EXPLORATION y I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION gotieras I-EXPLORATION paracólicas. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION espacio I-EXPLORATION vesicorrectal I-EXPLORATION se I-EXPLORATION visualizaba I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION ovalada, I-EXPLORATION con I-EXPLORATION líquido I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION imagen I-EXPLORATION quística I-EXPLORATION retro I-EXPLORATION y I-EXPLORATION supravesical, I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION que I-EXPLORATION parece I-EXPLORATION depender I-EXPLORATION de I-EXPLORATION un I-EXPLORATION vaso I-EXPLORATION arterial I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION llegar I-EXPLORATION a I-EXPLORATION detectar I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT sangrado I-TREATMENT en I-TREATMENT paciente I-TREATMENT hemofílico I-TREATMENT se I-TREATMENT decidió I-TREATMENT transfusión I-TREATMENT inmediata I-TREATMENT de I-TREATMENT 2 I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes, I-TREATMENT 3 I-TREATMENT viales I-TREATMENT de I-TREATMENT factor I-TREATMENT VIII I-TREATMENT además I-TREATMENT de I-TREATMENT otro I-TREATMENT de I-TREATMENT factor I-TREATMENT VII I-TREATMENT recombinante. I-TREATMENT La B-EXPLORATION administración I-EXPLORATION de I-EXPLORATION factor I-EXPLORATION VIII I-EXPLORATION requirió I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION Ac I-EXPLORATION antifactor I-EXPLORATION VIII I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION positivos, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT requirió, I-TREATMENT previa I-TREATMENT a I-TREATMENT su I-TREATMENT administración, I-TREATMENT la I-TREATMENT aplicación I-TREATMENT de I-TREATMENT inhibidores I-TREATMENT de I-TREATMENT Ac I-TREATMENT antifactor I-TREATMENT VIII I-TREATMENT (4). I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION analítica I-EVOLUTION y I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION del I-EVOLUTION mal I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION del I-EVOLUTION paciente, I-EVOLUTION se B-TREATMENT decidió I-TREATMENT intervenir I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT suprainfraumbilical I-TREATMENT hallando I-TREATMENT hemoperitoneo I-TREATMENT de I-TREATMENT aproximadamente I-TREATMENT 3 I-TREATMENT litros I-TREATMENT de I-TREATMENT coágulos I-TREATMENT y I-TREATMENT sangre I-TREATMENT roja. I-TREATMENT Se B-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION retrovesical, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION superficie I-EXPLORATION lisa, I-EXPLORATION íntimamente I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION vesical. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT disección I-TREATMENT roma I-TREATMENT y I-TREATMENT exéreis I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración. I-TREATMENT Posteriormente B-EXPLORATION se I-EXPLORATION revisó I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION abdominal I-EXPLORATION sin I-EXPLORATION objetivar I-EXPLORATION un I-EXPLORATION punto I-EXPLORATION sangrante I-EXPLORATION activo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION satisfactoriamente I-EVOLUTION en I-EVOLUTION planta, I-EVOLUTION manteniéndose I-EVOLUTION afebril, I-EVOLUTION con I-EVOLUTION hematocritos I-EVOLUTION mantenidos I-EVOLUTION y I-EVOLUTION débitos I-EVOLUTION decrecientes I-EVOLUTION por I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION El B-TREATMENT paciente I-TREATMENT precisó I-TREATMENT controles I-TREATMENT por I-TREATMENT hematología I-TREATMENT tras I-TREATMENT la I-TREATMENT administración I-TREATMENT del I-TREATMENT factor I-TREATMENT VIII I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT en I-TREATMENT los I-TREATMENT cuatro I-TREATMENT primeros I-TREATMENT días. I-TREATMENT I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION formación I-EXPLORATION cupuliforme I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION La I-EXPLORATION superficie I-EXPLORATION externa I-EXPLORATION era I-EXPLORATION lisa I-EXPLORATION y I-EXPLORATION la I-EXPLORATION interna I-EXPLORATION presentaba I-EXPLORATION múltiples I-EXPLORATION coágulos I-EXPLORATION hemáticos I-EXPLORATION adheridos. I-EXPLORATION La I-EXPLORATION cúpula I-EXPLORATION fibrosa I-EXPLORATION contenía I-EXPLORATION moderada I-EXPLORATION infiltración I-EXPLORATION inflamatoria I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION crónico I-EXPLORATION inespecífico I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION hemosiderofagos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION interna I-EXPLORATION presentaba, I-EXPLORATION además I-EXPLORATION del I-EXPLORATION material I-EXPLORATION hemático I-EXPLORATION adherido, I-EXPLORATION tejido I-EXPLORATION graso I-EXPLORATION maduro, I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION pseudotumor I-EXPLORATION hemofílico. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 64 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS mareo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS profusa. I-PRESENT_ILLNESS Unas I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS había I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS trabajando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS fumigando I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS insecticida I-PRESENT_ILLNESS que I-PRESENT_ILLNESS contenía I-PRESENT_ILLNESS polvo I-PRESENT_ILLNESS para I-PRESENT_ILLNESS espolvoreo. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION mostraba I-EXPLORATION importante I-EXPLORATION diaforesis I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION bradipsiquia I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION focalidad I-EXPLORATION neurológica. I-EXPLORATION Tras B-TREATMENT estabilización I-TREATMENT hemodinámica, I-TREATMENT se B-EXPLORATION realizó I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION hepático I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION distinta I-EXPLORATION intensidad I-EXPLORATION con I-EXPLORATION gran I-EXPLORATION colección I-EXPLORATION subcapsular I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION probable I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION hemoperitoneo. I-EXPLORATION La I-EXPLORATION vesícula I-EXPLORATION adyacente I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION nivel I-EXPLORATION líquido-líquido I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartar I-EXPLORATION contenido I-EXPLORATION hemático. I-EXPLORATION Así I-EXPLORATION mismo I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION y I-EXPLORATION realce I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION antro I-EXPLORATION gástrico I-EXPLORATION y I-EXPLORATION duodeno I-EXPLORATION con I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION periesplénico I-EXPLORATION y I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION gotieras, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION gastroscopia I-EXPLORATION confirmando I-EXPLORATION gastroduodenitis I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT los I-TREATMENT resultados, I-TREATMENT se I-TREATMENT decidió I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT urgente I-TREATMENT durante I-TREATMENT la I-TREATMENT cual I-TREATMENT se I-TREATMENT evidenció I-TREATMENT gran I-TREATMENT hemoperitoneo I-TREATMENT con I-TREATMENT coágulos I-TREATMENT suprahepáticos I-TREATMENT y I-TREATMENT brecha I-TREATMENT en I-TREATMENT lóbulo I-TREATMENT hepático I-TREATMENT derecho I-TREATMENT de I-TREATMENT unos I-TREATMENT 10 I-TREATMENT cm, I-TREATMENT de I-TREATMENT aspecto I-TREATMENT necrótico I-TREATMENT con I-TREATMENT sangrado I-TREATMENT activo I-TREATMENT en I-TREATMENT sábana. I-TREATMENT Se I-TREATMENT drenó I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 200 I-TREATMENT cc I-TREATMENT de I-TREATMENT contenido I-TREATMENT hemático I-TREATMENT y I-TREATMENT se I-TREATMENT controló I-TREATMENT el I-TREATMENT sangrado I-TREATMENT mediante I-TREATMENT medidas I-TREATMENT hemostáticas. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION postoperatorio. I-EVOLUTION La B-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION colección I-EXPLORATION aunque I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION tamaño I-EXPLORATION que I-EXPLORATION se I-EXPLORATION resolvió I-EXPLORATION en I-EXPLORATION su I-EXPLORATION práctica I-EXPLORATION totalidad I-EXPLORATION con I-EXPLORATION el I-EXPLORATION drenaje I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION I-EXPLORATION Varón 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 ulcus I-PAST_MEDICAL_HISTORY duodenal I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY (no I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY previamente I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY paquetes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cigarrillos/día). I-PAST_MEDICAL_HISTORY Intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY papila I-PAST_MEDICAL_HISTORY anal I-PAST_MEDICAL_HISTORY hipertrófica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2007 I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fístula I-PAST_MEDICAL_HISTORY perianal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY recidiva I-PAST_MEDICAL_HISTORY precoz. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8-10 I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS diarias, I-PRESENT_ILLNESS blandas-líquidas, I-PRESENT_ILLNESS algunas I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sangre, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carácter I-PRESENT_ILLNESS diurno I-PRESENT_ILLNESS y I-PRESENT_ILLNESS nocturno I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedieron I-PRESENT_ILLNESS parcialmente I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ciprofloxacino I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS oral. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS los I-PRESENT_ILLNESS días I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS aparece I-PRESENT_ILLNESS empeoramiento I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mucorrea I-PRESENT_ILLNESS sanguinolenta I-PRESENT_ILLNESS (6-8 I-PRESENT_ILLNESS deposiciones/día), I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS hipogástrico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS proctalgia I-PRESENT_ILLNESS intensa. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS aqueja I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS creciente I-PRESENT_ILLNESS y I-PRESENT_ILLNESS picos I-PRESENT_ILLNESS febriles I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS oC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS vespertino I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS semana. I-PRESENT_ILLNESS No B-EXPLORATION presentaba I-EXPLORATION fístulas I-EXPLORATION perianales I-EXPLORATION activas I-EXPLORATION ni I-EXPLORATION supuración. I-EXPLORATION I-EXPLORATION Desde I-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION evidencia I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION brusca I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION inflamatorias I-EXPLORATION eritematosas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION pustuloso I-EXPLORATION sobre I-EXPLORATION placas, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION brazos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION manos, I-EXPLORATION con I-EXPLORATION centro I-EXPLORATION umbilicado, I-EXPLORATION dolorosas, I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION asimétrica. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION rectal I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION perianal I-EXPLORATION complicada I-EXPLORATION con I-EXPLORATION dos I-EXPLORATION orificios I-EXPLORATION fistulosos I-EXPLORATION inactivos, I-EXPLORATION mariscas I-EXPLORATION hemorroidales I-EXPLORATION y I-EXPLORATION fisura I-EXPLORATION aguda I-EXPLORATION en I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION posterior. I-EXPLORATION I-EXPLORATION Analíticamente I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION anemia I-EXPLORATION microcítica I-EXPLORATION hipocroma I-EXPLORATION ferropénica I-EXPLORATION sin I-EXPLORATION leucocitosis I-EXPLORATION y I-EXPLORATION coagulación I-EXPLORATION normal, I-EXPLORATION destacando I-EXPLORATION GGT I-EXPLORATION de I-EXPLORATION 203 I-EXPLORATION mU/ml, I-EXPLORATION PCR: I-EXPLORATION 248 I-EXPLORATION mg/l I-EXPLORATION y I-EXPLORATION VSG: I-EXPLORATION 120 I-EXPLORATION mm/h. I-EXPLORATION Hemocultivos I-EXPLORATION y I-EXPLORATION coprocultivos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION describe I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION del I-EXPLORATION rectosigma, I-EXPLORATION confirmada I-EXPLORATION por I-EXPLORATION TC I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION también I-EXPLORATION revela I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION transverso I-EXPLORATION y I-EXPLORATION ciego, I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION adenopatías I-EXPLORATION en I-EXPLORATION territorio I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION iliacos, I-EXPLORATION sin I-EXPLORATION líquido I-EXPLORATION libre. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION rectal I-EXPLORATION aparece I-EXPLORATION edematosa I-EXPLORATION y I-EXPLORATION eritematosa I-EXPLORATION con I-EXPLORATION formaciones I-EXPLORATION pseudopolipoideas I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extienden I-EXPLORATION por I-EXPLORATION la I-EXPLORATION mayor I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION colon, I-EXPLORATION intercalando I-EXPLORATION áreas I-EXPLORATION con I-EXPLORATION mucosa I-EXPLORATION conservada. I-EXPLORATION El I-EXPLORATION íleon I-EXPLORATION es I-EXPLORATION macroscópicamente I-EXPLORATION normal. I-EXPLORATION Las I-EXPLORATION biopsias I-EXPLORATION colónicas I-EXPLORATION confirman I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION ulceración I-EXPLORATION e I-EXPLORATION inflamación I-EXPLORATION crónica, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION granulomas. I-EXPLORATION I-EXPLORATION El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO valorado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO Dermatología. I-DERIVED_FROM/TO Una B-EXPLORATION biopsia I-EXPLORATION cutánea I-EXPLORATION de I-EXPLORATION la I-EXPLORATION eminencia I-EXPLORATION hipotecar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION demuestra I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION infiltrado I-EXPLORATION neutrofílico I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION dérmico I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION vasculitis, I-EXPLORATION confirmándose I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION dermatosis I-EXPLORATION neutrofílica I-EXPLORATION (DN). I-EXPLORATION I-EXPLORATION Por I-EXPLORATION tanto I-EXPLORATION se I-EXPLORATION diagnostica I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION de: I-EXPLORATION a) I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn I-EXPLORATION colónica I-EXPLORATION con I-EXPLORATION brote I-EXPLORATION de I-EXPLORATION actividad I-EXPLORATION moderada I-EXPLORATION con I-EXPLORATION CDAI: I-EXPLORATION 345 I-EXPLORATION (debut I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad) I-EXPLORATION y I-EXPLORATION enfermedad I-EXPLORATION perianal I-EXPLORATION (EPA), I-EXPLORATION clasificación I-EXPLORATION de I-EXPLORATION Montreal: I-EXPLORATION A3 I-EXPLORATION L2 I-EXPLORATION B1p; I-EXPLORATION y I-EXPLORATION b) I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Sweet, I-EXPLORATION cumpliendo I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION aceptados. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT fluidoterapia, I-TREATMENT metilprednisolona I-TREATMENT (60 I-TREATMENT mg/i.v./24 I-TREATMENT h), I-TREATMENT antibioterapia I-TREATMENT (ciprofloxacino I-TREATMENT 400 I-TREATMENT mg/i.v./12 I-TREATMENT h I-TREATMENT y I-TREATMENT metronidazol I-TREATMENT 1.500 I-TREATMENT mg/i.v./24 I-TREATMENT h), I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT y I-TREATMENT mesalazina I-TREATMENT (3 I-TREATMENT g/v.o./24 I-TREATMENT h), I-TREATMENT con I-TREATMENT muy I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica. I-TREATMENT La B-EVOLUTION fiebre I-EVOLUTION desapareció I-EVOLUTION en I-EVOLUTION 48 I-EVOLUTION h, I-EVOLUTION mejorando I-EVOLUTION en I-EVOLUTION pocos I-EVOLUTION días I-EVOLUTION las I-EVOLUTION molestias I-EVOLUTION abdominales I-EVOLUTION y I-EVOLUTION la I-EVOLUTION diarrea. I-EVOLUTION I-EVOLUTION Como B-TREATMENT tratamiento I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT cutáneas I-TREATMENT se I-TREATMENT asoció I-TREATMENT beclometasona I-TREATMENT tópica. I-TREATMENT Estas B-EVOLUTION fueron I-EVOLUTION reduciéndose I-EVOLUTION de I-EVOLUTION tamaño, I-EVOLUTION disminuyendo I-EVOLUTION las I-EVOLUTION molestias I-EVOLUTION locales I-EVOLUTION tras I-EVOLUTION 3 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT dosis I-TREATMENT descendentes I-TREATMENT de I-TREATMENT prednisona I-TREATMENT por I-TREATMENT vía I-TREATMENT oral, I-TREATMENT comprobándose B-EVOLUTION la I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pápulas I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 6 I-EVOLUTION semanas, I-EVOLUTION sin I-EVOLUTION dejar I-EVOLUTION cicatriz I-EVOLUTION ni I-EVOLUTION secuelas I-EVOLUTION cutáneas. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS transplantado I-PRESENT_ILLNESS cardiaco I-PRESENT_ILLNESS que I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS décimo I-PRESENT_ILLNESS día I-PRESENT_ILLNESS del I-PRESENT_ILLNESS postoperatorio I-PRESENT_ILLNESS desarrolló I-PRESENT_ILLNESS un I-PRESENT_ILLNESS vólvulo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ciego. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY dilatada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fracción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY eyección I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY 23% I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY bypass I-PAST_MEDICAL_HISTORY aortocoronario. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacar I-PAST_MEDICAL_HISTORY apendicectomía, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY sometido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY cardiaco I-PAST_MEDICAL_HISTORY ortotópico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anastomosis I-PAST_MEDICAL_HISTORY bicava. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY isquemia I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 280 I-PAST_MEDICAL_HISTORY min I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY duración I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY circulación I-PAST_MEDICAL_HISTORY extracorpórea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 200 I-PAST_MEDICAL_HISTORY min. I-PAST_MEDICAL_HISTORY Presentó I-PAST_MEDICAL_HISTORY tendencia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY hipotensión I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY requerimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY drogas I-PAST_MEDICAL_HISTORY vasoactivas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hemoderivados. I-PAST_MEDICAL_HISTORY Recibió I-PAST_MEDICAL_HISTORY profilaxis I-PAST_MEDICAL_HISTORY antibiótica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inducción I-PAST_MEDICAL_HISTORY inmunosupresor I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY micofenolato I-PAST_MEDICAL_HISTORY mofetil, I-PAST_MEDICAL_HISTORY solu-moderin I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY daclizumab. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY postoperatorio I-PAST_MEDICAL_HISTORY inmediato I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY diarreas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fiebre, I-PAST_MEDICAL_HISTORY descartándose I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Clostridium I-PAST_MEDICAL_HISTORY difficile I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY determinación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY toxina I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY heces I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY enzimoinmunoanálisis. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS décimo I-PRESENT_ILLNESS día I-PRESENT_ILLNESS del I-PRESENT_ILLNESS postoperatorio I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS palpación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS iliaca I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS con I-PRESENT_ILLNESS leucocitosis I-PRESENT_ILLNESS (35.000 I-PRESENT_ILLNESS l/mm3). I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION urgente, I-EXPLORATION objetivándose I-EXPLORATION distensión I-EXPLORATION de I-EXPLORATION ciego I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION vólvulo I-EXPLORATION tipo I-EXPLORATION "báscula I-EXPLORATION cecal". I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION laparotomía I-EXPLORATION urgente I-EXPLORATION y I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION vólvulo I-EXPLORATION cecal I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION intestinal, I-EXPLORATION sin I-EXPLORATION perforación. I-EXPLORATION Se B-TREATMENT practicó I-TREATMENT hemicolectomía I-TREATMENT derecha I-TREATMENT con I-TREATMENT anastomosis I-TREATMENT íleo-cólica I-TREATMENT manual. I-TREATMENT I-TREATMENT El B-EVOLUTION enfermo I-EVOLUTION desarrolló I-EVOLUTION un I-EVOLUTION postoperatorio I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION El B-EXPLORATION informe I-EXPLORATION anatomopatológico: I-EXPLORATION infarto I-EXPLORATION hemorrágico I-EXPLORATION intestinal I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION transmural. I-EXPLORATION Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 45 I-EVOLUTION días I-EVOLUTION post-trasplante I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION complicaciones I-EVOLUTION postquirúrgicas I-EVOLUTION abdominales. I-EVOLUTION La I-EVOLUTION función I-EVOLUTION del I-EVOLUTION injerto I-EVOLUTION fue I-EVOLUTION normal, I-EVOLUTION con I-EVOLUTION fracción I-EVOLUTION de I-EVOLUTION eyección I-EVOLUTION del I-EVOLUTION 77% I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION trasplante. I-EVOLUTION I-EVOLUTION En I-EVOLUTION nuestra I-EVOLUTION experiencia I-EVOLUTION las I-EVOLUTION complicaciones I-EVOLUTION colónicas I-EVOLUTION agudas I-EVOLUTION afectan I-EVOLUTION al I-EVOLUTION 2% I-EVOLUTION de I-EVOLUTION los I-EVOLUTION trasplantados, I-EVOLUTION siendo I-EVOLUTION más I-EVOLUTION frecuentes I-EVOLUTION en I-EVOLUTION varones I-EVOLUTION y I-EVOLUTION con I-EVOLUTION una I-EVOLUTION edad I-EVOLUTION media I-EVOLUTION superior I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 55 I-EVOLUTION años I-EVOLUTION (2,3). I-EVOLUTION I-EVOLUTION La I-EVOLUTION patogenia I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION relacionado I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION inmunosupresor, I-EVOLUTION especialmente I-EVOLUTION los I-EVOLUTION esteroides, I-EVOLUTION bien I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION rechazo I-EVOLUTION agudo I-EVOLUTION o I-EVOLUTION por I-EVOLUTION acontecer I-EVOLUTION en I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION días I-EVOLUTION post-trasplante. I-EVOLUTION La I-EVOLUTION otra I-EVOLUTION causa I-EVOLUTION posible I-EVOLUTION son I-EVOLUTION las I-EVOLUTION derivadas I-EVOLUTION del I-EVOLUTION compromiso I-EVOLUTION vascular I-EVOLUTION gastrointestinal I-EVOLUTION bien I-EVOLUTION por I-EVOLUTION patología I-EVOLUTION vascular I-EVOLUTION previa I-EVOLUTION abdominal I-EVOLUTION o I-EVOLUTION por I-EVOLUTION el I-EVOLUTION bajo I-EVOLUTION gasto I-EVOLUTION cardiaco I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION trasplante I-EVOLUTION (isquemia I-EVOLUTION intestinal I-EVOLUTION no I-EVOLUTION oclusiva) I-EVOLUTION (1-3). I-EVOLUTION Deben I-EVOLUTION descartarse I-EVOLUTION las I-EVOLUTION infecciones, I-EVOLUTION especialmente I-EVOLUTION cuando I-EVOLUTION el I-EVOLUTION enfermo I-EVOLUTION había I-EVOLUTION desarrollado I-EVOLUTION fiebre, I-EVOLUTION leucocitosis I-EVOLUTION y I-EVOLUTION diarrea. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION días I-EVOLUTION post-trasplante I-EVOLUTION la I-EVOLUTION infección I-EVOLUTION por I-EVOLUTION Clostridium I-EVOLUTION difficile I-EVOLUTION cursa I-EVOLUTION con I-EVOLUTION diarreas, I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION leucocitosis, I-EVOLUTION descartándose I-EVOLUTION en I-EVOLUTION nuestro I-EVOLUTION caso I-EVOLUTION por I-EVOLUTION la I-EVOLUTION determinación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION toxina I-EVOLUTION A I-EVOLUTION y I-EVOLUTION B I-EVOLUTION (6). I-EVOLUTION I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION descrito I-EVOLUTION presentaba I-EVOLUTION varios I-EVOLUTION factores I-EVOLUTION de I-EVOLUTION riesgo I-EVOLUTION como I-EVOLUTION el I-EVOLUTION tratarse I-EVOLUTION de I-EVOLUTION una I-EVOLUTION reintervención, I-EVOLUTION duración I-EVOLUTION prolongada I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION transfusión I-EVOLUTION de I-EVOLUTION hemoderivados I-EVOLUTION y I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION drogas I-EVOLUTION vasoactivas I-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION (dobutamina, I-EVOLUTION noradrenalina). I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY medicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS hospitalario I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hematoquecia I-PRESENT_ILLNESS grave I-PRESENT_ILLNESS (Hb I-PRESENT_ILLNESS 7, I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS g/dl). I-PRESENT_ILLNESS No B-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta. I-EXPLORATION Sin I-EXPLORATION embargo, I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION estabilización I-EXPLORATION hemodinámica I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION ulcerada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION descendente, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION submucoso, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 12 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION diverticular I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño. I-EXPLORATION El I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION duplicación I-EXPLORATION colónica I-EXPLORATION a I-EXPLORATION dicho I-EXPLORATION nivel, I-EXPLORATION simulando I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION divertículo, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION fija I-EXPLORATION en I-EXPLORATION su I-EXPLORATION borde I-EXPLORATION superior. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION otras I-EXPLORATION lesiones. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION histológico I-EXPLORATION obtenido I-EXPLORATION por I-EXPLORATION biopsias I-EXPLORATION endoscópicas I-EXPLORATION fue I-EXPLORATION el I-EXPLORATION de I-EXPLORATION GIST I-EXPLORATION de I-EXPLORATION colon. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT la I-TREATMENT evaluación I-TREATMENT quirúrgica I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT resección I-TREATMENT colónica I-TREATMENT segmentaria I-TREATMENT por I-TREATMENT vía I-TREATMENT laparoscópica. I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION obtenida I-EXPLORATION contenía I-EXPLORATION una I-EXPLORATION duplicación I-EXPLORATION colónica I-EXPLORATION de I-EXPLORATION 32 I-EXPLORATION x I-EXPLORATION 30 I-EXPLORATION mm, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION grisáceo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION dura, I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION mm. I-EXPLORATION Histológicamente I-EXPLORATION este I-EXPLORATION nódulo I-EXPLORATION era I-EXPLORATION un I-EXPLORATION GIST I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION calcificado I-EXPLORATION (c-kit I-EXPLORATION +, I-EXPLORATION CD34 I-EXPLORATION +), I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION fusocelular, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION mitótico I-EXPLORATION < I-EXPLORATION 5/50 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION aumento. I-EXPLORATION I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION permanece I-EXPLORATION asintomática I-EXPLORATION 7 I-EXPLORATION meses I-EXPLORATION después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención. I-EXPLORATION I-EXPLORATION Una B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY reumatoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY metotrexate, I-PAST_MEDICAL_HISTORY es B-PRESENT_ILLNESS evaluada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mucorrea, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS rectorragia, I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS marcada I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS ponderal I-PRESENT_ILLNESS (10 I-PRESENT_ILLNESS kg). I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION detectó I-EXPLORATION leve I-EXPLORATION anemia I-EXPLORATION ferropénica I-EXPLORATION (hemoglobina I-EXPLORATION 9, I-EXPLORATION 2 I-EXPLORATION g/dl, I-EXPLORATION ferritina I-EXPLORATION 2 I-EXPLORATION ng/ml) I-EXPLORATION con I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ileocolonoscopia I-EXPLORATION con I-EXPLORATION biopsias I-EXPLORATION normales I-EXPLORATION a I-EXPLORATION ambos I-EXPLORATION niveles. I-EXPLORATION La I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION nodular I-EXPLORATION con I-EXPLORATION erosiones I-EXPLORATION milimétricas I-EXPLORATION parcheadas I-EXPLORATION en I-EXPLORATION bulbo I-EXPLORATION duodenal, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION en I-EXPLORATION la I-EXPLORATION 2a I-EXPLORATION y I-EXPLORATION 3a I-EXPLORATION porción I-EXPLORATION duodenales I-EXPLORATION había I-EXPLORATION erosiones I-EXPLORATION superficiales I-EXPLORATION longitudinales I-EXPLORATION y I-EXPLORATION un I-EXPLORATION mínimo I-EXPLORATION acortamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pliegues. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION interrogatorio I-EXPLORATION dirigido, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION negó I-EXPLORATION la I-EXPLORATION ingesta I-EXPLORATION de I-EXPLORATION aspirina I-EXPLORATION o I-EXPLORATION antiinflamatorios I-EXPLORATION no I-EXPLORATION esteroideos I-EXPLORATION (AINE). I-EXPLORATION La I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION Helicobacter I-EXPLORATION pylori I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION mediante I-EXPLORATION biopsias I-EXPLORATION gástricas I-EXPLORATION parcheadas. I-EXPLORATION Los I-EXPLORATION coprocultivos I-EXPLORATION para I-EXPLORATION parásitos, I-EXPLORATION bacterias I-EXPLORATION y I-EXPLORATION virus I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION gastrina I-EXPLORATION y I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION multicorte I-EXPLORATION descartaron I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Zollinger-Ellison. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION biopsias I-EXPLORATION duodenales I-EXPLORATION mostró I-EXPLORATION atrofia I-EXPLORATION vellositaria I-EXPLORATION severa I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION masiva I-EXPLORATION por I-EXPLORATION linfocitos I-EXPLORATION intraepiteliales, I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION EC I-EXPLORATION estadio I-EXPLORATION 3b I-EXPLORATION en I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION de I-EXPLORATION Marsh-Oberhuber. I-EXPLORATION La I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION fue I-EXPLORATION igualmente I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION EC I-EXPLORATION (Ig I-EXPLORATION A I-EXPLORATION anti-transglutaminasa I-EXPLORATION tisular I-EXPLORATION 112 I-EXPLORATION UI, I-EXPLORATION rango I-EXPLORATION normal I-EXPLORATION < I-EXPLORATION 7). I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION alcanzó I-EVOLUTION la I-EVOLUTION remisión I-EVOLUTION clínica, I-EVOLUTION endoscópica I-EVOLUTION e I-EVOLUTION histológica I-EVOLUTION tras I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION dieta I-EVOLUTION sin I-EVOLUTION gluten. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diabética B-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY insulina I-PAST_MEDICAL_HISTORY bifásica I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY UI I-PAST_MEDICAL_HISTORY - I-PAST_MEDICAL_HISTORY 0 I-PAST_MEDICAL_HISTORY - I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY UI, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS acompañante, I-PRESENT_ILLNESS salvo I-PRESENT_ILLNESS la I-PRESENT_ILLNESS necesidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aumentar I-PRESENT_ILLNESS progresivamente I-PRESENT_ILLNESS la I-PRESENT_ILLNESS dosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS insulina I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS UI I-PRESENT_ILLNESS - I-PRESENT_ILLNESS 0 I-PRESENT_ILLNESS - I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS UI I-PRESENT_ILLNESS para I-PRESENT_ILLNESS optimizar I-PRESENT_ILLNESS el I-PRESENT_ILLNESS control I-PRESENT_ILLNESS glucémico. I-PRESENT_ILLNESS Su B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION analíticamente I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION (601.000/l) I-EXPLORATION y I-EXPLORATION VSG I-EXPLORATION (107 I-EXPLORATION mm/1a I-EXPLORATION hora), I-EXPLORATION siendo I-EXPLORATION normal I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION resultados I-EXPLORATION que I-EXPLORATION incluían I-EXPLORATION transaminasas, I-EXPLORATION autoinmunidad, I-EXPLORATION hormonas I-EXPLORATION tiroi-deas, I-EXPLORATION inmunoglobulinas I-EXPLORATION e I-EXPLORATION IgG4, I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION y I-EXPLORATION serolo-gías I-EXPLORATION virales I-EXPLORATION (hepatitis, I-EXPLORATION CMV, I-EXPLORATION VIH, I-EXPLORATION Epstein-Barr, I-EXPLORATION amebiasis I-EXPLORATION e I-EXPLORATION hidatidosis). I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION lesiones I-EXPLORATION ocupantes I-EXPLORATION de I-EXPLORATION espacio I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 3 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 2, I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION respectivamente, I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION 4, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 2, I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION también I-EXPLORATION manifiesta I-EXPLORATION dos I-EXPLORATION masas I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION y I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION cada I-EXPLORATION una I-EXPLORATION asentadas I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION izquierdo, I-EXPLORATION todas I-EXPLORATION ellas I-EXPLORATION de I-EXPLORATION características I-EXPLORATION densitométricas I-EXPLORATION inespecíficas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION percutánea I-EXPLORATION bajo I-EXPLORATION control I-EXPLORATION ecográfico I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION malignidad, I-EXPLORATION y I-EXPLORATION su I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION revela I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION extenso I-EXPLORATION formado I-EXPLORATION por I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION menor I-EXPLORATION medida, I-EXPLORATION linfocitos I-EXPLORATION y I-EXPLORATION fibroblastos, I-EXPLORATION con I-EXPLORATION alguna I-EXPLORATION célula I-EXPLORATION gigante I-EXPLORATION multinucleada, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION pseudotumor I-EXPLORATION inflamatorio. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION inmunohistoquímico I-EXPLORATION mostró I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION con I-EXPLORATION cadenas I-EXPLORATION kappa- I-EXPLORATION y I-EXPLORATION lambda- I-EXPLORATION en I-EXPLORATION igual I-EXPLORATION proporción, I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION de I-EXPLORATION cadenas I-EXPLORATION IgG I-EXPLORATION pero I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION IgG4 I-EXPLORATION positivas. I-EXPLORATION Dado B-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT encontraba I-TREATMENT asintomática I-TREATMENT y I-TREATMENT con I-TREATMENT mejor I-TREATMENT control I-TREATMENT glucémico I-TREATMENT no I-TREATMENT se I-TREATMENT adoptó I-TREATMENT ninguna I-TREATMENT medida I-TREATMENT especial I-TREATMENT y B-EXPLORATION se I-EXPLORATION decide I-EXPLORATION reevaluar I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION un I-EXPLORATION mes I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION mediante I-EXPLORATION nuevo I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION ultrasonidos, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION resolución I-EXPLORATION espontánea I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION hepáticas. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION durante I-EVOLUTION este I-EVOLUTION tiempo I-EVOLUTION permaneció I-EVOLUTION asintomática I-EVOLUTION y B-TREATMENT con I-TREATMENT descenso I-TREATMENT progresivo I-TREATMENT en I-TREATMENT las I-TREATMENT necesidades I-TREATMENT de I-TREATMENT insulina I-TREATMENT hasta I-TREATMENT estabilizarse I-TREATMENT en I-TREATMENT su I-TREATMENT dosis I-TREATMENT basal I-TREATMENT habitual. I-TREATMENT I-TREATMENT Varón, B-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS gastrectomía B-PAST_MEDICAL_HISTORY parcial I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY Billroth I-PAST_MEDICAL_HISTORY II I-PAST_MEDICAL_HISTORY (gastroyeyunostomía) I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 21 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ulcus I-PAST_MEDICAL_HISTORY gástrico. I-PAST_MEDICAL_HISTORY Lumbalgia I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY sintomático I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY paracetamol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY metamizol. I-PAST_MEDICAL_HISTORY Ingresó I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY pancreatitis I-PAST_MEDICAL_HISTORY aguda I-PAST_MEDICAL_HISTORY biliar. I-PAST_MEDICAL_HISTORY En B-EXPLORATION ecoendoscopia I-EXPLORATION oral: I-EXPLORATION mucosa I-EXPLORATION metaplásica I-EXPLORATION en I-EXPLORATION anastomosis I-EXPLORATION de I-EXPLORATION gastrectomía. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT colecistectomía I-TREATMENT programada. I-TREATMENT Desde B-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS dorsolumbar I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derechos, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hiporexia, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS palidez I-PRESENT_ILLNESS y I-PRESENT_ILLNESS coloración I-PRESENT_ILLNESS amarillenta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS piel, I-PRESENT_ILLNESS orinas I-PRESENT_ILLNESS oscuras I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pico I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS antes. I-PRESENT_ILLNESS En B-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION febrícula I-EXPLORATION (37, I-EXPLORATION 2 I-EXPLORATION oC), I-EXPLORATION palidez I-EXPLORATION cutánea I-EXPLORATION e I-EXPLORATION ictericia. I-EXPLORATION Dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION epigastrio I-EXPLORATION e I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION hepatomegalia I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION al I-EXPLORATION borde I-EXPLORATION costal. I-EXPLORATION En I-EXPLORATION analítica, I-EXPLORATION destacaba: I-EXPLORATION hiperbilirrubinemia I-EXPLORATION (bilirrubina I-EXPLORATION total I-EXPLORATION 3 I-EXPLORATION mg/dl) I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION indirecta I-EXPLORATION (bilirrubina I-EXPLORATION directa I-EXPLORATION 0, I-EXPLORATION 02 I-EXPLORATION mg/dl), I-EXPLORATION LDH I-EXPLORATION muy I-EXPLORATION elevada I-EXPLORATION (2.960 I-EXPLORATION mU/ml), I-EXPLORATION hipertransaminasemia I-EXPLORATION ligera I-EXPLORATION (GOT I-EXPLORATION 303 I-EXPLORATION mU/ml, I-EXPLORATION GPT I-EXPLORATION 129 I-EXPLORATION mU/ml, I-EXPLORATION GGT I-EXPLORATION 383 I-EXPLORATION mU/ml) I-EXPLORATION y I-EXPLORATION ligera I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION (371 I-EXPLORATION mU/ml). I-EXPLORATION Además, I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION leve I-EXPLORATION (urea I-EXPLORATION 58 I-EXPLORATION mg/dl I-EXPLORATION creatinina I-EXPLORATION 1, I-EXPLORATION 3 I-EXPLORATION mg/dl). I-EXPLORATION En I-EXPLORATION hemograma: I-EXPLORATION anemia I-EXPLORATION moderada I-EXPLORATION (Hb I-EXPLORATION 8, I-EXPLORATION 1 I-EXPLORATION g/dl; I-EXPLORATION Hto I-EXPLORATION 24, I-EXPLORATION 3%) I-EXPLORATION macrocítica I-EXPLORATION (VCM I-EXPLORATION 102 I-EXPLORATION fl) I-EXPLORATION con I-EXPLORATION series I-EXPLORATION blanca I-EXPLORATION y I-EXPLORATION plaquetaria I-EXPLORATION normales. I-EXPLORATION Frotis I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION con I-EXPLORATION frecuentes I-EXPLORATION esquistozitos I-EXPLORATION y I-EXPLORATION algunos I-EXPLORATION esferocitos. I-EXPLORATION Test I-EXPLORATION de I-EXPLORATION Coombs I-EXPLORATION directo I-EXPLORATION negativo. I-EXPLORATION Haptoglobina I-EXPLORATION baja I-EXPLORATION (3 I-EXPLORATION mg/dl), I-EXPLORATION reticulocitos I-EXPLORATION elevados I-EXPLORATION (7,3%). I-EXPLORATION Vitamina I-EXPLORATION B12 I-EXPLORATION sérica I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION fólico I-EXPLORATION sérico I-EXPLORATION e I-EXPLORATION intraeritrocitario I-EXPLORATION normales. I-EXPLORATION Coagulación: I-EXPLORATION hipoprotrombinemia I-EXPLORATION (73%), I-EXPLORATION fibrinógeno I-EXPLORATION normal. I-EXPLORATION Orina: I-EXPLORATION urobilinógeno I-EXPLORATION y I-EXPLORATION bilirrubinuria I-EXPLORATION positivas. I-EXPLORATION Serologías I-EXPLORATION VHB, I-EXPLORATION VHC I-EXPLORATION VIH I-EXPLORATION negativas. I-EXPLORATION Marcadores I-EXPLORATION tumorales: I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION CEA I-EXPLORATION (66 I-EXPLORATION ng/ml, I-EXPLORATION VN I-EXPLORATION < I-EXPLORATION 5 I-EXPLORATION ng/ml) I-EXPLORATION y I-EXPLORATION CA I-EXPLORATION 19-9 I-EXPLORATION (82 I-EXPLORATION U/ml, I-EXPLORATION VN I-EXPLORATION < I-EXPLORATION 37 I-EXPLORATION U/ml). I-EXPLORATION En I-EXPLORATION gastroscopia: I-EXPLORATION en I-EXPLORATION muñón I-EXPLORATION gástrico, I-EXPLORATION 5-6 I-EXPLORATION cm I-EXPLORATION proximal I-EXPLORATION a I-EXPLORATION anastomosis, I-EXPLORATION lesión I-EXPLORATION sobreelevada I-EXPLORATION de I-EXPLORATION 25-30 I-EXPLORATION mm, I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION ulceración I-EXPLORATION y I-EXPLORATION necrosis, I-EXPLORATION friable, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION pétrea I-EXPLORATION a I-EXPLORATION la I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION biopsia, I-EXPLORATION con I-EXPLORATION histopatología I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION moderadamente I-EXPLORATION bien I-EXPLORATION diferenciado, I-EXPLORATION tipo I-EXPLORATION intestinal. I-EXPLORATION En I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TAC) I-EXPLORATION toracoabdominal: I-EXPLORATION hepatomegalia I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION hipodensas I-EXPLORATION de I-EXPLORATION diferentes I-EXPLORATION tamaños, I-EXPLORATION diseminadas I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION hepáticas. I-EXPLORATION Se B-TREATMENT consultó I-TREATMENT con I-TREATMENT Oncología, I-TREATMENT que I-TREATMENT desestimó I-TREATMENT quimioterapia, I-TREATMENT pautándose I-TREATMENT tratamiento I-TREATMENT sintomático I-TREATMENT paliativo. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION diagnóstico. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 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 por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico, I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Su I-PRESENT_ILLNESS hijo I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS una I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS semejante I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS habían I-PRESENT_ILLNESS ingerido I-PRESENT_ILLNESS codornices I-PRESENT_ILLNESS cocidas I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY diagnósticos I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertrofia I-PAST_MEDICAL_HISTORY benigna I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertension I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antagonistas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY receptores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY angiotensina-II I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY torasemida, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY duodenitis I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY toma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ibuprofeno I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY resuelto I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY omeprazol. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION afebril I-EXPLORATION y I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION abdominal, I-EXPLORATION auscultación I-EXPLORATION cardiaca I-EXPLORATION ni I-EXPLORATION respiratoria. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION mostraron I-EXPLORATION un I-EXPLORATION hemograma, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION amilasa, I-EXPLORATION lipasa I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION de I-EXPLORATION normalidad, I-EXPLORATION salvo I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bilirrubina I-EXPLORATION sérica I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 80 I-EXPLORATION mg/dl I-EXPLORATION (límite I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION mg/dl) I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION (lactato I-EXPLORATION deshidrogenasa) I-EXPLORATION de I-EXPLORATION 547 I-EXPLORATION U/l I-EXPLORATION (límite I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION 460 I-EXPLORATION U/l). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION pequeños I-EXPLORATION focos I-EXPLORATION hiperecoicos I-EXPLORATION móviles I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION principal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION porta, I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION múltiples I-EXPLORATION zonas I-EXPLORATION hipoecogénicas I-EXPLORATION distribuidas I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION hepáticos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION gas. I-EXPLORATION La I-EXPLORATION vesícula I-EXPLORATION biliar, I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas I-EXPLORATION y I-EXPLORATION las I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION visualizadas I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION alteraciones I-EXPLORATION y I-EXPLORATION no I-EXPLORATION existía I-EXPLORATION líquido I-EXPLORATION libre. I-EXPLORATION La I-EXPLORATION única I-EXPLORATION causa I-EXPLORATION posible I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neumatosis I-EXPLORATION podía I-EXPLORATION ser I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION del I-EXPLORATION estómago, I-EXPLORATION en I-EXPLORATION posible I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION una I-EXPLORATION gastroduodenitis I-EXPLORATION enfisematosa. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION abdominopélvica, I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION gas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION ramas I-EXPLORATION distales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION porta I-EXPLORATION así I-EXPLORATION como I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION hepáticos. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION isquemia I-EXPLORATION mesentérica, I-EXPLORATION inflamación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION alteraciones I-EXPLORATION pélvicas. I-EXPLORATION Al I-EXPLORATION contrario I-EXPLORATION que I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION previa, I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION del I-EXPLORATION estómago I-EXPLORATION parecían I-EXPLORATION normales, I-EXPLORATION aunque I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION mínima I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION gas I-EXPLORATION en I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION cortos I-EXPLORATION del I-EXPLORATION estómago. I-EXPLORATION I-EXPLORATION Aunque I-EXPLORATION la I-EXPLORATION presentación I-EXPLORATION del I-EXPLORATION caso I-EXPLORATION semejaba I-EXPLORATION una I-EXPLORATION gastroenteritis I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION una I-EXPLORATION contaminación I-EXPLORATION alimentaria, I-EXPLORATION la I-EXPLORATION neumatosis I-EXPLORATION portal I-EXPLORATION motivó I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION del I-EXPLORATION paciente. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amoxicilina-clavulámico I-TREATMENT y I-TREATMENT descoagulación I-TREATMENT con I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT subcutánea I-TREATMENT por I-TREATMENT el I-TREATMENT riesgo I-TREATMENT de I-TREATMENT trombosis I-TREATMENT portal I-TREATMENT secundaria I-TREATMENT a I-TREATMENT pileflebitis. I-TREATMENT Los B-EXPLORATION coprocultivos I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Entamoeba I-EXPLORATION histolytica, I-EXPLORATION huevos I-EXPLORATION y I-EXPLORATION parásitos. I-EXPLORATION En I-EXPLORATION un I-EXPLORATION hemocultivo I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION extraídos I-EXPLORATION creció I-EXPLORATION Streptococus I-EXPLORATION viridans. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 4 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION se I-EXPLORATION repitió I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION abdominopélvica I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION desaparición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neumatosis I-EXPLORATION portal. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION y I-EVOLUTION visto I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION externas, I-EVOLUTION encontrándose I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION con I-EVOLUTION una I-EVOLUTION ecografía I-EVOLUTION abdominal I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION los I-EVOLUTION límites I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS reiterada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS Era B-PAST_MEDICAL_HISTORY natural I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Ecuador I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY llevaba I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY viviendo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY España, I-PAST_MEDICAL_HISTORY actualmente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Murcia. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY intestinal I-PAST_MEDICAL_HISTORY realizada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY país I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY colelitiasis I-PAST_MEDICAL_HISTORY pendiente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY intervención. I-PAST_MEDICAL_HISTORY Refería B-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS periumbilical I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta, I-PRESENT_ILLNESS además I-PRESENT_ILLNESS de I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS verdosas I-PRESENT_ILLNESS abundantes, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS patológicos, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS respetaban I-PRESENT_ILLNESS el I-PRESENT_ILLNESS descanso I-PRESENT_ILLNESS nocturno, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS importante, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cuantificada. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaba I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas, I-EXPLORATION caquexia, I-EXPLORATION distensión I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION microcítica I-EXPLORATION (hemoglobina I-EXPLORATION 7 I-EXPLORATION g/dl, I-EXPLORATION VCM I-EXPLORATION 67 I-EXPLORATION nm), I-EXPLORATION leucocitos I-EXPLORATION totales I-EXPLORATION normales I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION eosinófilos I-EXPLORATION y I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION abdominal I-EXPLORATION era I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION suboclusión I-EXPLORATION intestinal I-EXPLORATION por I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION abundantes I-EXPLORATION niveles I-EXPLORATION hidroaéreos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION bulboduodenitis, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION que I-EXPLORATION se I-EXPLORATION informaron I-EXPLORATION como I-EXPLORATION inflamación I-EXPLORATION inespecífica I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION atrofia I-EXPLORATION vellositaria, I-EXPLORATION y I-EXPLORATION gastritis I-EXPLORATION erosiva. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION tránsito I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION se I-EXPLORATION vio I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION válvulas I-EXPLORATION conniventes I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION duodeno I-EXPLORATION y I-EXPLORATION yeyuno I-EXPLORATION y I-EXPLORATION otros I-EXPLORATION signos I-EXPLORATION radiológicos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION malabsorción, I-EXPLORATION siendo I-EXPLORATION las I-EXPLORATION determinaciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION D-xilosa I-EXPLORATION negativas I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION orina. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION heces I-EXPLORATION que I-EXPLORATION se I-EXPLORATION envió I-EXPLORATION a I-EXPLORATION microbiología, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION larvas I-EXPLORATION de I-EXPLORATION primera I-EXPLORATION fase I-EXPLORATION o I-EXPLORATION rabditiformes I-EXPLORATION de I-EXPLORATION Strongyloides I-EXPLORATION stercolaris. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT la I-TREATMENT infección I-TREATMENT con I-TREATMENT ivermectina I-TREATMENT 6 I-TREATMENT g I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT dos I-TREATMENT días I-TREATMENT consecutivos, I-TREATMENT quedando B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION no I-EVOLUTION visualizándose I-EVOLUTION el I-EVOLUTION parásito I-EVOLUTION en I-EVOLUTION muestras I-EVOLUTION de I-EVOLUTION heces I-EVOLUTION sucesivas I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION final I-EVOLUTION del I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY virus I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY portal, I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY B I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Child-Pugh, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY esofágicas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY descompensación I-PAST_MEDICAL_HISTORY edemoascítica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Estando B-PRESENT_ILLNESS en I-PRESENT_ILLNESS lista I-PRESENT_ILLNESS activa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS trasplante I-PRESENT_ILLNESS hepático, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS control I-PRESENT_ILLNESS ecográfico I-PRESENT_ILLNESS para I-PRESENT_ILLNESS cribado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS hepatocelular, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS detectan I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS LOES I-PRESENT_ILLNESS hepáticas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 1, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS compatibles I-PRESENT_ILLNESS con I-PRESENT_ILLNESS hepatocarcinoma I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS técnicas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS imagen I-PRESENT_ILLNESS (ecografía I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS con I-PRESENT_ILLNESS contraste I-PRESENT_ILLNESS y I-PRESENT_ILLNESS TAC I-PRESENT_ILLNESS abdominal). I-PRESENT_ILLNESS Iniciamos B-TREATMENT tratamiento I-TREATMENT percutáneo I-TREATMENT mediante I-TREATMENT etanolización I-TREATMENT de I-TREATMENT la I-TREATMENT LOE I-TREATMENT de I-TREATMENT mayor I-TREATMENT tamaño, I-TREATMENT realizando I-TREATMENT tres I-TREATMENT sesiones. I-TREATMENT I-TREATMENT En B-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION tras I-EXPLORATION tres I-EXPLORATION días I-EXPLORATION desde I-EXPLORATION de I-EXPLORATION la I-EXPLORATION última I-EXPLORATION etanolización, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION trombosis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tronco I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION porta I-EXPLORATION y I-EXPLORATION ramas I-EXPLORATION principales, I-EXPLORATION que I-EXPLORATION exploramos I-EXPLORATION con I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION (SonoVue®), I-EXPLORATION sin I-EXPLORATION apreciar I-EXPLORATION captación I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION arterial I-EXPLORATION ni I-EXPLORATION posteriores, I-EXPLORATION característica I-EXPLORATION sugestiva I-EXPLORATION de I-EXPLORATION benignidad. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION y I-EXPLORATION la I-EXPLORATION PAAF I-EXPLORATION realizadas I-EXPLORATION posteriormente, I-EXPLORATION confirman I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION benigno I-EXPLORATION del I-EXPLORATION trombo. I-EXPLORATION Dado I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION un I-EXPLORATION hallazgo I-EXPLORATION no I-EXPLORATION presente I-EXPLORATION en I-EXPLORATION ecografías I-EXPLORATION ni I-EXPLORATION TAC I-EXPLORATION abdominales I-EXPLORATION previas, I-EXPLORATION detectado I-EXPLORATION en I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION posterior I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION percutáneo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION SonoVue®, I-EXPLORATION TAC I-EXPLORATION y I-EXPLORATION PAAF I-EXPLORATION confirman I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION benigno I-EXPLORATION del I-EXPLORATION trombo I-EXPLORATION portal, I-EXPLORATION se I-EXPLORATION considera I-EXPLORATION como I-EXPLORATION una I-EXPLORATION complicación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION etanolización. I-EXPLORATION Iniciamos B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/kg/día I-TREATMENT subcutánea, I-TREATMENT comprobando I-TREATMENT en I-TREATMENT controles I-TREATMENT ecográficos I-TREATMENT posteriores I-TREATMENT que I-TREATMENT la I-TREATMENT trombosis I-TREATMENT ha I-TREATMENT mejorado, I-TREATMENT ya I-TREATMENT que I-TREATMENT tras I-TREATMENT 22 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT tan I-TREATMENT sólo I-TREATMENT está I-TREATMENT presente I-TREATMENT de I-TREATMENT forma I-TREATMENT parcial I-TREATMENT en I-TREATMENT la I-TREATMENT rama I-TREATMENT portal I-TREATMENT izquierda. I-TREATMENT I-TREATMENT Finalmente B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION trasplantado, I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION actualidad. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evisceración I-PRESENT_ILLNESS vaginal I-PRESENT_ILLNESS espontánea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS posmenopáusica. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY histerectomía I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY 13 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, B-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS salida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS asas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS intestino I-PRESENT_ILLNESS delgado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS través I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vagina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS hora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS ataque I-PRESENT_ILLNESS de I-PRESENT_ILLNESS risa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION evisceración I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 1 I-EXPLORATION metro I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION congestivo I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION vagina, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION indica I-EXPLORATION intervención I-EXPLORATION quirúrgica I-EXPLORATION urgente. I-EXPLORATION I-EXPLORATION La B-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT urgente I-TREATMENT se I-TREATMENT realiza I-TREATMENT de I-TREATMENT forma I-TREATMENT conjunta I-TREATMENT con I-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT ginecología I-TREATMENT con I-TREATMENT un I-TREATMENT abordaje I-TREATMENT combinado I-TREATMENT abdominal I-TREATMENT y I-TREATMENT vaginal. I-TREATMENT Mediante I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT infraumbilical I-TREATMENT se I-TREATMENT evidencia I-TREATMENT la I-TREATMENT cúpula I-TREATMENT vaginal I-TREATMENT abierta I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT introduce I-TREATMENT el I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT eviscerado I-TREATMENT que I-TREATMENT correspondía I-TREATMENT a I-TREATMENT íleon. I-TREATMENT Se I-TREATMENT reduce I-TREATMENT el I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT a I-TREATMENT la I-TREATMENT cavidad I-TREATMENT abdominal I-TREATMENT comprobando I-TREATMENT su I-TREATMENT viabilidad I-TREATMENT y I-TREATMENT se I-TREATMENT cierra I-TREATMENT el I-TREATMENT defecto I-TREATMENT vaginal I-TREATMENT con I-TREATMENT material I-TREATMENT irreabsorbible. I-TREATMENT Se I-TREATMENT utiliza I-TREATMENT una I-TREATMENT malla I-TREATMENT Dual I-TREATMENT Mesh I-TREATMENT para I-TREATMENT reforzar I-TREATMENT la I-TREATMENT sutura I-TREATMENT vaginal I-TREATMENT y I-TREATMENT se I-TREATMENT cierra I-TREATMENT el I-TREATMENT peritoneo I-TREATMENT del I-TREATMENT fondo I-TREATMENT de I-TREATMENT saco I-TREATMENT de I-TREATMENT Douglas. I-TREATMENT I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION satisfactorio I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION Tras I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2001 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY diarrea I-PAST_MEDICAL_HISTORY líquida I-PAST_MEDICAL_HISTORY (7-10 I-PAST_MEDICAL_HISTORY deposiciones I-PAST_MEDICAL_HISTORY diarias), I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY difuso I-PAST_MEDICAL_HISTORY abdominal, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY cólico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY (18 I-PAST_MEDICAL_HISTORY kg I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY síntomas) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS artralgias I-PRESENT_ILLNESS recurrentes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS autolimitadas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS grandes I-PRESENT_ILLNESS articulaciones. I-PRESENT_ILLNESS Acude B-EXPLORATION a I-EXPLORATION su I-EXPLORATION especialista I-EXPLORATION de I-EXPLORATION digestivo, I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION ambulatoria, I-EXPLORATION quien I-EXPLORATION solicita I-EXPLORATION analítica I-EXPLORATION elemental, I-EXPLORATION coprocultivo, I-EXPLORATION parásitos I-EXPLORATION y I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION que I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION hizo, I-EXPLORATION posteriormente, I-EXPLORATION colonoscopia I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION colon I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION íleon I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION mucosa I-EXPLORATION hiperémica, I-EXPLORATION edematosa I-EXPLORATION y I-EXPLORATION friable I-EXPLORATION con I-EXPLORATION un I-EXPLORATION punteado I-EXPLORATION blanquecino, I-EXPLORATION granuloso I-EXPLORATION y I-EXPLORATION aislado I-EXPLORATION que I-EXPLORATION se I-EXPLORATION hace I-EXPLORATION confluente I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION "grano I-EXPLORATION de I-EXPLORATION arroz" I-EXPLORATION a I-EXPLORATION medida I-EXPLORATION que I-EXPLORATION se I-EXPLORATION progresa I-EXPLORATION con I-EXPLORATION el I-EXPLORATION endoscopio. I-EXPLORATION I-EXPLORATION Mientras B-EVOLUTION espera I-EVOLUTION el I-EVOLUTION resultado I-EVOLUTION de I-EVOLUTION las I-EVOLUTION biopsias, I-EVOLUTION empeora I-EVOLUTION su I-EVOLUTION situación I-EVOLUTION clínica I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION número I-EVOLUTION de I-EVOLUTION deposiciones I-EVOLUTION e I-EVOLUTION hipertermia I-EVOLUTION de I-EVOLUTION 39o I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION ingresa I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital. I-EVOLUTION Se B-EXPLORATION aprecia I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION fiebre I-EXPLORATION de I-EXPLORATION 38, I-EXPLORATION 5o I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION difuso I-EXPLORATION abdominal. I-EXPLORATION No I-EXPLORATION hay I-EXPLORATION lesiones I-EXPLORATION cutáneas, I-EXPLORATION ni I-EXPLORATION se I-EXPLORATION palpan I-EXPLORATION adenopatías. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION resaltan I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION datos: I-EXPLORATION hematocrito I-EXPLORATION 29, I-EXPLORATION 8% I-EXPLORATION (40-50), I-EXPLORATION plaquetas I-EXPLORATION 409.000 I-EXPLORATION mm3 I-EXPLORATION (140-400.000), I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION 4, I-EXPLORATION 9 I-EXPLORATION g/dl, I-EXPLORATION albúmina I-EXPLORATION 2 I-EXPLORATION g/dl, I-EXPLORATION hierro I-EXPLORATION 10 I-EXPLORATION ng/dl I-EXPLORATION (60-160), I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION transferrina I-EXPLORATION 3% I-EXPLORATION (15-50) I-EXPLORATION y I-EXPLORATION test I-EXPLORATION de I-EXPLORATION D-xilosa I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION malabsorción. I-EXPLORATION Las I-EXPLORATION determinaciones I-EXPLORATION de I-EXPLORATION bilirrubina, I-EXPLORATION glucosa, I-EXPLORATION urea, I-EXPLORATION creatinina, I-EXPLORATION vitamina I-EXPLORATION B12, I-EXPLORATION ácido I-EXPLORATION fólico, I-EXPLORATION hormonas I-EXPLORATION tiroideas, I-EXPLORATION triglicéridos, I-EXPLORATION fósforo, I-EXPLORATION magnesio, I-EXPLORATION pruebas I-EXPLORATION hepáticas, I-EXPLORATION inmunoglobulinas, I-EXPLORATION transferrina, I-EXPLORATION ferritina I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antiendomisio I-EXPLORATION y I-EXPLORATION antigliadina I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION heces, I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION orina, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION y I-EXPLORATION bacterias I-EXPLORATION (virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION Salmonella, I-EXPLORATION Clostridium I-EXPLORATION difficile I-EXPLORATION y I-EXPLORATION micobacterias), I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION o I-EXPLORATION negativas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION tránsito I-EXPLORATION intestinal, I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION abdominopélvica I-EXPLORATION sin I-EXPLORATION apreciarse I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION La I-EXPLORATION fibrogastroscopia I-EXPLORATION detectó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION segunda I-EXPLORATION y I-EXPLORATION tercera I-EXPLORATION porción I-EXPLORATION duodenal I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION marcado I-EXPLORATION de I-EXPLORATION pliegues I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION granular I-EXPLORATION con I-EXPLORATION infiltrados I-EXPLORATION blanquecinos. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION duodenal I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION gránulos I-EXPLORATION PAS I-EXPLORATION positivos, I-EXPLORATION diastasa I-EXPLORATION resistentes, I-EXPLORATION hallazgos I-EXPLORATION también I-EXPLORATION presentes I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION previa I-EXPLORATION ileal. I-EXPLORATION Se I-EXPLORATION determinó I-EXPLORATION en I-EXPLORATION el I-EXPLORATION duodeno I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION de I-EXPLORATION ARN I-EXPLORATION ribosomal I-EXPLORATION 16 I-EXPLORATION S I-EXPLORATION de I-EXPLORATION T. I-EXPLORATION whippleii I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION positiva. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT penicilina I-TREATMENT (1, I-TREATMENT 2 I-TREATMENT x I-TREATMENT 106 I-TREATMENT unidades I-TREATMENT al I-TREATMENT día) I-TREATMENT más I-TREATMENT estreptomicina I-TREATMENT (1 I-TREATMENT g/día) I-TREATMENT durante I-TREATMENT 14 I-TREATMENT días, I-TREATMENT seguido I-TREATMENT de I-TREATMENT cotrimoxazol I-TREATMENT (800/160 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas) I-TREATMENT durante I-TREATMENT un I-TREATMENT año. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION desapareciendo I-EVOLUTION la I-EVOLUTION fiebre I-EVOLUTION y I-EVOLUTION ganando I-EVOLUTION peso I-EVOLUTION en I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION dos I-EVOLUTION semanas. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION meses, I-EVOLUTION la I-EVOLUTION duodenoscopia I-EVOLUTION era I-EVOLUTION normal I-EVOLUTION pero I-EVOLUTION persistían I-EVOLUTION focos I-EVOLUTION aislados I-EVOLUTION de I-EVOLUTION macrófagos I-EVOLUTION PAS I-EVOLUTION positivos I-EVOLUTION en I-EVOLUTION la I-EVOLUTION lámina I-EVOLUTION propia. I-EVOLUTION La B-EXPLORATION PCR I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION duodenal I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 8 I-EXPLORATION años I-EXPLORATION de I-EXPLORATION evolución, I-EXPLORATION las I-EXPLORATION biopsias I-EXPLORATION duodenal I-EXPLORATION e I-EXPLORATION ileal I-EXPLORATION no I-EXPLORATION mostraban I-EXPLORATION hallazgos I-EXPLORATION histológicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION al I-EXPLORATION microscopio I-EXPLORATION óptico. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador, B-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 26 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EC I-PAST_MEDICAL_HISTORY íleo-cólica. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fístula I-PAST_MEDICAL_HISTORY perianal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY suboclusión I-PAST_MEDICAL_HISTORY -intestinal I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY brote I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY EC, I-PAST_MEDICAL_HISTORY objetivando I-PAST_MEDICAL_HISTORY fístula I-PAST_MEDICAL_HISTORY entero-vesical, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY requirió I-PAST_MEDICAL_HISTORY intervención I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY (resección I-PAST_MEDICAL_HISTORY íleo-cólica). I-PAST_MEDICAL_HISTORY Coincidiendo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY suboclusión I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY edemas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY miembros I-PAST_MEDICAL_HISTORY inferiores, I-PAST_MEDICAL_HISTORY deterioro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY función I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY proteinuria I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY rango I-PAST_MEDICAL_HISTORY nefrótico, I-PAST_MEDICAL_HISTORY realizándosele I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY confirmó I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY sospecha I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY AA I-PAST_MEDICAL_HISTORY renal. I-PAST_MEDICAL_HISTORY Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT colchicina I-TREATMENT con I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal. I-TREATMENT La I-TREATMENT EC I-TREATMENT recidivó I-TREATMENT en I-TREATMENT la I-TREATMENT anastomosis I-TREATMENT siendo I-TREATMENT tratado I-TREATMENT con I-TREATMENT azatioprina, I-TREATMENT con B-EVOLUTION lo I-EVOLUTION que I-EVOLUTION ha I-EVOLUTION controlado I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION intestinal, I-EVOLUTION aunque I-EVOLUTION persiste I-EVOLUTION la I-EVOLUTION fístula I-EVOLUTION perianal I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION oligosintomática. I-EVOLUTION En B-TREATMENT la I-TREATMENT actualidad I-TREATMENT mantiene I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT azatioprina I-TREATMENT más I-TREATMENT mesalacina, I-TREATMENT presentando I-TREATMENT función I-TREATMENT renal I-TREATMENT normal, I-TREATMENT con I-TREATMENT persistencia I-TREATMENT de I-TREATMENT proteinuria I-TREATMENT en I-TREATMENT rango I-TREATMENT no I-TREATMENT nefrótico. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS fumador, B-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY quince I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY acalasia, I-PAST_MEDICAL_HISTORY realizándose I-PAST_MEDICAL_HISTORY dilatación I-PAST_MEDICAL_HISTORY endoscópica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY momento, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY decisión I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY paciente. I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro 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 disfagia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sólidos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS líquidos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION endoscopia I-EXPLORATION oral I-EXPLORATION objetivando I-EXPLORATION esófago I-EXPLORATION con I-EXPLORATION abundantes I-EXPLORATION restos I-EXPLORATION líquidos, I-EXPLORATION con I-EXPLORATION paredes I-EXPLORATION dilatadas, I-EXPLORATION morfología I-EXPLORATION sigmoide I-EXPLORATION y I-EXPLORATION mucosa I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION agrietado, I-EXPLORATION friable I-EXPLORATION y I-EXPLORATION cardias I-EXPLORATION puntiforme, I-EXPLORATION con I-EXPLORATION resistencia I-EXPLORATION al I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION acalasia I-EXPLORATION evolucionada, I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION subcardiales I-EXPLORATION que I-EXPLORATION justifiquen I-EXPLORATION pseudoacalasia. I-EXPLORATION A I-EXPLORATION 22 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION arcada I-EXPLORATION dentaria I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION lesión I-EXPLORATION mucosa I-EXPLORATION excavada, I-EXPLORATION profunda, I-EXPLORATION cubierta I-EXPLORATION de I-EXPLORATION fibrina I-EXPLORATION y I-EXPLORATION punteado I-EXPLORATION hemático, I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño, I-EXPLORATION que I-EXPLORATION abarca I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION circunferencia, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION maligno I-EXPLORATION que I-EXPLORATION se I-EXPLORATION biopsia, I-EXPLORATION con I-EXPLORATION histología I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION epidermoide I-EXPLORATION moderadamente I-EXPLORATION diferenciado. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION TC I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION esófago I-EXPLORATION marcadamente I-EXPLORATION dilatado I-EXPLORATION y I-EXPLORATION engrosamiento I-EXPLORATION parietal I-EXPLORATION del I-EXPLORATION tercio I-EXPLORATION proximal I-EXPLORATION esofágico I-EXPLORATION con I-EXPLORATION probable I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION posterior I-EXPLORATION traqueal, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION al I-EXPLORATION realizar I-EXPLORATION broncoscopia. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT epidermoide I-TREATMENT de I-TREATMENT esófago I-TREATMENT moderadamente I-TREATMENT diferenciado I-TREATMENT estadio I-TREATMENT III I-TREATMENT con I-TREATMENT infiltración I-TREATMENT traqueal I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT sistémica I-TREATMENT según I-TREATMENT esquema I-TREATMENT cisplatino/5-fluouracilo. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION sufre I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION compatible I-EVOLUTION con I-EVOLUTION broncoaspiración, I-EVOLUTION presentando I-EVOLUTION deterioro I-EVOLUTION clínico I-EVOLUTION progresivo I-EVOLUTION produciéndose I-EVOLUTION finalmente I-EVOLUTION el I-EVOLUTION fallecimiento I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento, I-EVOLUTION poniéndose I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION con I-EVOLUTION perforación I-EVOLUTION traqueoesofágica, I-EVOLUTION bronconeumonía I-EVOLUTION y I-EVOLUTION mediastinitis I-EVOLUTION asociada. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY subclínico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esclerodermia I-PAST_MEDICAL_HISTORY precoz I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY consultas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Reumatología I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Dermatología. I-PAST_MEDICAL_HISTORY Un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY necrosis I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY pulpejos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY dedos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY estudio. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY capilaroscopia I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY ANA I-PAST_MEDICAL_HISTORY positivos I-PAST_MEDICAL_HISTORY (1/640), I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anticentrómero, I-PAST_MEDICAL_HISTORY RNP I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY scl-70 I-PAST_MEDICAL_HISTORY negativos. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY bosentán I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY acetilsalicílico. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS melenas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS epistaxis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION presentó I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 8, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION con I-EXPLORATION una I-EXPLORATION cifra I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION normales, I-EXPLORATION una I-EXPLORATION coagulación I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION una I-EXPLORATION VSG I-EXPLORATION de I-EXPLORATION 48 I-EXPLORATION mm/h. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaban I-EXPLORATION múltiples I-EXPLORATION telangiectasias I-EXPLORATION en I-EXPLORATION los I-EXPLORATION pulpejos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dedos, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION en I-EXPLORATION mucosa I-EXPLORATION oral I-EXPLORATION y I-EXPLORATION región I-EXPLORATION peribucal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION gastroscopia I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION (menor I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm) I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION vascular I-EXPLORATION en I-EXPLORATION mucosa I-EXPLORATION esofágica, I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION duodenal, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION reciente I-EXPLORATION ni I-EXPLORATION restos I-EXPLORATION hemáticos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION múltiples I-EXPLORATION telangiectasias I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION ano I-EXPLORATION hasta I-EXPLORATION ciego. I-EXPLORATION No B-EVOLUTION presentó I-EVOLUTION melenas I-EVOLUTION durante I-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION ni I-EVOLUTION hubo I-EVOLUTION un I-EVOLUTION descenso I-EVOLUTION del I-EVOLUTION hematocrito I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT suplementos I-TREATMENT de I-TREATMENT hierro I-TREATMENT y I-TREATMENT ácido I-TREATMENT fólico I-TREATMENT orales. I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS urotelial I-PRESENT_ILLNESS sólido I-PRESENT_ILLNESS infiltrante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alto I-PRESENT_ILLNESS grado, I-PRESENT_ILLNESS pobremente I-PRESENT_ILLNESS diferenciado, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS infiltración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lámina I-PRESENT_ILLNESS propia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS muscular. I-PRESENT_ILLNESS Se B-TREATMENT realiza I-TREATMENT cistectomía I-TREATMENT radical I-TREATMENT y I-TREATMENT ureterosigmoidostomia I-TREATMENT destubulizada I-TREATMENT (Mainz I-TREATMENT II) I-TREATMENT implantándose I-TREATMENT ambos I-TREATMENT uréteres I-TREATMENT en I-TREATMENT cara I-TREATMENT lateral I-TREATMENT izquierda I-TREATMENT de I-TREATMENT la I-TREATMENT bolsa I-TREATMENT con I-TREATMENT colocación I-TREATMENT de I-TREATMENT catéteres I-TREATMENT que I-TREATMENT salen I-TREATMENT por I-TREATMENT contraincisión I-TREATMENT a I-TREATMENT bolsa I-TREATMENT de I-TREATMENT urostomía. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION comienza I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION en I-EVOLUTION flanco I-EVOLUTION derecho I-EVOLUTION con I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION irritación I-EVOLUTION peritoneal I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION leucocitosis. I-EVOLUTION Se I-EVOLUTION objetiva I-EVOLUTION migración I-EVOLUTION subcutánea I-EVOLUTION de I-EVOLUTION catéter I-EVOLUTION izquierdo. I-EVOLUTION Se B-EXPLORATION realiza I-EXPLORATION TC I-EXPLORATION urgente I-EXPLORATION identificándose I-EXPLORATION el I-EXPLORATION catéter I-EXPLORATION tipo I-EXPLORATION pig-tail I-EXPLORATION con I-EXPLORATION rizo I-EXPLORATION en I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION que I-EXPLORATION lleva I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION normal I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neovejiga, I-EXPLORATION saliendo I-EXPLORATION por I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION presentando I-EXPLORATION desde I-EXPLORATION entonces I-EXPLORATION una I-EXPLORATION trayectoria I-EXPLORATION ascendente I-EXPLORATION anterior I-EXPLORATION al I-EXPLORATION ciego I-EXPLORATION para I-EXPLORATION posteriormente I-EXPLORATION dirigirse I-EXPLORATION a I-EXPLORATION línea I-EXPLORATION media, I-EXPLORATION siempre I-EXPLORATION superficial I-EXPLORATION a I-EXPLORATION las I-EXPLORATION asas I-EXPLORATION girando I-EXPLORATION en I-EXPLORATION última I-EXPLORATION instancia I-EXPLORATION hacia I-EXPLORATION flanco I-EXPLORATION derecho. I-EXPLORATION La I-EXPLORATION punta I-EXPLORATION se I-EXPLORATION localiza I-EXPLORATION inmediatamente I-EXPLORATION posterior I-EXPLORATION al I-EXPLORATION músculo I-EXPLORATION recto I-EXPLORATION abdominal I-EXPLORATION anterior I-EXPLORATION derecho. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION ven I-EXPLORATION burbujas I-EXPLORATION aéreas I-EXPLORATION extraluminares I-EXPLORATION que I-EXPLORATION sugieran I-EXPLORATION perforación. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION colonoscopia I-EXPLORATION urgente, I-EXPLORATION introduciendo I-EXPLORATION el I-EXPLORATION endoscopio I-EXPLORATION hasta I-EXPLORATION 20 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION margen I-EXPLORATION anal. I-EXPLORATION A I-EXPLORATION ese I-EXPLORATION nivel I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION neovejiga I-EXPLORATION con I-EXPLORATION catéter I-EXPLORATION en I-EXPLORATION unión I-EXPLORATION uretero-vesical I-EXPLORATION con I-EXPLORATION salida I-EXPLORATION por I-EXPLORATION pared I-EXPLORATION posterior, I-EXPLORATION sin I-EXPLORATION identificarse I-EXPLORATION extremo I-EXPLORATION distal. I-EXPLORATION Se B-TREATMENT extrae I-TREATMENT catéter I-TREATMENT con I-TREATMENT pinza I-TREATMENT sin I-TREATMENT incidencias, I-TREATMENT presentando B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION posteriormente I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION clínica, I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION procedimiento. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS fue B-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO ya I-DERIVED_FROM/TO que I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO hacía I-DERIVED_FROM/TO dos I-DERIVED_FROM/TO años I-DERIVED_FROM/TO tenía I-DERIVED_FROM/TO la I-DERIVED_FROM/TO concentración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ferritina I-DERIVED_FROM/TO en I-DERIVED_FROM/TO suero I-DERIVED_FROM/TO superior I-DERIVED_FROM/TO a I-DERIVED_FROM/TO 1.000 I-DERIVED_FROM/TO µg/l I-DERIVED_FROM/TO (rango I-DERIVED_FROM/TO normal, I-DERIVED_FROM/TO 26-370). I-DERIVED_FROM/TO El B-EXPLORATION paciente I-EXPLORATION tenía I-EXPLORATION la I-EXPLORATION ferritina I-EXPLORATION sérica I-EXPLORATION (1.277 I-EXPLORATION µg/l) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION γGT I-EXPLORATION (116 I-EXPLORATION U/L; I-EXPLORATION rango I-EXPLORATION normal, I-EXPLORATION 10-60) I-EXPLORATION aumentadas, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION del I-EXPLORATION hígado I-EXPLORATION nos I-EXPLORATION llevó I-EXPLORATION a I-EXPLORATION sospechar I-EXPLORATION posible I-EXPLORATION hígado I-EXPLORATION graso. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION analíticas I-EXPLORATION y I-EXPLORATION serológicas I-EXPLORATION complementarias I-EXPLORATION no I-EXPLORATION revelaron I-EXPLORATION ninguna I-EXPLORATION anomalía. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION asintomático. I-EXPLORATION No B-PAST_MEDICAL_HISTORY bebía I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY consumía I-PAST_MEDICAL_HISTORY tabaco. I-PAST_MEDICAL_HISTORY Su B-FAMILY_HISTORY historia I-FAMILY_HISTORY clínica I-FAMILY_HISTORY personal I-FAMILY_HISTORY y I-FAMILY_HISTORY familiar, I-FAMILY_HISTORY y I-FAMILY_HISTORY el I-FAMILY_HISTORY examen I-FAMILY_HISTORY físico I-FAMILY_HISTORY no I-FAMILY_HISTORY reflejaban I-FAMILY_HISTORY nada I-FAMILY_HISTORY destacable. I-FAMILY_HISTORY I-FAMILY_HISTORY Analizamos B-EXPLORATION los I-EXPLORATION marcadores I-EXPLORATION del I-EXPLORATION metabolismo I-EXPLORATION del I-EXPLORATION hierro I-EXPLORATION (niveles I-EXPLORATION de I-EXPLORATION hierro I-EXPLORATION en I-EXPLORATION suero, I-EXPLORATION ferritina, I-EXPLORATION receptor I-EXPLORATION soluble I-EXPLORATION de I-EXPLORATION transferrina I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION transferrina), I-EXPLORATION y I-EXPLORATION la I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION hierro I-EXPLORATION hepático I-EXPLORATION y I-EXPLORATION la I-EXPLORATION arquitectura I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION hepático I-EXPLORATION mediante I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION del I-EXPLORATION hígado. I-EXPLORATION Las I-EXPLORATION secciones I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION cinco I-EXPLORATION micrómetros I-EXPLORATION se I-EXPLORATION tiñeron I-EXPLORATION con I-EXPLORATION hematoxilina-eosina, I-EXPLORATION y I-EXPLORATION azul I-EXPLORATION Prusia I-EXPLORATION de I-EXPLORATION Perls I-EXPLORATION para I-EXPLORATION detectar I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hierro. I-EXPLORATION Se I-EXPLORATION estudió I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION obtenida I-EXPLORATION mediante I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION del I-EXPLORATION hígado I-EXPLORATION (MRI). I-EXPLORATION También I-EXPLORATION se I-EXPLORATION buscaron I-EXPLORATION las I-EXPLORATION variaciones I-EXPLORATION alélicas I-EXPLORATION c.845G>A I-EXPLORATION (p.C282Y) I-EXPLORATION y I-EXPLORATION c.187C>G I-EXPLORATION (p.H63D) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION HFE. I-EXPLORATION I-EXPLORATION El I-EXPLORATION ADN I-EXPLORATION genómico I-EXPLORATION se I-EXPLORATION extrajo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica, I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION (PCR) I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION mediante I-EXPLORATION oligonucleótidos I-EXPLORATION específicos I-EXPLORATION para I-EXPLORATION amplificar I-EXPLORATION las I-EXPLORATION regiones I-EXPLORATION codificantes, I-EXPLORATION las I-EXPLORATION regiones I-EXPLORATION intrónicas I-EXPLORATION adyacentes, I-EXPLORATION y I-EXPLORATION las I-EXPLORATION regiones I-EXPLORATION sin I-EXPLORATION traducir I-EXPLORATION 5 I-EXPLORATION ' I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION ' I-EXPLORATION (UTR) I-EXPLORATION de I-EXPLORATION los I-EXPLORATION genes: I-EXPLORATION HFE, I-EXPLORATION hemojuvelina I-EXPLORATION (HJV), I-EXPLORATION hepcidina I-EXPLORATION (HAMP), I-EXPLORATION receptor I-EXPLORATION 2 I-EXPLORATION de I-EXPLORATION transferrina I-EXPLORATION (TFR2) I-EXPLORATION y I-EXPLORATION ferroportina I-EXPLORATION (SLC40A1). I-EXPLORATION Los I-EXPLORATION productos I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION se I-EXPLORATION secuenciaron I-EXPLORATION bidireccionalmente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION secuenciador I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION ABI I-EXPLORATION Prism I-EXPLORATION 3130x1, I-EXPLORATION y I-EXPLORATION las I-EXPLORATION secuencias I-EXPLORATION se I-EXPLORATION compararon I-EXPLORATION con I-EXPLORATION las I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION (números I-EXPLORATION de I-EXPLORATION accesión I-EXPLORATION del I-EXPLORATION GenBank: I-EXPLORATION NG_008720.1, I-EXPLORATION NG_011568.1, I-EXPLORATION NG_011563.1, I-EXPLORATION NM_003227.3 I-EXPLORATION y I-EXPLORATION NG_009027.1, I-EXPLORATION respectivamente, I-EXPLORATION para I-EXPLORATION los I-EXPLORATION genes I-EXPLORATION mencionados). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION obtuvo I-EXPLORATION el I-EXPLORATION consentimiento I-EXPLORATION informado I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION según I-EXPLORATION las I-EXPLORATION recomendaciones I-EXPLORATION locales I-EXPLORATION para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION y I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION del I-EXPLORATION hígado. I-EXPLORATION El I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION con I-EXPLORATION los I-EXPLORATION principios I-EXPLORATION éticos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION declaración I-EXPLORATION de I-EXPLORATION Helsinki I-EXPLORATION (2008). I-EXPLORATION I-EXPLORATION Los I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION hierro I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION fueron: I-EXPLORATION ferritina I-EXPLORATION en I-EXPLORATION suero, I-EXPLORATION 1.070 I-EXPLORATION µg/l I-EXPLORATION (rango I-EXPLORATION normal, I-EXPLORATION 26-370 I-EXPLORATION µg/l); I-EXPLORATION hierro I-EXPLORATION en I-EXPLORATION suero, I-EXPLORATION 160 I-EXPLORATION µg/dl I-EXPLORATION (rango I-EXPLORATION normal, I-EXPLORATION 59-158 I-EXPLORATION µg/dl); I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION transferrina, I-EXPLORATION 48% I-EXPLORATION (rango I-EXPLORATION normal, I-EXPLORATION 20-45%); I-EXPLORATION y I-EXPLORATION receptor I-EXPLORATION soluble I-EXPLORATION de I-EXPLORATION transferrina, I-EXPLORATION 0, I-EXPLORATION 90 I-EXPLORATION mg/l I-EXPLORATION (rango I-EXPLORATION normal, I-EXPLORATION 1, I-EXPLORATION 76 I-EXPLORATION ± I-EXPLORATION 0, I-EXPLORATION 83 I-EXPLORATION mg/l). I-EXPLORATION La I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION hepática I-EXPLORATION mostró I-EXPLORATION anomalías I-EXPLORATION difusas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intensidad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima, I-EXPLORATION asociadas I-EXPLORATION con I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION hierro; I-EXPLORATION el I-EXPLORATION contenido I-EXPLORATION de I-EXPLORATION hierro I-EXPLORATION hepático I-EXPLORATION fue I-EXPLORATION estimado I-EXPLORATION en I-EXPLORATION 160 I-EXPLORATION µmol/g I-EXPLORATION (valores I-EXPLORATION normales, I-EXPLORATION < I-EXPLORATION 36 I-EXPLORATION µmol/g). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION percutánea I-EXPLORATION guiada I-EXPLORATION por I-EXPLORATION ecografía. I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION histopatológica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION arquitectura I-EXPLORATION lobular I-EXPLORATION normal, I-EXPLORATION estrechos I-EXPLORATION espacios I-EXPLORATION portales I-EXPLORATION sin I-EXPLORATION inflamación I-EXPLORATION o I-EXPLORATION fibrosis I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION vasculares I-EXPLORATION o I-EXPLORATION ductales. I-EXPLORATION El I-EXPLORATION lóbulo I-EXPLORATION estaba I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION hepatocitos I-EXPLORATION con I-EXPLORATION morfología I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION con I-EXPLORATION depósitos I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION intensidad I-EXPLORATION de I-EXPLORATION hemosiderina, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION patrón I-EXPLORATION típico I-EXPLORATION de I-EXPLORATION hemocromatosis, I-EXPLORATION es I-EXPLORATION decir, I-EXPLORATION depósitos I-EXPLORATION de I-EXPLORATION hierro I-EXPLORATION localizados I-EXPLORATION casi I-EXPLORATION exclusivamente I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION parenquimatosas I-EXPLORATION en I-EXPLORATION áreas I-EXPLORATION periportales, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION granular I-EXPLORATION y I-EXPLORATION una I-EXPLORATION distribución I-EXPLORATION pericanalicular. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT flebotomías I-TREATMENT y, I-TREATMENT después I-TREATMENT de I-TREATMENT 20 I-TREATMENT flebotomías I-TREATMENT quincenales, I-TREATMENT se I-TREATMENT eliminaron I-TREATMENT más I-TREATMENT de I-TREATMENT 5 I-TREATMENT g I-TREATMENT de I-TREATMENT hierro, I-TREATMENT y I-TREATMENT las I-TREATMENT concentraciones I-TREATMENT de I-TREATMENT γGT I-TREATMENT y I-TREATMENT ferritina I-TREATMENT volvieron I-TREATMENT a I-TREATMENT valores I-TREATMENT normales. I-TREATMENT Actualmente I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT somete I-TREATMENT a I-TREATMENT flebotomías I-TREATMENT de I-TREATMENT mantenimiento I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT año. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION de I-EXPLORATION los I-EXPLORATION genes I-EXPLORATION implicados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION metabolismo I-EXPLORATION del I-EXPLORATION hierro I-EXPLORATION mostró I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION variantes I-EXPLORATION alélicas I-EXPLORATION en I-EXPLORATION estado I-EXPLORATION heterocigoto: I-EXPLORATION c.187C>G I-EXPLORATION (p.H63D) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION HFE I-EXPLORATION y I-EXPLORATION c.840C>G I-EXPLORATION (p.F280L) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION TFR2. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY arteriopatía I-PAST_MEDICAL_HISTORY periférica. I-PAST_MEDICAL_HISTORY Presenta B-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS tóxico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dispepsia I-PRESENT_ILLNESS gástrica. I-PRESENT_ILLNESS Estudio B-EXPLORATION endoscópico I-EXPLORATION que I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION neoformación I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION antral I-EXPLORATION yuxtapilórica I-EXPLORATION que I-EXPLORATION dificulta I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio I-EXPLORATION y I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION adenocarcinoma. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION hipocrómica, I-EXPLORATION y I-EXPLORATION unos I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION (CEA: I-EXPLORATION 3, I-EXPLORATION 17 I-EXPLORATION µg/l, I-EXPLORATION CA I-EXPLORATION 19.9: I-EXPLORATION 17, I-EXPLORATION 31 I-EXPLORATION KU/l). I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidencia I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION gástrica I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION por I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION curvatura I-EXPLORATION menor I-EXPLORATION hasta I-EXPLORATION bulbo I-EXPLORATION y I-EXPLORATION primera I-EXPLORATION porción I-EXPLORATION duodenal I-EXPLORATION con I-EXPLORATION adenopatías I-EXPLORATION adyacentes I-EXPLORATION al I-EXPLORATION margen I-EXPLORATION inferior. I-EXPLORATION Colelitiasis. I-EXPLORATION No I-EXPLORATION presenta I-EXPLORATION adenopatías I-EXPLORATION retroperitoneales I-EXPLORATION ni I-EXPLORATION metástasis I-EXPLORATION a I-EXPLORATION distancia. I-EXPLORATION Se B-TREATMENT practica I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT que I-TREATMENT evidencia I-TREATMENT neoplasia I-TREATMENT antral I-TREATMENT extendida I-TREATMENT a I-TREATMENT cuerpo I-TREATMENT gástrico I-TREATMENT y I-TREATMENT se I-TREATMENT practica I-TREATMENT colecistectomía, I-TREATMENT gastrectomía I-TREATMENT total I-TREATMENT y I-TREATMENT esófago-yeyunostomía I-TREATMENT en I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION masas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION neoplásico, I-EXPLORATION con I-EXPLORATION centro I-EXPLORATION úlcero-necrótico I-EXPLORATION y I-EXPLORATION márgenes I-EXPLORATION mamelonados, I-EXPLORATION separadas I-EXPLORATION por I-EXPLORATION pared I-EXPLORATION gástrica I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION una I-EXPLORATION longitud I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm. I-EXPLORATION La I-EXPLORATION tumoración I-EXPLORATION más I-EXPLORATION proximal I-EXPLORATION mide I-EXPLORATION 65 I-EXPLORATION x I-EXPLORATION 55 I-EXPLORATION mm I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION neoplásica, I-EXPLORATION de I-EXPLORATION patrón I-EXPLORATION difuso, I-EXPLORATION que I-EXPLORATION infiltra I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION gástrica I-EXPLORATION alcanzando I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION circundante, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION no I-EXPLORATION Hodgkin I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION linfoma I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION célula I-EXPLORATION grande I-EXPLORATION de I-EXPLORATION inmunofenotipo I-EXPLORATION B. I-EXPLORATION La I-EXPLORATION tumoración I-EXPLORATION más I-EXPLORATION distal I-EXPLORATION mide I-EXPLORATION 55 I-EXPLORATION x I-EXPLORATION 55 I-EXPLORATION mm, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION neoplásicas, I-EXPLORATION de I-EXPLORATION patrón I-EXPLORATION difuso I-EXPLORATION y I-EXPLORATION glandular, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION células I-EXPLORATION poligonales, I-EXPLORATION con I-EXPLORATION núcleo I-EXPLORATION irregular, I-EXPLORATION redondo, I-EXPLORATION con I-EXPLORATION nucléolo I-EXPLORATION prominente I-EXPLORATION y I-EXPLORATION citoplasma I-EXPLORATION amplio, I-EXPLORATION eosinófilo. I-EXPLORATION Dicha I-EXPLORATION proliferación I-EXPLORATION neoplásica I-EXPLORATION infiltra I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION gástrica I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION capa I-EXPLORATION muscular I-EXPLORATION propia, I-EXPLORATION sin I-EXPLORATION alcanzar I-EXPLORATION la I-EXPLORATION serosa I-EXPLORATION ni I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION adiposo. I-EXPLORATION Se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION patrón I-EXPLORATION intestinal I-EXPLORATION y I-EXPLORATION difuso. I-EXPLORATION Márgenes I-EXPLORATION quirúrgicos I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION no I-EXPLORATION afectados. I-EXPLORATION Se I-EXPLORATION halla I-EXPLORATION infiltración I-EXPLORATION neoplásica I-EXPLORATION por I-EXPLORATION adenocarcinoma I-EXPLORATION en I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION 32 I-EXPLORATION ganglios I-EXPLORATION resecados, I-EXPLORATION sin I-EXPLORATION extensión I-EXPLORATION extracapsular. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION curso I-EVOLUTION postoperatorio I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION Valorado B-TREATMENT por I-TREATMENT el I-TREATMENT comité I-TREATMENT oncológico I-TREATMENT se I-TREATMENT desestima I-TREATMENT tratamiento I-TREATMENT adyuvante I-TREATMENT por I-TREATMENT las I-TREATMENT comorbilidades I-TREATMENT del I-TREATMENT paciente. I-TREATMENT Controlado B-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION externas I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION sigue I-EVOLUTION buena I-EVOLUTION evolución. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY cirugías I-PAST_MEDICAL_HISTORY abdominales I-PAST_MEDICAL_HISTORY (colecistectomía, I-PAST_MEDICAL_HISTORY histerectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY eventroplastia) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY colon, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS recientes I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hábito I-PRESENT_ILLNESS intestinal. I-PRESENT_ILLNESS La B-EXPLORATION colonoscopia I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION sigmoideo I-EXPLORATION muy I-EXPLORATION angulado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION divertículos I-EXPLORATION que I-EXPLORATION impedía I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio I-EXPLORATION a I-EXPLORATION su I-EXPLORATION través. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION otras I-EXPLORATION anomalías. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION situación, I-EXPLORATION decidimos I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION con I-EXPLORATION cápsula I-EXPLORATION para I-EXPLORATION evaluar I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION colon, I-EXPLORATION observándose I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION izquierdo I-EXPLORATION estenótico, I-EXPLORATION escasamente I-EXPLORATION distensible I-EXPLORATION y I-EXPLORATION con I-EXPLORATION divertículos. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION otras I-EXPLORATION lesiones. I-EXPLORATION A I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION todo, I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION con I-EXPLORATION cápsula I-EXPLORATION fue I-EXPLORATION completa I-EXPLORATION siendo I-EXPLORATION esta I-EXPLORATION excretada I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION finalización I-EXPLORATION de I-EXPLORATION las I-EXPLORATION baterías I-EXPLORATION (< I-EXPLORATION 10 I-EXPLORATION horas). I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS femenina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS nulípara, B-PAST_MEDICAL_HISTORY sexualmente I-PAST_MEDICAL_HISTORY activa, I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY cuyos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY anticoncepción I-PAST_MEDICAL_HISTORY hormonal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anillo I-PAST_MEDICAL_HISTORY vaginal, I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY flujo I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY anormal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY año, I-PAST_MEDICAL_HISTORY algunas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY tópico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antimicóticos, I-PAST_MEDICAL_HISTORY drenaje I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY absceso I-PAST_MEDICAL_HISTORY adyacente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY clítoris I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY dispareunia I-PAST_MEDICAL_HISTORY profunda I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY leucorrea I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tratadas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY mes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución. I-PAST_MEDICAL_HISTORY Fumadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY habitual. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS rápidamente I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS exacerbado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS inspiración I-PRESENT_ILLNESS profunda, I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS maniobras I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Valsalva, I-PRESENT_ILLNESS inicialmente I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS iliaca I-PRESENT_ILLNESS derechas, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS exacerbación I-PRESENT_ILLNESS postprandial, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Coincidiendo I-PRESENT_ILLNESS el I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS menstruación, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompañaba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS a I-PRESENT_ILLNESS moderado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipogastrio. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS había I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hábito I-PRESENT_ILLNESS deposicional I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION en I-EXPLORATION urgencias I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION hemodinámicamente I-EXPLORATION estable, I-EXPLORATION afebril. I-EXPLORATION Auscultación I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION cardiacas I-EXPLORATION normales. I-EXPLORATION Abdomen I-EXPLORATION no I-EXPLORATION distendido, I-EXPLORATION peristaltismo I-EXPLORATION conservado, I-EXPLORATION blando I-EXPLORATION depresible I-EXPLORATION muy I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION defensa I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION doloroso I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipogastrio. I-EXPLORATION Blumberg I-EXPLORATION positivo I-EXPLORATION reflejado I-EXPLORATION en I-EXPLORATION dicha I-EXPLORATION localización. I-EXPLORATION Puñopercusión I-EXPLORATION lumbar I-EXPLORATION derecha I-EXPLORATION positiva I-EXPLORATION reflejada I-EXPLORATION a I-EXPLORATION hipocondrio I-EXPLORATION derecho. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION genital I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION eritema I-EXPLORATION vulvar I-EXPLORATION y I-EXPLORATION perianal, I-EXPLORATION vagina I-EXPLORATION con I-EXPLORATION anillo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION y I-EXPLORATION leucorrea. I-EXPLORATION Cérvix I-EXPLORATION posterior I-EXPLORATION formado I-EXPLORATION y I-EXPLORATION cerrado. I-EXPLORATION I-EXPLORATION Analíticamente I-EXPLORATION destacaba: I-EXPLORATION Hb: I-EXPLORATION 12, I-EXPLORATION 1 I-EXPLORATION g/dl; I-EXPLORATION leucocitos: I-EXPLORATION 12.800; I-EXPLORATION neutrófilos: I-EXPLORATION 77%; I-EXPLORATION plaquetas: I-EXPLORATION 281.000, I-EXPLORATION quick: I-EXPLORATION 103%, I-EXPLORATION fibrinógeno I-EXPLORATION 3, I-EXPLORATION 1 I-EXPLORATION mg/dl; I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION mg/dl; I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 0, I-EXPLORATION 2 I-EXPLORATION mg/dl; I-EXPLORATION sodio I-EXPLORATION 138; I-EXPLORATION potasio I-EXPLORATION 3, I-EXPLORATION 5; I-EXPLORATION AST I-EXPLORATION 14; I-EXPLORATION ALT I-EXPLORATION 12; I-EXPLORATION amilasa I-EXPLORATION 41; I-EXPLORATION LDH I-EXPLORATION 271; I-EXPLORATION PCR: I-EXPLORATION 6, I-EXPLORATION 77 I-EXPLORATION mg/dl; I-EXPLORATION VSG I-EXPLORATION 28. I-EXPLORATION El I-EXPLORATION sedimento I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION estaba I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION evidenciaba I-EXPLORATION únicamente I-EXPLORATION neumatización I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION No I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION y I-EXPLORATION gas I-EXPLORATION en I-EXPLORATION ampolla I-EXPLORATION rectal. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION patología I-EXPLORATION hepatobiliar, I-EXPLORATION por I-EXPLORATION tratarse I-EXPLORATION de I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION más I-EXPLORATION frecuente I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION cuadrante I-EXPLORATION superior I-EXPLORATION derecho, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION no I-EXPLORATION encontrar I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION al I-EXPLORATION respecto, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION reporta I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION distendida, I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION finas I-EXPLORATION y I-EXPLORATION alitiásica I-EXPLORATION y I-EXPLORATION con I-EXPLORATION mínima I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION perivesicular. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION descartar I-EXPLORATION patología I-EXPLORATION hepática, I-EXPLORATION biliar I-EXPLORATION litiásica I-EXPLORATION y I-EXPLORATION vesicular I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION que I-EXPLORATION objetiva I-EXPLORATION hepatomegalia I-EXPLORATION homogénea I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION focales, I-EXPLORATION edema I-EXPLORATION periportal I-EXPLORATION difuso I-EXPLORATION ; I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION no I-EXPLORATION dilatada, I-EXPLORATION líquido I-EXPLORATION perivesicular, I-EXPLORATION riñones I-EXPLORATION normales, I-EXPLORATION no I-EXPLORATION había I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION intestinales. I-EXPLORATION Ciego I-EXPLORATION y I-EXPLORATION apéndice I-EXPLORATION normales I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION pélvica. I-EXPLORATION Páncreas I-EXPLORATION normal. I-EXPLORATION Mínimo I-EXPLORATION líquido I-EXPLORATION pélvico I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION perianexial I-EXPLORATION izquierdo. I-EXPLORATION Resto I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Siendo I-EXPLORATION descartadas I-EXPLORATION otras I-EXPLORATION patologías I-EXPLORATION causantes I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION cuadrante I-EXPLORATION superior I-EXPLORATION izquierdo, I-EXPLORATION como I-EXPLORATION la I-EXPLORATION hepatobiliar, I-EXPLORATION neumonía, I-EXPLORATION patología I-EXPLORATION renal, I-EXPLORATION etc., I-EXPLORATION tanto I-EXPLORATION por I-EXPLORATION analítica I-EXPLORATION como I-EXPLORATION por I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION imagen, I-EXPLORATION y I-EXPLORATION tomando I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION las I-EXPLORATION características I-EXPLORATION del I-EXPLORATION dolor, I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION en I-EXPLORATION eco I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION inflamatoria I-EXPLORATION perihepática, I-EXPLORATION líquido I-EXPLORATION perianexial I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION inflamatorios, I-EXPLORATION en I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION probable I-EXPLORATION infección I-EXPLORATION ginecológica I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION pélvico, I-EXPLORATION se I-EXPLORATION orienta I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION como I-EXPLORATION perihepatitis I-EXPLORATION de I-EXPLORATION origen I-EXPLORATION infeccioso, I-EXPLORATION motivo I-EXPLORATION por I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION ecografía I-EXPLORATION transvaginal I-EXPLORATION que I-EXPLORATION reporta I-EXPLORATION útero I-EXPLORATION y I-EXPLORATION ovarios I-EXPLORATION normales, I-EXPLORATION endometrio I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION mm I-EXPLORATION homogéneo, I-EXPLORATION sin I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION en I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION saco I-EXPLORATION de I-EXPLORATION Douglas. I-EXPLORATION Se I-EXPLORATION obtienen I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION flujo I-EXPLORATION vaginal I-EXPLORATION para I-EXPLORATION cultivos I-EXPLORATION que I-EXPLORATION resultan I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Candida I-EXPLORATION albicans, I-EXPLORATION Gardnerella I-EXPLORATION vaginalis I-EXPLORATION y I-EXPLORATION Ureraplasma I-EXPLORATION urealiticum. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION amplificación I-EXPLORATION genética I-EXPLORATION de I-EXPLORATION PCR I-EXPLORATION (reacción I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION polimerasa) I-EXPLORATION para I-EXPLORATION Chlamydia I-EXPLORATION trachomatis I-EXPLORATION fue I-EXPLORATION positivo. I-EXPLORATION I-EXPLORATION Una B-TREATMENT vez I-TREATMENT confirmado I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT como I-TREATMENT una I-TREATMENT perihepatitis I-TREATMENT por I-TREATMENT C. I-TREATMENT trachomatis I-TREATMENT de I-TREATMENT punto I-TREATMENT de I-TREATMENT partida I-TREATMENT de I-TREATMENT una I-TREATMENT EIP, I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT azitromicina I-TREATMENT 2 I-TREATMENT g I-TREATMENT vía I-TREATMENT oral I-TREATMENT en I-TREATMENT dosis I-TREATMENT única, I-TREATMENT presentando B-EVOLUTION franca I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios I-EVOLUTION al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION 24-48 I-EVOLUTION horas. I-EVOLUTION Así B-TREATMENT mismo I-TREATMENT iniciamos I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT óvulos I-TREATMENT de I-TREATMENT clotrimazol I-TREATMENT con I-TREATMENT mejoría I-TREATMENT del I-TREATMENT prurito I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT leucorrea. I-TREATMENT Debido B-EXPLORATION a I-EXPLORATION que I-EXPLORATION la I-EXPLORATION Chlamydia I-EXPLORATION trachomatis I-EXPLORATION es I-EXPLORATION un I-EXPLORATION germen I-EXPLORATION de I-EXPLORATION transmisión I-EXPLORATION sexual, I-EXPLORATION se I-EXPLORATION practicaron I-EXPLORATION pruebas I-EXPLORATION serológicas I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION otros I-EXPLORATION agentes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION categoría I-EXPLORATION como I-EXPLORATION VIH I-EXPLORATION y I-EXPLORATION VDRL I-EXPLORATION siendo I-EXPLORATION ambas I-EXPLORATION negativas. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION haber I-EXPLORATION culminado I-EXPLORATION tratamiento I-EXPLORATION antibiótico, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION tomografía I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION control I-EXPLORATION que I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION fina I-EXPLORATION línea I-EXPLORATION de I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION saco I-EXPLORATION de I-EXPLORATION Douglas. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION estudio I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION 1 I-EVOLUTION mes I-EVOLUTION se I-EVOLUTION cita I-EVOLUTION a I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION para I-EVOLUTION valorar I-EVOLUTION estado I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION nuevo I-EVOLUTION control I-EVOLUTION analítico, I-EVOLUTION quien I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION con I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION sin I-EVOLUTION leucorrea, I-EVOLUTION dispareunia, I-EVOLUTION ni I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION a I-EVOLUTION la I-EVOLUTION palpación I-EVOLUTION superficial I-EVOLUTION y I-EVOLUTION profunda. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY únicos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS mucocutánea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS coluria, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS características I-PRESENT_ILLNESS cólicas, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION mostraba I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION peritonismo. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION destacaba I-EXPLORATION bilirrubina I-EXPLORATION 5, I-EXPLORATION 6 I-EXPLORATION mg/dl, I-EXPLORATION GOT I-EXPLORATION 608 I-EXPLORATION UI/l I-EXPLORATION y I-EXPLORATION GPT I-EXPLORATION 720 I-EXPLORATION UI/l. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION coledocolitiasis I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION colédoco I-EXPLORATION (22, I-EXPLORATION 4 I-EXPLORATION mm) I-EXPLORATION y I-EXPLORATION colelitiasis. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION CPRE, I-EXPLORATION confirmándose I-EXPLORATION la I-EXPLORATION coledocolitiasis; I-EXPLORATION se B-TREATMENT procedió I-TREATMENT a I-TREATMENT realizar I-TREATMENT esfinterotomía I-TREATMENT endoscópica I-TREATMENT y I-TREATMENT extracción I-TREATMENT del I-TREATMENT cálculo I-TREATMENT en I-TREATMENT colédoco. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION 2 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION finalizar I-EVOLUTION la I-EVOLUTION prueba, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION comienza I-EVOLUTION con I-EVOLUTION un I-EVOLUTION dolor I-EVOLUTION súbito I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION derecho. I-EVOLUTION La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal, I-EXPLORATION taquicardia, I-EXPLORATION taquipnea I-EXPLORATION e I-EXPLORATION hipotensión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 95/60. I-EXPLORATION Analíticamente I-EXPLORATION destacaba I-EXPLORATION bilirrubina I-EXPLORATION 3, I-EXPLORATION 4 I-EXPLORATION mg/dl, I-EXPLORATION GOT I-EXPLORATION 315, I-EXPLORATION amilasa I-EXPLORATION 64 I-EXPLORATION U/l, I-EXPLORATION GPT I-EXPLORATION 450, I-EXPLORATION leucocitos I-EXPLORATION 15.400/mm3, I-EXPLORATION hemoglobina I-EXPLORATION 5, I-EXPLORATION 5 I-EXPLORATION g/dl I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 4 I-EXPLORATION mg/dl. I-EXPLORATION Se B-TREATMENT administró I-TREATMENT fluidoterapia I-TREATMENT con I-TREATMENT parcial I-TREATMENT respuesta I-TREATMENT hemodinámica. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION evidenciándose I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION intraperitoneal I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION gotieras I-EXPLORATION y I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION saco I-EXPLORATION de I-EXPLORATION Douglas, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipodensa I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION aerobilia I-EXPLORATION en I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática, I-EXPLORATION sin I-EXPLORATION neumoperitoneo. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT y I-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT la I-TREATMENT inestabilidad I-TREATMENT hemodinámica I-TREATMENT se I-TREATMENT decide I-TREATMENT intervenir I-TREATMENT quirúrgicamente I-TREATMENT a I-TREATMENT la I-TREATMENT paciente. I-TREATMENT En B-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION hemoperitoneo I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION subcapsular I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION parcialmente I-EXPLORATION roto I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION segmentos I-EXPLORATION V-VI I-EXPLORATION hepáticos. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT evacuación I-TREATMENT del I-TREATMENT mismo I-TREATMENT y I-TREATMENT hemostasia I-TREATMENT local I-TREATMENT con I-TREATMENT electrocoagulación I-TREATMENT y I-TREATMENT Surgicel®, I-TREATMENT dejando I-TREATMENT un I-TREATMENT drenaje I-TREATMENT tipo I-TREATMENT Jackson-Pratt I-TREATMENT en I-TREATMENT espacio I-TREATMENT subfrénico I-TREATMENT derecho. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION estuvo I-EVOLUTION ingresada I-EVOLUTION en I-EVOLUTION UCI I-EVOLUTION durante I-EVOLUTION 48 I-EVOLUTION horas. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION y I-EVOLUTION en I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION no I-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION ninguna I-EVOLUTION colección, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 4 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS rectorragia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS coágulos, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Otros I-PRESENT_ILLNESS síntomas: I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS anorrectal I-PRESENT_ILLNESS al I-PRESENT_ILLNESS defecar, I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS defecatoria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS estreñimiento I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año. I-PRESENT_ILLNESS La B-EVOLUTION rectorragia I-EVOLUTION cedió I-EVOLUTION espontáneamente I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION ingreso. I-EVOLUTION I-EVOLUTION Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY autoadministraba I-PAST_MEDICAL_HISTORY supositorios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY paracetamol-codeína I-PAST_MEDICAL_HISTORY (500/300 I-PAST_MEDICAL_HISTORY mg) I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cefalea I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Exploración B-EXPLORATION física: I-EXPLORATION normal, I-EXPLORATION pero I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION muy I-EXPLORATION doloroso, I-EXPLORATION palpando I-EXPLORATION zonas I-EXPLORATION induradas I-EXPLORATION e I-EXPLORATION irregulares I-EXPLORATION en I-EXPLORATION mucosa I-EXPLORATION rectal, I-EXPLORATION apareciendo I-EXPLORATION sangre I-EXPLORATION fresca I-EXPLORATION en I-EXPLORATION guante. I-EXPLORATION I-EXPLORATION Analítica, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen: I-EXPLORATION normales. I-EXPLORATION Colonoscopia I-EXPLORATION total: I-EXPLORATION pérdida I-EXPLORATION del I-EXPLORATION patrón I-EXPLORATION vascular I-EXPLORATION normal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION rectal, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION gran I-EXPLORATION ulceración I-EXPLORATION difusa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION con I-EXPLORATION pseudopólipos I-EXPLORATION aislados, I-EXPLORATION extendiéndose I-EXPLORATION unos I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION desde I-EXPLORATION margen I-EXPLORATION anal. I-EXPLORATION Anatomía-patológica: I-EXPLORATION ulceración I-EXPLORATION inespecífica. I-EXPLORATION Tomografía I-EXPLORATION computerizada: I-EXPLORATION estenosis I-EXPLORATION rectal I-EXPLORATION concéntrica I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION perirectales. I-EXPLORATION Serologías I-EXPLORATION y I-EXPLORATION tuberculina: I-EXPLORATION negativas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION este I-EXPLORATION momento, I-EXPLORATION se I-EXPLORATION interrogó I-EXPLORATION de I-EXPLORATION nuevo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente, I-EXPLORATION que I-EXPLORATION finalmente I-EXPLORATION admitió I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION supositorios I-EXPLORATION al I-EXPLORATION día I-EXPLORATION de I-EXPLORATION paracetamol-codeína I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION último I-EXPLORATION año. I-EXPLORATION Entonces I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION como I-EXPLORATION rectitis/úlcera I-EXPLORATION rectal I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION supositorios I-EXPLORATION de I-EXPLORATION paracetamol-codeína, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION adicción I-EXPLORATION a I-EXPLORATION opiáceos I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION confirmado I-EXPLORATION y I-EXPLORATION seguido I-EXPLORATION por I-EXPLORATION Psiquiatría. I-EXPLORATION I-EXPLORATION Se B-TREATMENT suspendieron I-TREATMENT los I-TREATMENT supositorios I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT enemas I-TREATMENT de I-TREATMENT hidrocortisona, I-TREATMENT junto I-TREATMENT con I-TREATMENT benzodiazepinas I-TREATMENT por I-TREATMENT la I-TREATMENT adicción I-TREATMENT a I-TREATMENT opiáceos. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION mejoró I-EVOLUTION significativamente I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Las B-EXPLORATION colonoscopias I-EXPLORATION realizadas I-EXPLORATION al I-EXPLORATION segundo I-EXPLORATION y I-EXPLORATION sexto I-EXPLORATION mes I-EXPLORATION después I-EXPLORATION del I-EXPLORATION alta I-EXPLORATION demostraron I-EXPLORATION progresiva I-EXPLORATION mejoría I-EXPLORATION y I-EXPLORATION curación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION rectales. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT se I-TREATMENT suspendió I-TREATMENT a I-TREATMENT los I-TREATMENT 8 I-TREATMENT meses. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION estaba I-EVOLUTION completamente I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY nacionalidad I-PAST_MEDICAL_HISTORY argentina, I-PAST_MEDICAL_HISTORY que B-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 dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS estreñimiento. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION presenta I-EXPLORATION discomfort I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION inferior I-EXPLORATION con I-EXPLORATION sensación I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION hipogastrio. I-EXPLORATION Tacto I-EXPLORATION rectal I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION descarta I-EXPLORATION patología I-EXPLORATION ginecológica I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION Rx I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION abundante I-EXPLORATION material I-EXPLORATION fecal. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION objetiva I-EXPLORATION un I-EXPLORATION fecaloma I-EXPLORATION recto-sigmoidal I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION Los I-EXPLORATION enemas I-EXPLORATION de I-EXPLORATION limpieza I-EXPLORATION son I-EXPLORATION efectivos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION practica I-EXPLORATION fibrocolonoscopia I-EXPLORATION que I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION Durante B-FAMILY_HISTORY el I-FAMILY_HISTORY ingreso I-FAMILY_HISTORY se I-FAMILY_HISTORY reinterroga I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY paciente I-FAMILY_HISTORY destacando I-FAMILY_HISTORY como I-FAMILY_HISTORY antecedente I-FAMILY_HISTORY familiar I-FAMILY_HISTORY la I-FAMILY_HISTORY muerte I-FAMILY_HISTORY de I-FAMILY_HISTORY su I-FAMILY_HISTORY madre I-FAMILY_HISTORY por I-FAMILY_HISTORY afectación I-FAMILY_HISTORY cardíaca I-FAMILY_HISTORY por I-FAMILY_HISTORY ECH I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 45 I-FAMILY_HISTORY años. I-FAMILY_HISTORY Se B-EXPLORATION realiza I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION ECH I-EXPLORATION siendo I-EXPLORATION esta I-EXPLORATION positiva. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION sometida I-EVOLUTION a I-EVOLUTION tratamiento I-EVOLUTION conservador, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION intervención I-EVOLUTION quirúrgica. I-EVOLUTION I-EVOLUTION Una B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS fue B-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY células I-PAST_MEDICAL_HISTORY renales I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY 1. I-PAST_MEDICAL_HISTORY Fue I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY nefrectomía I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY quimioterapia I-PAST_MEDICAL_HISTORY adyuvante. I-PAST_MEDICAL_HISTORY Tres I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY tarde I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY metástasis I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cerebral. I-PAST_MEDICAL_HISTORY Hace B-PRESENT_ILLNESS un I-PRESENT_ILLNESS año, I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hemorragia I-PRESENT_ILLNESS digestiva I-PRESENT_ILLNESS alta. I-PRESENT_ILLNESS Presentaba B-EXPLORATION aceptable I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION y I-EXPLORATION nutricional, I-EXPLORATION TA I-EXPLORATION 120/70 I-EXPLORATION y I-EXPLORATION exploración I-EXPLORATION cardiorrespiratoria I-EXPLORATION normal. I-EXPLORATION Abdomen I-EXPLORATION blando, I-EXPLORATION depresible I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION palpables. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION reveló I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 3 I-EXPLORATION g/dl. I-EXPLORATION Un I-EXPLORATION TAC I-EXPLORATION toraco-abdominal I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION cuerpo I-EXPLORATION y I-EXPLORATION antro I-EXPLORATION gástrico I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor I-EXPLORATION sin I-EXPLORATION invasión I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION adyacentes. I-EXPLORATION Una I-EXPLORATION endoscopia I-EXPLORATION alta I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION cuerpo I-EXPLORATION y I-EXPLORATION antro I-EXPLORATION gástrico. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratada I-TREATMENT con I-TREATMENT gastrectomía I-TREATMENT subtotal I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION demostró I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION renal. I-EXPLORATION I-EXPLORATION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Crohn I-PAST_MEDICAL_HISTORY cólica I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 11 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY actualmente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mesalazina, I-PAST_MEDICAL_HISTORY y B-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS flanco I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hipogastrio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS esporádicos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS apetito. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS este I-PRESENT_ILLNESS contexto I-PRESENT_ILLNESS se I-PRESENT_ILLNESS palpa I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS dura I-PRESENT_ILLNESS en I-PRESENT_ILLNESS vacío I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS iliaca I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION palpó I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION pétrea, I-EXPLORATION no I-EXPLORATION dolorosa, I-EXPLORATION desplazable I-EXPLORATION ligeramente I-EXPLORATION aunque I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION profundos. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION detectó I-EXPLORATION leucocitosis I-EXPLORATION (16,79x10e9/l) I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION y I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 122.0 I-EXPLORATION g/l. I-EXPLORATION Tanto I-EXPLORATION la I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION (89, I-EXPLORATION 0 I-EXPLORATION mm/h) I-EXPLORATION como I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (38, I-EXPLORATION 6 I-EXPLORATION mg/l) I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION elevadas. I-EXPLORATION Los I-EXPLORATION marcadores I-EXPLORATION tumorales I-EXPLORATION (antígeno I-EXPLORATION carcinoembrionario, I-EXPLORATION beta-2-microglobulina, I-EXPLORATION antígeno I-EXPLORATION C.A. I-EXPLORATION 15.3, I-EXPLORATION 19.9 I-EXPLORATION y I-EXPLORATION 125) I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION tomografía I-EXPLORATION computadorizada I-EXPLORATION abdominal I-EXPLORATION apreciándose I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION que I-EXPLORATION englobaba I-EXPLORATION al I-EXPLORATION colon I-EXPLORATION sigmoideo I-EXPLORATION (flecha I-EXPLORATION hueca), I-EXPLORATION íleon I-EXPLORATION distal I-EXPLORATION (flecha I-EXPLORATION blanca) I-EXPLORATION y I-EXPLORATION ciego I-EXPLORATION (flecha I-EXPLORATION negra) I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION múltiples I-EXPLORATION adenopatías I-EXPLORATION en I-EXPLORATION algunos I-EXPLORATION casos I-EXPLORATION formando I-EXPLORATION conglomerados I-EXPLORATION (asteriscos). I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION sigmoideo I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION linfoma I-EXPLORATION B I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes, I-EXPLORATION con I-EXPLORATION inmunofenotipo I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION centrogerminal. I-EXPLORATION Ingresa B-TREATMENT para I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT según I-TREATMENT protocolo I-TREATMENT GELTAMO, I-TREATMENT falleciendo B-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION después. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sólidos I-PRESENT_ILLNESS y 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 El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY padecía I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY etílico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY B8 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Child-Pugh. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION gastroscopia I-EXPLORATION encontrando I-EXPLORATION dilatación I-EXPLORATION y I-EXPLORATION atonía I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION esofágico, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION tres I-EXPLORATION cordones I-EXPLORATION varicosos I-EXPLORATION de I-EXPLORATION mediano I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION inferior. I-EXPLORATION Un I-EXPLORATION tránsito I-EXPLORATION baritado I-EXPLORATION mostró I-EXPLORATION dilatación I-EXPLORATION esofágica I-EXPLORATION con I-EXPLORATION afilamiento I-EXPLORATION distal. I-EXPLORATION La I-EXPLORATION manometría I-EXPLORATION constató I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION peristaltismo I-EXPLORATION en I-EXPLORATION cuerpo I-EXPLORATION esofágico. I-EXPLORATION Un I-EXPLORATION TC I-EXPLORATION toraco-abdominal I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION regional. I-EXPLORATION Se I-EXPLORATION obtuvo I-EXPLORATION 6 I-EXPLORATION sobre I-EXPLORATION un I-EXPLORATION score I-EXPLORATION de I-EXPLORATION disfagia I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION puntos I-EXPLORATION (2). I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION acalasia I-EXPLORATION y B-TREATMENT tras I-TREATMENT valorar I-TREATMENT las I-TREATMENT diferentes I-TREATMENT opciones I-TREATMENT terapéuticas I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT ITB I-TREATMENT guiada I-TREATMENT por I-TREATMENT ecoendoscopia. I-TREATMENT Mediante I-TREATMENT ecoendoscopio I-TREATMENT Pentax I-TREATMENT EG-3830UT I-TREATMENT se I-TREATMENT localizó I-TREATMENT el I-TREATMENT EEI I-TREATMENT como I-TREATMENT área I-TREATMENT hipoecoica I-TREATMENT engrosada I-TREATMENT (7 I-TREATMENT mm) I-TREATMENT en I-TREATMENT continuidad I-TREATMENT con I-TREATMENT la I-TREATMENT capa I-TREATMENT muscular I-TREATMENT propia I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT esofágica. I-TREATMENT En I-TREATMENT dicha I-TREATMENT zona I-TREATMENT se I-TREATMENT inyectó I-TREATMENT mediante I-TREATMENT aguja I-TREATMENT de I-TREATMENT ecoendoscopio I-TREATMENT de I-TREATMENT 22 I-TREATMENT G I-TREATMENT EchoTip I-TREATMENT Ultra I-TREATMENT (COOK I-TREATMENT Medical), I-TREATMENT un I-TREATMENT ml I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT (20 I-TREATMENT UI) I-TREATMENT (BoTox; I-TREATMENT Inc., I-TREATMENT Irvine, I-TREATMENT Calif.) I-TREATMENT diluida I-TREATMENT a I-TREATMENT 1/5 I-TREATMENT por I-TREATMENT cuadrante I-TREATMENT evitando I-TREATMENT la I-TREATMENT inyección I-TREATMENT intravariz. I-TREATMENT No B-EVOLUTION hubo I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION toleró I-EVOLUTION dieta I-EVOLUTION sólida I-EVOLUTION en I-EVOLUTION 72 I-EVOLUTION horas. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 9 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION solo I-EVOLUTION refiere I-EVOLUTION disfagia I-EVOLUTION ocasional, I-EVOLUTION puntuando I-EVOLUTION 1 I-EVOLUTION sobre I-EVOLUTION 9 I-EVOLUTION en I-EVOLUTION el I-EVOLUTION score I-EVOLUTION de I-EVOLUTION disfagia. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 94 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 insuficiencia I-PAST_MEDICAL_HISTORY cardiaca I-PAST_MEDICAL_HISTORY clase I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY III, I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY litiasis I-PAST_MEDICAL_HISTORY vesicular I-PAST_MEDICAL_HISTORY conocida I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY requirió I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY esfinterotomía I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY endoscopia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY coledocolitiasis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 88 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY desestimó I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY colecistectomía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY comorbilidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS intensificado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS días. I-PRESENT_ILLNESS Refería I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cuadrante I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS Negó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Una B-EXPLORATION punción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa, I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 11, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION objetivó I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION material I-EXPLORATION purulento. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica, I-EXPLORATION presentaba I-EXPLORATION únicamente I-EXPLORATION leucocitosis I-EXPLORATION (17,6.103/μl) I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION del I-EXPLORATION 88, I-EXPLORATION 9%. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION litiasis I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vesícula, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION contactaba I-EXPLORATION directamente I-EXPLORATION con I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION adyacente, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 10 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 8, I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION con I-EXPLORATION aire I-EXPLORATION y I-EXPLORATION calcificaciones I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mismas I-EXPLORATION características I-EXPLORATION a I-EXPLORATION las I-EXPLORATION del I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION correspondiendo I-EXPLORATION a I-EXPLORATION un I-EXPLORATION Empiema I-EXPLORATION necessitatis I-EXPLORATION por I-EXPLORATION colecistitis. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT comorbilidad I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT únicamente I-TREATMENT desbridamiento I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT drenaje I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT del I-TREATMENT empiema I-TREATMENT bajo I-TREATMENT sedación. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION correcta. I-EVOLUTION Fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION noveno I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemiabdomen I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS oC, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS El B-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION inferior, I-EXPLORATION más I-EXPLORATION intenso I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION defensa I-EXPLORATION y I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Blumberg I-EXPLORATION positivo. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION leucocitosis I-EXPLORATION ni I-EXPLORATION neutrofilia I-EXPLORATION (leucocitos I-EXPLORATION 8, I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 109/L, I-EXPLORATION neutrófilos I-EXPLORATION 70%) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION únicamente I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION intestinales. I-EXPLORATION Se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION evidencia I-EXPLORATION un I-EXPLORATION apéndice I-EXPLORATION cecal I-EXPLORATION en I-EXPLORATION disposición I-EXPLORATION pélvica, I-EXPLORATION discretamente I-EXPLORATION engrosado, I-EXPLORATION con I-EXPLORATION mínimos I-EXPLORATION cambios I-EXPLORATION inflamatorios I-EXPLORATION en I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION adyacente I-EXPLORATION y I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION x I-EXPLORATION 9 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION punta, I-EXPLORATION sin I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION intraabdominal, I-EXPLORATION pneumoperitoneo I-EXPLORATION ni I-EXPLORATION adenopatías I-EXPLORATION retroperitoneales I-EXPLORATION o I-EXPLORATION pélvicas I-EXPLORATION significativas. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT presunción I-TREATMENT de I-TREATMENT apendicitis I-TREATMENT aguda I-TREATMENT se I-TREATMENT realiza I-TREATMENT una I-TREATMENT apendicectomía I-TREATMENT laparotómica, I-TREATMENT hallando I-TREATMENT un I-TREATMENT apéndice I-TREATMENT gangrenoso I-TREATMENT perforado I-TREATMENT con I-TREATMENT líquido I-TREATMENT libre I-TREATMENT intraabdominal. I-TREATMENT El B-EVOLUTION curso I-EVOLUTION postoperatorio I-EVOLUTION transcurre I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION identifica I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION mucinosa I-EXPLORATION apendicular I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION malignidad I-EXPLORATION con I-EXPLORATION extravasación I-EXPLORATION de I-EXPLORATION mucina I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION epitelio I-EXPLORATION extraapendicular, I-EXPLORATION con I-EXPLORATION margen I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION libre I-EXPLORATION y I-EXPLORATION cambios I-EXPLORATION típicos I-EXPLORATION de I-EXPLORATION apendicitis I-EXPLORATION aguda I-EXPLORATION sobreañadidos. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS seguido I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Departamento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Pediatría I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS por I-PRESENT_ILLNESS anemia I-PRESENT_ILLNESS ferropénica. I-PRESENT_ILLNESS Se B-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY gastroscopia, I-PAST_MEDICAL_HISTORY colonoscopia, I-PAST_MEDICAL_HISTORY tránsito I-PAST_MEDICAL_HISTORY gastrointestinal, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY gammagrafía I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY descartar I-PAST_MEDICAL_HISTORY divertículo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Meckel, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY todas I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY pruebas I-PAST_MEDICAL_HISTORY negativas. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY todos I-PAST_MEDICAL_HISTORY estos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY asintomático I-PAST_MEDICAL_HISTORY recibiendo I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hierro I-PAST_MEDICAL_HISTORY oral. I-PAST_MEDICAL_HISTORY El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO para I-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO y I-DERIVED_FROM/TO estudio. I-DERIVED_FROM/TO Se B-EXPLORATION le I-EXPLORATION repitieron I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION diagnósticas I-EXPLORATION iniciales I-EXPLORATION (gastroscopia, I-EXPLORATION colonoscopia I-EXPLORATION y I-EXPLORATION tránsito I-EXPLORATION gastrointestinal), I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION conseguir I-EXPLORATION llegar I-EXPLORATION al I-EXPLORATION diagnóstico. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION objetivo I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION mural I-EXPLORATION concéntrico I-EXPLORATION ileal I-EXPLORATION con I-EXPLORATION realce I-EXPLORATION homogéneo I-EXPLORATION de I-EXPLORATION su I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION sugerían I-EXPLORATION como I-EXPLORATION primera I-EXPLORATION posibilidad I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION inflamatoria I-EXPLORATION intestinal I-EXPLORATION crónica I-EXPLORATION tipo I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartarse I-EXPLORATION linfoma I-EXPLORATION intestinal. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT rechazó I-TREATMENT el I-TREATMENT estudio I-TREATMENT con I-TREATMENT cápsula I-TREATMENT endoscópica, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT 5-ASA I-TREATMENT y I-TREATMENT hierro I-TREATMENT intravenoso. I-TREATMENT I-TREATMENT Fue B-EVOLUTION ingresado I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION por I-EVOLUTION anemia I-EVOLUTION severa I-EVOLUTION (hemoglobina: I-EVOLUTION 4, I-EVOLUTION 8 I-EVOLUTION g/dl), I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION melenas, I-EVOLUTION aceptando B-TREATMENT esta I-TREATMENT vez I-TREATMENT realizarse I-TREATMENT cápsula I-TREATMENT endoscópica. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION lesión I-EXPLORATION polipoidea I-EXPLORATION submucosa I-EXPLORATION de I-EXPLORATION color I-EXPLORATION violáceo I-EXPLORATION en I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION corresponder I-EXPLORATION a I-EXPLORATION íleon I-EXPLORATION proximal, I-EXPLORATION que I-EXPLORATION ocluía I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION circunferencia I-EXPLORATION ileal I-EXPLORATION y I-EXPLORATION pareciendo I-EXPLORATION rezumar I-EXPLORATION sangre I-EXPLORATION de I-EXPLORATION dicha I-EXPLORATION zona. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT encontrando I-TREATMENT una I-TREATMENT tumoración I-TREATMENT de I-TREATMENT 10 I-TREATMENT cm I-TREATMENT de I-TREATMENT longitud I-TREATMENT de I-TREATMENT color I-TREATMENT púrpura, I-TREATMENT vascularizada, I-TREATMENT que I-TREATMENT fue I-TREATMENT resecada, I-TREATMENT siendo I-TREATMENT diagnosticado I-TREATMENT histológicamente I-TREATMENT como I-TREATMENT hemangioma I-TREATMENT cavernoso I-TREATMENT gigante I-TREATMENT de I-TREATMENT intestino I-TREATMENT delgado. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION cinco I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION permanecido I-EVOLUTION posteriormente I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION análisis I-EVOLUTION de I-EVOLUTION sangre I-EVOLUTION normales I-EVOLUTION desde I-EVOLUTION entonces. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS espalda I-PRESENT_ILLNESS y I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS consuntivo. I-PRESENT_ILLNESS En B-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION halló I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION páncreas I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos, I-EXPLORATION heterogénea I-EXPLORATION e I-EXPLORATION hipoecogénica, I-EXPLORATION sin I-EXPLORATION invasión I-EXPLORATION vascular I-EXPLORATION ni I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION nódulos I-EXPLORATION hepáticos I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION incierta. I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION inyección I-EXPLORATION de I-EXPLORATION un I-EXPLORATION bolo I-EXPLORATION convencional I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 4 I-EXPLORATION ml I-EXPLORATION del I-EXPLORATION contraste I-EXPLORATION ecográfico I-EXPLORATION hexafluoruro I-EXPLORATION de I-EXPLORATION azufre I-EXPLORATION (Sonovue®, I-EXPLORATION Bracco, I-EXPLORATION Milán). I-EXPLORATION La I-EXPLORATION fase I-EXPLORATION arterial I-EXPLORATION (10-30 I-EXPLORATION segundos) I-EXPLORATION definió I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION pancreática I-EXPLORATION hipocaptante I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION al I-EXPLORATION parénquima I-EXPLORATION vecino I-EXPLORATION que I-EXPLORATION estenosaba I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION esplénica. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION venosa I-EXPLORATION (30-120 I-EXPLORATION segundos) I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION permeabilidad I-EXPLORATION del I-EXPLORATION eje I-EXPLORATION venoso I-EXPLORATION esplenoportomesentérico I-EXPLORATION y I-EXPLORATION el I-EXPLORATION barrido I-EXPLORATION hepático I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION tardía I-EXPLORATION (> I-EXPLORATION 120 I-EXPLORATION segundos) I-EXPLORATION detectó I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION hipocaptantes. I-EXPLORATION En I-EXPLORATION resumen, I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION ecográficas I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION masa I-EXPLORATION pancreática I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION maligna I-EXPLORATION con I-EXPLORATION invasión I-EXPLORATION vascular I-EXPLORATION arterial I-EXPLORATION y I-EXPLORATION metastásica I-EXPLORATION hepática. I-EXPLORATION Estos I-EXPLORATION datos I-EXPLORATION fueron I-EXPLORATION corroborados I-EXPLORATION con I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION helicoidal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION figura I-EXPLORATION 1 I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION cómo I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION angiográficas I-EXPLORATION con I-EXPLORATION ecografía I-EXPLORATION contrastada I-EXPLORATION y I-EXPLORATION angioTAC I-EXPLORATION fueron I-EXPLORATION equiparables. I-EXPLORATION La I-EXPLORATION PAAF I-EXPLORATION guiada I-EXPLORATION por I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION hepático I-EXPLORATION fue I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION pancreático. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometida I-TREATMENT a I-TREATMENT quimioterapia I-TREATMENT paliativa. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes, I-PAST_MEDICAL_HISTORY estudiada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY oculta I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY CE. I-PAST_MEDICAL_HISTORY Su B-PRESENT_ILLNESS lectura I-PRESENT_ILLNESS objetivó I-PRESENT_ILLNESS detención I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS estenosis. I-PRESENT_ILLNESS A I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingesta, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cierre I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Analítica: B-EXPLORATION 9.400 I-EXPLORATION leucocitos/µl, I-EXPLORATION hemoglobina: I-EXPLORATION 11, I-EXPLORATION 2 I-EXPLORATION g/dl, I-EXPLORATION plaquetas I-EXPLORATION y I-EXPLORATION coagulación I-EXPLORATION normales. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION abdomen: I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION y I-EXPLORATION artefacto I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION CE. I-EXPLORATION Tomografía I-EXPLORATION computerizada I-EXPLORATION : I-EXPLORATION obstrucción I-EXPLORATION intestinal I-EXPLORATION mecánica I-EXPLORATION completa I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION CE. I-EXPLORATION Se B-TREATMENT indicó I-TREATMENT cirugía I-TREATMENT abdominal I-TREATMENT urgente, I-TREATMENT encontrando I-TREATMENT una I-TREATMENT distensión I-TREATMENT del I-TREATMENT intestino I-TREATMENT proximal I-TREATMENT a I-TREATMENT 4 I-TREATMENT estenosis I-TREATMENT de I-TREATMENT íleon I-TREATMENT de I-TREATMENT aspecto I-TREATMENT inflamatorio, I-TREATMENT causando I-TREATMENT una I-TREATMENT de I-TREATMENT ellas I-TREATMENT una I-TREATMENT obstrucción I-TREATMENT completa, I-TREATMENT en I-TREATMENT cuyo I-TREATMENT interior I-TREATMENT se I-TREATMENT palpaba I-TREATMENT la I-TREATMENT CE. I-TREATMENT Se I-TREATMENT resecaron I-TREATMENT 30 I-TREATMENT cm I-TREATMENT de I-TREATMENT íleon I-TREATMENT que I-TREATMENT incluían I-TREATMENT 3 I-TREATMENT de I-TREATMENT las I-TREATMENT 4 I-TREATMENT estenosis, I-TREATMENT se I-TREATMENT realizó I-TREATMENT anastomosis I-TREATMENT latero-lateral I-TREATMENT mecánica I-TREATMENT y I-TREATMENT estricturoplastia I-TREATMENT de I-TREATMENT la I-TREATMENT estenosis I-TREATMENT restante. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION transcurrió I-EVOLUTION favorablemente, I-EVOLUTION siendo I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 7.o I-EVOLUTION día I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION El B-EXPLORATION resultado I-EXPLORATION histológico I-EXPLORATION del I-EXPLORATION espécimen I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Crohn. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS estudiada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS epigastralgia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS ó I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS que I-PRESENT_ILLNESS mejoran I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS emesis. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY relevancia I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY anticonceptivos I-PAST_MEDICAL_HISTORY orales I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION tan I-EXPLORATION sólo, I-EXPLORATION leucocitos I-EXPLORATION en I-EXPLORATION 3.570 I-EXPLORATION x I-EXPLORATION 109/l, I-EXPLORATION Hb I-EXPLORATION 115 I-EXPLORATION g/l I-EXPLORATION con I-EXPLORATION VCM I-EXPLORATION de I-EXPLORATION 78 I-EXPLORATION fl. I-EXPLORATION Resto I-EXPLORATION en I-EXPLORATION límites I-EXPLORATION normales. I-EXPLORATION Entre I-EXPLORATION episodios I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION asintomática I-EXPLORATION con I-EXPLORATION hábito I-EXPLORATION intestinal I-EXPLORATION normal I-EXPLORATION sin I-EXPLORATION productos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION imágenes I-EXPLORATION heterogéneas I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION calcio I-EXPLORATION de I-EXPLORATION 4-5 I-EXPLORATION cm I-EXPLORATION proyectadas I-EXPLORATION sobre I-EXPLORATION flexura I-EXPLORATION hepática I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION objetiva I-EXPLORATION barro I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION adyacente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION mm, I-EXPLORATION heterogénea I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION hiperecogénicas I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION hidatídico. I-EXPLORATION A I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION referir I-EXPLORATION convivencia I-EXPLORATION continuada I-EXPLORATION con I-EXPLORATION perros I-EXPLORATION en I-EXPLORATION un I-EXPLORATION área I-EXPLORATION endémica I-EXPLORATION de I-EXPLORATION hidatidosis I-EXPLORATION como I-EXPLORATION es I-EXPLORATION España I-EXPLORATION (1,2), I-EXPLORATION y I-EXPLORATION orientar I-EXPLORATION inicialmente I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION hacia I-EXPLORATION esta I-EXPLORATION patología, I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION hidatidosis I-EXPLORATION resulta I-EXPLORATION negativa. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION hepatomegalia I-EXPLORATION con I-EXPLORATION LOE I-EXPLORATION parcialmente I-EXPLORATION calcificada I-EXPLORATION en I-EXPLORATION segmento I-EXPLORATION V I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION morfología I-EXPLORATION redondeada I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION lobulados I-EXPLORATION e I-EXPLORATION imágenes I-EXPLORATION redondeadas I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION periferia. I-EXPLORATION La I-EXPLORATION imagen I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION quiste I-EXPLORATION hidatídico I-EXPLORATION sin I-EXPLORATION descartar I-EXPLORATION en I-EXPLORATION su I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION hemangioma I-EXPLORATION parcialmente I-EXPLORATION calcificado. I-EXPLORATION La I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION es I-EXPLORATION de I-EXPLORATION numerosas I-EXPLORATION microlitiasis I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios. I-EXPLORATION Se I-EXPLORATION objetiva I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION modo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION un I-EXPLORATION hemangioma I-EXPLORATION de I-EXPLORATION 31 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION segmento I-EXPLORATION IV I-EXPLORATION así I-EXPLORATION como I-EXPLORATION quistes I-EXPLORATION corticales I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION riñones. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programa I-TREATMENT colecistectomía I-TREATMENT más I-TREATMENT quistoperiquistectomía I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT presunción I-TREATMENT de I-TREATMENT quiste I-TREATMENT hidatídico I-TREATMENT más I-TREATMENT colelitiasis. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT abordaje I-TREATMENT mediante I-TREATMENT laparotomía I-TREATMENT subcostal I-TREATMENT derecha. I-TREATMENT Se I-TREATMENT objetiva I-TREATMENT vesícula I-TREATMENT biliar I-TREATMENT con I-TREATMENT tumoración I-TREATMENT intravesicular I-TREATMENT de I-TREATMENT consistencia I-TREATMENT pétrea I-TREATMENT que I-TREATMENT no I-TREATMENT infiltra I-TREATMENT parénquima I-TREATMENT hepático, I-TREATMENT sin I-TREATMENT LOE I-TREATMENT en I-TREATMENT segmento I-TREATMENT V. I-TREATMENT Mediante B-EXPLORATION biopsia I-EXPLORATION intraoperatoria I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION se I-EXPLORATION diagnostica I-EXPLORATION como I-EXPLORATION angiomioma I-EXPLORATION vesicular I-EXPLORATION benigno, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT realizar I-TREATMENT colecistectomía I-TREATMENT simple, I-TREATMENT que I-TREATMENT incluye I-TREATMENT la I-TREATMENT totalidad I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT tumoral. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION transcurriendo I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION I-EVOLUTION El B-EXPLORATION posterior I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION describe I-EXPLORATION masa I-EXPLORATION sólida, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION crecimiento I-EXPLORATION expansivo I-EXPLORATION que I-EXPLORATION respeta I-EXPLORATION mucosa I-EXPLORATION y I-EXPLORATION serosa I-EXPLORATION císticas. I-EXPLORATION La I-EXPLORATION histología I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION concluyeron I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION leiomioma I-EXPLORATION intramural I-EXPLORATION y I-EXPLORATION endocavitario I-EXPLORATION con I-EXPLORATION calcificaciones I-EXPLORATION y I-EXPLORATION osificación I-EXPLORATION distrófica, I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION benigno I-EXPLORATION sin I-EXPLORATION infiltrar I-EXPLORATION parénquima I-EXPLORATION hepático. I-EXPLORATION La I-EXPLORATION muestra I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION VEB I-EXPLORATION y I-EXPLORATION C-Kit I-EXPLORATION / I-EXPLORATION CD-117. I-EXPLORATION I-EXPLORATION En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática, I-EVOLUTION tras I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION ecografía I-EVOLUTION abdominal I-EVOLUTION no I-EVOLUTION muestra I-EVOLUTION recidiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION ni I-EVOLUTION otras I-EVOLUTION alteraciones I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION después. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rectorragia I-PRESENT_ILLNESS masiva I-PRESENT_ILLNESS indolora, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS síncope. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacan: I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY epidermoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cérvix I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2004 I-PAST_MEDICAL_HISTORY (histerectomía, I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY anexectomía, I-PAST_MEDICAL_HISTORY radioterapia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY braquiterapia), I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY epidermoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY lengua I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2005 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY atípica I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY metástasis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION estable, I-EXPLORATION destacando I-EXPLORATION una I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 8 I-EXPLORATION g/dl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION del I-EXPLORATION 24%. I-EXPLORATION La I-EXPLORATION radiología I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION eran I-EXPLORATION inespecíficas. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION endoscópicos I-EXPLORATION evidenciaban I-EXPLORATION abundantes I-EXPLORATION restos I-EXPLORATION hemáticos I-EXPLORATION en I-EXPLORATION colon, I-EXPLORATION sin I-EXPLORATION identificar I-EXPLORATION causa. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION con I-EXPLORATION gas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION psoas I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT y I-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT rectorragia, I-TREATMENT la I-TREATMENT paciente I-TREATMENT fue I-TREATMENT intervenida I-TREATMENT al I-TREATMENT cuarto I-TREATMENT día I-TREATMENT del I-TREATMENT ingreso, I-TREATMENT realizándose I-TREATMENT una I-TREATMENT laparotomía I-TREATMENT de I-TREATMENT urgencia I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT encontró I-TREATMENT un I-TREATMENT proceso I-TREATMENT inflamatorio I-TREATMENT retrocecal I-TREATMENT afectando I-TREATMENT a I-TREATMENT ciego, I-TREATMENT apéndice I-TREATMENT y I-TREATMENT englobando I-TREATMENT la I-TREATMENT arteria I-TREATMENT iliaca I-TREATMENT derecha, I-TREATMENT comprobándose I-TREATMENT la I-TREATMENT existencia I-TREATMENT de I-TREATMENT fistulización I-TREATMENT iliaco-apendicular. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT hemicolectomía I-TREATMENT derecha I-TREATMENT ampliada I-TREATMENT y I-TREATMENT by-pass I-TREATMENT fémoro-femoral I-TREATMENT con I-TREATMENT vena I-TREATMENT safena. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION La B-EXPLORATION anatomía-patológica I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION pieza I-EXPLORATION de I-EXPLORATION hemicolectomía I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION mucosa I-EXPLORATION y I-EXPLORATION abundante I-EXPLORATION material I-EXPLORATION sanguíneo I-EXPLORATION parcialmente I-EXPLORATION organizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lecho I-EXPLORATION apendicular. I-EXPLORATION Focos I-EXPLORATION metastáticos I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION escamosas I-EXPLORATION afectando I-EXPLORATION a I-EXPLORATION serosa, I-EXPLORATION tejido I-EXPLORATION graso I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION perineurales I-EXPLORATION y I-EXPLORATION perivasculares I-EXPLORATION (grandes I-EXPLORATION vasos). I-EXPLORATION Ganglios I-EXPLORATION linfáticos I-EXPLORATION aislados I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION malignidad. I-EXPLORATION Material I-EXPLORATION endoarterial I-EXPLORATION con I-EXPLORATION grupos I-EXPLORATION de I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION de I-EXPLORATION hábito I-EXPLORATION escamoso. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Filipinas, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS había I-PRESENT_ILLNESS regresado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS país I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes, I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pancreatitis I-PRESENT_ILLNESS aguda. I-PRESENT_ILLNESS Presenta B-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION eosinofilia, I-EXPLORATION hipertransaminasemia I-EXPLORATION leve I-EXPLORATION (< I-EXPLORATION 90 I-EXPLORATION mg/dl) I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION distendida I-EXPLORATION con I-EXPLORATION paredes I-EXPLORATION engrosadas I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION una I-EXPLORATION estructura I-EXPLORATION alargada I-EXPLORATION hiperecogénica I-EXPLORATION con I-EXPLORATION movimientos I-EXPLORATION ondulatorios I-EXPLORATION espontáneos. I-EXPLORATION Se I-EXPLORATION extendía I-EXPLORATION por I-EXPLORATION el I-EXPLORATION conducto I-EXPLORATION biliar I-EXPLORATION principal I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION papila. I-EXPLORATION Ante B-TREATMENT este I-TREATMENT hallazgo, I-TREATMENT se I-TREATMENT administra I-TREATMENT albendazol I-TREATMENT y I-TREATMENT se I-TREATMENT realiza I-TREATMENT una I-TREATMENT colangiopancreatografía I-TREATMENT retrógrada I-TREATMENT endoscópica I-TREATMENT (CPRE) I-TREATMENT 24 I-TREATMENT horas I-TREATMENT después I-TREATMENT para I-TREATMENT extraer I-TREATMENT el I-TREATMENT parásito. I-TREATMENT Sin B-EXPLORATION embargo, I-EXPLORATION la I-EXPLORATION papila I-EXPLORATION estaba I-EXPLORATION rasgada I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION el I-EXPLORATION mismo. I-EXPLORATION Una I-EXPLORATION nueva I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION una I-EXPLORATION colangiorresonancia I-EXPLORATION magnética I-EXPLORATION confirmaron I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION parásito I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS iliaca I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Febrícula I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS vómito I-PRESENT_ILLNESS alimentario. I-PRESENT_ILLNESS Deposiciones I-PRESENT_ILLNESS normales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presentaba I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION La I-EXPLORATION palpación I-EXPLORATION abdominal I-EXPLORATION objetivó I-EXPLORATION defensa I-EXPLORATION voluntaria I-EXPLORATION en I-EXPLORATION FID, I-EXPLORATION Blumberg I-EXPLORATION y I-EXPLORATION psoas I-EXPLORATION positivo. I-EXPLORATION I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION mostraba I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION y I-EXPLORATION eosinofilia. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION visualizó I-EXPLORATION apéndice I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm I-EXPLORATION retrocecal. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT apendicectomía I-TREATMENT laparotómica I-TREATMENT urgente, I-TREATMENT apreciando I-TREATMENT inflamación I-TREATMENT macroscópica I-TREATMENT del I-TREATMENT apéndice, I-TREATMENT sin I-TREATMENT líquido. I-TREATMENT Exploración B-EXPLORATION ileal I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico, I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION AA, I-EXPLORATION visualizándose I-EXPLORATION células I-EXPLORATION de I-EXPLORATION inflamación I-EXPLORATION aguda I-EXPLORATION invadiendo I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION apendicular I-EXPLORATION y I-EXPLORATION oxiuros I-EXPLORATION ocluyendo I-EXPLORATION la I-EXPLORATION luz. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT estos I-TREATMENT hallazgos, I-TREATMENT se I-TREATMENT contactó I-TREATMENT con I-TREATMENT la I-TREATMENT familia I-TREATMENT para I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT mebendazol. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 61 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Asmática, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY sustitutivo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY portadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY marcapasos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY bloqueo I-PAST_MEDICAL_HISTORY aurículo-ventricular I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2o I-PAST_MEDICAL_HISTORY grado. I-PAST_MEDICAL_HISTORY Apendicectomizada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS distensión, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS saciedad I-PRESENT_ILLNESS precoz, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS postprandiales I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2-3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS este I-PRESENT_ILLNESS tiempo I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS perdido I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destaca I-EXPLORATION abdomen I-EXPLORATION distendido, I-EXPLORATION timpanizado, I-EXPLORATION doloroso I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación. I-EXPLORATION Ruidos I-EXPLORATION metálicos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION urgencias I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION Rx I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION marcada I-EXPLORATION dilatación I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION duodenal I-EXPLORATION (signo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION doble I-EXPLORATION burbuja). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION gastroscopia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION estómago I-EXPLORATION con I-EXPLORATION motilidad I-EXPLORATION prácticamente I-EXPLORATION ausente I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION restos I-EXPLORATION alimentarios. I-EXPLORATION El I-EXPLORATION duodeno I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION edematoso I-EXPLORATION con I-EXPLORATION imposibilidad I-EXPLORATION de I-EXPLORATION pasar I-EXPLORATION a I-EXPLORATION segunda I-EXPLORATION porción, I-EXPLORATION se I-EXPLORATION toman I-EXPLORATION biopsias I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION informadas I-EXPLORATION posteriormente I-EXPLORATION como I-EXPLORATION duodenitis I-EXPLORATION inespecífica I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION malignas. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION visualiza I-EXPLORATION dilatación I-EXPLORATION gástrica I-EXPLORATION y I-EXPLORATION duodenal I-EXPLORATION con I-EXPLORATION estenosis I-EXPLORATION en I-EXPLORATION 3a I-EXPLORATION porción I-EXPLORATION duodenal. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION resultados I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION EGD I-EXPLORATION baritado I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION 3 I-EXPLORATION estenosis I-EXPLORATION lisas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION regulares, I-EXPLORATION en I-EXPLORATION segunda-tercera I-EXPLORATION porción I-EXPLORATION duodenal, I-EXPLORATION con I-EXPLORATION paso I-EXPLORATION dificultoso I-EXPLORATION de I-EXPLORATION contraste, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION diafragmas. I-EXPLORATION I-EXPLORATION Dado B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY hallazgos, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY rehistorió I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY comentó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY siempre I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY tenido I-PAST_MEDICAL_HISTORY saciedad I-PAST_MEDICAL_HISTORY precoz I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY digestiones I-PAST_MEDICAL_HISTORY lentas, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY siempre I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY persona I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY delgada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY talla I-PAST_MEDICAL_HISTORY corta. I-PAST_MEDICAL_HISTORY Se B-TREATMENT realizó I-TREATMENT gastroenteroanastomosis I-TREATMENT en I-TREATMENT Y I-TREATMENT Roux. I-TREATMENT I-TREATMENT Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY paquetes/año, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS para I-PRESENT_ILLNESS sólidos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS a I-PRESENT_ILLNESS líquidos I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION endoscopia I-EXPLORATION detecta I-EXPLORATION una I-EXPLORATION neoformación I-EXPLORATION exofítica I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION esófago I-EXPLORATION de I-EXPLORATION seis I-EXPLORATION centímetros I-EXPLORATION que I-EXPLORATION provoca I-EXPLORATION estenosis I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz. I-EXPLORATION El I-EXPLORATION escáner I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION esofágica I-EXPLORATION sin I-EXPLORATION extensión I-EXPLORATION local I-EXPLORATION ni I-EXPLORATION a I-EXPLORATION distancia. I-EXPLORATION La I-EXPLORATION broncoscopia I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION malignidad I-EXPLORATION descartando I-EXPLORATION así I-EXPLORATION invasión I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION respiratorio. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION células I-EXPLORATION fusiformes I-EXPLORATION mesenquimales I-EXPLORATION dispuestas I-EXPLORATION en I-EXPLORATION haces, I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vascularización I-EXPLORATION y I-EXPLORATION elevado I-EXPLORATION índice I-EXPLORATION mitótico I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION abundante I-EXPLORATION necrosis. I-EXPLORATION I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION inmunohistoquímico I-EXPLORATION es I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION desmina, I-EXPLORATION proteína I-EXPLORATION S-100, I-EXPLORATION c-kit I-EXPLORATION y I-EXPLORATION citoqueratina I-EXPLORATION C117 I-EXPLORATION así I-EXPLORATION como I-EXPLORATION para I-EXPLORATION las I-EXPLORATION citoqueratinas I-EXPLORATION AE1/AE3, I-EXPLORATION CAM5, I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION 5/6. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION lo I-EXPLORATION tanto, I-EXPLORATION concluíamos I-EXPLORATION que I-EXPLORATION nuestro I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION mesenquimal I-EXPLORATION maligno I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION sarcoma I-EXPLORATION pobremente I-EXPLORATION diferenciado. I-EXPLORATION Fue B-TREATMENT valorado I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT y I-TREATMENT oncológico, I-TREATMENT desestimando I-TREATMENT los I-TREATMENT mismos I-TREATMENT por I-TREATMENT deterioro I-TREATMENT de I-TREATMENT su I-TREATMENT estado I-TREATMENT general, I-TREATMENT con I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT endoprótesis. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 79 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS artritis I-PRESENT_ILLNESS metacarpofalángica, I-PRESENT_ILLNESS recibe I-PRESENT_ILLNESS amoxilicina-clavulánico I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS y I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS ciprofloxacino I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS finalización I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS antibiótico, I-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS diarreicas I-PRESENT_ILLNESS acuosas I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS patológicos I-PRESENT_ILLNESS (tanto I-PRESENT_ILLNESS diurnas I-PRESENT_ILLNESS como I-PRESENT_ILLNESS nocturnas), I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS oC, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS decaimiento I-PRESENT_ILLNESS progresivo. I-PRESENT_ILLNESS Acude B-EVOLUTION en I-EVOLUTION varias I-EVOLUTION ocasiones I-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencias, I-EVOLUTION realizándose I-EVOLUTION coprocultivos I-EVOLUTION y I-EVOLUTION determinación I-EVOLUTION de I-EVOLUTION toxina I-EVOLUTION de I-EVOLUTION Clostridium I-EVOLUTION difficile I-EVOLUTION que I-EVOLUTION resultan I-EVOLUTION negativos I-EVOLUTION con I-EVOLUTION posterior I-EVOLUTION alta I-EVOLUTION por I-EVOLUTION mejoría I-EVOLUTION tras I-EVOLUTION medidas I-EVOLUTION astringentes I-EVOLUTION (aunque I-EVOLUTION sin I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION cuadro). I-EVOLUTION Una I-EVOLUTION semana I-EVOLUTION después I-EVOLUTION reingresa I-EVOLUTION por I-EVOLUTION continuar I-EVOLUTION con I-EVOLUTION abundantes I-EVOLUTION diarreas I-EVOLUTION acuosas, I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION febrícula I-EVOLUTION y I-EVOLUTION decaimiento. I-EVOLUTION Analíticamente B-EXPLORATION solo I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION anemia I-EXPLORATION normocítica I-EXPLORATION normocrómica. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION realizada I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION úlceras I-EXPLORATION de I-EXPLORATION diferentes I-EXPLORATION tamaños I-EXPLORATION y I-EXPLORATION profundidad, I-EXPLORATION con I-EXPLORATION fondo I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION halo I-EXPLORATION enrojecido, I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa I-EXPLORATION hasta I-EXPLORATION colon I-EXPLORATION ascendente. I-EXPLORATION Las I-EXPLORATION biopsias I-EXPLORATION confirmaron I-EXPLORATION el I-EXPLORATION diagnóstico. I-EXPLORATION Se I-EXPLORATION extrajeron I-EXPLORATION hemocultivos I-EXPLORATION por I-EXPLORATION fiebre I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION Clostridium I-EXPLORATION ramosum. I-EXPLORATION Tras B-TREATMENT la I-TREATMENT sospecha I-TREATMENT endoscópica, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT metronidazol, I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días I-TREATMENT con I-TREATMENT buena I-TREATMENT evolución I-TREATMENT posterior. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS periumbilical, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ausencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS expulsión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS heces I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Presentaba B-EXPLORATION deshidratación I-EXPLORATION cutáneo-mucosa I-EXPLORATION importante I-EXPLORATION y I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 12.100/mm3. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION hidroaéreos I-EXPLORATION y I-EXPLORATION neumoperitoneo. I-EXPLORATION Un I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION confirmó I-EXPLORATION los I-EXPLORATION hallazgos, I-EXPLORATION y I-EXPLORATION mostró I-EXPLORATION aerobilia, I-EXPLORATION un I-EXPLORATION cálculo I-EXPLORATION impactado I-EXPLORATION en I-EXPLORATION yeyuno I-EXPLORATION y I-EXPLORATION una I-EXPLORATION fístula I-EXPLORATION colecisto-duodenal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION laparotomía I-EXPLORATION urgente I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION cálculo I-EXPLORATION intraluminal I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION localizado I-EXPLORATION a I-EXPLORATION 100 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION de I-EXPLORATION Treitz I-EXPLORATION y I-EXPLORATION una I-EXPLORATION perforación I-EXPLORATION puntiforme I-EXPLORATION en I-EXPLORATION el I-EXPLORATION borde I-EXPLORATION mesentérico I-EXPLORATION a I-EXPLORATION 40 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION de I-EXPLORATION Treitz. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT enterotomía, I-TREATMENT extracción I-TREATMENT del I-TREATMENT cálculo I-TREATMENT y I-TREATMENT resección I-TREATMENT del I-TREATMENT intestino I-TREATMENT perforado. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION recuperó I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION perforación I-EXPLORATION intestinal, I-EXPLORATION con I-EXPLORATION material I-EXPLORATION necrótico I-EXPLORATION y I-EXPLORATION restos I-EXPLORATION alimenticios I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION divertículos I-EXPLORATION en I-EXPLORATION las I-EXPLORATION proximidades I-EXPLORATION de I-EXPLORATION la I-EXPLORATION perforación. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS rectorragia I-PRESENT_ILLNESS al I-PRESENT_ILLNESS finalizar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS deposición; I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS niega I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS acompañante, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hábito I-PRESENT_ILLNESS intestinal, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION salvo I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hemorroides I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION rectal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION tanto I-EXPLORATION la I-EXPLORATION hematimetría I-EXPLORATION como I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION son I-EXPLORATION estrictamente I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT le I-TREATMENT solicita I-TREATMENT una I-TREATMENT colonoscopia I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT observa I-TREATMENT pólipo I-TREATMENT submucoso I-TREATMENT que I-TREATMENT se I-TREATMENT extirpa I-TREATMENT y I-TREATMENT hemorroides I-TREATMENT internas. I-TREATMENT La B-EXPLORATION histopatología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION extirpada I-EXPLORATION dio I-EXPLORATION como I-EXPLORATION resultado I-EXPLORATION granuloma I-EXPLORATION eosinofílico I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION parásito I-EXPLORATION Anisakis. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS junio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2010 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hepatitis I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS colestásica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS probable I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS etílico. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esquizofrenia I-PAST_MEDICAL_HISTORY paranoide I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY olanzapina I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 11 I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY Aunque B-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION inicial I-EXPLORATION del I-EXPLORATION cuadro I-EXPLORATION clínico I-EXPLORATION era I-EXPLORATION favorable, I-EXPLORATION con I-EXPLORATION normalización I-EXPLORATION paulatina I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION (bilirrubina I-EXPLORATION y I-EXPLORATION coagulación), I-EXPLORATION cada I-EXPLORATION vez I-EXPLORATION estaba I-EXPLORATION más I-EXPLORATION acentuada I-EXPLORATION la I-EXPLORATION citolisis. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION completo I-EXPLORATION (virus, I-EXPLORATION autoanticuerpos, I-EXPLORATION fármacos, I-EXPLORATION etc.) I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Al B-TREATMENT haber I-TREATMENT casos I-TREATMENT descritos I-TREATMENT en I-TREATMENT la I-TREATMENT literatura I-TREATMENT de I-TREATMENT hepatotoxicidad I-TREATMENT a I-TREATMENT olanzapina, I-TREATMENT se I-TREATMENT suspende I-TREATMENT el I-TREATMENT fármaco I-TREATMENT y I-TREATMENT se I-TREATMENT sustituye I-TREATMENT por I-TREATMENT haloperidol, I-TREATMENT existiendo I-TREATMENT mejoría I-TREATMENT evidente I-TREATMENT de I-TREATMENT la I-TREATMENT citolisis I-TREATMENT hasta B-EVOLUTION su I-EVOLUTION total I-EVOLUTION normalización. 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 cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY enólico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY cardiopulmonares I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS encefalopatía I-PRESENT_ILLNESS hepática I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS estreñimiento. I-PRESENT_ILLNESS En B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION radiopaca, I-EXPLORATION redondeada I-EXPLORATION y I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION regulares I-EXPLORATION en I-EXPLORATION hemitórax I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION existía I-EXPLORATION en I-EXPLORATION controles I-EXPLORATION previos I-EXPLORATION iniciándose I-EXPLORATION tratamiento I-EXPLORATION antibiótico I-EXPLORATION empírico I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION neumonía. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION torácica I-EXPLORATION la I-EXPLORATION colección I-EXPLORATION era I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION lisos I-EXPLORATION y I-EXPLORATION regulares I-EXPLORATION y I-EXPLORATION con I-EXPLORATION contenido I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION "agua" I-EXPLORATION planteándose I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION una I-EXPLORATION ascitis I-EXPLORATION intratorácica I-EXPLORATION loculada. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION mejoró I-EVOLUTION rápidamente I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION síntomas, I-EVOLUTION pero I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION persistía I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION anteriormente I-EVOLUTION descrita, I-EVOLUTION la I-EVOLUTION cual I-EVOLUTION desapareció I-EVOLUTION al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION un I-EVOLUTION mes I-EVOLUTION con B-TREATMENT terapia I-TREATMENT diurética. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos. I-PAST_MEDICAL_HISTORY Presenta B-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS brusca, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS biliosos I-PRESENT_ILLNESS incoercibles I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS profusa. I-PRESENT_ILLNESS A I-PRESENT_ILLNESS las I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS del I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS rectorragia I-PRESENT_ILLNESS abundante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sangre I-PRESENT_ILLNESS fresca I-PRESENT_ILLNESS con I-PRESENT_ILLNESS coágulos, I-PRESENT_ILLNESS emisión I-PRESENT_ILLNESS independiente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS alivio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dolor. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontraba I-PRESENT_ILLNESS destacado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS extranjero I-PRESENT_ILLNESS en I-PRESENT_ILLNESS misión I-PRESENT_ILLNESS militar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS realizado I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS las I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS centrales I-PRESENT_ILLNESS del I-PRESENT_ILLNESS día I-PRESENT_ILLNESS a I-PRESENT_ILLNESS alta I-PRESENT_ILLNESS temperatura I-PRESENT_ILLNESS ambiente, I-PRESENT_ILLNESS sesiones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS entrenamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS musculación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carrera I-PRESENT_ILLNESS continua. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS clínica, I-PRESENT_ILLNESS además, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS entrenamiento I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS inmediatamente I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS copiosa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alimento. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS trasladado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS local I-PRESENT_ILLNESS con I-PRESENT_ILLNESS mal I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general I-PRESENT_ILLNESS y I-PRESENT_ILLNESS febrícula, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS objetivó I-PRESENT_ILLNESS "leucocitosis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS elevación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS creatinina" I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS colonoscopia I-PRESENT_ILLNESS cuyo I-PRESENT_ILLNESS informe I-PRESENT_ILLNESS refleja I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS cantidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sangre I-PRESENT_ILLNESS intraluminal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mucosa I-PRESENT_ILLNESS intensamente I-PRESENT_ILLNESS edematosa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS sigma I-PRESENT_ILLNESS que I-PRESENT_ILLNESS impide I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS endoscopio. I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS mantenido I-PRESENT_ILLNESS en I-PRESENT_ILLNESS observación I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dieta I-PRESENT_ILLNESS absoluta, I-PRESENT_ILLNESS sueroterapia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ciprofloxacino I-PRESENT_ILLNESS intravenoso. I-PRESENT_ILLNESS Ante B-DERIVED_FROM/TO la I-DERIVED_FROM/TO persistencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO y I-DERIVED_FROM/TO aparición I-DERIVED_FROM/TO de I-DERIVED_FROM/TO somnolencia I-DERIVED_FROM/TO y I-DERIVED_FROM/TO palidez I-DERIVED_FROM/TO cérea, I-DERIVED_FROM/TO los I-DERIVED_FROM/TO médicos I-DERIVED_FROM/TO militares I-DERIVED_FROM/TO españoles I-DERIVED_FROM/TO encargados I-DERIVED_FROM/TO del I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO solicitaron I-DERIVED_FROM/TO evacuación I-DERIVED_FROM/TO aérea I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION su I-EXPLORATION llegada, I-EXPLORATION 48 I-EXPLORATION horas I-EXPLORATION después I-EXPLORATION del I-EXPLORATION inicio I-EXPLORATION del I-EXPLORATION cuadro, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION hipertenso, I-EXPLORATION taquicárdico, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION saturación I-EXPLORATION basal I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION y I-EXPLORATION febrícula. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION blando, I-EXPLORATION discretamente I-EXPLORATION distendido I-EXPLORATION y I-EXPLORATION timpánico, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION (superficial I-EXPLORATION y I-EXPLORATION profunda) I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa, I-EXPLORATION con I-EXPLORATION contractura I-EXPLORATION voluntaria I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura, I-EXPLORATION sin I-EXPLORATION claros I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION ruidos I-EXPLORATION hidroaéreos I-EXPLORATION presentes. I-EXPLORATION Al I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION el I-EXPLORATION dedil I-EXPLORATION mostraba I-EXPLORATION restos I-EXPLORATION hemáticos I-EXPLORATION frescos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION analítica I-EXPLORATION completa I-EXPLORATION con I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 26.010 I-EXPLORATION células I-EXPLORATION (85% I-EXPLORATION neutrófilos) I-EXPLORATION y I-EXPLORATION glucosa I-EXPLORATION 146 I-EXPLORATION mg/dl I-EXPLORATION como I-EXPLORATION únicos I-EXPLORATION hallazgos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION abdominopélvica I-EXPLORATION (sin I-EXPLORATION y I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION intravenoso) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION halló I-EXPLORATION una I-EXPLORATION marcada I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION difuso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared, I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION grasa I-EXPLORATION pericólica, I-EXPLORATION gran I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION intraabdominal I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION ganglios I-EXPLORATION mesentéricos I-EXPLORATION menores I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm. I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION perforación I-EXPLORATION y I-EXPLORATION de I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION vasculares. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION urgente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION solo I-EXPLORATION pudieron I-EXPLORATION introducirse I-EXPLORATION 100 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION endoscopio I-EXPLORATION debido I-EXPLORATION al I-EXPLORATION alto I-EXPLORATION riesgo I-EXPLORATION de I-EXPLORATION perforación, I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION ulceraciones I-EXPLORATION geográficas I-EXPLORATION profundas I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION rectosigma I-EXPLORATION y I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION edematosa I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION hematoma I-EXPLORATION submucoso, I-EXPLORATION más I-EXPLORATION intensas I-EXPLORATION en I-EXPLORATION las I-EXPLORATION regiones I-EXPLORATION proximales I-EXPLORATION y I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION pseudotumoral I-EXPLORATION (que I-EXPLORATION se I-EXPLORATION biopsiaron). I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION endoscópico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION colitis I-EXPLORATION isquémica, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION posteriormente I-EXPLORATION con I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION anatomopatológicos. I-EXPLORATION I-EXPLORATION El B-EVOLUTION enfermo I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION con B-TREATMENT tratamiento I-TREATMENT conservador I-TREATMENT con I-TREATMENT dieta I-TREATMENT absoluta, I-TREATMENT nutrición I-TREATMENT parenteral, I-TREATMENT -antibioterapia I-TREATMENT intravenosa, I-TREATMENT analgesia I-TREATMENT y I-TREATMENT corticoterapia I-TREATMENT a I-TREATMENT dosis I-TREATMENT bajas. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION colonoscopia I-EXPLORATION de I-EXPLORATION control I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 12 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION persistían I-EXPLORATION las I-EXPLORATION alteraciones I-EXPLORATION anteriormente I-EXPLORATION descritas. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION alteraciones I-EXPLORATION vasculares I-EXPLORATION en I-EXPLORATION angio-TC. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION inmunológicos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION hipercoagulabilidad I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION focos I-EXPLORATION trombóticos. I-EXPLORATION Los I-EXPLORATION coprocultivos I-EXPLORATION fueron I-EXPLORATION reiteradamente I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION asimismo I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION inflamatoria I-EXPLORATION intestinal I-EXPLORATION por I-EXPLORATION histología I-EXPLORATION no I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION dicha I-EXPLORATION patología. I-EXPLORATION El B-EVOLUTION enfermo I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION asintomático I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 29 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION colonoscopia I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 6 I-EXPLORATION semanas I-EXPLORATION del I-EXPLORATION alta, I-EXPLORATION que I-EXPLORATION constató I-EXPLORATION restitución I-EXPLORATION ad I-EXPLORATION integrum I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa. I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION descartar I-EXPLORATION otra I-EXPLORATION etiología, I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION que I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION del I-EXPLORATION cuadro I-EXPLORATION fue I-EXPLORATION un I-EXPLORATION secuestro I-EXPLORATION vascular I-EXPLORATION producido I-EXPLORATION por I-EXPLORATION el I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION demandas I-EXPLORATION sanguíneas I-EXPLORATION por I-EXPLORATION el I-EXPLORATION ejercicio I-EXPLORATION intenso I-EXPLORATION en I-EXPLORATION un I-EXPLORATION día I-EXPLORATION caluroso, I-EXPLORATION en I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION la I-EXPLORATION gran I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION su I-EXPLORATION gasto I-EXPLORATION cardiaco I-EXPLORATION en I-EXPLORATION el I-EXPLORATION territorio I-EXPLORATION mesentérico. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 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 médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS hiporexia, I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS cutánea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS conjuntival, I-PRESENT_ILLNESS orinas I-PRESENT_ILLNESS colúricas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS heces I-PRESENT_ILLNESS hipocólicas. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION urgente I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION citolisis I-EXPLORATION (GOT I-EXPLORATION 1720 I-EXPLORATION UI/dl, I-EXPLORATION GPT I-EXPLORATION 2660 I-EXPLORATION UI/dl), I-EXPLORATION hiperbilirrubinemia I-EXPLORATION (bilirrubina I-EXPLORATION total I-EXPLORATION 20, I-EXPLORATION 94 I-EXPLORATION mg/dl) I-EXPLORATION y I-EXPLORATION coagulopatía I-EXPLORATION (actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 45%, I-EXPLORATION INR I-EXPLORATION 1, I-EXPLORATION 79). I-EXPLORATION En I-EXPLORATION las I-EXPLORATION serologías I-EXPLORATION virales I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION HBsAg I-EXPLORATION positivo I-EXPLORATION con I-EXPLORATION antiHBc I-EXPLORATION IgM I-EXPLORATION positivo I-EXPLORATION y I-EXPLORATION AgHBe I-EXPLORATION positivo. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION del I-EXPLORATION VHC, I-EXPLORATION VHD I-EXPLORATION y I-EXPLORATION VIH I-EXPLORATION resultaron I-EXPLORATION negativas. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT insuficiencia I-TREATMENT hepática I-TREATMENT aguda I-TREATMENT grave, I-TREATMENT se I-TREATMENT decide I-TREATMENT instaurar I-TREATMENT tratamiento I-TREATMENT específico I-TREATMENT para I-TREATMENT la I-TREATMENT hepatitis I-TREATMENT aguda I-TREATMENT por I-TREATMENT VHB I-TREATMENT con I-TREATMENT tenofovir I-TREATMENT 245 I-TREATMENT mg/24 I-TREATMENT horas I-TREATMENT desde I-TREATMENT el I-TREATMENT día I-TREATMENT 1 I-TREATMENT de I-TREATMENT ingreso I-TREATMENT hospitalario. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION ingresado I-EVOLUTION durante I-EVOLUTION 14 I-EVOLUTION días, I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION encefalopatía I-EVOLUTION hepática I-EVOLUTION ni I-EVOLUTION signos I-EVOLUTION externos I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION en I-EVOLUTION ningún I-EVOLUTION momento, I-EVOLUTION mejorando I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION analíticas I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION del I-EVOLUTION día I-EVOLUTION +7 I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antiviral. I-EVOLUTION Posteriormente, B-TREATMENT el I-TREATMENT paciente I-TREATMENT continuó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tenofovir I-TREATMENT de I-TREATMENT manera I-TREATMENT ambulatoria, I-TREATMENT produciéndose I-TREATMENT la I-TREATMENT seroconversión I-TREATMENT antiHBe I-TREATMENT al I-TREATMENT mes I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT negativizando I-TREATMENT el I-TREATMENT AgHBs I-TREATMENT a I-TREATMENT las I-TREATMENT 8 I-TREATMENT semanas I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT Tras I-TREATMENT 2 I-TREATMENT serologías I-TREATMENT consecutivas I-TREATMENT AgHBs I-TREATMENT negativo I-TREATMENT y I-TREATMENT antiHBs I-TREATMENT positivo I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antiviral. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 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 I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY hormonal I-PAST_MEDICAL_HISTORY anticonceptivo I-PAST_MEDICAL_HISTORY (etonogestrel I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY etinilestradiol) I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY anillo I-PAST_MEDICAL_HISTORY intravaginal I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY debido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY trastornos I-PAST_MEDICAL_HISTORY menstruales. I-PAST_MEDICAL_HISTORY B-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS este I-PRESENT_ILLNESS tiempo I-PRESENT_ILLNESS desarrolló I-PRESENT_ILLNESS un I-PRESENT_ILLNESS estreñimiento I-PRESENT_ILLNESS crónico I-PRESENT_ILLNESS por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colonoscopia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION en I-EXPLORATION el I-EXPLORATION colon I-EXPLORATION descendente I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION edematosa I-EXPLORATION y I-EXPLORATION friable I-EXPLORATION con I-EXPLORATION ulceraciones I-EXPLORATION superficiales I-EXPLORATION cubiertas I-EXPLORATION por I-EXPLORATION fibrina. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION biopsias I-EXPLORATION mostró I-EXPLORATION cambios I-EXPLORATION atróficos I-EXPLORATION y I-EXPLORATION regenerativos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION epitelio I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION microtrombos. I-EXPLORATION El I-EXPLORATION infiltrado I-EXPLORATION neutrofílico I-EXPLORATION era I-EXPLORATION mínimo, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION importante I-EXPLORATION edema I-EXPLORATION submucoso. I-EXPLORATION Los I-EXPLORATION cambios I-EXPLORATION eran I-EXPLORATION atribuibles I-EXPLORATION a I-EXPLORATION isquemia, I-EXPLORATION aunque I-EXPLORATION las I-EXPLORATION causas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION isquemia I-EXPLORATION estaban I-EXPLORATION aún I-EXPLORATION por I-EXPLORATION determinar. I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION colonoscopia, I-EXPLORATION se I-EXPLORATION retiró I-EXPLORATION el I-EXPLORATION anillo I-EXPLORATION vaginal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION repitió I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 4 I-EXPLORATION meses I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION la I-EXPLORATION resolución I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones. I-EXPLORATION El B-TREATMENT estreñimiento I-TREATMENT se I-TREATMENT corrigió I-TREATMENT con I-TREATMENT medidas I-TREATMENT convencionales. I-TREATMENT Con B-EXPLORATION la I-EXPLORATION finalidad I-EXPLORATION de I-EXPLORATION excluir I-EXPLORATION otras I-EXPLORATION posibles I-EXPLORATION causas I-EXPLORATION de I-EXPLORATION colitis I-EXPLORATION isquémica, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION analítico, I-EXPLORATION electrocardiograma, I-EXPLORATION ecocardiograma I-EXPLORATION y I-EXPLORATION angio-TC I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION hipercoagulabilidad I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION S I-EXPLORATION antigénica I-EXPLORATION y I-EXPLORATION anticoagulante. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION detectaron I-EXPLORATION el I-EXPLORATION factor I-EXPLORATION V I-EXPLORATION de I-EXPLORATION Leyden I-EXPLORATION ni I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION FII I-EXPLORATION G20210A I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION protrombina. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION familiar I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION el I-EXPLORATION padre I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS intermitentes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS melenas. I-PRESENT_ILLNESS Estudio I-PRESENT_ILLNESS inicial I-PRESENT_ILLNESS con I-PRESENT_ILLNESS EDA I-PRESENT_ILLNESS y I-PRESENT_ILLNESS colonoscopia I-PRESENT_ILLNESS normal. I-PRESENT_ILLNESS Ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS melenas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS anemización. I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION de I-EXPLORATION nuevo I-EXPLORATION EDA I-EXPLORATION y I-EXPLORATION colonoscopia, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION tránsito I-EXPLORATION intestinal I-EXPLORATION seguido I-EXPLORATION de I-EXPLORATION cápsula I-EXPLORATION endoscópica I-EXPLORATION (CE) I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION reseñables. I-EXPLORATION Ante I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION HDOO I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION angioTAC: I-EXPLORATION "lesión I-EXPLORATION sólida I-EXPLORATION hipercaptante I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 3 I-EXPLORATION x I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION x I-EXPLORATION 4, I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION con I-EXPLORATION crecimiento I-EXPLORATION exofítico I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION un I-EXPLORATION asa I-EXPLORATION yeyunal, I-EXPLORATION con I-EXPLORATION hipertrofia I-EXPLORATION vascular I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION nutricios I-EXPLORATION que I-EXPLORATION drenan I-EXPLORATION directamente I-EXPLORATION a I-EXPLORATION ramas I-EXPLORATION arteriales I-EXPLORATION mesentéricas, I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION GIST, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION adenopatías". I-EXPLORATION La B-TREATMENT paciente I-TREATMENT es I-TREATMENT intervenida: I-TREATMENT resección I-TREATMENT segmentaria I-TREATMENT de I-TREATMENT yeyuno I-TREATMENT medio. I-TREATMENT Estudio B-EXPLORATION histológico I-EXPLORATION e I-EXPLORATION inmunohistoquímico: I-EXPLORATION GIST I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION malignidad: I-EXPLORATION tamaño I-EXPLORATION < I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION < I-EXPLORATION 1 I-EXPLORATION mitosis/10 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION aumento, I-EXPLORATION diferenciación I-EXPLORATION muscular I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION proliferativo I-EXPLORATION < I-EXPLORATION 1 I-EXPLORATION %, I-EXPLORATION medido I-EXPLORATION con I-EXPLORATION el I-EXPLORATION anticuerpo I-EXPLORATION monoclonal I-EXPLORATION KI67. I-EXPLORATION La B-TREATMENT resección I-TREATMENT completa I-TREATMENT del I-TREATMENT tumor I-TREATMENT sin I-TREATMENT afectación I-TREATMENT metastásica I-TREATMENT determina I-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT necesidad I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT posterior I-TREATMENT con I-TREATMENT inhibidores I-TREATMENT de I-TREATMENT la I-TREATMENT tirosin I-TREATMENT quinasa I-TREATMENT (imatinib). I-TREATMENT Tres B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS EC I-PRESENT_ILLNESS ileal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 1978, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS perianal I-PRESENT_ILLNESS (EPA) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS larga I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS difícil I-PRESENT_ILLNESS control. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Debido B-EXPLORATION a I-EXPLORATION la I-EXPLORATION severidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION EPA, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION observándose I-EXPLORATION una I-EXPLORATION abscesificación I-EXPLORATION del I-EXPLORATION paquete I-EXPLORATION adenopático I-EXPLORATION intraabdominal. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT laparotomía I-TREATMENT exploradora I-TREATMENT con I-TREATMENT biopsia I-TREATMENT intraoperatoria I-TREATMENT con I-TREATMENT histología I-TREATMENT de I-TREATMENT adenocarcinoma I-TREATMENT mucinoso I-TREATMENT de I-TREATMENT bajo I-TREATMENT grado, I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT una I-TREATMENT amputación I-TREATMENT abdominoperineal I-TREATMENT amplia I-TREATMENT con I-TREATMENT cistoprostatectomía I-TREATMENT radical I-TREATMENT por I-TREATMENT infiltración I-TREATMENT vesical, I-TREATMENT no I-TREATMENT pudiendo I-TREATMENT resecar I-TREATMENT la I-TREATMENT zona I-TREATMENT obturatriz I-TREATMENT también I-TREATMENT infiltrada I-TREATMENT por I-TREATMENT el I-TREATMENT tumor. I-TREATMENT En B-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION histológica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION moderadamente I-EXPLORATION diferenciado I-EXPLORATION de I-EXPLORATION recto I-EXPLORATION y I-EXPLORATION periné, I-EXPLORATION implantado I-EXPLORATION sobre I-EXPLORATION fístula I-EXPLORATION perineal I-EXPLORATION profunda. I-EXPLORATION I-EXPLORATION Se B-TREATMENT descartó I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT radioterapia, I-TREATMENT estando I-TREATMENT actualmente I-TREATMENT con I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematoquecia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología. I-PRESENT_ILLNESS Destaca B-EXPLORATION hemiabdomen I-EXPLORATION derecho I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION sin I-EXPLORATION masas, I-EXPLORATION anemia I-EXPLORATION ferropénica I-EXPLORATION (hemoglobina I-EXPLORATION 6, I-EXPLORATION 6 I-EXPLORATION g/dl I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION transferrina I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION %) I-EXPLORATION y I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION gastroscopia I-EXPLORATION y I-EXPLORATION colonoscopia I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION lesiones I-EXPLORATION potencialmente I-EXPLORATION sangrantes. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION tránsito I-EXPLORATION gastrointestinal, I-EXPLORATION un I-EXPLORATION dudoso I-EXPLORATION defecto I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION en I-EXPLORATION el I-EXPLORATION último I-EXPLORATION asa I-EXPLORATION ileal. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION cápsula I-EXPLORATION endoscópica I-EXPLORATION que I-EXPLORATION detecta I-EXPLORATION 10 I-EXPLORATION minutos I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION imagen I-EXPLORATION del I-EXPLORATION ciego I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION submucoso I-EXPLORATION erosionada I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION sangrado I-EXPLORATION en I-EXPLORATION sábana. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION este I-EXPLORATION hallazgo I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION una I-EXPLORATION exploración I-EXPLORATION quirúrgica. I-EXPLORATION Se I-EXPLORATION identifica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION a I-EXPLORATION 70 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION ileocecal I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION < I-EXPLORATION 1 I-EXPLORATION cm, I-EXPLORATION rosada I-EXPLORATION sobre I-EXPLORATION mucosa I-EXPLORATION pálida; I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION ni I-EXPLORATION adenopatías I-EXPLORATION en I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION asas, I-EXPLORATION mesenterio I-EXPLORATION y I-EXPLORATION cavidad I-EXPLORATION abdominal. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT una I-TREATMENT enterectomía I-TREATMENT de I-TREATMENT 7 I-TREATMENT cm I-TREATMENT con I-TREATMENT márgenes I-TREATMENT de I-TREATMENT seguridad I-TREATMENT de I-TREATMENT 3 I-TREATMENT cm I-TREATMENT y I-TREATMENT anastomosis I-TREATMENT término-terminal. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION describe I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION células I-EXPLORATION eosinófilas I-EXPLORATION epitelioides I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION irregular I-EXPLORATION y I-EXPLORATION nucléolos I-EXPLORATION prominentes, I-EXPLORATION formando I-EXPLORATION lóbulos I-EXPLORATION y I-EXPLORATION pequeñas I-EXPLORATION luces I-EXPLORATION vasculares I-EXPLORATION que I-EXPLORATION contienen I-EXPLORATION hematíes. I-EXPLORATION La I-EXPLORATION inmunohistoquímica I-EXPLORATION CD34+ I-EXPLORATION con I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION Ki67 I-EXPLORATION del I-EXPLORATION 20 I-EXPLORATION % I-EXPLORATION traduce I-EXPLORATION malignidad I-EXPLORATION intermedia, I-EXPLORATION siendo I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION hemangioendotelioma. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION mediante I-EXPLORATION PET-TAC I-EXPLORATION no I-EXPLORATION detectó I-EXPLORATION captación I-EXPLORATION patológica. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION remisión I-EVOLUTION tras I-EVOLUTION tres I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento. 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 ingresada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cirugía I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS anemia, I-PRESENT_ILLNESS ascitis, I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS generalizada, I-PRESENT_ILLNESS neurológicamente I-PRESENT_ILLNESS estuporosa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS rectal I-PRESENT_ILLNESS prolapsada I-PRESENT_ILLNESS e I-PRESENT_ILLNESS irreductible. I-PRESENT_ILLNESS La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY venido I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY diarrea I-PAST_MEDICAL_HISTORY mucosa, I-PAST_MEDICAL_HISTORY sangrado I-PAST_MEDICAL_HISTORY rectal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY prolapso I-PAST_MEDICAL_HISTORY rectal I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION rectal I-EXPLORATION prolapsada I-EXPLORATION e I-EXPLORATION incarcerada I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION que I-EXPLORATION secretaba I-EXPLORATION abundante I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION moco. I-EXPLORATION Analíticamente I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION anémica I-EXPLORATION con I-EXPLORATION hemoglobina I-EXPLORATION 6 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION 18 I-EXPLORATION %, I-EXPLORATION y I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION aguda I-EXPLORATION (urea I-EXPLORATION 158 I-EXPLORATION mg/dl, I-EXPLORATION creatinina I-EXPLORATION 1, I-EXPLORATION 94 I-EXPLORATION mg/dl), I-EXPLORATION hiponatrémica I-EXPLORATION e I-EXPLORATION hipopotasémica I-EXPLORATION (sodio, I-EXPLORATION 126 I-EXPLORATION mEq/ I-EXPLORATION l; I-EXPLORATION potasio, I-EXPLORATION 2, I-EXPLORATION 6 I-EXPLORATION mEq/l). I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION urgente I-EXPLORATION que I-EXPLORATION informa I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION rectal I-EXPLORATION prolapsada, I-EXPLORATION ascitis I-EXPLORATION y I-EXPLORATION metástasis I-EXPLORATION hepáticas I-EXPLORATION múltiples I-EXPLORATION algunas I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION necrosadas. I-EXPLORATION Debido B-TREATMENT al I-TREATMENT intenso I-TREATMENT dolor I-TREATMENT que I-TREATMENT le I-TREATMENT causaba I-TREATMENT la I-TREATMENT tumoración I-TREATMENT prolapsada I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT profusa I-TREATMENT mucorrea I-TREATMENT y I-TREATMENT rectorragia, I-TREATMENT la I-TREATMENT paciente I-TREATMENT fue I-TREATMENT intervenida I-TREATMENT quirúrgicamente, I-TREATMENT una I-TREATMENT vez I-TREATMENT corregida I-TREATMENT la I-TREATMENT insuficiencia I-TREATMENT renal, I-TREATMENT realizándose I-TREATMENT una I-TREATMENT resección I-TREATMENT transanal I-TREATMENT con I-TREATMENT carácter I-TREATMENT paliativo. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION complicaciones I-EVOLUTION cardiorrespiratorias. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS exfumador, B-PAST_MEDICAL_HISTORY asintomático, I-PAST_MEDICAL_HISTORY remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO en I-DERIVED_FROM/TO julio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2001 I-DERIVED_FROM/TO por I-DERIVED_FROM/TO hepatomegalia I-DERIVED_FROM/TO (de I-DERIVED_FROM/TO 4 I-DERIVED_FROM/TO cm I-DERIVED_FROM/TO a I-DERIVED_FROM/TO expensas I-DERIVED_FROM/TO del I-DERIVED_FROM/TO lóbulo I-DERIVED_FROM/TO hepático I-DERIVED_FROM/TO derecho) I-DERIVED_FROM/TO y I-DERIVED_FROM/TO colestasis I-DERIVED_FROM/TO disociada I-DERIVED_FROM/TO -fosfatasa I-DERIVED_FROM/TO alcalina I-DERIVED_FROM/TO (FA) I-DERIVED_FROM/TO 873 I-DERIVED_FROM/TO IU/L I-DERIVED_FROM/TO y I-DERIVED_FROM/TO gamma-glutaryl I-DERIVED_FROM/TO transpeptidasa I-DERIVED_FROM/TO (GGT) I-DERIVED_FROM/TO 637 I-DERIVED_FROM/TO IU/L- I-DERIVED_FROM/TO en I-DERIVED_FROM/TO una I-DERIVED_FROM/TO analítica I-DERIVED_FROM/TO rutinaria. I-DERIVED_FROM/TO El B-EXPLORATION resto I-EXPLORATION de I-EXPLORATION parámetros, I-EXPLORATION incluyendo I-EXPLORATION ANA I-EXPLORATION (anticuerpos I-EXPLORATION antinucleares), I-EXPLORATION AMA I-EXPLORATION (anticuerpos I-EXPLORATION antimitocondriales), I-EXPLORATION ASMA I-EXPLORATION (anticuerpos I-EXPLORATION anti-músculo I-EXPLORATION liso) I-EXPLORATION y I-EXPLORATION LKM I-EXPLORATION (anticuerpos I-EXPLORATION anti I-EXPLORATION anti-antígenos I-EXPLORATION microsomales I-EXPLORATION de I-EXPLORATION hígado I-EXPLORATION y I-EXPLORATION riñón), I-EXPLORATION porfirias, I-EXPLORATION ceruloplasmina, I-EXPLORATION alfa-fetoproteína, I-EXPLORATION beta2-microglobulina, I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION (VHB), I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION C I-EXPLORATION (VHC) I-EXPLORATION y I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION (VIH) I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION IgG I-EXPLORATION 1.900 I-EXPLORATION mg/dl I-EXPLORATION (690-1400), I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION gammapatía I-EXPLORATION monoclonal I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION mieloma I-EXPLORATION tras I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION diátesis I-EXPLORATION protrombótica I-EXPLORATION también I-EXPLORATION resultó I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION no I-EXPLORATION aportó I-EXPLORATION datos I-EXPLORATION relevantes. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION insinuó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION subdiafragmática, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION VIII I-EXPLORATION y I-EXPLORATION IV, I-EXPLORATION de I-EXPLORATION contorno I-EXPLORATION mal I-EXPLORATION definido, I-EXPLORATION hipodensa, I-EXPLORATION a I-EXPLORATION ambos I-EXPLORATION lados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION suprahepática I-EXPLORATION media. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION hepática I-EXPLORATION objetivó I-EXPLORATION dos I-EXPLORATION lesiones I-EXPLORATION hepáticas I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION × I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION × I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION IV-VIII I-EXPLORATION y I-EXPLORATION II-III I-EXPLORATION respectivamente, I-EXPLORATION que I-EXPLORATION encajaban I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION suprahepática I-EXPLORATION media I-EXPLORATION y I-EXPLORATION desplazaban I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION suprahepática I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION apreciarse I-EXPLORATION trombosis I-EXPLORATION intravascular, I-EXPLORATION ni I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION extrahepática, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION esplenomegalia I-EXPLORATION e I-EXPLORATION hipoplasia I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION un I-EXPLORATION colangiocarcinoma I-EXPLORATION y I-EXPLORATION menos I-EXPLORATION probablemente I-EXPLORATION de I-EXPLORATION un I-EXPLORATION hepatocarcinoma I-EXPLORATION sobre I-EXPLORATION un I-EXPLORATION hígado I-EXPLORATION no I-EXPLORATION cirrótico, I-EXPLORATION se I-EXPLORATION desestimó I-EXPLORATION la I-EXPLORATION PAAF I-EXPLORATION (punción-aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION diagnóstico-terapéutica, I-EXPLORATION observándose I-EXPLORATION un I-EXPLORATION hígado I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION lisa I-EXPLORATION y I-EXPLORATION brillante, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION quístico, I-EXPLORATION de I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION obtuvieron I-EXPLORATION biopsias I-EXPLORATION en I-EXPLORATION cuña. I-EXPLORATION I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION histopatológico I-EXPLORATION intraoperatorio I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION fibro-inflamatorio I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION agregados I-EXPLORATION linfoides, I-EXPLORATION hialinización I-EXPLORATION vascular, I-EXPLORATION en I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION microorganismos I-EXPLORATION y I-EXPLORATION atipia, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION pseudotumor I-EXPLORATION inflamatorio I-EXPLORATION hepático. I-EXPLORATION Dado B-TREATMENT que I-TREATMENT la I-TREATMENT lesión I-TREATMENT no I-TREATMENT cumplía I-TREATMENT criterios I-TREATMENT de I-TREATMENT malignidad I-TREATMENT y I-TREATMENT dada I-TREATMENT la I-TREATMENT alta I-TREATMENT morbimortalidad I-TREATMENT asociada, I-TREATMENT se I-TREATMENT desestimó I-TREATMENT su I-TREATMENT resección I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT y I-TREATMENT esteroideo, I-TREATMENT sin I-TREATMENT respuesta. I-TREATMENT I-TREATMENT En B-EVOLUTION enero I-EVOLUTION de I-EVOLUTION 2006 I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION alta I-EVOLUTION autolimitada, I-EVOLUTION seguido I-EVOLUTION de I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION fiebre, I-EVOLUTION astenia, I-EVOLUTION hiporexia I-EVOLUTION y I-EVOLUTION alteración I-EVOLUTION del I-EVOLUTION comportamiento. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION subictericia I-EXPLORATION cutáneo-mucosa, I-EXPLORATION bradipsiquia, I-EXPLORATION flapping I-EXPLORATION tardío, I-EXPLORATION hepatomegalia I-EXPLORATION y I-EXPLORATION ascitis. I-EXPLORATION Analíticamente I-EXPLORATION destacaba I-EXPLORATION anemia I-EXPLORATION de I-EXPLORATION procesos I-EXPLORATION crónicos I-EXPLORATION (hemoglobina I-EXPLORATION 9, I-EXPLORATION 1 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION 26, I-EXPLORATION 3%, I-EXPLORATION VCM I-EXPLORATION 95), I-EXPLORATION ligera I-EXPLORATION trombopenia I-EXPLORATION (116.000), I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 4, I-EXPLORATION 3 I-EXPLORATION mg/dl I-EXPLORATION (bilirrubina I-EXPLORATION conjugada: I-EXPLORATION 3, I-EXPLORATION 8 I-EXPLORATION mg/dl) I-EXPLORATION GOT I-EXPLORATION 56 I-EXPLORATION UI/l, I-EXPLORATION GPT I-EXPLORATION 106 I-EXPLORATION UI/l, I-EXPLORATION GGT I-EXPLORATION 335 I-EXPLORATION UI/l, I-EXPLORATION FA I-EXPLORATION 700 I-EXPLORATION UI/l. I-EXPLORATION Gamma I-EXPLORATION 30, I-EXPLORATION 7% I-EXPLORATION (10,5-19,5), I-EXPLORATION leucocitos I-EXPLORATION 7.700 I-EXPLORATION y I-EXPLORATION 800 I-EXPLORATION linfocitos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION líquido I-EXPLORATION ascítico I-EXPLORATION reveló I-EXPLORATION 900 I-EXPLORATION células I-EXPLORATION (> I-EXPLORATION 250 I-EXPLORATION polimorfonucleares/mm3), I-EXPLORATION albúmina I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION g/dl, I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION 0, I-EXPLORATION 6 I-EXPLORATION g/dl, I-EXPLORATION GASA I-EXPLORATION > I-EXPLORATION 1, I-EXPLORATION 1. I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION negativo. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT peritonitis I-TREATMENT bacteriana I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT (cefalosporina I-TREATMENT de I-TREATMENT tercera I-TREATMENT generación) I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínico-analítica. I-TREATMENT En I-TREATMENT la I-TREATMENT gastroscopia I-TREATMENT se I-TREATMENT observaron I-TREATMENT varices I-TREATMENT esofágicas I-TREATMENT grado I-TREATMENT II/III, I-TREATMENT iniciándose I-TREATMENT tratamiento I-TREATMENT beta-bloqueante. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION RM, I-EXPLORATION que I-EXPLORATION describía I-EXPLORATION un I-EXPLORATION hígado I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION crónica I-EXPLORATION y I-EXPLORATION cómo I-EXPLORATION el I-EXPLORATION PTI I-EXPLORATION comprimía I-EXPLORATION y I-EXPLORATION colapsaba I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior I-EXPLORATION en I-EXPLORATION su I-EXPLORATION trayecto I-EXPLORATION intrahepático. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT síndrome I-TREATMENT de I-TREATMENT Budd-Chiari I-TREATMENT subagudo I-TREATMENT secundario I-TREATMENT al I-TREATMENT PTI I-TREATMENT hepático, I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT TIPS I-TREATMENT (anastomosis I-TREATMENT porto-sistémica I-TREATMENT transyugular I-TREATMENT tipo I-TREATMENT Wallstent I-TREATMENT autoexpandible I-TREATMENT de I-TREATMENT 10 I-TREATMENT mm I-TREATMENT de I-TREATMENT calibre) I-TREATMENT con I-TREATMENT buenos I-TREATMENT resultados I-TREATMENT durante I-TREATMENT los I-TREATMENT cinco I-TREATMENT años I-TREATMENT de I-TREATMENT seguimiento. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS urente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS epigastrio, I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS saciedad I-PRESENT_ILLNESS temprana, I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS blandas, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS kg, I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS adinamia. I-PRESENT_ILLNESS Dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS hospitalario I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematemesis. I-PRESENT_ILLNESS Tenía B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sífilis I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso I-EXPLORATION hospitalario I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION en I-EXPLORATION anasarca I-EXPLORATION y I-EXPLORATION palidez I-EXPLORATION mucocutánea. I-EXPLORATION Se I-EXPLORATION objetivó I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION epigastrio, I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION ni I-EXPLORATION visceromegalias, I-EXPLORATION con I-EXPLORATION onda I-EXPLORATION ascítica. I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION máculas I-EXPLORATION violáceas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION paladar I-EXPLORATION duro, I-EXPLORATION el I-EXPLORATION piso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua I-EXPLORATION y I-EXPLORATION el I-EXPLORATION glande I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION vascular, I-EXPLORATION no I-EXPLORATION sangrantes, I-EXPLORATION con I-EXPLORATION laceración I-EXPLORATION del I-EXPLORATION surco I-EXPLORATION balano-prepucial I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION grado I-EXPLORATION II I-EXPLORATION en I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION inferiores. I-EXPLORATION Se I-EXPLORATION documentó I-EXPLORATION VIH I-EXPLORATION positivo I-EXPLORATION por I-EXPLORATION ELISA, I-EXPLORATION confirmado I-EXPLORATION por I-EXPLORATION Western I-EXPLORATION Blot, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION hipoproteinemia I-EXPLORATION sin I-EXPLORATION etiología I-EXPLORATION clara; I-EXPLORATION se I-EXPLORATION descartaron I-EXPLORATION causas I-EXPLORATION cardiacas, I-EXPLORATION hepáticas, I-EXPLORATION renales I-EXPLORATION o I-EXPLORATION nutricionales. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION abdominal I-EXPLORATION contrastada I-EXPLORATION reportó I-EXPLORATION engrosamiento I-EXPLORATION polipoide I-EXPLORATION de I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION gástricas I-EXPLORATION y I-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION extensa I-EXPLORATION lesión I-EXPLORATION gástrica I-EXPLORATION difusa I-EXPLORATION multinodular I-EXPLORATION y I-EXPLORATION exofítica, I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION fondo. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION gástrica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION marcada I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION foveolares, I-EXPLORATION formando I-EXPLORATION invaginaciones I-EXPLORATION profundas I-EXPLORATION y I-EXPLORATION reemplazando I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION oxíntica I-EXPLORATION original. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lámina I-EXPLORATION propia I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION SK I-EXPLORATION confirmado I-EXPLORATION con I-EXPLORATION inmunomarcación I-EXPLORATION para I-EXPLORATION herpes I-EXPLORATION virus I-EXPLORATION humano I-EXPLORATION tipo I-EXPLORATION 8 I-EXPLORATION (HHV8). I-EXPLORATION Se B-TREATMENT inició I-TREATMENT terapia I-TREATMENT antirretroviral I-TREATMENT y I-TREATMENT se I-TREATMENT programó I-TREATMENT para I-TREATMENT ulterior I-TREATMENT inicio I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT antraciclinas. I-TREATMENT I-TREATMENT Los B-PRESENT_ILLNESS autores I-PRESENT_ILLNESS presentan I-PRESENT_ILLNESS un I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS insuficiente B-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemodiálisis, I-PAST_MEDICAL_HISTORY referenciado B-DERIVED_FROM/TO para I-DERIVED_FROM/TO realización I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cápsula I-DERIVED_FROM/TO endoscópica I-DERIVED_FROM/TO por I-DERIVED_FROM/TO hemorragia I-DERIVED_FROM/TO gastrointestinal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO causa I-DERIVED_FROM/TO oscura, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO necesidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO transfusión I-DERIVED_FROM/TO sanguínea, I-DERIVED_FROM/TO no I-DERIVED_FROM/TO esclarecida I-DERIVED_FROM/TO por I-DERIVED_FROM/TO gastroscopia I-DERIVED_FROM/TO o I-DERIVED_FROM/TO colonoscopia. I-DERIVED_FROM/TO Se B-EXPLORATION usó I-EXPLORATION una I-EXPLORATION cápsula I-EXPLORATION PillCam I-EXPLORATION SB I-EXPLORATION (Given I-EXPLORATION Imaging, I-EXPLORATION Israel). I-EXPLORATION La I-EXPLORATION ingesta I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION fue I-EXPLORATION presenciada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION médico. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION dificultad I-EVOLUTION en I-EVOLUTION iniciar I-EVOLUTION la I-EVOLUTION deglución, I-EVOLUTION con I-EVOLUTION varias I-EVOLUTION tentativas I-EVOLUTION sin I-EVOLUTION éxito. I-EVOLUTION Súbitamente I-EVOLUTION desarrolló I-EVOLUTION una I-EVOLUTION crisis I-EVOLUTION de I-EVOLUTION tos I-EVOLUTION vigorosa I-EVOLUTION que I-EVOLUTION revertió I-EVOLUTION espontáneamente I-EVOLUTION después I-EVOLUTION de I-EVOLUTION algunos I-EVOLUTION minutos, I-EVOLUTION sin I-EVOLUTION recurrencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION respiratoria. I-EVOLUTION El B-EXPLORATION grabador I-EXPLORATION de I-EXPLORATION datos I-EXPLORATION fue I-EXPLORATION recuperado I-EXPLORATION agotada I-EXPLORATION la I-EXPLORATION duración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION batería I-EXPLORATION (9 I-EXPLORATION h) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION fue I-EXPLORATION interpretado I-EXPLORATION al I-EXPLORATION día I-EXPLORATION siguiente. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION que, I-EXPLORATION después I-EXPLORATION de I-EXPLORATION un I-EXPLORATION periodo I-EXPLORATION de I-EXPLORATION permanencia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION oral I-EXPLORATION de I-EXPLORATION 75 I-EXPLORATION segundos, I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION transitó I-EXPLORATION para I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION aérea, I-EXPLORATION con I-EXPLORATION la I-EXPLORATION típica I-EXPLORATION estructura I-EXPLORATION anular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tráquea I-EXPLORATION y I-EXPLORATION la I-EXPLORATION bifurcación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION bronquios I-EXPLORATION principales. I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION cerca I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION minutos I-EXPLORATION de I-EXPLORATION inactividad, I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION transmite I-EXPLORATION imágenes I-EXPLORATION del I-EXPLORATION esófago. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tubo I-EXPLORATION digestivo, I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION sigue I-EXPLORATION el I-EXPLORATION trayecto I-EXPLORATION habitual, I-EXPLORATION alcanzando I-EXPLORATION el I-EXPLORATION ciego I-EXPLORATION transcurridas I-EXPLORATION 7 I-EXPLORATION h I-EXPLORATION 28 I-EXPLORATION m. I-EXPLORATION Se I-EXPLORATION identificaron I-EXPLORATION abundantes I-EXPLORATION angiodisplasias I-EXPLORATION en I-EXPLORATION el I-EXPLORATION intestino I-EXPLORATION delgado, I-EXPLORATION probable I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hemorragia I-EXPLORATION gastrointestinal I-EXPLORATION en I-EXPLORATION este I-EXPLORATION paciente. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY valvulopatía I-PAST_MEDICAL_HISTORY mitral, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular, I-PAST_MEDICAL_HISTORY estudiada B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS anemia I-PRESENT_ILLNESS ferropénica. I-PRESENT_ILLNESS La B-EXPLORATION colonoscopia I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION vegetante I-EXPLORATION polilobulada, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION el I-EXPLORATION 60-70 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION cecal, I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION moderadamente I-EXPLORATION diferenciado. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION marcado I-EXPLORATION estrechamiento I-EXPLORATION cecal I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 8 I-EXPLORATION x I-EXPLORATION 4, I-EXPLORATION 9 I-EXPLORATION x I-EXPLORATION 3, I-EXPLORATION 7 I-EXPLORATION cm, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION obstrucción. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION región I-EXPLORATION paravertebral I-EXPLORATION derecha, I-EXPLORATION entre I-EXPLORATION D1-D2, I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION en I-EXPLORATION reloj I-EXPLORATION de I-EXPLORATION arena I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION x I-EXPLORATION 29 I-EXPLORATION x I-EXPLORATION 21mm, I-EXPLORATION que I-EXPLORATION crecía I-EXPLORATION a I-EXPLORATION través I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION espinal, I-EXPLORATION ensanchando I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION intervertebral. I-EXPLORATION Mediante I-EXPLORATION PAAF-USE, I-EXPLORATION se I-EXPLORATION accedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION esófago, I-EXPLORATION observando I-EXPLORATION en I-EXPLORATION disposición I-EXPLORATION para-espinal I-EXPLORATION derecha I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION redondeada I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION hiperecogénica I-EXPLORATION y I-EXPLORATION con I-EXPLORATION ecogenicidad I-EXPLORATION grasa, I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION 3 I-EXPLORATION pases I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION de I-EXPLORATION 25-gauge I-EXPLORATION (ECHO-25-HD I-EXPLORATION Cook©). I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION sin I-EXPLORATION jeringa I-EXPLORATION de I-EXPLORATION aspiración, I-EXPLORATION mediante I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION retirada I-EXPLORATION lenta I-EXPLORATION del I-EXPLORATION estilete I-EXPLORATION y I-EXPLORATION movimientos I-EXPLORATION de I-EXPLORATION entrada-salida, I-EXPLORATION con I-EXPLORATION patólogo I-EXPLORATION in I-EXPLORATION situ, I-EXPLORATION obteniéndose I-EXPLORATION material I-EXPLORATION suficiente I-EXPLORATION para I-EXPLORATION establecer I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION meningioma I-EXPLORATION (inmunorreactividad I-EXPLORATION intensa I-EXPLORATION para I-EXPLORATION receptores I-EXPLORATION progesterona; I-EXPLORATION TTF-1 I-EXPLORATION y I-EXPLORATION CK I-EXPLORATION AE3-AE1 I-EXPLORATION negativas) I-EXPLORATION (parte I-EXPLORATION inferior I-EXPLORATION Fig. I-EXPLORATION 1), I-EXPLORATION apreciándose I-EXPLORATION células I-EXPLORATION redondas I-EXPLORATION de I-EXPLORATION mediano I-EXPLORATION tamaño, I-EXPLORATION sin I-EXPLORATION atipia I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION modificaciones I-EXPLORATION nucleares I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION pseudoinclusiones I-EXPLORATION y I-EXPLORATION cuerpos I-EXPLORATION de I-EXPLORATION psammoma, I-EXPLORATION que I-EXPLORATION formaban I-EXPLORATION estructuras I-EXPLORATION lobuladas I-EXPLORATION rodeadas I-EXPLORATION por I-EXPLORATION tabiques I-EXPLORATION de I-EXPLORATION colágeno. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT hemicolectomía I-TREATMENT derecha I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT adenocarcinoma I-TREATMENT de I-TREATMENT ciego, I-TREATMENT sin I-TREATMENT afectación I-TREATMENT en I-TREATMENT los I-TREATMENT 11 I-TREATMENT ganglios I-TREATMENT resecados, I-TREATMENT ni I-TREATMENT factores I-TREATMENT de I-TREATMENT riesgo I-TREATMENT (pT2 I-TREATMENT pN0 I-TREATMENT Mx). I-TREATMENT Se B-EVOLUTION recomendó I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION revisiones, I-EVOLUTION no I-EVOLUTION hallándose, I-EVOLUTION cumplidos I-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION recaída I-EVOLUTION local I-EVOLUTION o I-EVOLUTION a I-EVOLUTION distancia. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS procedente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Marruecos I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colecistectomía, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos, I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY sexual. I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS picos I-PRESENT_ILLNESS febriles I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS oC, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS epigastrio, I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disfagia. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presentaba I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION abdominal, I-EXPLORATION focalizado I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal, I-EXPLORATION tinte I-EXPLORATION ictérico, I-EXPLORATION y I-EXPLORATION muguet I-EXPLORATION oral. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION anamnesis I-EXPLORATION y I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacaban I-EXPLORATION hemoglobina I-EXPLORATION 10, I-EXPLORATION 9 I-EXPLORATION g/dl, I-EXPLORATION VCM I-EXPLORATION 82 I-EXPLORATION fl, I-EXPLORATION leucocitos I-EXPLORATION 2.300 I-EXPLORATION cél/μl, I-EXPLORATION 58, I-EXPLORATION 3% I-EXPLORATION de I-EXPLORATION neutrófilos, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 0, I-EXPLORATION 1 I-EXPLORATION mg/dl, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 44 I-EXPLORATION mg/dl, I-EXPLORATION FA I-EXPLORATION 663 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 185 I-EXPLORATION U/l, I-EXPLORATION GOT I-EXPLORATION 231U/l, I-EXPLORATION GPT I-EXPLORATION 156 I-EXPLORATION U/l; I-EXPLORATION gammaglobulinas I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 04 I-EXPLORATION g/dl, I-EXPLORATION Ig I-EXPLORATION A I-EXPLORATION 553 I-EXPLORATION mg/dl, I-EXPLORATION Ig I-EXPLORATION G I-EXPLORATION 2400 I-EXPLORATION mg/dl I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION 62 I-EXPLORATION mg/dl; I-EXPLORATION autoanticuerpos I-EXPLORATION anticitoplasma I-EXPLORATION de I-EXPLORATION neutrófilo I-EXPLORATION perinucleares I-EXPLORATION (p-ANCA) I-EXPLORATION positivos I-EXPLORATION 1: I-EXPLORATION 320 I-EXPLORATION U/l I-EXPLORATION patrón I-EXPLORATION atípico, I-EXPLORATION y I-EXPLORATION antimúsculo I-EXPLORATION liso I-EXPLORATION (SMA) I-EXPLORATION positivos I-EXPLORATION 1: I-EXPLORATION 320 I-EXPLORATION U/l. I-EXPLORATION Autoanticuerpos I-EXPLORATION anticitoplasma I-EXPLORATION de I-EXPLORATION neutrófilo I-EXPLORATION citoplasmáticos I-EXPLORATION (c-ANCA), I-EXPLORATION antinucleares I-EXPLORATION (ANA), I-EXPLORATION antimitocondriales I-EXPLORATION (AMA), I-EXPLORATION antimicrosomales I-EXPLORATION (LKM-1) I-EXPLORATION y I-EXPLORATION antisacaromices I-EXPLORATION (ASCA) I-EXPLORATION negativos. I-EXPLORATION Serología I-EXPLORATION VIH I-EXPLORATION positiva I-EXPLORATION con I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION millones I-EXPLORATION de I-EXPLORATION copias/ml, I-EXPLORATION CMV I-EXPLORATION IgG I-EXPLORATION positiva I-EXPLORATION con I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION 2 I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION millones I-EXPLORATION de I-EXPLORATION copias/ml, I-EXPLORATION rubéola I-EXPLORATION IgG I-EXPLORATION positiva I-EXPLORATION y I-EXPLORATION Toxoplasma I-EXPLORATION gondii I-EXPLORATION IgG I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION 250 I-EXPLORATION UI/ml. I-EXPLORATION Serología I-EXPLORATION VHB, I-EXPLORATION VHC, I-EXPLORATION VHA, I-EXPLORATION LUES, I-EXPLORATION Brucella, I-EXPLORATION Cryptococcus, I-EXPLORATION Leishmania, I-EXPLORATION CMV I-EXPLORATION IgM I-EXPLORATION negativa; I-EXPLORATION VEB I-EXPLORATION IgM I-EXPLORATION resultado I-EXPLORATION indeterminado. I-EXPLORATION Antígeno I-EXPLORATION de I-EXPLORATION Giardia I-EXPLORATION lamblia I-EXPLORATION y I-EXPLORATION Cryptosporidium I-EXPLORATION en I-EXPLORATION heces, I-EXPLORATION antígeno I-EXPLORATION de I-EXPLORATION Legionella I-EXPLORATION y I-EXPLORATION neumococo I-EXPLORATION en I-EXPLORATION orina, I-EXPLORATION baciloscopias I-EXPLORATION en I-EXPLORATION esputo I-EXPLORATION y I-EXPLORATION orina I-EXPLORATION por I-EXPLORATION tres, I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION urocultivos I-EXPLORATION negativos. I-EXPLORATION Desarrollo I-EXPLORATION de I-EXPLORATION Candida I-EXPLORATION albicans I-EXPLORATION en I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION esputo. I-EXPLORATION Mantoux I-EXPLORATION negativo. I-EXPLORATION Las I-EXPLORATION poblaciones I-EXPLORATION linfocitarias I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION 177 I-EXPLORATION CD4/μl, I-EXPLORATION 534 I-EXPLORATION CD3/μl, I-EXPLORATION 346 I-EXPLORATION CD8/μl I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cociente I-EXPLORATION CD4/CD8 I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 51. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION colédoco I-EXPLORATION dilatado I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fusiforme, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION placas I-EXPLORATION blanquecinas I-EXPLORATION por I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION esófago I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION candidiasis I-EXPLORATION esofágica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION colangiorresonancia I-EXPLORATION que I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION ectasia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION con I-EXPLORATION algún I-EXPLORATION segmento I-EXPLORATION estenótico I-EXPLORATION y I-EXPLORATION ligera I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION hepatocolédoco I-EXPLORATION sin I-EXPLORATION estenosis I-EXPLORATION ni I-EXPLORATION litiasis. I-EXPLORATION Durante B-TREATMENT el I-TREATMENT ingreso I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT con I-TREATMENT ganciclovir I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 500 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT intravenoso I-TREATMENT durante I-TREATMENT dos I-TREATMENT semanas, I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT valganciclovir I-TREATMENT 900 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 24 I-TREATMENT horas. I-TREATMENT A I-TREATMENT partir I-TREATMENT de I-TREATMENT la I-TREATMENT segunda I-TREATMENT semana I-TREATMENT se I-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT antirretroviral I-TREATMENT (emtricitabina/tenofovir, I-TREATMENT darunavir I-TREATMENT y I-TREATMENT ritonavir) I-TREATMENT con I-TREATMENT buena I-TREATMENT tolerancia. I-TREATMENT Junto I-TREATMENT a I-TREATMENT esto, I-TREATMENT se I-TREATMENT pautó I-TREATMENT vía I-TREATMENT oral I-TREATMENT fluconazol I-TREATMENT 100 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 24 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 7 I-TREATMENT días, I-TREATMENT ácido I-TREATMENT ursodesoxicólico I-TREATMENT 300 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas, I-TREATMENT colestiramina I-TREATMENT 4 I-TREATMENT g I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas, I-TREATMENT dexclorfeniramina I-TREATMENT 6 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT y I-TREATMENT cotrimoxazol I-TREATMENT 800/160 I-TREATMENT mg I-TREATMENT lunes, I-TREATMENT miércoles I-TREATMENT y I-TREATMENT viernes. I-TREATMENT A B-EXPLORATION pesar I-EXPLORATION del I-EXPLORATION tratamiento I-EXPLORATION médico I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION continuaba I-EXPLORATION con I-EXPLORATION colestasis I-EXPLORATION y I-EXPLORATION citolisis I-EXPLORATION (bilirrubina I-EXPLORATION total I-EXPLORATION 10, I-EXPLORATION 26 I-EXPLORATION mg/dl, I-EXPLORATION FA I-EXPLORATION 544 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 175 I-EXPLORATION U/l, I-EXPLORATION GOT I-EXPLORATION 448 I-EXPLORATION U/l, I-EXPLORATION GPT I-EXPLORATION 170 I-EXPLORATION U/l) I-EXPLORATION motivo I-EXPLORATION por I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION CPRE I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 25 I-EXPLORATION días I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION instauración I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION ganciclovir. I-EXPLORATION La B-TREATMENT CPRE I-TREATMENT confirmó I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT dilatación I-TREATMENT fusiforme I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT biliar I-TREATMENT extrahepática, I-TREATMENT con I-TREATMENT normalidad I-TREATMENT de I-TREATMENT la I-TREATMENT intrahepática, I-TREATMENT y I-TREATMENT permitió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT esfinterotomía, I-TREATMENT colocándosele I-TREATMENT una I-TREATMENT endoprótesis I-TREATMENT plástica I-TREATMENT en I-TREATMENT la I-TREATMENT porción I-TREATMENT extrahepática. I-TREATMENT Cuatro B-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION CPRE I-EVOLUTION mejoró I-EVOLUTION tanto I-EVOLUTION clínica I-EVOLUTION como I-EVOLUTION analíticamente I-EVOLUTION (FA I-EVOLUTION 310 I-EVOLUTION U/l, I-EVOLUTION GGT I-EVOLUTION 94 I-EVOLUTION U/l, I-EVOLUTION GOT I-EVOLUTION 212 I-EVOLUTION U/l, I-EVOLUTION GPT I-EVOLUTION 84 I-EVOLUTION U/l, I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION de I-EVOLUTION CMV I-EVOLUTION negativa I-EVOLUTION y I-EVOLUTION de I-EVOLUTION VIH I-EVOLUTION 1.602 I-EVOLUTION copias/ml). I-EVOLUTION En I-EVOLUTION las I-EVOLUTION revisiones I-EVOLUTION posteriores I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION estable I-EVOLUTION con I-EVOLUTION elevación I-EVOLUTION persistente I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fosfatasa I-EVOLUTION alcalina I-EVOLUTION en I-EVOLUTION rangos I-EVOLUTION de I-EVOLUTION 400-600 I-EVOLUTION U/l, I-EVOLUTION carga I-EVOLUTION viral I-EVOLUTION de I-EVOLUTION VIH I-EVOLUTION y I-EVOLUTION CMV I-EVOLUTION negativas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-EXPLORATION presencia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION excrecente, I-EXPLORATION ulcerada I-EXPLORATION y I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION dura I-EXPLORATION en I-EXPLORATION flanco I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION acompañada I-EXPLORATION de I-EXPLORATION otra I-EXPLORATION similar I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION infraclavicular I-EXPLORATION izquierda. I-EXPLORATION Presenta I-EXPLORATION disfagia I-EXPLORATION a I-EXPLORATION sólidos I-EXPLORATION y I-EXPLORATION líquidos I-EXPLORATION semanas I-EXPLORATION después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aparición I-EXPLORATION de I-EXPLORATION dichas I-EXPLORATION lesiones, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION kg I-EXPLORATION de I-EXPLORATION peso. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION endoscópico I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION excrecente I-EXPLORATION y I-EXPLORATION ulcerada, I-EXPLORATION a I-EXPLORATION 22 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arcada I-EXPLORATION dental, I-EXPLORATION que I-EXPLORATION ocluye I-EXPLORATION casi I-EXPLORATION completamente I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION del I-EXPLORATION esófago I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION epidermoide I-EXPLORATION infiltrante. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION dérmicas I-EXPLORATION revela I-EXPLORATION infiltración I-EXPLORATION cutánea I-EXPLORATION metastásica I-EXPLORATION por I-EXPLORATION carcinoma I-EXPLORATION epidermoide, I-EXPLORATION inmunohistoquimica I-EXPLORATION más I-EXPLORATION paracitoqueratina I-EXPLORATION alto I-EXPLORATION peso I-EXPLORATION molecular I-EXPLORATION y I-EXPLORATION vimentina. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION indicaron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION metastásica I-EXPLORATION ósea I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION costal I-EXPLORATION izquierdo, I-EXPLORATION cuerpo I-EXPLORATION vertebral I-EXPLORATION D9 I-EXPLORATION y I-EXPLORATION hueso I-EXPLORATION iliaco I-EXPLORATION derecho. I-EXPLORATION Finalmente B-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT colocación I-TREATMENT de I-TREATMENT prótesis I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT quimioterápico. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hidatidosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2009 I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY portal I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY cavernomatosis I-PAST_MEDICAL_HISTORY portal I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY complicación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cirugía, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY asociada. I-PAST_MEDICAL_HISTORY Presentó I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY esofágicas I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY III-IV I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sangrado I-PAST_MEDICAL_HISTORY digestivo. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematemesis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS melénicas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION gastroscopia I-EXPLORATION urgente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION 4 I-EXPLORATION cordones I-EXPLORATION varicosos I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION desde I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION esofágico I-EXPLORATION que I-EXPLORATION se I-EXPLORATION prolongan I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION región I-EXPLORATION subcardial, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION rojos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared I-EXPLORATION aunque I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION activo. I-EXPLORATION Se B-TREATMENT colocaron I-TREATMENT 9 I-TREATMENT bandas I-TREATMENT de I-TREATMENT ligadura I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT En B-EXPLORATION estómago I-EXPLORATION no I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION lesiones I-EXPLORATION potencialmente I-EXPLORATION sangrantes I-EXPLORATION ni I-EXPLORATION restos I-EXPLORATION hemáticos, I-EXPLORATION ni I-EXPLORATION tampoco I-EXPLORATION en I-EXPLORATION duodeno. I-EXPLORATION Posteriormente B-EVOLUTION presentó I-EVOLUTION múltiples I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION melenas, I-EVOLUTION con I-EVOLUTION anemización I-EVOLUTION secundaria I-EVOLUTION y I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION transfusión I-EVOLUTION de I-EVOLUTION un I-EVOLUTION total I-EVOLUTION de I-EVOLUTION 22 I-EVOLUTION UCH. I-EVOLUTION Se B-TREATMENT realizaron I-TREATMENT dos I-TREATMENT intentos I-TREATMENT por I-TREATMENT vía I-TREATMENT endoscópica I-TREATMENT de I-TREATMENT controlar I-TREATMENT el I-TREATMENT sangrado I-TREATMENT sin I-TREATMENT objetivar I-TREATMENT sangrado I-TREATMENT de I-TREATMENT las I-TREATMENT escaras I-TREATMENT de I-TREATMENT las I-TREATMENT bandas I-TREATMENT previas I-TREATMENT ni I-TREATMENT a I-TREATMENT otro I-TREATMENT nivel I-TREATMENT gastrointestinal. I-TREATMENT En B-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION realizada, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION varices I-EXPLORATION esofágicas I-EXPLORATION secundarias I-EXPLORATION a I-EXPLORATION trombosis I-EXPLORATION crónica I-EXPLORATION del I-EXPLORATION eje I-EXPLORATION espleno-portal, I-EXPLORATION esplenomegalia I-EXPLORATION y I-EXPLORATION ascitis I-EXPLORATION sin I-EXPLORATION identificar I-EXPLORATION sangrado I-EXPLORATION activo. I-EXPLORATION Una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION mostró I-EXPLORATION hidatidosis I-EXPLORATION hepática I-EXPLORATION ya I-EXPLORATION descrita I-EXPLORATION en I-EXPLORATION estudios I-EXPLORATION anteriores, I-EXPLORATION cavernomatosis I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION trombosis I-EXPLORATION portal I-EXPLORATION y I-EXPLORATION esplenomegalia. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION decidimos I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION arteriografía I-EXPLORATION abdominal I-EXPLORATION selectiva I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION celiaco I-EXPLORATION y I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION superior I-EXPLORATION que I-EXPLORATION no I-EXPLORATION identificó I-EXPLORATION puntos I-EXPLORATION sangrantes I-EXPLORATION activos I-EXPLORATION ni I-EXPLORATION malformaciones I-EXPLORATION vasculares. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION hallazgos, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION enteroscopia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION en I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION rodilla I-EXPLORATION duodenal I-EXPLORATION un I-EXPLORATION conglomerado I-EXPLORATION de I-EXPLORATION varices I-EXPLORATION submucosas I-EXPLORATION que I-EXPLORATION se I-EXPLORATION comprueban I-EXPLORATION con I-EXPLORATION ecoendoscopio I-EXPLORATION radial. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT inyectar I-TREATMENT 3 I-TREATMENT cc I-TREATMENT de I-TREATMENT pegamento I-TREATMENT (cianoacrilato) I-TREATMENT en I-TREATMENT varices I-TREATMENT duodenales I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT Tras B-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION sin I-EVOLUTION recidiva I-EVOLUTION del I-EVOLUTION sangrado I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION hematemesis I-EVOLUTION de I-EVOLUTION alto I-EVOLUTION volumen I-EVOLUTION que I-EVOLUTION le I-EVOLUTION ocasionó I-EVOLUTION una I-EVOLUTION broncoaspiración I-EVOLUTION y I-EVOLUTION secundariamente I-EVOLUTION parada I-EVOLUTION cardiorrespiratoria I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION las I-EVOLUTION maniobras I-EVOLUTION de I-EVOLUTION resucitación I-EVOLUTION realizadas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertenso, B-PAST_MEDICAL_HISTORY diabético I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY alcohólico, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Child, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY portal. I-PAST_MEDICAL_HISTORY Presentaba I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY esofágicas I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY II I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY requerido I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sangrado I-PAST_MEDICAL_HISTORY digestivo. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematemesis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rectorragia. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION gastroscopia I-EXPLORATION urgente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION tres I-EXPLORATION cordones I-EXPLORATION varicosos I-EXPLORATION de I-EXPLORATION mediano-pequeño I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION rojos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared I-EXPLORATION que I-EXPLORATION afectaban I-EXPLORATION a I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION esófago, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION activo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION realizar I-EXPLORATION la I-EXPLORATION exploración. I-EXPLORATION Se B-TREATMENT colocaron I-TREATMENT dos I-TREATMENT bandas I-TREATMENT de I-TREATMENT ligadura. I-TREATMENT Una B-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION reveló I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hepatopatía I-EXPLORATION crónica I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hipertensión I-EXPLORATION portal, I-EXPLORATION flujo I-EXPLORATION portal I-EXPLORATION hepatófugo I-EXPLORATION y I-EXPLORATION ascitis. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION sangrado I-EXPLORATION activo I-EXPLORATION ni I-EXPLORATION lesiones I-EXPLORATION potencialmente I-EXPLORATION sangrantes I-EXPLORATION en I-EXPLORATION estómago I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION duodeno. I-EXPLORATION Posteriormente B-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION deposiciones I-EVOLUTION melénicas, I-EVOLUTION realizándose B-EXPLORATION endoscopia I-EXPLORATION que I-EXPLORATION observó I-EXPLORATION tres I-EXPLORATION cordones I-EXPLORATION varicosos I-EXPLORATION pequeños I-EXPLORATION con I-EXPLORATION 2 I-EXPLORATION escaras I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION y I-EXPLORATION cierto I-EXPLORATION edema. I-EXPLORATION En I-EXPLORATION estómago I-EXPLORATION sangre I-EXPLORATION roja I-EXPLORATION en I-EXPLORATION curvatura I-EXPLORATION mayor. I-EXPLORATION En I-EXPLORATION duodeno I-EXPLORATION presentaba I-EXPLORATION variz I-EXPLORATION duodenal I-EXPLORATION en I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION con I-EXPLORATION pezón I-EXPLORATION de I-EXPLORATION fibrina. I-EXPLORATION Se B-TREATMENT inyectó I-TREATMENT 1 I-TREATMENT cc I-TREATMENT de I-TREATMENT cianoacrilato I-TREATMENT y I-TREATMENT 4 I-TREATMENT cc I-TREATMENT de I-TREATMENT etoxiesclerol. I-TREATMENT Tras B-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION endoscópico I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION exteriorización I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION ni I-EVOLUTION anemización I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION es I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION Tras I-EVOLUTION trece I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION nuevos I-EVOLUTION ingresos I-EVOLUTION por I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION alta I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION sangrado I-EVOLUTION por I-EVOLUTION variz I-EVOLUTION duodenal. I-EVOLUTION I-EVOLUTION Mujer 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 personales I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Graves-Basedow, I-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY reumatoide I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY CU I-PAST_MEDICAL_HISTORY corticodependiente I-PAST_MEDICAL_HISTORY refractaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY inmunosupresores I-PAST_MEDICAL_HISTORY tiopurínicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antiTNF, I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY asociadas I-PAST_MEDICAL_HISTORY son I-PAST_MEDICAL_HISTORY eritema I-PAST_MEDICAL_HISTORY nodoso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY perianal I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY precisó I-PAST_MEDICAL_HISTORY drenaje I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abscesos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY colocación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY seton I-PAST_MEDICAL_HISTORY laxo I-PAST_MEDICAL_HISTORY sobre I-PAST_MEDICAL_HISTORY fístula I-PAST_MEDICAL_HISTORY anal I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY antes. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Controlada B-TREATMENT por I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Enfermedad I-TREATMENT Inflamatoria I-TREATMENT Intestinal I-TREATMENT (EII), I-TREATMENT es I-TREATMENT refractaria I-TREATMENT al I-TREATMENT tratamiento, I-TREATMENT manteniéndose I-TREATMENT lesiones I-TREATMENT evidentes I-TREATMENT endoscópicas I-TREATMENT e I-TREATMENT histológicas, I-TREATMENT unido I-TREATMENT a I-TREATMENT importante I-TREATMENT afectación I-TREATMENT de I-TREATMENT su I-TREATMENT estado I-TREATMENT general I-TREATMENT y I-TREATMENT calidad I-TREATMENT de I-TREATMENT vida, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT recomienda I-TREATMENT tratamiento I-TREATMENT quirúrgico. I-TREATMENT Dada I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT perianal I-TREATMENT se I-TREATMENT realiza I-TREATMENT pancoloproctectomía I-TREATMENT e I-TREATMENT ileostomía I-TREATMENT terminal I-TREATMENT en I-TREATMENT fosa I-TREATMENT ilíaca I-TREATMENT derecha. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION CU. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION es I-EVOLUTION lenta, I-EVOLUTION con I-EVOLUTION infección I-EVOLUTION del I-EVOLUTION tracto I-EVOLUTION urinario I-EVOLUTION e I-EVOLUTION íleo I-EVOLUTION paralítico I-EVOLUTION que B-TREATMENT requiere I-TREATMENT colocación I-TREATMENT de I-TREATMENT sonda I-TREATMENT naso-gástrica. I-TREATMENT I-TREATMENT Previo I-TREATMENT a I-TREATMENT la I-TREATMENT realización I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT había I-TREATMENT retirado I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tiopurinas I-TREATMENT y I-TREATMENT antiTNF I-TREATMENT y I-TREATMENT durante I-TREATMENT el I-TREATMENT ingreso I-TREATMENT se I-TREATMENT inicia I-TREATMENT pauta I-TREATMENT de I-TREATMENT retirada I-TREATMENT de I-TREATMENT corticoides I-TREATMENT orales I-TREATMENT hasta I-TREATMENT su I-TREATMENT suspensión I-TREATMENT completa. I-TREATMENT Es B-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION asintomática, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 35 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Siete I-EVOLUTION días I-EVOLUTION después I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION la I-EVOLUTION consulta I-EVOLUTION de I-EVOLUTION estomaterapia I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION una I-EVOLUTION ulceración I-EVOLUTION de I-EVOLUTION bordes I-EVOLUTION anfractuosos I-EVOLUTION y I-EVOLUTION un I-EVOLUTION absceso I-EVOLUTION subcutáneo I-EVOLUTION en I-EVOLUTION la I-EVOLUTION proximidad I-EVOLUTION del I-EVOLUTION estoma, I-EVOLUTION que I-EVOLUTION le I-EVOLUTION origina I-EVOLUTION intenso I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION dificultad I-EVOLUTION para I-EVOLUTION la I-EVOLUTION aplicación I-EVOLUTION del I-EVOLUTION dispositivo I-EVOLUTION colector. I-EVOLUTION I-EVOLUTION A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION ulceración I-EXPLORATION profunda, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION e I-EXPLORATION indurados, I-EXPLORATION sumamente I-EXPLORATION dolorosa, I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION gran I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION margen I-EXPLORATION izquierdo I-EXPLORATION e I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION estoma; I-EXPLORATION en I-EXPLORATION proximidad, I-EXPLORATION pequeña I-EXPLORATION colección I-EXPLORATION purulenta I-EXPLORATION que, I-EXPLORATION al I-EXPLORATION drenarla, I-EXPLORATION pone I-EXPLORATION en I-EXPLORATION evidencia I-EXPLORATION otra I-EXPLORATION ulceración, I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION necróticos I-EXPLORATION y I-EXPLORATION eritematosos, I-EXPLORATION tunelizada I-EXPLORATION mediante I-EXPLORATION un I-EXPLORATION pequeño I-EXPLORATION puente I-EXPLORATION dérmico I-EXPLORATION con I-EXPLORATION la I-EXPLORATION anterior. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT PGP I-TREATMENT se I-TREATMENT decide I-TREATMENT ingreso I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT vigilar I-TREATMENT evolución. I-TREATMENT I-TREATMENT Se B-EXPLORATION tomaron I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION cultivo I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION histológico; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION ningún I-EXPLORATION germen I-EXPLORATION anormal I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION informado I-EXPLORATION de I-EXPLORATION inflamación I-EXPLORATION inespecífica. I-EXPLORATION I-EXPLORATION Se B-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT mediante I-TREATMENT tacrolimus I-TREATMENT vía I-TREATMENT tópica, I-TREATMENT en I-TREATMENT solución I-TREATMENT al I-TREATMENT 0, I-TREATMENT 3 I-TREATMENT %, I-TREATMENT una I-TREATMENT aplicación I-TREATMENT diaria; I-TREATMENT adalimumab: I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT inducción I-TREATMENT de I-TREATMENT 80 I-TREATMENT mg I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT 40 I-TREATMENT mg I-TREATMENT subcutáneos I-TREATMENT cada I-TREATMENT dos I-TREATMENT semanas, I-TREATMENT de I-TREATMENT mantenimiento; I-TREATMENT metilprednisolona: I-TREATMENT 32 I-TREATMENT mg I-TREATMENT vía I-TREATMENT oral I-TREATMENT con I-TREATMENT pauta I-TREATMENT descendente I-TREATMENT de I-TREATMENT 8 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 14 I-TREATMENT días; I-TREATMENT y I-TREATMENT metronidazol I-TREATMENT y I-TREATMENT ciprofloxacino I-TREATMENT a I-TREATMENT las I-TREATMENT dosis I-TREATMENT habituales I-TREATMENT durante I-TREATMENT dos I-TREATMENT semanas. I-TREATMENT I-TREATMENT Sobreañadido I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT general, I-TREATMENT se I-TREATMENT realizaron I-TREATMENT curas I-TREATMENT locales I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Estomaterapia, I-TREATMENT aplicándose I-TREATMENT apósito I-TREATMENT absorbente I-TREATMENT hidrocoloide I-TREATMENT transparente I-TREATMENT (carboximetilcelulosa I-TREATMENT y I-TREATMENT film I-TREATMENT de I-TREATMENT poliuretano), I-TREATMENT sobre I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT adapta I-TREATMENT dispositivo I-TREATMENT de I-TREATMENT ileostomía I-TREATMENT de I-TREATMENT doble I-TREATMENT sistema I-TREATMENT y I-TREATMENT cinturón, I-TREATMENT realizando I-TREATMENT cambios I-TREATMENT diarios I-TREATMENT para I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT tacrolimus I-TREATMENT tópico. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION fue I-EVOLUTION muy I-EVOLUTION satisfactoria I-EVOLUTION con I-EVOLUTION resolución I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION pioderma I-EVOLUTION a I-EVOLUTION las I-EVOLUTION ocho I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION Continúa I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION externas I-EVOLUTION y I-EVOLUTION diez I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION han I-EVOLUTION desaparecido I-EVOLUTION y B-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT precisa I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT de I-TREATMENT mantenimiento. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus, I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardiaca, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY vascular I-PAST_MEDICAL_HISTORY periférica, I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY ferropénica I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY Seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY furosemida, I-PAST_MEDICAL_HISTORY hidralacina, I-PAST_MEDICAL_HISTORY sulfato I-PAST_MEDICAL_HISTORY ferroso, I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY acetilsalicílico, I-PAST_MEDICAL_HISTORY lisinopril, I-PAST_MEDICAL_HISTORY carvedilol, I-PAST_MEDICAL_HISTORY doxazosina I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insulina. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION EDA I-EXPLORATION por I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION anemia, I-EXPLORATION visualizándose I-EXPLORATION bandas I-EXPLORATION longitudinales I-EXPLORATION de I-EXPLORATION color I-EXPLORATION negruzco I-EXPLORATION en I-EXPLORATION antro I-EXPLORATION gástrico I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION manchas I-EXPLORATION puntiformes I-EXPLORATION oscuras I-EXPLORATION en I-EXPLORATION bulbo I-EXPLORATION y I-EXPLORATION segunda I-EXPLORATION porción I-EXPLORATION duodenal. I-EXPLORATION La I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION confirmó, I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Perls, I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION depósitos I-EXPLORATION de I-EXPLORATION material I-EXPLORATION férrico. I-EXPLORATION I-EXPLORATION Varón, B-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY enólica, I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY esofágicas, I-PAST_MEDICAL_HISTORY trombosis I-PAST_MEDICAL_HISTORY portal I-PAST_MEDICAL_HISTORY recanalizada, I-PAST_MEDICAL_HISTORY derivación I-PAST_MEDICAL_HISTORY percutánea I-PAST_MEDICAL_HISTORY portosistémica I-PAST_MEDICAL_HISTORY intrahepática I-PAST_MEDICAL_HISTORY (DPPI) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cavernomatosis I-PAST_MEDICAL_HISTORY portal. I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS colangitis I-PRESENT_ILLNESS aguda. I-PRESENT_ILLNESS Se B-EXPLORATION solicita I-EXPLORATION colangiopancreatografía I-EXPLORATION retrógrada I-EXPLORATION endoscópica, I-EXPLORATION objetivándose I-EXPLORATION una I-EXPLORATION VB I-EXPLORATION extrahepática I-EXPLORATION irregular, I-EXPLORATION con I-EXPLORATION estenosis I-EXPLORATION y I-EXPLORATION dilataciones; I-EXPLORATION se I-EXPLORATION extraen I-EXPLORATION varios I-EXPLORATION coágulos I-EXPLORATION con I-EXPLORATION balón, I-EXPLORATION persistiendo I-EXPLORATION algunos I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción, I-EXPLORATION planteando I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION entre I-EXPLORATION colangiocarcinoma I-EXPLORATION y I-EXPLORATION colangitis I-EXPLORATION esclerosante. I-EXPLORATION Se I-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION DPPI I-EXPLORATION no I-EXPLORATION permeable I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hipertensión I-EXPLORATION portal. I-EXPLORATION Al I-EXPLORATION alta I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION ecoendoscopia I-EXPLORATION objetivándose I-EXPLORATION varices I-EXPLORATION esofagogástricas, I-EXPLORATION circulación I-EXPLORATION colateral I-EXPLORATION periesplénica I-EXPLORATION y I-EXPLORATION periportal, I-EXPLORATION cavernomatosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION mesentérica I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION circulación I-EXPLORATION colateral I-EXPLORATION en I-EXPLORATION torno I-EXPLORATION a I-EXPLORATION la I-EXPLORATION VB, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION prominente I-EXPLORATION ovillo I-EXPLORATION vascular I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION la I-EXPLORATION VB I-EXPLORATION extrahepática I-EXPLORATION y I-EXPLORATION del I-EXPLORATION cístico, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION varices I-EXPLORATION coledocianas. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO por I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO abdominal I-DERIVED_FROM/TO y I-DERIVED_FROM/TO anemia I-DERIVED_FROM/TO (Hb I-DERIVED_FROM/TO 11, I-DERIVED_FROM/TO 4 I-DERIVED_FROM/TO mg/dl I-DERIVED_FROM/TO y I-DERIVED_FROM/TO hierro I-DERIVED_FROM/TO sérico I-DERIVED_FROM/TO 15 I-DERIVED_FROM/TO µg/dl) I-DERIVED_FROM/TO asociada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO hiperferritinemia I-DERIVED_FROM/TO (707 I-DERIVED_FROM/TO ng/ml). I-DERIVED_FROM/TO La B-EXPLORATION gastroscopia, I-EXPLORATION colonoscopia, I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION tránsito I-EXPLORATION gastrointestinal I-EXPLORATION descartaron I-EXPLORATION afectación I-EXPLORATION inflamatoria. I-EXPLORATION A I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION presentar I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION transferrina I-EXPLORATION bajo I-EXPLORATION (3, I-EXPLORATION 7 I-EXPLORATION %) I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION de I-EXPLORATION hemocromatosis I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION la I-EXPLORATION ceruloplasmina I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION metabolismo I-EXPLORATION del I-EXPLORATION cobre, I-EXPLORATION que I-EXPLORATION confirmaron I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION aceruloplasminemia: I-EXPLORATION ceruloplasmina I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION 7 I-EXPLORATION mg/dl I-EXPLORATION (rango I-EXPLORATION normal, I-EXPLORATION 22-61 I-EXPLORATION mg/dl), I-EXPLORATION cobre I-EXPLORATION sérico I-EXPLORATION 13 I-EXPLORATION µg/dl I-EXPLORATION (rango I-EXPLORATION normal, I-EXPLORATION 70-150 I-EXPLORATION µg/dl) I-EXPLORATION y I-EXPLORATION cobre I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION normal. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION test I-EXPLORATION genético I-EXPLORATION por I-EXPLORATION no I-EXPLORATION encontrarse I-EXPLORATION disponible I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION centro. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION abdominal I-EXPLORATION identificó I-EXPLORATION baja I-EXPLORATION intensidad I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION T2 I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION depósito I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION hierro I-EXPLORATION sin I-EXPLORATION observar I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION RM I-EXPLORATION cerebral I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION oftalmológico. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS en I-PRESENT_ILLNESS lista I-PRESENT_ILLNESS de I-PRESENT_ILLNESS espera I-PRESENT_ILLNESS quirúrgica I-PRESENT_ILLNESS para I-PRESENT_ILLNESS colecistectomía I-PRESENT_ILLNESS por I-PRESENT_ILLNESS litiasis I-PRESENT_ILLNESS biliar I-PRESENT_ILLNESS sintomática I-PRESENT_ILLNESS y I-PRESENT_ILLNESS resección I-PRESENT_ILLNESS de I-PRESENT_ILLNESS adenoma I-PRESENT_ILLNESS hepático I-PRESENT_ILLNESS (de I-PRESENT_ILLNESS 6, I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS x I-PRESENT_ILLNESS 5, I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS x I-PRESENT_ILLNESS 6, I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS segmento I-PRESENT_ILLNESS II-III). I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS hipocondrios, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION amilasa I-EXPLORATION de I-EXPLORATION 3315 I-EXPLORATION UI/L I-EXPLORATION (rango I-EXPLORATION de I-EXPLORATION normalidad: I-EXPLORATION 25-115 I-EXPLORATION UI/L), I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos; I-EXPLORATION ingresándose I-EXPLORATION con I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION aguda I-EXPLORATION biliar, I-EXPLORATION sin I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION Ranson. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION litiasis, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intra I-EXPLORATION y I-EXPLORATION extrahepática, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION páncreas I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa. I-EXPLORATION I-EXPLORATION Requirió B-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Medicina I-EVOLUTION Intensiva I-EVOLUTION por I-EVOLUTION mala I-EVOLUTION evolución I-EVOLUTION con I-EVOLUTION oligoanuria I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso; I-EVOLUTION realizándose B-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION abdomen, I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION pancreatitis I-EXPLORATION grado I-EXPLORATION E I-EXPLORATION de I-EXPLORATION Balthazar. I-EXPLORATION Durante B-EVOLUTION su I-EVOLUTION estancia I-EVOLUTION prolongada I-EVOLUTION en I-EVOLUTION planta I-EVOLUTION presentó I-EVOLUTION numerosas I-EVOLUTION complicaciones: I-EVOLUTION condensación I-EVOLUTION pulmonar I-EVOLUTION con I-EVOLUTION derrame I-EVOLUTION pleural I-EVOLUTION asociado I-EVOLUTION (Klebsiella I-EVOLUTION pneumoniae I-EVOLUTION en I-EVOLUTION esputo), I-EVOLUTION infección I-EVOLUTION del I-EVOLUTION tracto I-EVOLUTION urinario I-EVOLUTION (Candida I-EVOLUTION albicans), I-EVOLUTION sepsis I-EVOLUTION por I-EVOLUTION catéter I-EVOLUTION (Stafilococo I-EVOLUTION haemolyticus), I-EVOLUTION trombosis I-EVOLUTION venosa I-EVOLUTION profunda I-EVOLUTION de I-EVOLUTION yugular I-EVOLUTION interna I-EVOLUTION y I-EVOLUTION subclavia I-EVOLUTION derecha I-EVOLUTION por I-EVOLUTION catéter I-EVOLUTION central, I-EVOLUTION desnutrición I-EVOLUTION proteica I-EVOLUTION severa, I-EVOLUTION e I-EVOLUTION imposibilidad I-EVOLUTION de I-EVOLUTION reintroducir I-EVOLUTION alimentación I-EVOLUTION por I-EVOLUTION vía I-EVOLUTION enteral I-EVOLUTION por I-EVOLUTION cuadros I-EVOLUTION suboclusivos I-EVOLUTION con I-EVOLUTION vómitos I-EVOLUTION y I-EVOLUTION distensión I-EVOLUTION abdominal. I-EVOLUTION En B-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION estenosis I-EXPLORATION severa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION pliegues I-EXPLORATION y I-EXPLORATION varios I-EXPLORATION trayectos I-EXPLORATION fistulosos, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmaron I-EXPLORATION con I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION ; I-EXPLORATION así I-EXPLORATION como I-EXPLORATION colecciones I-EXPLORATION multiloculadas I-EXPLORATION en I-EXPLORATION psoas-iliaco I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT falta I-TREATMENT de I-TREATMENT respuesta I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT conservador I-TREATMENT se I-TREATMENT programó I-TREATMENT para I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT realizándose I-TREATMENT bypass I-TREATMENT íleo-cólico, I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT resección I-TREATMENT del I-TREATMENT adenoma I-TREATMENT hepático. I-TREATMENT I-TREATMENT Actualmente B-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática, I-EVOLUTION con I-EVOLUTION TAC I-EVOLUTION abdomen I-EVOLUTION de I-EVOLUTION control I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Varón 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 antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY espasmo I-PAST_MEDICAL_HISTORY hemifacial I-PAST_MEDICAL_HISTORY izquierdo, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS en I-PRESENT_ILLNESS epigastrio I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS coluria I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION Murphy I-EXPLORATION negativo I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION transaminasas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION analítica. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION hepático. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION manifiesta I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION hipodensa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hilio I-EXPLORATION hepático. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION RMN I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION hilio I-EXPLORATION hepático I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION polilobulada I-EXPLORATION con I-EXPLORATION compresión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION sin I-EXPLORATION realce I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION I-EXPLORATION Dados I-EXPLORATION los I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION colangitis I-EXPLORATION se I-EXPLORATION diagnostica I-EXPLORATION como I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Caroli I-EXPLORATION y I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION laparotomía I-EXPLORATION exploradora, I-EXPLORATION apreciándose I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION quística I-EXPLORATION intrahepática I-EXPLORATION en I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION IV-III I-EXPLORATION que, I-EXPLORATION tras I-EXPLORATION una I-EXPLORATION colangiografía I-EXPLORATION intraoperatoria, I-EXPLORATION presenta I-EXPLORATION comunicación I-EXPLORATION con I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION principal. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT una I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT hepatectomía I-TREATMENT izquierda I-TREATMENT reglada, I-TREATMENT siendo B-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION La B-EXPLORATION histología I-EXPLORATION describe I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION múltiples I-EXPLORATION quistes I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION fibrosa, I-EXPLORATION revestidas I-EXPLORATION por I-EXPLORATION epitelio I-EXPLORATION mucosecretor I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION planas, I-EXPLORATION proyecciones I-EXPLORATION papilares, I-EXPLORATION atipia I-EXPLORATION citológica I-EXPLORATION y I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION sólido I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION focal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION del I-EXPLORATION quiste, I-EXPLORATION sin I-EXPLORATION alcanzar I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION hepático I-EXPLORATION ni I-EXPLORATION bordes I-EXPLORATION quirúrgicos. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION estroma I-EXPLORATION ovárico. I-EXPLORATION Todo I-EXPLORATION ello I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION cistoadenocarcinoma I-EXPLORATION hepático. I-EXPLORATION I-EXPLORATION Cinco B-EVOLUTION años I-EVOLUTION después, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION asintomático I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION radiológicos I-EVOLUTION de I-EVOLUTION recidiva. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY hábito I-PAST_MEDICAL_HISTORY tabáquico, I-PAST_MEDICAL_HISTORY alcoholismo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pancreatitis I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION en I-EXPLORATION urgencias I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION izquierdo I-EXPLORATION masivo. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION toracocentesis I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION negativo, I-EXPLORATION con I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION exudado I-EXPLORATION con I-EXPLORATION 60 I-EXPLORATION % I-EXPLORATION de I-EXPLORATION polimorfonucleares, I-EXPLORATION destacando I-EXPLORATION 12.400 I-EXPLORATION UI/L I-EXPLORATION de I-EXPLORATION amilasa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION pleural. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION torácico, I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION infiltrado I-EXPLORATION en I-EXPLORATION LII I-EXPLORATION y I-EXPLORATION pequeñas I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION deslustrado. I-EXPLORATION Con B-TREATMENT sospecha I-TREATMENT de I-TREATMENT derrame I-TREATMENT paraneumónico I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT médico. I-TREATMENT Sin B-EXPLORATION embargo, I-EXPLORATION el I-EXPLORATION derrame I-EXPLORATION empeoró, I-EXPLORATION realizándose I-EXPLORATION nueva I-EXPLORATION toracocentesis I-EXPLORATION diagnóstica I-EXPLORATION y I-EXPLORATION evacuadora, I-EXPLORATION con I-EXPLORATION citología I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION células I-EXPLORATION malignas, I-EXPLORATION cultivo I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION biopsia I-EXPLORATION pleural I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION tumor, I-EXPLORATION destacando I-EXPLORATION nuevamente I-EXPLORATION amilasa I-EXPLORATION elevada, I-EXPLORATION con I-EXPLORATION 10.156 I-EXPLORATION UL/L. I-EXPLORATION Ante I-EXPLORATION el I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION recidivante I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION toraco-abdominal, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION un I-EXPLORATION pseudoquiste I-EXPLORATION pancreático I-EXPLORATION de I-EXPLORATION 28 I-EXPLORATION mm I-EXPLORATION comunicado I-EXPLORATION con I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION x I-EXPLORATION 5, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION páncreas I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION espacio I-EXPLORATION subfrénico, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION izquierdo I-EXPLORATION masivo, I-EXPLORATION siendo I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION fístula I-EXPLORATION pleuropancreática. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT con I-TREATMENT dieta I-TREATMENT absoluta, I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT total, I-TREATMENT drenaje I-TREATMENT torácico I-TREATMENT con I-TREATMENT tubo I-TREATMENT y I-TREATMENT octeótrido I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 100 I-TREATMENT µg I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT subcutáneo, I-TREATMENT duplicando I-TREATMENT la I-TREATMENT dosis I-TREATMENT ante I-TREATMENT el I-TREATMENT alto I-TREATMENT débito. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT CPRE I-TREATMENT con I-TREATMENT intento I-TREATMENT de I-TREATMENT colocación I-TREATMENT de I-TREATMENT stent I-TREATMENT en I-TREATMENT el I-TREATMENT conducto I-TREATMENT pancreático I-TREATMENT principal, I-TREATMENT que I-TREATMENT no I-TREATMENT fue I-TREATMENT posible I-TREATMENT técnicamente I-TREATMENT al I-TREATMENT encontrarse I-TREATMENT el I-TREATMENT origen I-TREATMENT de I-TREATMENT la I-TREATMENT fístula I-TREATMENT en I-TREATMENT pseudoquiste I-TREATMENT pancreático I-TREATMENT situado I-TREATMENT en I-TREATMENT la I-TREATMENT cola I-TREATMENT del I-TREATMENT páncreas. I-TREATMENT Pese I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT inicial, I-TREATMENT el I-TREATMENT paciente I-TREATMENT no I-TREATMENT presentó I-TREATMENT mejoría, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT finalmente I-TREATMENT fue I-TREATMENT intervenido I-TREATMENT tras I-TREATMENT dos I-TREATMENT meses I-TREATMENT de I-TREATMENT iniciado I-TREATMENT el I-TREATMENT tratamiento, I-TREATMENT evidenciando I-TREATMENT un I-TREATMENT orifico I-TREATMENT en I-TREATMENT el I-TREATMENT diafragma I-TREATMENT de I-TREATMENT 2 I-TREATMENT cm I-TREATMENT que I-TREATMENT comunicaba I-TREATMENT el I-TREATMENT pseudoquiste I-TREATMENT con I-TREATMENT la I-TREATMENT cavidad I-TREATMENT pleural I-TREATMENT y I-TREATMENT que I-TREATMENT determinaba I-TREATMENT la I-TREATMENT fístula I-TREATMENT pleuropancreática. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT pancreatectomía I-TREATMENT distal, I-TREATMENT no I-TREATMENT pudiendo I-TREATMENT respetar I-TREATMENT el I-TREATMENT bazo I-TREATMENT por I-TREATMENT la I-TREATMENT gran I-TREATMENT inflamación I-TREATMENT presente, I-TREATMENT así I-TREATMENT como I-TREATMENT cierre I-TREATMENT del I-TREATMENT orificio I-TREATMENT diafragmático I-TREATMENT y I-TREATMENT drenaje I-TREATMENT pleural I-TREATMENT izquierdo, I-TREATMENT con I-TREATMENT derivación I-TREATMENT de I-TREATMENT conducto I-TREATMENT de I-TREATMENT Wirsung I-TREATMENT distal I-TREATMENT término-lateral I-TREATMENT en I-TREATMENT Y I-TREATMENT de I-TREATMENT Roux I-TREATMENT retrocólica-transmesocólica I-TREATMENT tras I-TREATMENT extracción I-TREATMENT de I-TREATMENT cálculos. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION satisfactoria, I-EVOLUTION siendo I-EVOLUTION retirado I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION pleural I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION sin I-EVOLUTION recidiva I-EVOLUTION del I-EVOLUTION derrame I-EVOLUTION y I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION sexto I-EVOLUTION día I-EVOLUTION post-operatorio. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION asintomático I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS embarazada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS semanas, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cavernomatosis I-PRESENT_ILLNESS portal I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 7años. I-PRESENT_ILLNESS Durante B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY adolescencia I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY secundarios I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY varices I-PAST_MEDICAL_HISTORY esofágicas I-PAST_MEDICAL_HISTORY (VE). I-PAST_MEDICAL_HISTORY Anticoagulada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY trombosis I-PAST_MEDICAL_HISTORY venosa I-PAST_MEDICAL_HISTORY mesentérica I-PAST_MEDICAL_HISTORY aguda. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY trimestre I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY retiraron I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY beta-bloqueantes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY anticoagulantes I-PAST_MEDICAL_HISTORY orales, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY pasó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY heparina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bajo I-PAST_MEDICAL_HISTORY peso. I-PAST_MEDICAL_HISTORY En B-EXPLORATION gastroscopia I-EXPLORATION realizada I-EXPLORATION para I-EXPLORATION control I-EXPLORATION de I-EXPLORATION varices I-EXPLORATION esofágicas I-EXPLORATION 6 I-EXPLORATION días I-EXPLORATION antes I-EXPLORATION del I-EXPLORATION evento, I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION VE I-EXPLORATION grado I-EXPLORATION I I-EXPLORATION y I-EXPLORATION II I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION rojos. I-EXPLORATION I-EXPLORATION Acudió I-EXPLORATION a I-EXPLORATION urgencias I-EXPLORATION por I-EXPLORATION melenas I-EXPLORATION e I-EXPLORATION hipotensión I-EXPLORATION arterial. I-EXPLORATION En I-EXPLORATION analítica I-EXPLORATION destacaba I-EXPLORATION hemoglobina I-EXPLORATION 7, I-EXPLORATION 1 I-EXPLORATION g/dl. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT gastroscopia I-TREATMENT urgente I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT observaron I-TREATMENT VE I-TREATMENT grado I-TREATMENT II I-TREATMENT con I-TREATMENT puntos I-TREATMENT rojos I-TREATMENT y I-TREATMENT sangrado I-TREATMENT activo, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT ligadura I-TREATMENT con I-TREATMENT bandas I-TREATMENT elásticas. I-TREATMENT Se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT cesárea I-TREATMENT urgente I-TREATMENT para I-TREATMENT extracción I-TREATMENT fetal I-TREATMENT por I-TREATMENT shock I-TREATMENT hipovolémico I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT y I-TREATMENT a I-TREATMENT continuación I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT somatostatina I-TREATMENT y I-TREATMENT se I-TREATMENT revisó I-TREATMENT endoscópicamente, I-TREATMENT objetivando I-TREATMENT el I-TREATMENT cese I-TREATMENT del I-TREATMENT sangrado. I-TREATMENT La B-EVOLUTION recién I-EVOLUTION nacida I-EVOLUTION requirió I-EVOLUTION cuidados I-EVOLUTION en I-EVOLUTION incubadora I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION unos I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION ambas I-EVOLUTION fueron I-EVOLUTION dadas I-EVOLUTION de I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY madre I-FAMILY_HISTORY fallecida I-FAMILY_HISTORY por I-FAMILY_HISTORY hepatopatía I-FAMILY_HISTORY crónica I-FAMILY_HISTORY inespecífica I-FAMILY_HISTORY evolucionada I-FAMILY_HISTORY hacia I-FAMILY_HISTORY cirrosis I-FAMILY_HISTORY hepática I-FAMILY_HISTORY y I-FAMILY_HISTORY hermana I-FAMILY_HISTORY con I-FAMILY_HISTORY hepatopatía I-FAMILY_HISTORY no I-FAMILY_HISTORY filiada. I-FAMILY_HISTORY En B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY (VHC) I-PAST_MEDICAL_HISTORY genotipo I-PAST_MEDICAL_HISTORY 1b I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY nula I-PAST_MEDICAL_HISTORY respuesta I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY peginterferón I-PAST_MEDICAL_HISTORY α-2a I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ribavirina I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones. I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY nefríticos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS febrero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS intensa, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS y I-PRESENT_ILLNESS epigastralgia I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS Los B-EXPLORATION valores I-EXPLORATION analíticos I-EXPLORATION más I-EXPLORATION destacables I-EXPLORATION fueron: I-EXPLORATION AST I-EXPLORATION 145 I-EXPLORATION U/L I-EXPLORATION (0-37 I-EXPLORATION U/L), I-EXPLORATION ALT I-EXPLORATION 121 I-EXPLORATION U/L I-EXPLORATION (0-37 I-EXPLORATION U/L), I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION 116 I-EXPLORATION U/L I-EXPLORATION (50-190 I-EXPLORATION U/L), I-EXPLORATION GGT I-EXPLORATION 167 I-EXPLORATION U/L I-EXPLORATION (6-50 I-EXPLORATION U/L), I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 14, I-EXPLORATION 6 I-EXPLORATION mg/dl I-EXPLORATION (0-1, I-EXPLORATION 8 I-EXPLORATION mg/dl), I-EXPLORATION y I-EXPLORATION alfa-feto I-EXPLORATION proteína I-EXPLORATION 19, I-EXPLORATION 14 I-EXPLORATION ng/ml I-EXPLORATION (0-5 I-EXPLORATION ng/ml), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION VHC I-EXPLORATION de I-EXPLORATION 14.600.000 I-EXPLORATION UI I-EXPLORATION ml. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION pruebas I-EXPLORATION diagnósticas: I-EXPLORATION ecografía I-EXPLORATION digestiva, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION lesiones I-EXPLORATION ocupantes I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION ni I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION vías I-EXPLORATION biliares I-EXPLORATION y I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION bilis I-EXPLORATION espesa I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION concluyentes I-EXPLORATION de I-EXPLORATION colelitiasis; I-EXPLORATION colangio-RM I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION coledocolitiasis I-EXPLORATION y I-EXPLORATION litiasis I-EXPLORATION intrahepática; I-EXPLORATION endoscopia I-EXPLORATION oral I-EXPLORATION normal; I-EXPLORATION angio-TAC I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION hepatomegalia I-EXPLORATION homogénea I-EXPLORATION y I-EXPLORATION ecoendoscopia I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION páncreas I-EXPLORATION o I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION fibrosis I-EXPLORATION grado I-EXPLORATION 3 I-EXPLORATION según I-EXPLORATION METAVIR I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION hepatitis I-EXPLORATION C, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones I-EXPLORATION valorables. I-EXPLORATION I-EXPLORATION Un B-EVOLUTION año I-EVOLUTION después I-EVOLUTION (febrero I-EVOLUTION 2012) I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION consulta I-EVOLUTION presentando I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION similares I-EVOLUTION características I-EVOLUTION (ictericia, I-EVOLUTION prurito I-EVOLUTION y I-EVOLUTION epigastralgia); I-EVOLUTION ante B-TREATMENT la I-TREATMENT recurrencia I-TREATMENT del I-TREATMENT cuadro I-TREATMENT se I-TREATMENT prescribió I-TREATMENT AUDC, I-TREATMENT con B-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION rápida I-EVOLUTION del I-EVOLUTION cuadro. I-EVOLUTION I-EVOLUTION Ante B-EXPLORATION la I-EXPLORATION clínica I-EXPLORATION recidivante I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION causa I-EXPLORATION etiológica, I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION de I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION LPAC. I-EXPLORATION Se I-EXPLORATION envió I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION al I-EXPLORATION Hospital I-EXPLORATION Universitario I-EXPLORATION La I-EXPLORATION Paz I-EXPLORATION (Madrid) I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION hepática, I-EXPLORATION apreciándose I-EXPLORATION una I-EXPLORATION expresión I-EXPLORATION canicular I-EXPLORATION normal I-EXPLORATION de I-EXPLORATION MRD3. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION estudió I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION codificante I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION ABCB4 I-EXPLORATION (muestra I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Hospital I-EXPLORATION Universitario I-EXPLORATION Saint-Antoine I-EXPLORATION (París) I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION tecnología I-EXPLORATION Roche I-EXPLORATION 454 I-EXPLORATION GS I-EXPLORATION Junior I-EXPLORATION sequencing, I-EXPLORATION siendo I-EXPLORATION esta I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION generación I-EXPLORATION de I-EXPLORATION secuenciación I-EXPLORATION del I-EXPLORATION ADN I-EXPLORATION por I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION una I-EXPLORATION secuenciación I-EXPLORATION ultraprofunda I-EXPLORATION de I-EXPLORATION productos I-EXPLORATION PCR, I-EXPLORATION no I-EXPLORATION encontrándose I-EXPLORATION tampoco I-EXPLORATION ninguna I-EXPLORATION mutación. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION clínica, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Hospital I-EXPLORATION Universitario I-EXPLORATION La I-EXPLORATION Paz I-EXPLORATION se I-EXPLORATION analizó I-EXPLORATION nuevamente I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION ABCB4 I-EXPLORATION esta I-EXPLORATION vez I-EXPLORATION con I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION MLPA® I-EXPLORATION (Multiplex I-EXPLORATION Ligation-dependent I-EXPLORATION Probe I-EXPLORATION Amplification) I-EXPLORATION (9), I-EXPLORATION tratándose I-EXPLORATION de I-EXPLORATION una I-EXPLORATION técnica I-EXPLORATION complementaria I-EXPLORATION que I-EXPLORATION detecta I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION el I-EXPLORATION número I-EXPLORATION de I-EXPLORATION copias I-EXPLORATION genómicas, I-EXPLORATION inserciones I-EXPLORATION o I-EXPLORATION deleciones I-EXPLORATION no I-EXPLORATION detectados I-EXPLORATION por I-EXPLORATION los I-EXPLORATION métodos I-EXPLORATION convencionales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION secuenciación. I-EXPLORATION Se I-EXPLORATION comparó I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION su I-EXPLORATION hermana I-EXPLORATION (control I-EXPLORATION 1) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION de I-EXPLORATION un I-EXPLORATION individuo I-EXPLORATION sano I-EXPLORATION (control I-EXPLORATION 2). I-EXPLORATION Se I-EXPLORATION identificó I-EXPLORATION una I-EXPLORATION mutación I-EXPLORATION en I-EXPLORATION heterocigosis I-EXPLORATION por I-EXPLORATION la I-EXPLORATION deleción I-EXPLORATION de I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION gen I-EXPLORATION que I-EXPLORATION contiene I-EXPLORATION el I-EXPLORATION exón I-EXPLORATION 4 I-EXPLORATION completo, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION una I-EXPLORATION deficiencia I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION MDR3 I-EXPLORATION (10), I-EXPLORATION confirmándose I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION LPAC. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS intermitente, I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS progresiva. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION evidencian I-EXPLORATION hepatomegalia I-EXPLORATION y I-EXPLORATION onda I-EXPLORATION ascítica I-EXPLORATION positiva. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destaca: I-EXPLORATION Mantoux I-EXPLORATION +, I-EXPLORATION CA I-EXPLORATION 125 I-EXPLORATION 797.7, I-EXPLORATION leucocitos I-EXPLORATION 4.000, I-EXPLORATION Hb I-EXPLORATION 9.7. I-EXPLORATION TC I-EXPLORATION toracoabdominal: I-EXPLORATION ascitis, I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION serosa I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION nodulares I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION implantes I-EXPLORATION peritoneales, I-EXPLORATION principalmente I-EXPLORATION en I-EXPLORATION epiplón. I-EXPLORATION Leve I-EXPLORATION esplenomegalia. I-EXPLORATION Múltiples I-EXPLORATION adenopatías I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION patológico, I-EXPLORATION mesentéricas, I-EXPLORATION en I-EXPLORATION eje I-EXPLORATION aortoilíaco, I-EXPLORATION retrocurales I-EXPLORATION y I-EXPLORATION periceliacas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION biopsia I-EXPLORATION peritoneal I-EXPLORATION ecoguiada I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION mayor I-EXPLORATION engrosamiento I-EXPLORATION peritoneal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION toman I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION cultivo, I-EXPLORATION con I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION Mycobacterium I-EXPLORATION tuberculosis. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tuberculostáticos I-TREATMENT con B-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION clínica, I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ascitis I-EVOLUTION y I-EVOLUTION del I-EVOLUTION engrosamiento I-EVOLUTION peritoneal. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 31 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS octubre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2012 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS e I-PRESENT_ILLNESS ingresada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico-analítico I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS hepatitis I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS no I-PRESENT_ILLNESS grave. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tatuaje I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS toma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Inneov I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS capilar® I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION resumen I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION I. I-EXPLORATION La I-EXPLORATION inmunología I-EXPLORATION y I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION viral I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION Al B-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION suspender I-EVOLUTION Inneov I-EVOLUTION masa I-EVOLUTION capilar® I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION mejoría I-EVOLUTION clínica, I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION prurito, I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION analítica, I-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION función I-EVOLUTION hepática I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde. I-EVOLUTION I-EVOLUTION La I-EVOLUTION causalidad I-EVOLUTION utilizando I-EVOLUTION la I-EVOLUTION escala I-EVOLUTION de I-EVOLUTION CIOMS/RUCAM I-EVOLUTION en I-EVOLUTION el I-EVOLUTION caso I-EVOLUTION 2 I-EVOLUTION y I-EVOLUTION 3 I-EVOLUTION fue I-EVOLUTION altamente I-EVOLUTION probable. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS niño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY citopatía I-PAST_MEDICAL_HISTORY mitocondrial I-PAST_MEDICAL_HISTORY (déficit I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY complejos I-PAST_MEDICAL_HISTORY I-III-IV I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cadena I-PAST_MEDICAL_HISTORY respiratoria) I-PAST_MEDICAL_HISTORY en B-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS vitaminas I-PRESENT_ILLNESS B1 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS B6, I-PRESENT_ILLNESS carnitina, I-PRESENT_ILLNESS coenzima I-PRESENT_ILLNESS Q, I-PRESENT_ILLNESS clobazam I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fenobarbital. I-PRESENT_ILLNESS El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Gastroenterología I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Nutrición I-DERIVED_FROM/TO Infantil I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO por I-DERIVED_FROM/TO episodios I-DERIVED_FROM/TO de I-DERIVED_FROM/TO atragantamiento I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO las I-DERIVED_FROM/TO comidas I-DERIVED_FROM/TO y I-DERIVED_FROM/TO varios I-DERIVED_FROM/TO ingresos I-DERIVED_FROM/TO por I-DERIVED_FROM/TO neumonía. I-DERIVED_FROM/TO En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis I-PRESENT_ILLNESS los I-PRESENT_ILLNESS padres I-PRESENT_ILLNESS referían I-PRESENT_ILLNESS que I-PRESENT_ILLNESS era I-PRESENT_ILLNESS alimentado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS purés, I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS accesos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS carraspeo I-PRESENT_ILLNESS al I-PRESENT_ILLNESS tragar. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION tenía I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION deshidratación I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION desnutrición, I-EXPLORATION con I-EXPLORATION datos I-EXPLORATION antropométricos I-EXPLORATION en I-EXPLORATION percentiles I-EXPLORATION adecuados I-EXPLORATION para I-EXPLORATION su I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION sexo. I-EXPLORATION Como I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION presentaba I-EXPLORATION hipotonía I-EXPLORATION generalizada, I-EXPLORATION apraxia I-EXPLORATION fonoarticulatoria I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION deglución, I-EXPLORATION e I-EXPLORATION hipotonía I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION oral I-EXPLORATION con I-EXPLORATION babeo I-EXPLORATION constante. I-EXPLORATION Resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION previos I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION disfagia I-EXPLORATION orofaríngea, I-EXPLORATION y I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION videofluoroscopia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION centro, I-EXPLORATION se I-EXPLORATION le I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION fibroendoscopia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION deglución I-EXPLORATION (FEES) I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION test I-EXPLORATION de I-EXPLORATION deglución I-EXPLORATION con I-EXPLORATION diferentes I-EXPLORATION volúmenes/texturas. I-EXPLORATION En I-EXPLORATION reposo I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION secreciones I-EXPLORATION en I-EXPLORATION vallécula, I-EXPLORATION faringe I-EXPLORATION y I-EXPLORATION senos I-EXPLORATION piriformes; I-EXPLORATION tras I-EXPLORATION administrar I-EXPLORATION distintas I-EXPLORATION consistencias I-EXPLORATION y I-EXPLORATION volúmenes I-EXPLORATION teñidos I-EXPLORATION con I-EXPLORATION azul I-EXPLORATION de I-EXPLORATION metileno I-EXPLORATION se I-EXPLORATION concluyó I-EXPLORATION que I-EXPLORATION con I-EXPLORATION 5 I-EXPLORATION cc I-EXPLORATION de I-EXPLORATION textura I-EXPLORATION néctar I-EXPLORATION había I-EXPLORATION reflejo I-EXPLORATION deglutorio I-EXPLORATION enlentecido I-EXPLORATION y I-EXPLORATION muy I-EXPLORATION fraccionado I-EXPLORATION sin I-EXPLORATION reflejo I-EXPLORATION tusígeno; I-EXPLORATION el I-EXPLORATION alimento I-EXPLORATION se I-EXPLORATION quedaba I-EXPLORATION inicialmente I-EXPLORATION en I-EXPLORATION vallécula, I-EXPLORATION faringe I-EXPLORATION y I-EXPLORATION senos I-EXPLORATION piriformes I-EXPLORATION (pasando I-EXPLORATION posteriormente I-EXPLORATION a I-EXPLORATION esófago I-EXPLORATION por I-EXPLORATION gravedad). I-EXPLORATION Con I-EXPLORATION 5 I-EXPLORATION cc I-EXPLORATION de I-EXPLORATION pudding I-EXPLORATION (más I-EXPLORATION espeso) I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION penetración I-EXPLORATION sin I-EXPLORATION reflejo I-EXPLORATION tusígeno; I-EXPLORATION deglución I-EXPLORATION fraccionada I-EXPLORATION con I-EXPLORATION acumulación I-EXPLORATION en I-EXPLORATION vallécula, I-EXPLORATION faringe I-EXPLORATION y I-EXPLORATION senos I-EXPLORATION piriformes; I-EXPLORATION enlentecimiento I-EXPLORATION del I-EXPLORATION paso I-EXPLORATION a I-EXPLORATION esófago I-EXPLORATION y I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION apertura I-EXPLORATION del I-EXPLORATION esfínter I-EXPLORATION esofágico I-EXPLORATION superior. I-EXPLORATION I-EXPLORATION En I-EXPLORATION este I-EXPLORATION paciente, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION su I-EXPLORATION patología I-EXPLORATION neurológica I-EXPLORATION de I-EXPLORATION base, I-EXPLORATION también I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION manometría I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION esofágica. I-EXPLORATION Con I-EXPLORATION dicha I-EXPLORATION prueba I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION hallazgos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION esfínter I-EXPLORATION esofágico I-EXPLORATION superior I-EXPLORATION hipertenso I-EXPLORATION con I-EXPLORATION pobre I-EXPLORATION bomba I-EXPLORATION faríngea I-EXPLORATION y I-EXPLORATION ondas I-EXPLORATION peristálticas I-EXPLORATION normales I-EXPLORATION alternando I-EXPLORATION con I-EXPLORATION contracciones I-EXPLORATION de I-EXPLORATION muy I-EXPLORATION baja I-EXPLORATION amplitud. I-EXPLORATION La I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION reposo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION esofágico I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION la I-EXPLORATION del I-EXPLORATION esfínter I-EXPLORATION esofágico I-EXPLORATION inferior I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION el I-EXPLORATION límite I-EXPLORATION bajo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION disfagia I-EXPLORATION orofaríngea I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION neurógena I-EXPLORATION y I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION un I-EXPLORATION abordaje I-EXPLORATION multidisciplinar. I-EXPLORATION Se B-TREATMENT prescribió I-TREATMENT espesante I-TREATMENT para I-TREATMENT líquidos I-TREATMENT y I-TREATMENT dieta I-TREATMENT hipercalórica I-TREATMENT en I-TREATMENT forma I-TREATMENT de I-TREATMENT textura I-TREATMENT néctar, I-TREATMENT administrándolos I-TREATMENT en I-TREATMENT pequeños I-TREATMENT volúmenes, I-TREATMENT que I-TREATMENT fue I-TREATMENT lo I-TREATMENT que I-TREATMENT mostró I-TREATMENT menor I-TREATMENT riesgo I-TREATMENT de I-TREATMENT aspiración I-TREATMENT en I-TREATMENT las I-TREATMENT pruebas I-TREATMENT de I-TREATMENT deglución I-TREATMENT realizadas. I-TREATMENT Se I-TREATMENT recomendaron I-TREATMENT medidas I-TREATMENT generales I-TREATMENT como I-TREATMENT evitar I-TREATMENT dobles I-TREATMENT texturas I-TREATMENT y I-TREATMENT posturar I-TREATMENT al I-TREATMENT paciente I-TREATMENT durante I-TREATMENT las I-TREATMENT comidas I-TREATMENT (tronco I-TREATMENT erguido, I-TREATMENT hombros I-TREATMENT simétricos, I-TREATMENT cabeza I-TREATMENT ligeramente I-TREATMENT flexionada), I-TREATMENT y I-TREATMENT también I-TREATMENT se I-TREATMENT solicitó I-TREATMENT interconsulta I-TREATMENT a I-TREATMENT Logopedia I-TREATMENT para I-TREATMENT ejercicios I-TREATMENT de I-TREATMENT rehabilitación I-TREATMENT de I-TREATMENT la I-TREATMENT deglución. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION en I-EVOLUTION años I-EVOLUTION posteriores I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION favorable; I-EVOLUTION presenta I-EVOLUTION atragantamientos I-EVOLUTION leves I-EVOLUTION pero I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION vuelto I-EVOLUTION a I-EVOLUTION ingresar I-EVOLUTION por I-EVOLUTION neumonía I-EVOLUTION aspirativa I-EVOLUTION ni I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION otras I-EVOLUTION complicaciones I-EVOLUTION como I-EVOLUTION deshidratación I-EVOLUTION o I-EVOLUTION desnutrición, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION no I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION considerado I-EVOLUTION la I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION una I-EVOLUTION gastrostomía. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY endometriosis, I-PAST_MEDICAL_HISTORY mioma I-PAST_MEDICAL_HISTORY uterino I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY embolización I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY miomectomía, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY alcoholismo. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY hijos; I-PAST_MEDICAL_HISTORY padres I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hermanos I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS perímetro I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS epigastrio I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pirosis, I-PRESENT_ILLNESS pesadez I-PRESENT_ILLNESS posprandial I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS continuo, I-PRESENT_ILLNESS más I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION distendido, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION epigastrio I-EXPLORATION y I-EXPLORATION mesogastrio, I-EXPLORATION indurada I-EXPLORATION y I-EXPLORATION dolorosa. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION esplenomegalia I-EXPLORATION ni I-EXPLORATION existe I-EXPLORATION semiología I-EXPLORATION de I-EXPLORATION ascitis. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION GGT, I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION (hemograma, I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION orina, I-EXPLORATION bioquímica I-EXPLORATION general, I-EXPLORATION proteinograma, I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION coagulación, I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION hepatotropos I-EXPLORATION y I-EXPLORATION tumorales), I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION abdominal I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION hepatomegalia I-EXPLORATION con I-EXPLORATION incontables I-EXPLORATION lesiones I-EXPLORATION quísticas; I-EXPLORATION destaca I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION derecho I-EXPLORATION (LHD) I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION páncreas I-EXPLORATION y I-EXPLORATION bazo I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Riñón I-EXPLORATION derecho I-EXPLORATION pélvico I-EXPLORATION por I-EXPLORATION desplazamiento I-EXPLORATION hepático. I-EXPLORATION Sendos I-EXPLORATION quistes I-EXPLORATION renales I-EXPLORATION bilaterales I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño. I-EXPLORATION Miomas I-EXPLORATION uterinos I-EXPLORATION calcificados. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION hepática I-EXPLORATION poliquística, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION gigante I-EXPLORATION en I-EXPLORATION LHD. I-EXPLORATION La I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION quistes I-EXPLORATION renales I-EXPLORATION significativos I-EXPLORATION y I-EXPLORATION de I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION poliquística I-EXPLORATION renal I-EXPLORATION permite I-EXPLORATION establecer I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION EHPA. I-EXPLORATION Posteriormente B-TREATMENT la I-TREATMENT paciente I-TREATMENT ingresa I-TREATMENT de I-TREATMENT forma I-TREATMENT programada I-TREATMENT a I-TREATMENT la I-TREATMENT planta I-TREATMENT del I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Digestivo, I-TREATMENT y I-TREATMENT se I-TREATMENT realiza I-TREATMENT un I-TREATMENT drenaje I-TREATMENT percutáneo I-TREATMENT con I-TREATMENT catéter I-TREATMENT 8F I-TREATMENT pig-tail, I-TREATMENT con I-TREATMENT control I-TREATMENT ecográfico I-TREATMENT del I-TREATMENT quiste I-TREATMENT hepático I-TREATMENT gigante, I-TREATMENT evacuándose I-TREATMENT un I-TREATMENT líquido I-TREATMENT transparente, I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT En I-TREATMENT un I-TREATMENT segundo I-TREATMENT tiempo, I-TREATMENT durante I-TREATMENT el I-TREATMENT mismo I-TREATMENT día, I-TREATMENT se I-TREATMENT realiza I-TREATMENT en I-TREATMENT el I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Radiología I-TREATMENT una I-TREATMENT quistografía I-TREATMENT transcatéter, I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT advierten I-TREATMENT signos I-TREATMENT de I-TREATMENT fugas I-TREATMENT de I-TREATMENT contraste I-TREATMENT y I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT instilación I-TREATMENT de I-TREATMENT 270 I-TREATMENT ml I-TREATMENT de I-TREATMENT alcohol I-TREATMENT puro I-TREATMENT durante I-TREATMENT treinta I-TREATMENT minutos, I-TREATMENT y I-TREATMENT que I-TREATMENT se I-TREATMENT aspira I-TREATMENT posteriormente. I-TREATMENT Más B-EVOLUTION tarde I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION analítica, I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION inmediatas. I-EVOLUTION Continúa I-EVOLUTION en I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION las I-EVOLUTION consultas, I-EVOLUTION permaneciendo I-EVOLUTION asintomática, I-EVOLUTION sin I-EVOLUTION requerir I-EVOLUTION más I-EVOLUTION sesiones I-EVOLUTION de I-EVOLUTION escleroterapia. I-EVOLUTION Tras I-EVOLUTION 4 I-EVOLUTION años I-EVOLUTION del I-EVOLUTION procedimiento, I-EVOLUTION se I-EVOLUTION le I-EVOLUTION realizó I-EVOLUTION un I-EVOLUTION TAC I-EVOLUTION abdominal, I-EVOLUTION observándose I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION tamaño I-EVOLUTION del I-EVOLUTION quiste I-EVOLUTION hepático I-EVOLUTION tratado I-EVOLUTION (8, I-EVOLUTION 4 I-EVOLUTION cm). I-EVOLUTION I-EVOLUTION En B-PRESENT_ILLNESS este I-PRESENT_ILLNESS trabajo I-PRESENT_ILLNESS presentamos I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY catorce I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esteatohepatitis I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY alcohólica I-PAST_MEDICAL_HISTORY -confirmada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY biopsia, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY indicar I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY misma-, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY periodo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY recomendaciones I-PAST_MEDICAL_HISTORY generales I-PAST_MEDICAL_HISTORY dietéticas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY práctica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ejercicio I-PAST_MEDICAL_HISTORY físico I-PAST_MEDICAL_HISTORY recreativo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY aeróbico. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sujeto I-PRESENT_ILLNESS participó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS programa I-PRESENT_ILLNESS individualizado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prescripción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ejercicio I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS supervisión, I-PRESENT_ILLNESS además I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seguir I-PRESENT_ILLNESS su I-PRESENT_ILLNESS control I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS habitual. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS incorporación I-PRESENT_ILLNESS al I-PRESENT_ILLNESS programa, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sujeto I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS las I-PRESENT_ILLNESS características I-PRESENT_ILLNESS antropométricas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fisiológicas I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS resumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tabla I-PRESENT_ILLNESS I. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS sujeto I-PRESENT_ILLNESS declaró: I-PRESENT_ILLNESS a) I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS físicamente I-PRESENT_ILLNESS activo I-PRESENT_ILLNESS -realizando I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS sesiones I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS semana, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pádel, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS rutas I-PRESENT_ILLNESS cicloturistas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS larga I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fines I-PRESENT_ILLNESS de I-PRESENT_ILLNESS semana, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS controlar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ninguna I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ellas-; I-PRESENT_ILLNESS y I-PRESENT_ILLNESS b) I-PRESENT_ILLNESS seguir I-PRESENT_ILLNESS una I-PRESENT_ILLNESS dieta I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS en I-PRESENT_ILLNESS lípidos, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alcohol I-PRESENT_ILLNESS o I-PRESENT_ILLNESS fármacos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manera I-PRESENT_ILLNESS habitual. I-PRESENT_ILLNESS A B-EXPLORATION su I-EXPLORATION incorporación I-EXPLORATION al I-EXPLORATION programa I-EXPLORATION se I-EXPLORATION estudió I-EXPLORATION su I-EXPLORATION condición I-EXPLORATION física I-EXPLORATION cardiorrespiratoria I-EXPLORATION -mediante I-EXPLORATION una I-EXPLORATION ergometría I-EXPLORATION submáxima I-EXPLORATION (conforme I-EXPLORATION al I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION YMCA) I-EXPLORATION (8) I-EXPLORATION - I-EXPLORATION y I-EXPLORATION su I-EXPLORATION fuerza I-EXPLORATION muscular I-EXPLORATION (conforme I-EXPLORATION al I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION Brzycki) I-EXPLORATION (9), I-EXPLORATION estimándose I-EXPLORATION con I-EXPLORATION ello I-EXPLORATION la I-EXPLORATION intensidad I-EXPLORATION a I-EXPLORATION la I-EXPLORATION que I-EXPLORATION prescribir I-EXPLORATION el I-EXPLORATION entrenamiento, I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION resistencia I-EXPLORATION aeróbica I-EXPLORATION como I-EXPLORATION de I-EXPLORATION fuerza, I-EXPLORATION respectivamente. I-EXPLORATION Se B-TREATMENT animó I-TREATMENT al I-TREATMENT sujeto I-TREATMENT a I-TREATMENT seguir I-TREATMENT manteniendo I-TREATMENT su I-TREATMENT práctica I-TREATMENT autónoma I-TREATMENT de I-TREATMENT ejercicio I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT instruyó I-TREATMENT para I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT un I-TREATMENT pulsómetro I-TREATMENT durante I-TREATMENT la I-TREATMENT misma, I-TREATMENT así I-TREATMENT como I-TREATMENT para I-TREATMENT recoger I-TREATMENT los I-TREATMENT datos I-TREATMENT de I-TREATMENT cada I-TREATMENT sesión I-TREATMENT en I-TREATMENT un I-TREATMENT "diario I-TREATMENT de I-TREATMENT entrenamiento" I-TREATMENT digital. I-TREATMENT Se I-TREATMENT diseñó I-TREATMENT un I-TREATMENT programa I-TREATMENT de I-TREATMENT entrenamiento I-TREATMENT -complementario I-TREATMENT al I-TREATMENT ejercicio I-TREATMENT auto-reportado I-TREATMENT por I-TREATMENT el I-TREATMENT paciente-, I-TREATMENT consistente I-TREATMENT en I-TREATMENT dos I-TREATMENT sesiones I-TREATMENT de I-TREATMENT una I-TREATMENT hora I-TREATMENT al I-TREATMENT día, I-TREATMENT en I-TREATMENT dos I-TREATMENT días I-TREATMENT no I-TREATMENT consecutivos, I-TREATMENT a I-TREATMENT realizar I-TREATMENT en I-TREATMENT gimnasio I-TREATMENT bajo I-TREATMENT supervisión I-TREATMENT de I-TREATMENT un I-TREATMENT instructor. I-TREATMENT Se I-TREATMENT intentó I-TREATMENT con I-TREATMENT estas I-TREATMENT sesiones I-TREATMENT complementarias I-TREATMENT ajustar I-TREATMENT la I-TREATMENT carga I-TREATMENT de I-TREATMENT entrenamiento I-TREATMENT del I-TREATMENT sujeto I-TREATMENT para I-TREATMENT que, I-TREATMENT sumada I-TREATMENT a I-TREATMENT la I-TREATMENT realizada I-TREATMENT espontáneamente I-TREATMENT por I-TREATMENT él, I-TREATMENT se I-TREATMENT cumplieran I-TREATMENT las I-TREATMENT recomendaciones I-TREATMENT del I-TREATMENT American I-TREATMENT College I-TREATMENT of I-TREATMENT Sports I-TREATMENT Medicine I-TREATMENT (10). I-TREATMENT Periódicamente I-TREATMENT se I-TREATMENT reevaluaba I-TREATMENT la I-TREATMENT condición I-TREATMENT física I-TREATMENT del I-TREATMENT paciente, I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT reajustar I-TREATMENT las I-TREATMENT intensidades I-TREATMENT de I-TREATMENT entrenamiento I-TREATMENT a I-TREATMENT las I-TREATMENT mejoras I-TREATMENT funcionales I-TREATMENT que I-TREATMENT se I-TREATMENT iban I-TREATMENT consiguiendo I-TREATMENT progresivamente I-TREATMENT con I-TREATMENT el I-TREATMENT mismo. I-TREATMENT En B-EXPLORATION un I-EXPLORATION análisis I-EXPLORATION post I-EXPLORATION hoc I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION cuatro I-EXPLORATION grandes I-EXPLORATION periodos I-EXPLORATION según I-EXPLORATION el I-EXPLORATION porcentaje I-EXPLORATION promedio I-EXPLORATION de I-EXPLORATION carga I-EXPLORATION de I-EXPLORATION trabajo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sesión I-EXPLORATION que I-EXPLORATION se I-EXPLORATION dedicaba I-EXPLORATION a I-EXPLORATION mejorar I-EXPLORATION la I-EXPLORATION resistencia I-EXPLORATION cardiorrespiratoria I-EXPLORATION y I-EXPLORATION la I-EXPLORATION fuerza I-EXPLORATION muscular. I-EXPLORATION Durante B-TREATMENT el I-TREATMENT periodo I-TREATMENT de I-TREATMENT intervención I-TREATMENT no I-TREATMENT se I-TREATMENT realizaron I-TREATMENT ajustes I-TREATMENT de I-TREATMENT la I-TREATMENT dieta, I-TREATMENT sino I-TREATMENT que I-TREATMENT el I-TREATMENT sujeto I-TREATMENT siguió I-TREATMENT manteniendo I-TREATMENT las I-TREATMENT pautas I-TREATMENT nutricionales I-TREATMENT que I-TREATMENT le I-TREATMENT eran I-TREATMENT indicadas I-TREATMENT en I-TREATMENT sus I-TREATMENT controles I-TREATMENT médicos I-TREATMENT periódicos. I-TREATMENT I-TREATMENT Tras B-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION este I-EVOLUTION entrenamiento I-EVOLUTION complementario I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION objetivar I-EVOLUTION un I-EVOLUTION incremento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION cardiorrespiratoria I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fuerza I-EVOLUTION muscular I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION indica I-EVOLUTION que I-EVOLUTION tanto I-EVOLUTION la I-EVOLUTION intensidad, I-EVOLUTION como I-EVOLUTION la I-EVOLUTION periodización I-EVOLUTION y I-EVOLUTION planificación I-EVOLUTION de I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION complementarias I-EVOLUTION de I-EVOLUTION ejercicio I-EVOLUTION fueron I-EVOLUTION los I-EVOLUTION correctos I-EVOLUTION como I-EVOLUTION para I-EVOLUTION desencadenar I-EVOLUTION y I-EVOLUTION mantener I-EVOLUTION las I-EVOLUTION adaptaciones I-EVOLUTION fisiológicas I-EVOLUTION buscadas. I-EVOLUTION Los I-EVOLUTION parámetros I-EVOLUTION analíticos I-EVOLUTION registrados I-EVOLUTION en I-EVOLUTION las I-EVOLUTION revisiones I-EVOLUTION periódicas I-EVOLUTION realizadas I-EVOLUTION mostraron I-EVOLUTION un I-EVOLUTION importante I-EVOLUTION cambio I-EVOLUTION de I-EVOLUTION tendencia I-EVOLUTION en I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION colesterolemia I-EVOLUTION y I-EVOLUTION de I-EVOLUTION trigliceridemia I-EVOLUTION -datos I-EVOLUTION no I-EVOLUTION mostrados- I-EVOLUTION en I-EVOLUTION el I-EVOLUTION periodo I-EVOLUTION de I-EVOLUTION intervención. I-EVOLUTION Del I-EVOLUTION mismo I-EVOLUTION modo, I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION plasmáticos I-EVOLUTION de I-EVOLUTION transaminasas, I-EVOLUTION aunque I-EVOLUTION siguieron I-EVOLUTION elevados, I-EVOLUTION mostraron I-EVOLUTION una I-EVOLUTION tendencia I-EVOLUTION a I-EVOLUTION ser I-EVOLUTION inferiores I-EVOLUTION al I-EVOLUTION periodo I-EVOLUTION anterior I-EVOLUTION a I-EVOLUTION la I-EVOLUTION entrada I-EVOLUTION del I-EVOLUTION sujeto I-EVOLUTION en I-EVOLUTION el I-EVOLUTION programa, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION a I-EVOLUTION mostrar I-EVOLUTION menor I-EVOLUTION dispersión. I-EVOLUTION No I-EVOLUTION se I-EVOLUTION observó, I-EVOLUTION sin I-EVOLUTION embargo, I-EVOLUTION ninguna I-EVOLUTION reducción I-EVOLUTION del I-EVOLUTION peso I-EVOLUTION corporal I-EVOLUTION o I-EVOLUTION del I-EVOLUTION porcentaje I-EVOLUTION de I-EVOLUTION masa I-EVOLUTION grasa I-EVOLUTION que, I-EVOLUTION por I-EVOLUTION el I-EVOLUTION contrario, I-EVOLUTION tendieron I-EVOLUTION a I-EVOLUTION elevarse. I-EVOLUTION De I-EVOLUTION todo I-EVOLUTION ello I-EVOLUTION se I-EVOLUTION puede I-EVOLUTION concluir I-EVOLUTION que I-EVOLUTION con I-EVOLUTION las I-EVOLUTION adaptaciones I-EVOLUTION fisiológicas I-EVOLUTION que I-EVOLUTION se I-EVOLUTION logran I-EVOLUTION con I-EVOLUTION el I-EVOLUTION ejercicio I-EVOLUTION adecuadamente I-EVOLUTION "dosificado", I-EVOLUTION puede I-EVOLUTION alterarse I-EVOLUTION el I-EVOLUTION curso I-EVOLUTION natural I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION Por I-EVOLUTION el I-EVOLUTION contrario, I-EVOLUTION la I-EVOLUTION realización I-EVOLUTION autónoma I-EVOLUTION y I-EVOLUTION recreativa I-EVOLUTION de I-EVOLUTION ejercicio I-EVOLUTION no I-EVOLUTION lograría I-EVOLUTION dichas I-EVOLUTION adaptaciones, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION resultaría I-EVOLUTION ineficaz I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS anal, I-PRESENT_ILLNESS sangrado I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cambio I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS heces, I-PRESENT_ILLNESS estudiado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS centro, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS han I-PRESENT_ILLNESS realizado I-PRESENT_ILLNESS colonoscopia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS resonancia I-PRESENT_ILLNESS magnética I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS ano-rectal, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS ecoendoscopia I-PRESENT_ILLNESS diagnosticándose I-PRESENT_ILLNESS de I-PRESENT_ILLNESS anillo I-PRESENT_ILLNESS estenótico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS importantes I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS inflamatorios I-PRESENT_ILLNESS que I-PRESENT_ILLNESS desestructuran I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pared, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS poder I-PRESENT_ILLNESS definir I-PRESENT_ILLNESS infiltración, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS biospias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS displasia I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS úlcera I-PRESENT_ILLNESS rectal I-PRESENT_ILLNESS solitaria. I-PRESENT_ILLNESS Se B-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY han I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dicho I-PAST_MEDICAL_HISTORY centro I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY anorrectoplastias, I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY colgajo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Z I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY dilataciones, I-PAST_MEDICAL_HISTORY persistiendo I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY crónico. I-PAST_MEDICAL_HISTORY En B-EXPLORATION nuestro I-EXPLORATION centro I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION importante I-EXPLORATION dolor I-EXPLORATION mal I-EXPLORATION controlado I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION altas I-EXPLORATION dosis I-EXPLORATION de I-EXPLORATION mórficos, I-EXPLORATION incontinencia I-EXPLORATION rectal I-EXPLORATION severa I-EXPLORATION y I-EXPLORATION exploración I-EXPLORATION rectal I-EXPLORATION con I-EXPLORATION estenosis I-EXPLORATION a I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION línea I-EXPLORATION pectínea I-EXPLORATION que I-EXPLORATION permite I-EXPLORATION malamente I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION un I-EXPLORATION dedo. I-EXPLORATION Ante B-TREATMENT este I-TREATMENT cuadro, I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT resección I-TREATMENT anterior I-TREATMENT laparoscópica I-TREATMENT ultrabaja. I-TREATMENT Intraoperatoriamente I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT pulltrough I-TREATMENT endoanal, I-TREATMENT a I-TREATMENT expensas I-TREATMENT de I-TREATMENT la I-TREATMENT anatomía I-TREATMENT patológica I-TREATMENT definitiva, I-TREATMENT siendo I-TREATMENT el I-TREATMENT resultado I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT adenocarcinoma I-TREATMENT de I-TREATMENT glándulas I-TREATMENT anales I-TREATMENT sin I-TREATMENT áreas I-TREATMENT mucinosas, I-TREATMENT CD7 I-TREATMENT (+) I-TREATMENT /CD20 I-TREATMENT (-) I-TREATMENT /PSA I-TREATMENT (-), I-TREATMENT T3 I-TREATMENT N0, I-TREATMENT con I-TREATMENT márgenes I-TREATMENT radial I-TREATMENT y I-TREATMENT distal I-TREATMENT afectos, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decide I-TREATMENT completar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT mediante I-TREATMENT amputación I-TREATMENT abdómino-perineal I-TREATMENT cilíndrica I-TREATMENT laparoscópica. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION supervivencia I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION a I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticada B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EW I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cirrosis I-PAST_MEDICAL_HISTORY hepática I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY portal, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY afectación I-PAST_MEDICAL_HISTORY neuropsiquiátrica. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY D-penicilamina I-PAST_MEDICAL_HISTORY (350 I-PAST_MEDICAL_HISTORY mg/8 I-PAST_MEDICAL_HISTORY horas I-PAST_MEDICAL_HISTORY v.o.) I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico. I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS flexibilidad I-PRESENT_ILLNESS cutánea, I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pápulas I-PRESENT_ILLNESS blanquecinas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS redundante I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS y I-PRESENT_ILLNESS axilar. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION pseudo-pseudoxantoma I-EXPLORATION elástico I-EXPLORATION (PPXE) I-EXPLORATION secundario I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION D-penicilamina. I-EXPLORATION Ante B-TREATMENT este I-TREATMENT hallazgo I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT D-penicilamina I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT acetato I-TREATMENT de I-TREATMENT zinc I-TREATMENT (50 I-TREATMENT mg/8 I-TREATMENT horas I-TREATMENT v.o.). I-TREATMENT Así B-EXPLORATION mismo, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION examen I-EXPLORATION oftalmológico I-EXPLORATION y I-EXPLORATION ecocardiográfico I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION elástico I-EXPLORATION a I-EXPLORATION otro I-EXPLORATION nivel, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatopatía I-PAST_MEDICAL_HISTORY previa, I-PAST_MEDICAL_HISTORY consumidora B-PRESENT_ILLNESS habitual I-PRESENT_ILLNESS de I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Herbalife I-PRESENT_ILLNESS y I-PRESENT_ILLNESS zumo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Noni. I-PRESENT_ILLNESS Acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS inespecífico, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS e I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS mucocutánea. I-PRESENT_ILLNESS No B-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION deterioro I-EXPLORATION neurológico. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION destacaba: I-EXPLORATION ALT I-EXPLORATION 940 I-EXPLORATION U/l, I-EXPLORATION AST I-EXPLORATION 1300 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 173U/l, I-EXPLORATION FA I-EXPLORATION 187 I-EXPLORATION U/l, I-EXPLORATION LDH I-EXPLORATION 431 I-EXPLORATION U/l, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 21, I-EXPLORATION 45 I-EXPLORATION mg/dl, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION del I-EXPLORATION 41% I-EXPLORATION (INR I-EXPLORATION 2.03). I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION etiología I-EXPLORATION incluyó I-EXPLORATION serologías I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION hepatotropos: I-EXPLORATION VHA, I-EXPLORATION VHB, I-EXPLORATION VHC, I-EXPLORATION VHE, I-EXPLORATION CMV, I-EXPLORATION EB, I-EXPLORATION VVZ, I-EXPLORATION HHV I-EXPLORATION 6-8 I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION IgG I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION negativas. I-EXPLORATION Serología I-EXPLORATION VIH I-EXPLORATION negativa. I-EXPLORATION ARN-VHC I-EXPLORATION y I-EXPLORATION ADN-VHB I-EXPLORATION negativos. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION Coxiella, I-EXPLORATION T. I-EXPLORATION Cruzi, I-EXPLORATION Treponema I-EXPLORATION y I-EXPLORATION Brucella, I-EXPLORATION fueron I-EXPLORATION negativas I-EXPLORATION para I-EXPLORATION IgG I-EXPLORATION e I-EXPLORATION IgM. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION además I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Wilson, I-EXPLORATION deficiencia I-EXPLORATION de I-EXPLORATION alfa I-EXPLORATION 1 I-EXPLORATION antitripsina I-EXPLORATION y I-EXPLORATION hepatitis I-EXPLORATION autoinmune. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION colangio-hepato I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION descartaron I-EXPLORATION patología I-EXPLORATION biliopancreática. I-EXPLORATION La I-EXPLORATION evolución I-EXPLORATION analítica I-EXPLORATION fue I-EXPLORATION tórpida I-EXPLORATION como I-EXPLORATION se I-EXPLORATION muestra I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION I. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION transyugular I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION hepatitis I-EXPLORATION lobulillar I-EXPLORATION con I-EXPLORATION necrosis I-EXPLORATION confluente I-EXPLORATION que I-EXPLORATION iniciaba I-EXPLORATION transformación I-EXPLORATION nodular. I-EXPLORATION I-EXPLORATION En B-EVOLUTION la I-EVOLUTION tercera I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION desarrolló I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION encefalopatía I-EVOLUTION hepática I-EVOLUTION grado I-EVOLUTION II I-EVOLUTION y I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION clínico I-EVOLUTION con I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION ascitis. I-EVOLUTION El B-TREATMENT cuadro I-TREATMENT clínico I-TREATMENT progresó I-TREATMENT hacia I-TREATMENT fallo I-TREATMENT hepático I-TREATMENT que I-TREATMENT precisó I-TREATMENT trasplante I-TREATMENT hepático I-TREATMENT urgente, I-TREATMENT con I-TREATMENT buena I-TREATMENT evolución I-TREATMENT posterior. I-TREATMENT I-TREATMENT Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS por I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS abdominalgia I-PRESENT_ILLNESS generalizada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS horario I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS que I-PRESENT_ILLNESS incluso I-PRESENT_ILLNESS la I-PRESENT_ILLNESS despierta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS noche. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS asocia I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hábito I-PRESENT_ILLNESS deposicional. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realiza I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION hemoglobina I-EXPLORATION 12, I-EXPLORATION 6 I-EXPLORATION g/dl, I-EXPLORATION volumen I-EXPLORATION corpuscular I-EXPLORATION medio I-EXPLORATION 79, I-EXPLORATION 6 I-EXPLORATION fl. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION hemograma I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION Además, I-EXPLORATION presenta I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION con I-EXPLORATION AST, I-EXPLORATION ALT I-EXPLORATION y I-EXPLORATION GGT I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Destaca I-EXPLORATION ferropenia I-EXPLORATION con I-EXPLORATION ferritina I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION ng/ml I-EXPLORATION (20-200 I-EXPLORATION ng/ml) I-EXPLORATION sin I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda I-EXPLORATION (proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION y I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular). I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION despistaje I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION celiaca I-EXPLORATION con I-EXPLORATION IgA I-EXPLORATION total, I-EXPLORATION anticuerpos I-EXPLORATION antitransglutaminasa I-EXPLORATION (IgA-AAT), I-EXPLORATION anticuerpos I-EXPLORATION antipéptido I-EXPLORATION deaminado I-EXPLORATION de I-EXPLORATION gliadina I-EXPLORATION que I-EXPLORATION son I-EXPLORATION negativos I-EXPLORATION y I-EXPLORATION HLA I-EXPLORATION DQ2-DQ8 I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION enfermedad I-EXPLORATION celiaca. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION sensibilización I-EXPLORATION alimentaria I-EXPLORATION con I-EXPLORATION IgE I-EXPLORATION total I-EXPLORATION y I-EXPLORATION específica I-EXPLORATION a I-EXPLORATION proteínas I-EXPLORATION de I-EXPLORATION leche I-EXPLORATION de I-EXPLORATION vaca I-EXPLORATION (PLV) I-EXPLORATION y I-EXPLORATION a I-EXPLORATION huevo I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Tras I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION normales, I-EXPLORATION se I-EXPLORATION había I-EXPLORATION realizado I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION en I-EXPLORATION otro I-EXPLORATION centro I-EXPLORATION hospitalario I-EXPLORATION con I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION gastritis, I-EXPLORATION con I-EXPLORATION test I-EXPLORATION rápido I-EXPLORATION de I-EXPLORATION ureasa I-EXPLORATION en I-EXPLORATION biopsia I-EXPLORATION antral I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION Helicobacter I-EXPLORATION pylori. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION otras I-EXPLORATION muestras I-EXPLORATION gástricas I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION anatomopatológico. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT IBP I-TREATMENT a I-TREATMENT dosis I-TREATMENT altas I-TREATMENT (2 I-TREATMENT mg/ I-TREATMENT kg/día) I-TREATMENT con I-TREATMENT mejoría I-TREATMENT inicial I-TREATMENT presentando I-TREATMENT recaída I-TREATMENT al I-TREATMENT suspender I-TREATMENT IBP I-TREATMENT a I-TREATMENT los I-TREATMENT 2 I-TREATMENT meses. I-TREATMENT I-TREATMENT Reconsulta B-EVOLUTION en I-EVOLUTION nuestro I-EVOLUTION centro I-EVOLUTION por I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION sintomatología, I-EVOLUTION dolor I-EVOLUTION más I-EVOLUTION localizado I-EVOLUTION e I-EVOLUTION intensificado I-EVOLUTION en I-EVOLUTION epigastrio I-EVOLUTION en I-EVOLUTION el I-EVOLUTION último I-EVOLUTION mes. I-EVOLUTION Se B-EXPLORATION decide I-EXPLORATION nueva I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION únicamente I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION en I-EXPLORATION antro I-EXPLORATION gástrico. I-EXPLORATION Se I-EXPLORATION toman I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION antro I-EXPLORATION gástrico I-EXPLORATION para I-EXPLORATION test I-EXPLORATION rápido I-EXPLORATION de I-EXPLORATION ureasa I-EXPLORATION para I-EXPLORATION Helicobacter I-EXPLORATION pylori I-EXPLORATION que I-EXPLORATION es I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION anatomopatológico. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION descripción I-EXPLORATION histológica I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION gástrica I-EXPLORATION con I-EXPLORATION moderado I-EXPLORATION componente I-EXPLORATION inflamatorio I-EXPLORATION linfoplasmocitario I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION colágena I-EXPLORATION subepitelial I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION parcheada I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION que I-EXPLORATION superan I-EXPLORATION las I-EXPLORATION 10 I-EXPLORATION micras I-EXPLORATION de I-EXPLORATION espesor I-EXPLORATION y I-EXPLORATION que I-EXPLORATION también I-EXPLORATION se I-EXPLORATION distribuyen I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION linfocitosis I-EXPLORATION intraepitelial I-EXPLORATION significativa, I-EXPLORATION ni I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION Helicobacter I-EXPLORATION pylori. I-EXPLORATION Las I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION esófago I-EXPLORATION y I-EXPLORATION duodeno I-EXPLORATION no I-EXPLORATION presentan I-EXPLORATION alteraciones I-EXPLORATION histológicas. I-EXPLORATION I-EXPLORATION Orientada I-EXPLORATION como I-EXPLORATION GC I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION colonoscopia I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION colitis I-EXPLORATION colágena I-EXPLORATION asociada I-EXPLORATION que I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION tanto I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION como I-EXPLORATION histológicamente. I-EXPLORATION Se B-TREATMENT reinicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT esomeprazol I-TREATMENT oral I-TREATMENT 40 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 24 I-TREATMENT horas, I-TREATMENT desapareciendo I-TREATMENT la I-TREATMENT sintomatología I-TREATMENT a I-TREATMENT los I-TREATMENT pocos I-TREATMENT días I-TREATMENT junto I-TREATMENT suplemento I-TREATMENT de I-TREATMENT hierro I-TREATMENT oral. I-TREATMENT A I-TREATMENT los I-TREATMENT 3 I-TREATMENT meses I-TREATMENT de I-TREATMENT inicio I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT puede I-TREATMENT disminuir I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT IBP I-TREATMENT a I-TREATMENT la I-TREATMENT mitad I-TREATMENT permaneciendo B-EVOLUTION asintomática I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY relevantes, I-PAST_MEDICAL_HISTORY con B-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS esofágica I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Dos B-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY impactación I-PAST_MEDICAL_HISTORY alimentaria. I-PAST_MEDICAL_HISTORY El B-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION gastroduodenal I-EXPLORATION baritado I-EXPLORATION (EGD) I-EXPLORATION detectó I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION esofágico I-EXPLORATION inferior I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION sacular I-EXPLORATION con I-EXPLORATION nivel I-EXPLORATION hidroaéreo, I-EXPLORATION bien I-EXPLORATION delimitada I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION tóraco-abdominal I-EXPLORATION corroboró I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION descritos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION EGD. I-EXPLORATION La I-EXPLORATION gastroscopia I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION doble I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION con I-EXPLORATION contenido I-EXPLORATION alimentario I-EXPLORATION semisólido I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION I-EXPLORATION Varón 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 reseñables, I-PAST_MEDICAL_HISTORY remitido B-DERIVED_FROM/TO desde I-DERIVED_FROM/TO otorrinolaringología I-DERIVED_FROM/TO por I-DERIVED_FROM/TO sensación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cuerpo I-DERIVED_FROM/TO extraño I-DERIVED_FROM/TO faringo-laríngeo I-DERIVED_FROM/TO para I-DERIVED_FROM/TO descartar I-DERIVED_FROM/TO reflujo I-DERIVED_FROM/TO gastroesofágico. I-DERIVED_FROM/TO El B-EXPLORATION EGD I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION sacular I-EXPLORATION en I-EXPLORATION región I-EXPLORATION epifrénica, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION endoscópicamente. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY virus I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hiato, I-PAST_MEDICAL_HISTORY con B-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS esofágica I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pirosis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS ocasionales I-PRESENT_ILLNESS de I-PRESENT_ILLNESS regurgitación I-PRESENT_ILLNESS alimentaria. I-PRESENT_ILLNESS El B-EXPLORATION EGD I-EXPLORATION identificó I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION sacular I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION boca I-EXPLORATION ancha I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION distales I-EXPLORATION del I-EXPLORATION esófago I-EXPLORATION y I-EXPLORATION una I-EXPLORATION hernia I-EXPLORATION hiatal I-EXPLORATION por I-EXPLORATION deslizamiento. I-EXPLORATION La I-EXPLORATION endoscopia I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION divertículo, I-EXPLORATION con I-EXPLORATION contenido I-EXPLORATION alimentario I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION a I-EXPLORATION 30 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arcada I-EXPLORATION dentaria. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY con B-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sólidos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS líquidos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS broncoaspiración. I-PRESENT_ILLNESS El B-EXPLORATION EGD I-EXPLORATION sugería I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION contracciones I-EXPLORATION terciarias I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION inferior, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION divertículo I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION derecha I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 9x2, I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION diámetro I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION endoscópico. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 86 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY multinodular I-PAST_MEDICAL_HISTORY endotorácico, I-PAST_MEDICAL_HISTORY esofagitis I-PAST_MEDICAL_HISTORY denudativa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2011 I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY amoxicilina, I-PAST_MEDICAL_HISTORY divertículo I-PAST_MEDICAL_HISTORY esofágico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pequeña I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hiato. I-PAST_MEDICAL_HISTORY Presentaba B-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS a I-PRESENT_ILLNESS líquidos I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS motivó I-PRESENT_ILLNESS ingresos I-PRESENT_ILLNESS hospitalarios I-PRESENT_ILLNESS por I-PRESENT_ILLNESS broncoaspiración I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS ocasiones. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION último I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION divertículo I-EXPLORATION ya I-EXPLORATION conocido I-EXPLORATION situado I-EXPLORATION a I-EXPLORATION unos I-EXPLORATION 28 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION arcada I-EXPLORATION dentaria I-EXPLORATION en I-EXPLORATION la I-EXPLORATION endoscopia. I-EXPLORATION I-EXPLORATION A I-EXPLORATION los I-EXPLORATION seis I-EXPLORATION pacientes I-EXPLORATION descritos I-EXPLORATION se I-EXPLORATION les I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION manometría I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución I-EXPLORATION (MAR), I-EXPLORATION identificándose I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION un I-EXPLORATION trastorno I-EXPLORATION motor I-EXPLORATION esofágico I-EXPLORATION (TME) I-EXPLORATION concomitante. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION obtenidos I-EXPLORATION con I-EXPLORATION MAR I-EXPLORATION en I-EXPLORATION cada I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION I. I-EXPLORATION Se I-EXPLORATION utilizaron I-EXPLORATION como I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION descritos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION de I-EXPLORATION Chicago I-EXPLORATION vigente I-EXPLORATION (7). I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION caso I-EXPLORATION presentaba I-EXPLORATION ondas I-EXPLORATION hipercontráctiles I-EXPLORATION en I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION S2 I-EXPLORATION y I-EXPLORATION S3, I-EXPLORATION siendo I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION manométrico I-EXPLORATION de I-EXPLORATION TME I-EXPLORATION hipercontráctil I-EXPLORATION ("jackhammer"). I-EXPLORATION La I-EXPLORATION MAR I-EXPLORATION del I-EXPLORATION segundo I-EXPLORATION paciente I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION TME I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION espasmo I-EXPLORATION esofágico I-EXPLORATION distal, I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION S3. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION tercer I-EXPLORATION caso, I-EXPLORATION la I-EXPLORATION MAR I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION TME I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION peristalsis I-EXPLORATION débil I-EXPLORATION por I-EXPLORATION defecto I-EXPLORATION peristáltico I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contorno I-EXPLORATION isobárico I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION mmHg I-EXPLORATION (en I-EXPLORATION el I-EXPLORATION 50% I-EXPLORATION de I-EXPLORATION las I-EXPLORATION degluciones), I-EXPLORATION con I-EXPLORATION ondas I-EXPLORATION de I-EXPLORATION duración I-EXPLORATION prolongada I-EXPLORATION y I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION doble I-EXPLORATION y I-EXPLORATION triple I-EXPLORATION pico I-EXPLORATION en I-EXPLORATION un I-EXPLORATION 56% I-EXPLORATION y I-EXPLORATION 11% I-EXPLORATION de I-EXPLORATION las I-EXPLORATION degluciones I-EXPLORATION respectivamente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION S3. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION del I-EXPLORATION caso I-EXPLORATION 4 I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION obstrucción I-EXPLORATION al I-EXPLORATION tracto I-EXPLORATION de I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION gastroesofágica I-EXPLORATION (UGE) I-EXPLORATION y I-EXPLORATION simultáneamente I-EXPLORATION un I-EXPLORATION TME I-EXPLORATION con I-EXPLORATION rasgos I-EXPLORATION de I-EXPLORATION acalasia I-EXPLORATION tipo I-EXPLORATION III I-EXPLORATION (espástica) I-EXPLORATION de I-EXPLORATION probable I-EXPLORATION origen I-EXPLORATION secundario, I-EXPLORATION observándose I-EXPLORATION gran I-EXPLORATION duración I-EXPLORATION de I-EXPLORATION las I-EXPLORATION ondas I-EXPLORATION peristálticas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION S2 I-EXPLORATION (a I-EXPLORATION unos I-EXPLORATION 30 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION orificio I-EXPLORATION nasal). I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION 5 I-EXPLORATION presentó I-EXPLORATION también I-EXPLORATION un I-EXPLORATION TME I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION hipercontráctil I-EXPLORATION ("jackhammer") I-EXPLORATION con I-EXPLORATION ondas I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION en I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION S2 I-EXPLORATION y I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION en I-EXPLORATION S3. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION del I-EXPLORATION caso I-EXPLORATION 6 I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION TME I-EXPLORATION consistente I-EXPLORATION en I-EXPLORATION obstrucción I-EXPLORATION al I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION UGE, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION contráctil I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION del I-EXPLORATION divertículo I-EXPLORATION esofágico I-EXPLORATION consistente I-EXPLORATION en I-EXPLORATION ensanchamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION de I-EXPLORATION contracción I-EXPLORATION (entre I-EXPLORATION segmentos I-EXPLORATION S2-S3). I-EXPLORATION I-EXPLORATION En I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION casos I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION predominantemente I-EXPLORATION afectado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION MAR, I-EXPLORATION coincidió I-EXPLORATION con I-EXPLORATION la I-EXPLORATION localización I-EXPLORATION del I-EXPLORATION DE I-EXPLORATION objetivada I-EXPLORATION en I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION radiológicos I-EXPLORATION y I-EXPLORATION endoscópicos. I-EXPLORATION I-EXPLORATION Cinco B-DERIVED_FROM/TO de I-DERIVED_FROM/TO los I-DERIVED_FROM/TO pacientes I-DERIVED_FROM/TO fueron I-DERIVED_FROM/TO remitidos I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO quirúrgico. I-DERIVED_FROM/TO El B-TREATMENT paciente I-TREATMENT del I-TREATMENT primer I-TREATMENT caso I-TREATMENT fue I-TREATMENT tratado I-TREATMENT mediante I-TREATMENT diverticulectomía I-TREATMENT que I-TREATMENT se I-TREATMENT complicó I-TREATMENT con I-TREATMENT fístula I-TREATMENT esófago-pleural I-TREATMENT y I-TREATMENT que I-TREATMENT fue I-TREATMENT tratada I-TREATMENT mediante I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT prótesis I-TREATMENT esofágica I-TREATMENT metálica I-TREATMENT cubierta I-TREATMENT (Wallflex®). I-TREATMENT Los I-TREATMENT pacientes I-TREATMENT del I-TREATMENT segundo I-TREATMENT y I-TREATMENT tercer I-TREATMENT caso I-TREATMENT decidieron I-TREATMENT continuar I-TREATMENT un I-TREATMENT manejo I-TREATMENT conservador, I-TREATMENT tras I-TREATMENT desestimar I-TREATMENT la I-TREATMENT opción I-TREATMENT de I-TREATMENT cirugía I-TREATMENT debido I-TREATMENT al I-TREATMENT riesgo I-TREATMENT de I-TREATMENT morbi-mortalidad I-TREATMENT asociado I-TREATMENT al I-TREATMENT mismo. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION del I-EVOLUTION cuarto I-EVOLUTION caso I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION alta, I-EVOLUTION identificándose B-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION endoscópico I-EXPLORATION urgente I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION coágulo I-EXPLORATION adherido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION del I-EXPLORATION divertículo. I-EXPLORATION Ello B-EVOLUTION aceleró I-EVOLUTION la I-EVOLUTION decisión I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION quirúrgico I-EVOLUTION del I-EVOLUTION DE, I-EVOLUTION una I-EVOLUTION vez I-EVOLUTION superado I-EVOLUTION el I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION digestivo. I-EVOLUTION No I-EVOLUTION obstante, I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores I-EVOLUTION al I-EVOLUTION evento I-EVOLUTION hemorrágico, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION desarrolló I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION séptico I-EVOLUTION secundario I-EVOLUTION a I-EVOLUTION neumonía I-EVOLUTION de I-EVOLUTION origen I-EVOLUTION espirativo, I-EVOLUTION falleciendo I-EVOLUTION finalmente. I-EVOLUTION La B-TREATMENT paciente I-TREATMENT del I-TREATMENT quinto I-TREATMENT caso I-TREATMENT fue I-TREATMENT tratada I-TREATMENT quirúrgicamente I-TREATMENT realizándose I-TREATMENT diverticulectomía I-TREATMENT y I-TREATMENT miotomía I-TREATMENT mediante I-TREATMENT toracoscopia. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION tórpida I-EVOLUTION al I-EVOLUTION presentar I-EVOLUTION mediastinitis I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION fístula I-EVOLUTION esófago-pleural. I-EVOLUTION Se B-TREATMENT trató I-TREATMENT la I-TREATMENT misma I-TREATMENT mediante I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT prótesis I-TREATMENT esofágica I-TREATMENT metálica I-TREATMENT cubierta I-TREATMENT (Wallflex®). I-TREATMENT La I-TREATMENT paciente I-TREATMENT número I-TREATMENT seis I-TREATMENT fue I-TREATMENT tratada I-TREATMENT mediante I-TREATMENT inyección I-TREATMENT de I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT UGE I-TREATMENT para I-TREATMENT resolver I-TREATMENT el I-TREATMENT cuadro I-TREATMENT de I-TREATMENT obstrucción I-TREATMENT funcional. I-TREATMENT Se I-TREATMENT consideró I-TREATMENT el I-TREATMENT mejor I-TREATMENT tratamiento I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT edad I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT mejorando I-TREATMENT la I-TREATMENT sintomatología. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS español, B-PAST_MEDICAL_HISTORY ingeniero I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY caminos I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY residido I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Costa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Marfil I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY motivos I-PAST_MEDICAL_HISTORY laborales. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS actualidad I-PRESENT_ILLNESS regresa I-PRESENT_ILLNESS a I-PRESENT_ILLNESS España I-PRESENT_ILLNESS y I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS perianal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS difuso I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS cólico. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS asocia I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS deposición I-PRESENT_ILLNESS es I-PRESENT_ILLNESS diarreica, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deja I-PRESENT_ILLNESS entrever I-PRESENT_ILLNESS un I-PRESENT_ILLNESS gusano I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS tamaño. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destaca I-EXPLORATION dolor I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION derecha. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION resalta I-EXPLORATION discreta I-EXPLORATION eosinofilia I-EXPLORATION (750 I-EXPLORATION eosinófilos I-EXPLORATION por I-EXPLORATION microlitro). I-EXPLORATION I-EXPLORATION La I-EXPLORATION visualización I-EXPLORATION macroscópica I-EXPLORATION del I-EXPLORATION parásito I-EXPLORATION impresiona I-EXPLORATION de I-EXPLORATION Taenia. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION diferido I-EXPLORATION microbiológico I-EXPLORATION lo I-EXPLORATION describe I-EXPLORATION como I-EXPLORATION Taenia I-EXPLORATION saginata I-EXPLORATION (T. I-EXPLORATION saginata). I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 85 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY hipertensiva, I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY crónica, I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY isquémico I-PAST_MEDICAL_HISTORY transitorio I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY secuelas I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY infecciones I-PAST_MEDICAL_HISTORY respiratorias I-PAST_MEDICAL_HISTORY recurrentes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY broncoaspiración. I-PAST_MEDICAL_HISTORY Intervenido B-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS subcapital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fémur I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS corrección I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS coagulación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS A B-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION presenta I-EXPLORATION dificultad I-EXPLORATION respiratoria I-EXPLORATION y I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION consciencia I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION pulmonar, I-EXPLORATION con I-EXPLORATION mejoría I-EXPLORATION tras I-EXPLORATION antibioterapia. I-EXPLORATION A I-EXPLORATION las I-EXPLORATION 96 I-EXPLORATION horas I-EXPLORATION postoperatorias I-EXPLORATION presenta I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION brusco, I-EXPLORATION vómitos I-EXPLORATION y I-EXPLORATION distensión. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION abdomen: I-EXPLORATION aire I-EXPLORATION en I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION curvatura I-EXPLORATION mayor I-EXPLORATION gástrica. I-EXPLORATION Tomografía I-EXPLORATION computarizada I-EXPLORATION abdominal I-EXPLORATION urgente: I-EXPLORATION gas I-EXPLORATION intramural I-EXPLORATION circunferencial I-EXPLORATION gástrico I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION difusa I-EXPLORATION y I-EXPLORATION hacia I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION esofágico, I-EXPLORATION con I-EXPLORATION pequeña I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION neumoperitoneo I-EXPLORATION adyacente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION curvatura I-EXPLORATION menor, I-EXPLORATION gas I-EXPLORATION venoso I-EXPLORATION portal I-EXPLORATION y I-EXPLORATION neumomediastino I-EXPLORATION adyacente I-EXPLORATION a I-EXPLORATION esófago; I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION una I-EXPLORATION gastritis I-EXPLORATION enfisematosa. I-EXPLORATION Tratamiento B-TREATMENT con I-TREATMENT antibioterapia I-TREATMENT intravenosa I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro, I-TREATMENT nutrición I-TREATMENT parenteral, I-TREATMENT inhibidores I-TREATMENT de I-TREATMENT la I-TREATMENT bomba I-TREATMENT de I-TREATMENT protones I-TREATMENT y I-TREATMENT sonda I-TREATMENT nasogástrica. I-TREATMENT Se B-EXPLORATION descarta I-EXPLORATION etiología I-EXPLORATION isquémica I-EXPLORATION en I-EXPLORATION una I-EXPLORATION angiotomografía I-EXPLORATION computarizada: I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION arterial. I-EXPLORATION Tomografía I-EXPLORATION computarizada I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 11 I-EXPLORATION días: I-EXPLORATION desaparición I-EXPLORATION de I-EXPLORATION neumatosis I-EXPLORATION gastroesofágica I-EXPLORATION ; I-EXPLORATION colapso I-EXPLORATION completo I-EXPLORATION del I-EXPLORATION pulmón I-EXPLORATION izquierdo. I-EXPLORATION Broncoscopia I-EXPLORATION urgente I-EXPLORATION resolutiva: I-EXPLORATION aspiración I-EXPLORATION de I-EXPLORATION tapones I-EXPLORATION de I-EXPLORATION moco. I-EXPLORATION Se B-TREATMENT suspende I-TREATMENT la I-TREATMENT antibioterapia I-TREATMENT tras I-TREATMENT 14 I-TREATMENT días I-TREATMENT iniciando I-TREATMENT tolerancia I-TREATMENT vía I-TREATMENT oral I-TREATMENT satisfactoriamente. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 96 I-EVOLUTION horas, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION broncoaspiración, I-EVOLUTION empeoramiento I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION respiratorio, I-EVOLUTION falleciendo I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY biliares I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY colelitiasis I-PAST_MEDICAL_HISTORY conocida, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION destacaban I-EXPLORATION dolor I-EXPLORATION y I-EXPLORATION defensa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Murphy I-EXPLORATION positivo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION solicitada, I-EXPLORATION el I-EXPLORATION rango I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 7x103/µL I-EXPLORATION (referencia: I-EXPLORATION 4-10, I-EXPLORATION 5 I-EXPLORATION 103/µL), I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION asociada. I-EXPLORATION Bilirrubina I-EXPLORATION total I-EXPLORATION 0, I-EXPLORATION 6 I-EXPLORATION mg/dl I-EXPLORATION (referencia: I-EXPLORATION 0, I-EXPLORATION 2-1, I-EXPLORATION 10 I-EXPLORATION mg/dl), I-EXPLORATION AST I-EXPLORATION 66 I-EXPLORATION mg/dl I-EXPLORATION (referencia I-EXPLORATION 8-40 I-EXPLORATION mg/dl), I-EXPLORATION amilasa I-EXPLORATION 43 I-EXPLORATION mg/dl I-EXPLORATION (referencia: I-EXPLORATION 25-115 I-EXPLORATION mg/dl), I-EXPLORATION PCR I-EXPLORATION 15, I-EXPLORATION 84 I-EXPLORATION mg/dl I-EXPLORATION (referencia I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION 5 I-EXPLORATION mg/dl). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION urgente I-EXPLORATION con I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION distendida, I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION en I-EXPLORATION su I-EXPLORATION pared I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION colelitiasis. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT colecistitis I-TREATMENT aguda, I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT colecistectomía I-TREATMENT laparoscópica I-TREATMENT urgente I-TREATMENT tras B-EVOLUTION la I-EVOLUTION cual I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION recuperación I-EVOLUTION postoperatoria I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION El B-EXPLORATION resultado I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION colecistitis I-EXPLORATION crónica I-EXPLORATION y I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION pancreático I-EXPLORATION ectópico I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula I-EXPLORATION biliar. I-EXPLORATION I-EXPLORATION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS estenosis I-PRESENT_ILLNESS esofágica I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS caústicos I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS respondió I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS dilataciones I-PRESENT_ILLNESS consecutivas I-PRESENT_ILLNESS realizadas I-PRESENT_ILLNESS con I-PRESENT_ILLNESS balón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dilatación I-PRESENT_ILLNESS esofágico. I-PRESENT_ILLNESS La B-EXPLORATION estenosis I-EXPLORATION tenía I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION y I-EXPLORATION un I-EXPLORATION calibre I-EXPLORATION inicial I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION mm. I-EXPLORATION Se B-TREATMENT realizaron I-TREATMENT 2 I-TREATMENT sesiones I-TREATMENT de I-TREATMENT inyección I-TREATMENT intralesional I-TREATMENT de I-TREATMENT mitomicina I-TREATMENT C I-TREATMENT (1, I-TREATMENT 6 I-TREATMENT ml I-TREATMENT en I-TREATMENT cada I-TREATMENT ocasión) I-TREATMENT y I-TREATMENT dilatación I-TREATMENT con I-TREATMENT balones I-TREATMENT de I-TREATMENT 10-11-12 I-TREATMENT mm I-TREATMENT con I-TREATMENT 40 I-TREATMENT días I-TREATMENT de I-TREATMENT separación I-TREATMENT entre I-TREATMENT sesiones, I-TREATMENT obteniendo B-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION cuadro. I-EVOLUTION Han I-EVOLUTION transcurrido I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION y I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION precisado I-EVOLUTION nuevas I-EVOLUTION dilataciones I-EVOLUTION esofágicas I-EVOLUTION en I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION 19 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS intervenida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS atresia I-PRESENT_ILLNESS esofágica I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS long-gap, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS realización I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gastrostomía I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mismo I-PRESENT_ILLNESS acto I-PRESENT_ILLNESS quirúrgico. I-PRESENT_ILLNESS A B-TREATMENT los I-TREATMENT 2 I-TREATMENT meses I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT (4 I-TREATMENT meses I-TREATMENT de I-TREATMENT vida) I-TREATMENT requiere I-TREATMENT dilatación I-TREATMENT esofágica I-TREATMENT con I-TREATMENT balón I-TREATMENT hidroneumático I-TREATMENT por I-TREATMENT estenosis I-TREATMENT de I-TREATMENT la I-TREATMENT zona I-TREATMENT anastomótica. I-TREATMENT Tras I-TREATMENT una I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT inicial I-TREATMENT se I-TREATMENT produjo I-TREATMENT una I-TREATMENT reestenosis I-TREATMENT a I-TREATMENT las I-TREATMENT 4 I-TREATMENT semanas I-TREATMENT motivo I-TREATMENT por I-TREATMENT el I-TREATMENT que I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT una I-TREATMENT segunda I-TREATMENT dilatación. I-TREATMENT Desde I-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT hicieron I-TREATMENT dilataciones I-TREATMENT sucesivas I-TREATMENT con I-TREATMENT una I-TREATMENT periodicidad I-TREATMENT que I-TREATMENT oscila I-TREATMENT entre I-TREATMENT 4 I-TREATMENT y I-TREATMENT 8 I-TREATMENT semanas I-TREATMENT (excepto I-TREATMENT en I-TREATMENT una I-TREATMENT ocasión I-TREATMENT que I-TREATMENT precisó I-TREATMENT dilatación I-TREATMENT a I-TREATMENT las I-TREATMENT 2 I-TREATMENT semanas I-TREATMENT de I-TREATMENT la I-TREATMENT previa I-TREATMENT y I-TREATMENT otra I-TREATMENT ocasión I-TREATMENT en I-TREATMENT que I-TREATMENT no I-TREATMENT precisó I-TREATMENT dilataciones I-TREATMENT por I-TREATMENT ausencia I-TREATMENT de I-TREATMENT reestenosis I-TREATMENT en I-TREATMENT un I-TREATMENT periodo I-TREATMENT de I-TREATMENT 7 I-TREATMENT meses). I-TREATMENT Además B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY marcada I-PAST_MEDICAL_HISTORY traqueomalacia I-PAST_MEDICAL_HISTORY asociada, I-PAST_MEDICAL_HISTORY lo B-TREATMENT que I-TREATMENT condicionaba I-TREATMENT una I-TREATMENT intubación I-TREATMENT nasotraqueal I-TREATMENT compleja I-TREATMENT y I-TREATMENT ciertos I-TREATMENT problemas I-TREATMENT en I-TREATMENT la I-TREATMENT extubación I-TREATMENT tras I-TREATMENT cada I-TREATMENT proceso I-TREATMENT de I-TREATMENT dilatación I-TREATMENT esofágica. I-TREATMENT I-TREATMENT Tras I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 14 I-TREATMENT dilataciones I-TREATMENT hidroneumáticas I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT una I-TREATMENT sesión I-TREATMENT de I-TREATMENT MC I-TREATMENT (con I-TREATMENT 2 I-TREATMENT años I-TREATMENT y I-TREATMENT 6 I-TREATMENT meses I-TREATMENT de I-TREATMENT vida). I-TREATMENT Se B-EVOLUTION produjo I-EVOLUTION una I-EVOLUTION respuesta I-EVOLUTION muy I-EVOLUTION favorable I-EVOLUTION pues I-EVOLUTION tras I-EVOLUTION una I-EVOLUTION sesión, I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION precisado I-EVOLUTION nuevas I-EVOLUTION dilataciones I-EVOLUTION en I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION 19 I-EVOLUTION meses I-EVOLUTION ni I-EVOLUTION ha I-EVOLUTION mostrado I-EVOLUTION ningún I-EVOLUTION tipo I-EVOLUTION de I-EVOLUTION clínica I-EVOLUTION digestiva I-EVOLUTION ni I-EVOLUTION respiratoria I-EVOLUTION en I-EVOLUTION este I-EVOLUTION periodo. I-EVOLUTION I-EVOLUTION Análisis B-TREATMENT de I-TREATMENT la I-TREATMENT serie I-TREATMENT I-TREATMENT En I-TREATMENT total I-TREATMENT se I-TREATMENT han I-TREATMENT puesto I-TREATMENT 5 I-TREATMENT prótesis I-TREATMENT en I-TREATMENT 4 I-TREATMENT pacientes I-TREATMENT (en I-TREATMENT 1 I-TREATMENT caso I-TREATMENT se I-TREATMENT han I-TREATMENT usado I-TREATMENT 2 I-TREATMENT prótesis). I-TREATMENT Se B-EVOLUTION ha I-EVOLUTION conseguido I-EVOLUTION el I-EVOLUTION objetivo I-EVOLUTION de I-EVOLUTION solucionar I-EVOLUTION la I-EVOLUTION estenosis I-EVOLUTION en I-EVOLUTION 2 I-EVOLUTION casos, I-EVOLUTION ha I-EVOLUTION habido I-EVOLUTION respuesta I-EVOLUTION parcial I-EVOLUTION temporal I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION casos I-EVOLUTION y I-EVOLUTION en I-EVOLUTION un I-EVOLUTION paciente I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION clínico I-EVOLUTION (por I-EVOLUTION presentar I-EVOLUTION una I-EVOLUTION úlcera I-EVOLUTION esofágica). I-EVOLUTION Tres I-EVOLUTION han I-EVOLUTION sido I-EVOLUTION customizadas I-EVOLUTION y I-EVOLUTION 2 I-EVOLUTION comercializadas I-EVOLUTION (todas I-EVOLUTION del I-EVOLUTION menor I-EVOLUTION calibre I-EVOLUTION 23/18/23). I-EVOLUTION Tres I-EVOLUTION han I-EVOLUTION sido I-EVOLUTION no I-EVOLUTION recubiertas, I-EVOLUTION una I-EVOLUTION parcialmente I-EVOLUTION cubierta I-EVOLUTION y I-EVOLUTION otra I-EVOLUTION completamente I-EVOLUTION cubierta. I-EVOLUTION De I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION fístulas I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION efectiva I-EVOLUTION la I-EVOLUTION de I-EVOLUTION prótesis I-EVOLUTION cubierta I-EVOLUTION y I-EVOLUTION falló I-EVOLUTION la I-EVOLUTION parcialmente I-EVOLUTION cubierta. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION analizar I-EVOLUTION las I-EVOLUTION complicaciones I-EVOLUTION observadas I-EVOLUTION con I-EVOLUTION las I-EVOLUTION PD I-EVOLUTION hemos I-EVOLUTION visto I-EVOLUTION como I-EVOLUTION la I-EVOLUTION más I-EVOLUTION frecuente I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION significativo I-EVOLUTION (necesidad I-EVOLUTION de I-EVOLUTION analgesia I-EVOLUTION mantenida I-EVOLUTION más I-EVOLUTION de I-EVOLUTION 5 I-EVOLUTION días) I-EVOLUTION en I-EVOLUTION 2 I-EVOLUTION casos I-EVOLUTION (2/5, I-EVOLUTION 40%), I-EVOLUTION hiperplasia I-EVOLUTION grave I-EVOLUTION (que I-EVOLUTION ha I-EVOLUTION requerido I-EVOLUTION dilatación I-EVOLUTION específica I-EVOLUTION en I-EVOLUTION 2 I-EVOLUTION casos I-EVOLUTION (2/5, I-EVOLUTION 40%), I-EVOLUTION hiperplasia I-EVOLUTION leve I-EVOLUTION (no I-EVOLUTION precisa I-EVOLUTION dilatación) I-EVOLUTION en I-EVOLUTION 2 I-EVOLUTION casos I-EVOLUTION (2/5, I-EVOLUTION 40%), I-EVOLUTION migración I-EVOLUTION de I-EVOLUTION la I-EVOLUTION prótesis I-EVOLUTION en I-EVOLUTION 1 I-EVOLUTION caso I-EVOLUTION (1/5, I-EVOLUTION 20%), I-EVOLUTION aunque I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION recolocar I-EVOLUTION y I-EVOLUTION una I-EVOLUTION úlcera I-EVOLUTION penetrante I-EVOLUTION en I-EVOLUTION el I-EVOLUTION borde I-EVOLUTION superior I-EVOLUTION de I-EVOLUTION la I-EVOLUTION prótesis I-EVOLUTION en I-EVOLUTION un I-EVOLUTION paciente I-EVOLUTION (1/5, I-EVOLUTION 20%). I-EVOLUTION Todas I-EVOLUTION han I-EVOLUTION podido I-EVOLUTION ser I-EVOLUTION resueltas I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION conservadora. I-EVOLUTION I-EVOLUTION Con I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION MC I-EVOLUTION se I-EVOLUTION han I-EVOLUTION hecho I-EVOLUTION 5 I-EVOLUTION terapias I-EVOLUTION en I-EVOLUTION 6 I-EVOLUTION enfermos, I-EVOLUTION con I-EVOLUTION 2 I-EVOLUTION en I-EVOLUTION 4 I-EVOLUTION enfermos I-EVOLUTION y I-EVOLUTION 1 I-EVOLUTION sesión I-EVOLUTION en I-EVOLUTION uno. I-EVOLUTION Se I-EVOLUTION ha I-EVOLUTION solucionado I-EVOLUTION la I-EVOLUTION estenosis I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION definitiva I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION casos I-EVOLUTION (60%) I-EVOLUTION y I-EVOLUTION en I-EVOLUTION otros I-EVOLUTION dos I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION efectiva I-EVOLUTION (40%). I-EVOLUTION I-EVOLUTION No I-EVOLUTION hemos I-EVOLUTION detectado I-EVOLUTION efectos I-EVOLUTION secundarios I-EVOLUTION al I-EVOLUTION uso I-EVOLUTION de I-EVOLUTION MC. I-EVOLUTION I-EVOLUTION El I-EVOLUTION tiempo I-EVOLUTION medio I-EVOLUTION dedicado I-EVOLUTION a I-EVOLUTION la I-EVOLUTION técnica I-EVOLUTION de I-EVOLUTION la I-EVOLUTION MC I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION de I-EVOLUTION 28, I-EVOLUTION 7 I-EVOLUTION minutos I-EVOLUTION (16-75). I-EVOLUTION I-EVOLUTION En I-EVOLUTION cuanto I-EVOLUTION al I-EVOLUTION cómputo I-EVOLUTION total I-EVOLUTION de I-EVOLUTION la I-EVOLUTION serie I-EVOLUTION manejando I-EVOLUTION ambas I-EVOLUTION técnicas, I-EVOLUTION podemos I-EVOLUTION decir I-EVOLUTION que I-EVOLUTION hemos I-EVOLUTION solucionado I-EVOLUTION las I-EVOLUTION estenosis I-EVOLUTION en I-EVOLUTION 5 I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION casos I-EVOLUTION de I-EVOLUTION EER I-EVOLUTION (83,3%) I-EVOLUTION y I-EVOLUTION en I-EVOLUTION 1 I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION fístulas I-EVOLUTION (50%); I-EVOLUTION la I-EVOLUTION fístula I-EVOLUTION que I-EVOLUTION fracasó I-EVOLUTION tuvo I-EVOLUTION que I-EVOLUTION reintervenirse. I-EVOLUTION De I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION fracasos I-EVOLUTION uno I-EVOLUTION presenta I-EVOLUTION un I-EVOLUTION cierre I-EVOLUTION completo I-EVOLUTION esofágico I-EVOLUTION que I-EVOLUTION ha I-EVOLUTION obligado I-EVOLUTION a I-EVOLUTION replantear I-EVOLUTION cirugía I-EVOLUTION reparadora I-EVOLUTION y I-EVOLUTION el I-EVOLUTION otro I-EVOLUTION persiste I-EVOLUTION con I-EVOLUTION dieta I-EVOLUTION oral I-EVOLUTION mediante I-EVOLUTION dilataciones I-EVOLUTION quincenales. I-EVOLUTION I-EVOLUTION El I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION casos I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION prótesis I-EVOLUTION o I-EVOLUTION mitomicina I-EVOLUTION final I-EVOLUTION (último I-EVOLUTION caso I-EVOLUTION incluido) I-EVOLUTION osciló I-EVOLUTION entre I-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION y I-EVOLUTION 2 I-EVOLUTION años. I-EVOLUTION I-EVOLUTION Lactante B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipotonía I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS respiratoria, I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen. I-PRESENT_ILLNESS Durante B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION fiebre, I-EXPLORATION deposiciones I-EXPLORATION líquidas, I-EXPLORATION hipoglucemia I-EXPLORATION sintomática I-EXPLORATION con I-EXPLORATION clonias I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION de I-EXPLORATION menos I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION segundos I-EXPLORATION de I-EXPLORATION duración I-EXPLORATION y I-EXPLORATION nistagmo, I-EXPLORATION acidosis I-EXPLORATION metabólica, I-EXPLORATION hiperlactacidemia I-EXPLORATION y I-EXPLORATION coagulopatía I-EXPLORATION moderada I-EXPLORATION con I-EXPLORATION sangrado I-EXPLORATION digestivo. I-EXPLORATION Sufrió B-EVOLUTION deterioro I-EVOLUTION hemodinámico I-EVOLUTION progresivo I-EVOLUTION hasta I-EVOLUTION situación I-EVOLUTION de I-EVOLUTION shock, I-EVOLUTION precisando I-EVOLUTION expansión I-EVOLUTION volumétrica I-EVOLUTION y I-EVOLUTION administración I-EVOLUTION de I-EVOLUTION dopamina, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION cefotaxima I-EVOLUTION y I-EVOLUTION clindamicina I-EVOLUTION tras I-EVOLUTION objetivar I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION procalcitonina I-EVOLUTION (59, I-EVOLUTION 1 I-EVOLUTION ng/ml). I-EVOLUTION Ante B-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO de I-DERIVED_FROM/TO shock I-DERIVED_FROM/TO séptico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO origen I-DERIVED_FROM/TO entérico, I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO las I-DERIVED_FROM/TO primeras I-DERIVED_FROM/TO 24 I-DERIVED_FROM/TO horas I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro, I-DERIVED_FROM/TO ingresando I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cuidados I-DERIVED_FROM/TO Críticos I-DERIVED_FROM/TO Pediátricos. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY prematuridad I-PAST_MEDICAL_HISTORY tardía I-PAST_MEDICAL_HISTORY (34 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional), I-PAST_MEDICAL_HISTORY alimentación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fórmula I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY ganancia I-PAST_MEDICAL_HISTORY ponderoestatural, I-PAST_MEDICAL_HISTORY refiriendo I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY frecuentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY llanto, I-PAST_MEDICAL_HISTORY considerados I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cólico. I-PAST_MEDICAL_HISTORY Recibía I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY producto I-PAST_MEDICAL_HISTORY homeopático I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY contenía I-PAST_MEDICAL_HISTORY Argentum I-PAST_MEDICAL_HISTORY nitricum I-PAST_MEDICAL_HISTORY D5, I-PAST_MEDICAL_HISTORY Chamomilla I-PAST_MEDICAL_HISTORY D1, I-PAST_MEDICAL_HISTORY China I-PAST_MEDICAL_HISTORY D3 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Cuprum I-PAST_MEDICAL_HISTORY aceticum I-PAST_MEDICAL_HISTORY D4, I-PAST_MEDICAL_HISTORY infusiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY manzanilla I-PAST_MEDICAL_HISTORY adquiridas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY farmacia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY paracetamol I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY puntual, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY adecuada. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION palidez I-EXPLORATION cutánea, I-EXPLORATION sangrado I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION puntos I-EXPLORATION de I-EXPLORATION punción I-EXPLORATION y I-EXPLORATION capilaritis, I-EXPLORATION distensión I-EXPLORATION abdominal, I-EXPLORATION hepatomegalia I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm, I-EXPLORATION irritabilidad, I-EXPLORATION hiperexcitabilidad I-EXPLORATION y I-EXPLORATION discreto I-EXPLORATION nistagmo I-EXPLORATION horizontal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION fallo I-EXPLORATION hepático I-EXPLORATION agudo I-EXPLORATION con I-EXPLORATION hipertransaminasemia I-EXPLORATION (aspartato I-EXPLORATION aminotransferasa I-EXPLORATION [AST] I-EXPLORATION 812 I-EXPLORATION U/l, I-EXPLORATION alanino I-EXPLORATION aminotransferasa I-EXPLORATION [ALT] I-EXPLORATION 1002 I-EXPLORATION U/l), I-EXPLORATION coagulopatía I-EXPLORATION grave I-EXPLORATION (actividad I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION 22%, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION tromboplastina I-EXPLORATION parcial I-EXPLORATION activada I-EXPLORATION [TTPa] I-EXPLORATION 59 I-EXPLORATION segundos, I-EXPLORATION factor I-EXPLORATION V I-EXPLORATION Leiden I-EXPLORATION 34%, I-EXPLORATION plaquetas I-EXPLORATION 86.000/μl), I-EXPLORATION administrándose I-EXPLORATION vitamina I-EXPLORATION K I-EXPLORATION y I-EXPLORATION plasma. I-EXPLORATION Presentó I-EXPLORATION hipoglucemia I-EXPLORATION (27 I-EXPLORATION mg/dl) I-EXPLORATION con I-EXPLORATION cetonemia I-EXPLORATION negativa, I-EXPLORATION acidosis I-EXPLORATION metabólica I-EXPLORATION moderada I-EXPLORATION (pH I-EXPLORATION 7, I-EXPLORATION 25, I-EXPLORATION bicarbonato I-EXPLORATION 13 I-EXPLORATION mmol/l, I-EXPLORATION exceso I-EXPLORATION de I-EXPLORATION bases I-EXPLORATION -12, I-EXPLORATION 7 I-EXPLORATION mmol/l), I-EXPLORATION precisando I-EXPLORATION elevado I-EXPLORATION aporte I-EXPLORATION endovenoso I-EXPLORATION de I-EXPLORATION glucosa I-EXPLORATION (14 I-EXPLORATION mg/kg/min) I-EXPLORATION y I-EXPLORATION bicarbonato. I-EXPLORATION Los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION y I-EXPLORATION directa, I-EXPLORATION amonio I-EXPLORATION y I-EXPLORATION albúmina I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Presentó B-TREATMENT febrícula I-TREATMENT las I-TREATMENT primeras I-TREATMENT 72 I-TREATMENT horas, I-TREATMENT aumento I-TREATMENT de I-TREATMENT proteína I-TREATMENT C I-TREATMENT reactiva I-TREATMENT (56 I-TREATMENT mg/l) I-TREATMENT y I-TREATMENT procalcitonina I-TREATMENT (88 I-TREATMENT ng/ml), I-TREATMENT sustituyéndose I-TREATMENT la I-TREATMENT antibioterapia I-TREATMENT por I-TREATMENT piperacilina-tazobactam I-TREATMENT ante I-TREATMENT probable I-TREATMENT clínica I-TREATMENT infecciosa I-TREATMENT entérica, I-TREATMENT ampliándose I-TREATMENT el I-TREATMENT estudio I-TREATMENT etiológico I-TREATMENT infeccioso. I-TREATMENT La B-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION mostró I-EXPLORATION ascitis I-EXPLORATION y I-EXPLORATION peristaltismo I-EXPLORATION aumentado I-EXPLORATION de I-EXPLORATION asas I-EXPLORATION intestinales, I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION hepáticas. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT insuficiencia I-TREATMENT hepática I-TREATMENT aguda I-TREATMENT grave I-TREATMENT con I-TREATMENT sospecha I-TREATMENT inicial I-TREATMENT de I-TREATMENT enfermedad I-TREATMENT metabólica I-TREATMENT descompensada, I-TREATMENT se I-TREATMENT efectuó I-TREATMENT despistaje I-TREATMENT metabólico I-TREATMENT y I-TREATMENT se I-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT N-acetilcisteina, I-TREATMENT y I-TREATMENT NTBC I-TREATMENT (2-[2-nitro-4-trifluorometibenzoil]-1-3-ciclohexanediona) I-TREATMENT así I-TREATMENT como I-TREATMENT dieta I-TREATMENT exenta I-TREATMENT de I-TREATMENT tirosina I-TREATMENT ante I-TREATMENT la I-TREATMENT presunción I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT tirosinemia. I-TREATMENT I-TREATMENT Se B-EVOLUTION objetivó I-EVOLUTION mejoría I-EVOLUTION neurológica, I-EVOLUTION hemodinámica, I-EVOLUTION infecciosa I-EVOLUTION y I-EVOLUTION de I-EVOLUTION función I-EVOLUTION hepática I-EVOLUTION progresivas, I-EVOLUTION presentando I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 60 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION actividad I-EVOLUTION de I-EVOLUTION protrombina I-EVOLUTION del I-EVOLUTION 82%, I-EVOLUTION AST I-EVOLUTION 148 I-EVOLUTION U/l I-EVOLUTION y I-EVOLUTION ALT I-EVOLUTION 684 I-EVOLUTION U/l. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION infeccioso I-EXPLORATION ampliado I-EXPLORATION resultó I-EXPLORATION negativo, I-EXPLORATION incluidos I-EXPLORATION virus I-EXPLORATION hepatotropos I-EXPLORATION (VHA, I-EXPLORATION VHB I-EXPLORATION y I-EXPLORATION VHC), I-EXPLORATION influenzae I-EXPLORATION (A, I-EXPLORATION B), I-EXPLORATION perfil I-EXPLORATION TORCH, I-EXPLORATION citoquímica I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION virales I-EXPLORATION en I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION (LCR), I-EXPLORATION y I-EXPLORATION cultivos I-EXPLORATION (sangre, I-EXPLORATION LCR, I-EXPLORATION orina, I-EXPLORATION heces). I-EXPLORATION También I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION hepático I-EXPLORATION autoinmune. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION metabólico I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION excreción I-EXPLORATION elevada I-EXPLORATION de I-EXPLORATION ácido I-EXPLORATION homovanílico, I-EXPLORATION ligeramente I-EXPLORATION elevada I-EXPLORATION de I-EXPLORATION vanilmandélico I-EXPLORATION y I-EXPLORATION 4-hidroxifenilpirúvico I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION hipoaminoacidemia. I-EXPLORATION La I-EXPLORATION espectometría I-EXPLORATION de I-EXPLORATION masas I-EXPLORATION en I-EXPLORATION tándem, I-EXPLORATION alfafetoproteína I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION succinilacetona I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION reevaluó I-EXPLORATION la I-EXPLORATION anamnesis, I-EXPLORATION registrándose I-EXPLORATION la I-EXPLORATION ingesta I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION mantenida I-EXPLORATION durante I-EXPLORATION los I-EXPLORATION últimos I-EXPLORATION dos I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION infusión I-EXPLORATION elaborada I-EXPLORATION con I-EXPLORATION dos I-EXPLORATION cucharadas I-EXPLORATION de I-EXPLORATION manzanilla, I-EXPLORATION una I-EXPLORATION estrella I-EXPLORATION de I-EXPLORATION anís I-EXPLORATION estrellado I-EXPLORATION (Illicium I-EXPLORATION verum) I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION granos I-EXPLORATION de I-EXPLORATION matalahúva I-EXPLORATION (anís I-EXPLORATION verde I-EXPLORATION o I-EXPLORATION Pimpinella I-EXPLORATION anisum) I-EXPLORATION en I-EXPLORATION 500 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION agua, I-EXPLORATION con I-EXPLORATION ingesta I-EXPLORATION diaria I-EXPLORATION de I-EXPLORATION 250 I-EXPLORATION ml. I-EXPLORATION Se B-EVOLUTION contactó I-EVOLUTION con I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Información I-EVOLUTION Toxicológica, I-EVOLUTION que I-EVOLUTION recomendó I-EVOLUTION determinar I-EVOLUTION la I-EVOLUTION posible I-EVOLUTION existencia I-EVOLUTION de I-EVOLUTION contaminación I-EVOLUTION con I-EVOLUTION Illicium I-EVOLUTION anisatum, I-EVOLUTION de I-EVOLUTION conocido I-EVOLUTION efecto I-EVOLUTION tóxico, I-EVOLUTION que I-EVOLUTION justificara I-EVOLUTION el I-EVOLUTION cuadro I-EVOLUTION clínico I-EVOLUTION mediante I-EVOLUTION un I-EVOLUTION sencillo I-EVOLUTION procedimiento I-EVOLUTION que I-EVOLUTION sugiere I-EVOLUTION su I-EVOLUTION presencia: I-EVOLUTION a B-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION estrella I-EXPLORATION de I-EXPLORATION anís I-EXPLORATION estrellado I-EXPLORATION se I-EXPLORATION añadieron I-EXPLORATION 3 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION 96o I-EXPLORATION y, I-EXPLORATION tras I-EXPLORATION hervir I-EXPLORATION y I-EXPLORATION filtrar, I-EXPLORATION se I-EXPLORATION añadieron I-EXPLORATION al I-EXPLORATION líquido I-EXPLORATION obtenido I-EXPLORATION cinco I-EXPLORATION gotas I-EXPLORATION de I-EXPLORATION agua. I-EXPLORATION La I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION turbidez I-EXPLORATION sugirió I-EXPLORATION la I-EXPLORATION contaminación I-EXPLORATION con I-EXPLORATION Illicium I-EXPLORATION anisatum. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION fue I-EVOLUTION satisfactoria I-EVOLUTION con I-EVOLUTION recuperación I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION analítica I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION paciente. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS boliviana B-PAST_MEDICAL_HISTORY de B-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Fue B-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Chagas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Madrid, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS serología I-PRESENT_ILLNESS positiva I-PRESENT_ILLNESS para I-PRESENT_ILLNESS IgG I-PRESENT_ILLNESS Trypanosoma I-PRESENT_ILLNESS cruzi, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS seguimiento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Málaga. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS abdominales I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS estreñimiento, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS empeora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS refractario I-PRESENT_ILLNESS al I-PRESENT_ILLNESS uso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS laxantes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS enemas, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS recurriendo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS a I-PRESENT_ILLNESS desimpactaciones I-PRESENT_ILLNESS manuales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prolapso I-PRESENT_ILLNESS rectal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS maniobra I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Valsalva I-PRESENT_ILLNESS intensa, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS reducido I-PRESENT_ILLNESS por I-PRESENT_ILLNESS los I-PRESENT_ILLNESS cirujanos I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS complicaciones I-PRESENT_ILLNESS inmediatas. I-PRESENT_ILLNESS Tras I-PRESENT_ILLNESS el I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS agudo, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS enema I-PRESENT_ILLNESS opaco I-PRESENT_ILLNESS objetivándose I-PRESENT_ILLNESS dilatación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS colon I-PRESENT_ILLNESS y I-PRESENT_ILLNESS recto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS cm. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS después, I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS difuso, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS asociados. I-PRESENT_ILLNESS Se B-EXPLORATION objetiva I-EXPLORATION mediante I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION un I-EXPLORATION vólvulo I-EXPLORATION colónico, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION resolvió I-EXPLORATION sin I-EXPLORATION incidencias I-EXPLORATION con I-EXPLORATION endoscopia I-EXPLORATION descompresiva. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS ambulatoria I-PRESENT_ILLNESS por I-PRESENT_ILLNESS epigastralgia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION esofagogastroduodenoscopia I-EXPLORATION evidenció I-EXPLORATION gastritis I-EXPLORATION nodular I-EXPLORATION antral. I-EXPLORATION Las I-EXPLORATION biopsias I-EXPLORATION de I-EXPLORATION antro I-EXPLORATION reportaron I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION difusa I-EXPLORATION no I-EXPLORATION atrófica, I-EXPLORATION activa I-EXPLORATION grave, I-EXPLORATION con I-EXPLORATION plasmocitos I-EXPLORATION y I-EXPLORATION cuerpos I-EXPLORATION de I-EXPLORATION Russell I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION bacilos I-EXPLORATION Helicobacter I-EXPLORATION pylori I-EXPLORATION (HP) I-EXPLORATION +++/+++. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION inmunohistoquímica I-EXPLORATION con I-EXPLORATION CD138 I-EXPLORATION demostraron I-EXPLORATION reactividad I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION citoplasmáticas I-EXPLORATION y I-EXPLORATION las I-EXPLORATION cadenas I-EXPLORATION livianas I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION Kappa I-EXPLORATION y I-EXPLORATION Lambda, I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION GCR. I-EXPLORATION I-EXPLORATION Se B-TREATMENT suministró I-TREATMENT tratamiento I-TREATMENT para I-TREATMENT HP, I-TREATMENT con I-TREATMENT lo I-TREATMENT cual I-TREATMENT la I-TREATMENT paciente I-TREATMENT presentó I-TREATMENT resolución I-TREATMENT de I-TREATMENT su I-TREATMENT sintomatología. I-TREATMENT I-TREATMENT Se B-EVOLUTION realizó I-EVOLUTION control I-EVOLUTION endoscópico I-EVOLUTION e I-EVOLUTION histopatológico I-EVOLUTION a I-EVOLUTION los I-EVOLUTION nueve I-EVOLUTION meses I-EVOLUTION en I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION evidenció I-EVOLUTION marcada I-EVOLUTION mejoría I-EVOLUTION con I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION estudio I-EVOLUTION previo. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS presentación I-PRESENT_ILLNESS episódica. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cannabis I-PAST_MEDICAL_HISTORY inhalado I-PAST_MEDICAL_HISTORY (10-15 I-PAST_MEDICAL_HISTORY porros I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día). I-PAST_MEDICAL_HISTORY Mediante B-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION es I-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION pinza I-EXPLORATION aortomesentérica I-EXPLORATION tanto I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION porción I-EXPLORATION duodenal I-EXPLORATION como I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION que B-TREATMENT no I-TREATMENT mejora I-TREATMENT con I-TREATMENT la I-TREATMENT ganancia I-TREATMENT ponderal, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decide I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT (duodeno-yeyunostomía I-TREATMENT en I-TREATMENT septiembre I-TREATMENT de I-TREATMENT 2009). I-TREATMENT Posteriormente B-EVOLUTION los I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION continúan I-EVOLUTION sin I-EVOLUTION cambios I-EVOLUTION pese I-EVOLUTION a I-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION radiológica I-EVOLUTION de I-EVOLUTION las I-EVOLUTION alteraciones I-EVOLUTION anatómicas. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION crisis I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION con I-EXPLORATION asistencia I-EXPLORATION a I-EXPLORATION Urgencias I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION ecográficamente I-EXPLORATION varias I-EXPLORATION invaginaciones I-EXPLORATION intestinales I-EXPLORATION en I-EXPLORATION diferentes I-EXPLORATION localizaciones I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION que I-EXPLORATION se I-EXPLORATION resuelven I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION conservadora. I-EXPLORATION En I-EXPLORATION otras I-EXPLORATION múltiples I-EXPLORATION exploraciones I-EXPLORATION realizadas I-EXPLORATION en I-EXPLORATION periodos I-EXPLORATION asintomáticos I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION patología I-EXPLORATION intestinal I-EXPLORATION que I-EXPLORATION justifique I-EXPLORATION el I-EXPLORATION cuadro. I-EXPLORATION Durante B-EVOLUTION el I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION consultas, I-EVOLUTION y I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION el I-EVOLUTION abandono I-EVOLUTION del I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION cannabis, I-EVOLUTION los I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION vómitos I-EVOLUTION desaparecen I-EVOLUTION por I-EVOLUTION completo, I-EVOLUTION pudiendo I-EVOLUTION ser I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION año I-EVOLUTION completamente I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS adenocarcinoma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vejiga, I-PRESENT_ILLNESS tratado I-PRESENT_ILLNESS mediante I-PRESENT_ILLNESS derivación I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS Mainz I-PRESENT_ILLNESS II. I-PRESENT_ILLNESS Durante B-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT colonoscopia I-TREATMENT posterior, I-TREATMENT se I-TREATMENT extirparon I-TREATMENT dos I-TREATMENT lesiones I-TREATMENT polipoides I-TREATMENT sesiles, I-TREATMENT que I-TREATMENT resultaron I-TREATMENT ser I-TREATMENT granulomas I-TREATMENT de I-TREATMENT la I-TREATMENT ureterosigmoidostomía. I-TREATMENT En B-EVOLUTION los I-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION apareció I-EVOLUTION una I-EVOLUTION dilatación I-EVOLUTION ureteral I-EVOLUTION y I-EVOLUTION estenosis I-EVOLUTION de I-EVOLUTION la I-EVOLUTION anastomosis I-EVOLUTION del I-EVOLUTION uréter I-EVOLUTION izquierdo I-EVOLUTION a I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cicatrización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION "polipectomía". I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT realizar I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT combinado I-TREATMENT uro-endoscópico I-TREATMENT en I-TREATMENT quirófano I-TREATMENT y I-TREATMENT radioguiado: I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT nefrostomía I-TREATMENT izquierda, I-TREATMENT se I-TREATMENT pasó I-TREATMENT una I-TREATMENT guía I-TREATMENT radio-opaca I-TREATMENT que I-TREATMENT atravesó I-TREATMENT el I-TREATMENT estoma I-TREATMENT estenosado I-TREATMENT y I-TREATMENT apareció I-TREATMENT en I-TREATMENT sigma. I-TREATMENT Por I-TREATMENT endoscopia, I-TREATMENT sobre I-TREATMENT la I-TREATMENT guía, I-TREATMENT se I-TREATMENT aplicó I-TREATMENT un I-TREATMENT balón I-TREATMENT de I-TREATMENT dilatación I-TREATMENT de I-TREATMENT 6 I-TREATMENT mm I-TREATMENT Ø, I-TREATMENT sin I-TREATMENT conseguir I-TREATMENT un I-TREATMENT aumento I-TREATMENT significativo I-TREATMENT del I-TREATMENT calibre I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT Finalmente, I-TREATMENT se I-TREATMENT decidió I-TREATMENT ampliar I-TREATMENT la I-TREATMENT estenosis I-TREATMENT utilizando I-TREATMENT un I-TREATMENT esfinterótomo I-TREATMENT convencional, I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT consiguió I-TREATMENT una I-TREATMENT apertura I-TREATMENT significativa I-TREATMENT de I-TREATMENT la I-TREATMENT anastomosis I-TREATMENT comprobando I-TREATMENT débito I-TREATMENT de I-TREATMENT suero I-TREATMENT salino. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION muy I-EVOLUTION satisfactoria. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diaforesis I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS g I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hachís I-PRESENT_ILLNESS para I-PRESENT_ILLNESS su I-PRESENT_ILLNESS transporte I-PRESENT_ILLNESS ilegal, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS custodiado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Policía I-PRESENT_ILLNESS Nacional I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS toda I-PRESENT_ILLNESS su I-PRESENT_ILLNESS estancia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hospital. I-PRESENT_ILLNESS En B-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION dos I-EXPLORATION cuerpos I-EXPLORATION extraños I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION íleon, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION obstrucción I-EXPLORATION mecánica I-EXPLORATION sin I-EXPLORATION perforación, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION expulsaron I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION espontánea I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 24 I-EXPLORATION horas, I-EXPLORATION confirmándose I-EXPLORATION su I-EXPLORATION naturaleza I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION específico. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION control I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION horas I-EXPLORATION se I-EXPLORATION describía I-EXPLORATION otro I-EXPLORATION cuerpo I-EXPLORATION extraño I-EXPLORATION en I-EXPLORATION antro I-EXPLORATION gástrico, I-EXPLORATION no I-EXPLORATION objetivado I-EXPLORATION previamente, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT endoscopia I-TREATMENT oral I-TREATMENT con I-TREATMENT extracción I-TREATMENT mediante I-TREATMENT cesta I-TREATMENT de I-TREATMENT Dormia I-TREATMENT de I-TREATMENT un I-TREATMENT tercer I-TREATMENT paquete I-TREATMENT de I-TREATMENT 4 I-TREATMENT cm, I-TREATMENT morfología I-TREATMENT redondeada I-TREATMENT y I-TREATMENT consistencia I-TREATMENT semidura. I-TREATMENT El B-EVOLUTION procedimiento I-EVOLUTION se I-EVOLUTION llevó I-EVOLUTION a I-EVOLUTION cabo I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION bajo I-EVOLUTION sedación I-EVOLUTION profunda I-EVOLUTION por I-EVOLUTION anestesista. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS trasplantado B-PAST_MEDICAL_HISTORY hepático, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY inmunosupresor I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY esteroides I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tacrolimus, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS el I-PRESENT_ILLNESS trasplante I-PRESENT_ILLNESS es I-PRESENT_ILLNESS intervenido I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS neoplasia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS colon I-PRESENT_ILLNESS obstructiva I-PRESENT_ILLNESS realizándose B-TREATMENT resección. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION bien I-EXPLORATION diferenciado I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION perirrectal, I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION márgenes I-EXPLORATION quirúrgicos I-EXPLORATION o I-EXPLORATION de I-EXPLORATION los I-EXPLORATION ganglios I-EXPLORATION linfáticos. I-EXPLORATION Tras B-TREATMENT la I-TREATMENT cirugía I-TREATMENT se I-TREATMENT modificó I-TREATMENT la I-TREATMENT inmunosupresión I-TREATMENT introduciendo I-TREATMENT everolimus. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION se I-EVOLUTION detectaron I-EVOLUTION metástasis I-EVOLUTION hepáticas I-EVOLUTION en I-EVOLUTION segmentos I-EVOLUTION IV I-EVOLUTION y I-EVOLUTION VII. I-EVOLUTION Se B-TREATMENT intervino I-TREATMENT de I-TREATMENT nuevo I-TREATMENT realizando I-TREATMENT una I-TREATMENT hepatectomía I-TREATMENT izquierda I-TREATMENT y I-TREATMENT una I-TREATMENT ablación I-TREATMENT por I-TREATMENT microondas I-TREATMENT de I-TREATMENT la I-TREATMENT metástasis I-TREATMENT del I-TREATMENT segmento I-TREATMENT VII. I-TREATMENT Tras B-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION está I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION controlada. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS intervenida B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY recidiva I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinomatosis I-PAST_MEDICAL_HISTORY peritoneal, I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY quimioterapia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cirugía, I-PAST_MEDICAL_HISTORY utilizando I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cierre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pared I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY malla I-PAST_MEDICAL_HISTORY biológica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Permacol™. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS 2015, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS nueva I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fondo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS saco I-PRESENT_ILLNESS recto-vesical I-PRESENT_ILLNESS con I-PRESENT_ILLNESS infiltración I-PRESENT_ILLNESS del I-PRESENT_ILLNESS recto, I-PRESENT_ILLNESS vejiga I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cúpula I-PRESENT_ILLNESS vaginal, I-PRESENT_ILLNESS por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT exenteración I-TREATMENT pélvica I-TREATMENT con I-TREATMENT reconstrucción I-TREATMENT vaginal I-TREATMENT y I-TREATMENT derivación I-TREATMENT urinaria I-TREATMENT tipo I-TREATMENT Bricker I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT malla. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION fístula I-EVOLUTION urinaria I-EVOLUTION del I-EVOLUTION asa I-EVOLUTION ileal, I-EVOLUTION secundaria I-EVOLUTION al I-EVOLUTION decúbito I-EVOLUTION de I-EVOLUTION la I-EVOLUTION malla. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION endoscopia I-EXPLORATION del I-EXPLORATION asa I-EXPLORATION del I-EXPLORATION Bricker, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION orificio I-EXPLORATION fistuloso I-EXPLORATION con I-EXPLORATION fondo I-EXPLORATION blanquecino I-EXPLORATION a I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ileostomía I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION malla, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION el I-EXPLORATION 50% I-EXPLORATION de I-EXPLORATION la I-EXPLORATION circunferencia. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT colocación I-TREATMENT endoscópica I-TREATMENT de I-TREATMENT una I-TREATMENT prótesis I-TREATMENT metálica I-TREATMENT cubierta I-TREATMENT (Hanarostent® I-TREATMENT Colon/Rectum) I-TREATMENT de I-TREATMENT 100 I-TREATMENT mm I-TREATMENT x I-TREATMENT 20 I-TREATMENT mm, I-TREATMENT que I-TREATMENT se I-TREATMENT retiró I-TREATMENT sin I-TREATMENT incidencias I-TREATMENT tras I-TREATMENT 12 I-TREATMENT semanas, I-TREATMENT objetivándose I-TREATMENT resolución I-TREATMENT de I-TREATMENT la I-TREATMENT fístula. I-TREATMENT I-TREATMENT La B-EVOLUTION permanencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION prótesis I-EVOLUTION fue I-EVOLUTION más I-EVOLUTION prolongada I-EVOLUTION que I-EVOLUTION la I-EVOLUTION recomendada, I-EVOLUTION dada I-EVOLUTION nuestra I-EVOLUTION experiencia I-EVOLUTION y I-EVOLUTION el I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fístula. I-EVOLUTION A I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION la I-EVOLUTION posibilidad I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION por I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION malla, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION sin I-EVOLUTION recurrencia, I-EVOLUTION probablemente I-EVOLUTION por I-EVOLUTION formación I-EVOLUTION de I-EVOLUTION tejido I-EVOLUTION fibroso I-EVOLUTION perifístula. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY dislipemia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY suprarrenalectomía I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hipertrofia I-PAST_MEDICAL_HISTORY macronodular I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY glándulas I-PAST_MEDICAL_HISTORY suprarrenales. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY losartán I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hidroclorotiazida, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY sustitutivo I-PAST_MEDICAL_HISTORY hormonal, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hidrocortisona I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY horas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fludrocortisona I-PAST_MEDICAL_HISTORY 0, I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY horas. I-PAST_MEDICAL_HISTORY Presenta B-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pancreatitis I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS recidivante, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS manifiesta I-PRESENT_ILLNESS como I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS agudos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS autolimitan I-PRESENT_ILLNESS en I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 4-5 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dieta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS analgésico. I-PRESENT_ILLNESS Durante B-EXPLORATION su I-EXPLORATION primer I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION perfil I-EXPLORATION hepático I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION lipídico I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION elevación I-EXPLORATION del I-EXPLORATION colesterol I-EXPLORATION (225 I-EXPLORATION mg/dL) I-EXPLORATION y I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION TG I-EXPLORATION normales, I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION colangio-RMN, I-EXPLORATION en I-EXPLORATION las I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION colelitiasis I-EXPLORATION ni I-EXPLORATION lesiones I-EXPLORATION pancreáticas I-EXPLORATION o I-EXPLORATION biliares, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION cataloga I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION aguda I-EXPLORATION idiopática. I-EXPLORATION Posteriormente I-EXPLORATION presenta I-EXPLORATION nuevos I-EXPLORATION episodios I-EXPLORATION con I-EXPLORATION una I-EXPLORATION periodicidad I-EXPLORATION de I-EXPLORATION entre I-EXPLORATION siete I-EXPLORATION meses I-EXPLORATION y I-EXPLORATION tres I-EXPLORATION años, I-EXPLORATION realizándose I-EXPLORATION en I-EXPLORATION este I-EXPLORATION tiempo I-EXPLORATION estudios I-EXPLORATION analíticos I-EXPLORATION que I-EXPLORATION son I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION que I-EXPLORATION incluyen I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION colangio-RMN, I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION ecoendoscopia I-EXPLORATION en I-EXPLORATION las I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION identifica I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pancreatitis. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION últimos I-EXPLORATION dos I-EXPLORATION años I-EXPLORATION la I-EXPLORATION periodicidad I-EXPLORATION se I-EXPLORATION reduce, I-EXPLORATION con I-EXPLORATION episodios I-EXPLORATION cada I-EXPLORATION 6-7 I-EXPLORATION meses, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION repite I-EXPLORATION nuevamente I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION estudio, I-EXPLORATION objetivándose I-EXPLORATION en I-EXPLORATION la I-EXPLORATION colangio-RMN I-EXPLORATION realizada I-EXPLORATION un I-EXPLORATION remanente I-EXPLORATION de I-EXPLORATION glándula I-EXPLORATION suprarrenal I-EXPLORATION que I-EXPLORATION plantea I-EXPLORATION el I-EXPLORATION posible I-EXPLORATION origen I-EXPLORATION tóxico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pancreatitis, I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION corticoterapia I-EXPLORATION crónica I-EXPLORATION e I-EXPLORATION hiperproducción I-EXPLORATION endógena I-EXPLORATION de I-EXPLORATION corticoides. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION estudio I-EXPLORATION hormonal I-EXPLORATION con I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION cortisol I-EXPLORATION de I-EXPLORATION 25, I-EXPLORATION 7 I-EXPLORATION mcg/dL, I-EXPLORATION ACTH I-EXPLORATION y I-EXPLORATION cortisol I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION normales, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION reduce I-EXPLORATION la I-EXPLORATION dosis I-EXPLORATION de I-EXPLORATION corticoterapia I-EXPLORATION sustitutiva I-EXPLORATION a I-EXPLORATION hidrocortisona I-EXPLORATION 10 I-EXPLORATION mg I-EXPLORATION al I-EXPLORATION día, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION van I-EXPLORATION reduciendo I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION progresiva I-EXPLORATION hasta I-EXPLORATION su I-EXPLORATION suspensión. I-EXPLORATION Además, B-TREATMENT ante I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT origen I-TREATMENT farmacológico I-TREATMENT se I-TREATMENT cambia I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antihipertensivo I-TREATMENT de I-TREATMENT la I-TREATMENT asociación I-TREATMENT de I-TREATMENT losartán I-TREATMENT e I-TREATMENT hidroclorotiazida I-TREATMENT a I-TREATMENT ramipril I-TREATMENT en I-TREATMENT monoterapia. I-TREATMENT Se B-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION IG4 I-EXPLORATION y I-EXPLORATION ANA I-EXPLORATION que I-EXPLORATION son I-EXPLORATION normales, I-EXPLORATION test I-EXPLORATION del I-EXPLORATION sudor I-EXPLORATION y I-EXPLORATION test I-EXPLORATION genético I-EXPLORATION para I-EXPLORATION fibrosis I-EXPLORATION quística I-EXPLORATION que I-EXPLORATION son I-EXPLORATION negativos. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION modificación I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION ingresar I-EVOLUTION por I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION pancreatitis I-EVOLUTION aguda I-EVOLUTION leve. I-EVOLUTION Se I-EVOLUTION interroga I-EVOLUTION nuevamente I-EVOLUTION a I-EVOLUTION la I-EVOLUTION paciente, I-EVOLUTION quien I-EVOLUTION finalmente I-EVOLUTION refiere I-EVOLUTION consumir I-EVOLUTION infusiones I-EVOLUTION de I-EVOLUTION cola I-EVOLUTION de I-EVOLUTION caballo I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION habitual. I-EVOLUTION Ante I-EVOLUTION la I-EVOLUTION posibilidad I-EVOLUTION de I-EVOLUTION una I-EVOLUTION pancreatitis I-EVOLUTION recidivante I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION la I-EVOLUTION toma I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION infusión, I-EVOLUTION se I-EVOLUTION suspende I-EVOLUTION por I-EVOLUTION completo I-EVOLUTION la I-EVOLUTION misma. I-EVOLUTION Desde I-EVOLUTION entonces, I-EVOLUTION 14 I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION asintomática I-EVOLUTION con I-EVOLUTION controles I-EVOLUTION ecográficos I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS tres I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pseudodiverticulosis I-PRESENT_ILLNESS yeyunal I-PRESENT_ILLNESS que I-PRESENT_ILLNESS debutaron I-PRESENT_ILLNESS como I-PRESENT_ILLNESS abdomen I-PRESENT_ILLNESS agudo. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS primero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ellos, I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS obstrucción I-PRESENT_ILLNESS intestinal. I-PRESENT_ILLNESS El B-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION sugiere I-EXPLORATION brida I-EXPLORATION o I-EXPLORATION hernia I-EXPLORATION interna, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION cirugía. I-EXPLORATION En B-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS lugar, I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 90 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS El B-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION no I-EXPLORATION objetiva I-EXPLORATION causa I-EXPLORATION obstructiva. I-EXPLORATION Tras B-TREATMENT 24 I-TREATMENT horas I-TREATMENT de I-TREATMENT manejo I-TREATMENT conservador I-TREATMENT sufre I-TREATMENT empeoramiento. I-TREATMENT Se I-TREATMENT objetiva I-TREATMENT neumoperitoneo I-TREATMENT en I-TREATMENT TC I-TREATMENT abdominal, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realiza I-TREATMENT cirugía. I-TREATMENT Por B-PRESENT_ILLNESS último, I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS El B-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION informa I-EXPLORATION perforación I-EXPLORATION de I-EXPLORATION divertículo I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT es I-TREATMENT llevado I-TREATMENT a I-TREATMENT quirófano. I-TREATMENT I-TREATMENT En B-EXPLORATION los I-EXPLORATION dos I-EXPLORATION primeros I-EXPLORATION casos I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION causa I-EXPLORATION obstructiva I-EXPLORATION en I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION pseudodivertículos I-EXPLORATION yeyunales I-EXPLORATION proximalmente; I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION y I-EXPLORATION tercer I-EXPLORATION caso, I-EXPLORATION con I-EXPLORATION perforación I-EXPLORATION de I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION estos. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT consistió I-TREATMENT en I-TREATMENT resección I-TREATMENT intestinal I-TREATMENT del I-TREATMENT segmento I-TREATMENT afecto I-TREATMENT y I-TREATMENT anastomosis I-TREATMENT primaria. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION cursó I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION El B-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION falsos I-EXPLORATION divertículos I-EXPLORATION en I-EXPLORATION yeyuno, I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION casos I-EXPLORATION perforados, I-EXPLORATION sin I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION malignidad. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cirrosis I-PRESENT_ILLNESS hepática I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS infección I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS VHC I-PRESENT_ILLNESS en I-PRESENT_ILLNESS seguimiento I-PRESENT_ILLNESS estrecho I-PRESENT_ILLNESS en I-PRESENT_ILLNESS consultas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Hepatología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS año I-PRESENT_ILLNESS 2000. I-PRESENT_ILLNESS Estaba B-PAST_MEDICAL_HISTORY infectado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY genotipo I-PAST_MEDICAL_HISTORY 1b I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY recibido I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antiviral I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY pasado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY rechazo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY parte I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY recibir I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY interferón. I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY relevantes I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY intervención I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY ductus I-PAST_MEDICAL_HISTORY arterioso I-PAST_MEDICAL_HISTORY persistente, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY paroxística, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY colocación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY stents I-PAST_MEDICAL_HISTORY coronarios I-PAST_MEDICAL_HISTORY convencionales I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2004 I-PAST_MEDICAL_HISTORY indicados I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY isquémica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY recambio I-PAST_MEDICAL_HISTORY valvular I-PAST_MEDICAL_HISTORY aórtico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2013 I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY prótesis I-PAST_MEDICAL_HISTORY metálica, I-PAST_MEDICAL_HISTORY requiriendo I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY entonces I-PAST_MEDICAL_HISTORY anticoagulación I-PAST_MEDICAL_HISTORY oral I-PAST_MEDICAL_HISTORY (Eliquis®). I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2007 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 2013 I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY accidentes I-PAST_MEDICAL_HISTORY cerebrovasculares I-PAST_MEDICAL_HISTORY agudos I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY secuelas I-PAST_MEDICAL_HISTORY posteriores I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY afectación I-PAST_MEDICAL_HISTORY moderada. I-PAST_MEDICAL_HISTORY En B-EXPLORATION mayo I-EXPLORATION de I-EXPLORATION 2014, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION cribado I-EXPLORATION de I-EXPLORATION hepatocarcinoma, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION hepática I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION 25 I-EXPLORATION x I-EXPLORATION 17 I-EXPLORATION milímetros I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION VI I-EXPLORATION hepático I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION hepatocelular. I-EXPLORATION Se B-TREATMENT optó I-TREATMENT por I-TREATMENT realizar I-TREATMENT ablación I-TREATMENT mediante I-TREATMENT radiofrecuencia I-TREATMENT como I-TREATMENT tratamiento, I-TREATMENT lográndose I-TREATMENT respuesta I-TREATMENT completa I-TREATMENT radiológica I-TREATMENT en I-TREATMENT la I-TREATMENT resonancia I-TREATMENT magnética I-TREATMENT realizada I-TREATMENT cuatro I-TREATMENT semanas I-TREATMENT tras I-TREATMENT el I-TREATMENT tratamiento. I-TREATMENT Se B-EVOLUTION sometió I-EVOLUTION al I-EVOLUTION paciente I-EVOLUTION a I-EVOLUTION continuación I-EVOLUTION a I-EVOLUTION seguimiento I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION radiológico I-EVOLUTION realizando I-EVOLUTION pruebas I-EVOLUTION de I-EVOLUTION imagen I-EVOLUTION cada I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION sin I-EVOLUTION objetivarse I-EVOLUTION recidiva I-EVOLUTION tumoral. I-EVOLUTION En B-TREATMENT mayo I-TREATMENT de I-TREATMENT 2015, I-TREATMENT el I-TREATMENT paciente I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT antiviral I-TREATMENT con I-TREATMENT ledipasvir/sofosbuvir I-TREATMENT 90/400 I-TREATMENT mg I-TREATMENT (Harvoni®) I-TREATMENT una I-TREATMENT vez I-TREATMENT al I-TREATMENT día I-TREATMENT durante I-TREATMENT 12 I-TREATMENT semanas, I-TREATMENT tras I-TREATMENT documentarse I-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT enfermedad I-TREATMENT tumoral I-TREATMENT mediante I-TREATMENT una I-TREATMENT resonancia I-TREATMENT magnética I-TREATMENT hepática I-TREATMENT dos I-TREATMENT días I-TREATMENT antes I-TREATMENT de I-TREATMENT empezar I-TREATMENT el I-TREATMENT tratamiento. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION finalizó I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION eventos I-EVOLUTION adversos I-EVOLUTION ni I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION logrando I-EVOLUTION alcanzar I-EVOLUTION respuesta I-EVOLUTION virológica I-EVOLUTION sostenida I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 12 I-EVOLUTION y I-EVOLUTION 24 I-EVOLUTION semanas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION finalizar I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION En B-EXPLORATION octubre I-EXPLORATION de I-EXPLORATION 2015 I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION hepática I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION el I-EXPLORATION área I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION hepático I-EXPLORATION tratado I-EXPLORATION con I-EXPLORATION radiofrecuencia I-EXPLORATION sin I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION datos I-EXPLORATION que I-EXPLORATION orientaran I-EXPLORATION a I-EXPLORATION recidiva I-EXPLORATION tumoral. I-EXPLORATION No I-EXPLORATION obstante, I-EXPLORATION tres I-EXPLORATION meses I-EXPLORATION después I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION resonancia I-EXPLORATION magnética, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION aparecieron I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION hipointensas I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION ligeramente I-EXPLORATION hiperintensas I-EXPLORATION en I-EXPLORATION T2 I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION hepático, I-EXPLORATION algunas I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cuales I-EXPLORATION presentaban I-EXPLORATION realce I-EXPLORATION periférico I-EXPLORATION en I-EXPLORATION anillo, I-EXPLORATION siendo I-EXPLORATION sugerentes I-EXPLORATION como I-EXPLORATION primera I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION hepáticas. I-EXPLORATION La I-EXPLORATION zona I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION VI I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION había I-EXPLORATION aplicado I-EXPLORATION radiofrecuencia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pasado I-EXPLORATION se I-EXPLORATION mantenía I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION radiológicos I-EXPLORATION de I-EXPLORATION recidiva I-EXPLORATION tumoral. I-EXPLORATION En I-EXPLORATION ese I-EXPLORATION momento, I-EXPLORATION la I-EXPLORATION hipótesis I-EXPLORATION de I-EXPLORATION una I-EXPLORATION posible I-EXPLORATION recidiva I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION comportamiento I-EXPLORATION agresivo I-EXPLORATION del I-EXPLORATION hepatocarcinoma I-EXPLORATION previo I-EXPLORATION era I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION diagnósticos I-EXPLORATION más I-EXPLORATION probables, I-EXPLORATION aunque I-EXPLORATION el I-EXPLORATION comportamiento I-EXPLORATION radiológico I-EXPLORATION también I-EXPLORATION hacía I-EXPLORATION sospechar I-EXPLORATION que I-EXPLORATION se I-EXPLORATION tratara I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION primario I-EXPLORATION no I-EXPLORATION conocido I-EXPLORATION y I-EXPLORATION originado I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION extrahepático. I-EXPLORATION Por I-EXPLORATION ello, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION punción-aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION de I-EXPLORATION una I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION hepáticas I-EXPLORATION para I-EXPLORATION análisis I-EXPLORATION citológico, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION mostró I-EXPLORATION células I-EXPLORATION metastásicas I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION neuroendocrino I-EXPLORATION de I-EXPLORATION célula I-EXPLORATION pequeña I-EXPLORATION (CD56+; I-EXPLORATION sinaptofisina+ I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION a I-EXPLORATION continuación I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION cérvico-tóraco-abdominal I-EXPLORATION para I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION lesiones I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION dorsales I-EXPLORATION y I-EXPLORATION lumbosacros, I-EXPLORATION siendo I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION metastásica. I-EXPLORATION La I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION y I-EXPLORATION la I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION realizadas I-EXPLORATION posteriormente I-EXPLORATION confirmaron I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tomografía. I-EXPLORATION I-EXPLORATION Hasta I-EXPLORATION la I-EXPLORATION fecha, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION logrado I-EXPLORATION encontrar I-EXPLORATION la I-EXPLORATION localización I-EXPLORATION primaria I-EXPLORATION del I-EXPLORATION tumor, I-EXPLORATION si I-EXPLORATION bien I-EXPLORATION la I-EXPLORATION hipótesis I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION microcítico I-EXPLORATION de I-EXPLORATION pulmón I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION metastásica I-EXPLORATION es I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION más I-EXPLORATION probable. I-EXPLORATION En B-TREATMENT el I-TREATMENT momento I-TREATMENT actual I-TREATMENT el I-TREATMENT paciente I-TREATMENT está I-TREATMENT recibiendo I-TREATMENT quimioterapia I-TREATMENT basada I-TREATMENT en I-TREATMENT un I-TREATMENT régimen I-TREATMENT consistente I-TREATMENT en I-TREATMENT carboplatino I-TREATMENT y I-TREATMENT etopósido I-TREATMENT y I-TREATMENT ha I-TREATMENT recibido I-TREATMENT radioterapia I-TREATMENT paliativa I-TREATMENT para I-TREATMENT control I-TREATMENT del I-TREATMENT dolor I-TREATMENT secundario I-TREATMENT a I-TREATMENT las I-TREATMENT metástasis I-TREATMENT óseas I-TREATMENT de I-TREATMENT columna, I-TREATMENT presentando I-TREATMENT buena I-TREATMENT respuesta I-TREATMENT clínica. I-TREATMENT En B-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION tóraco-abdominal I-EXPLORATION realizada I-EXPLORATION seis I-EXPLORATION meses I-EXPLORATION después I-EXPLORATION de I-EXPLORATION comenzar I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION quimioterápico I-EXPLORATION han I-EXPLORATION desaparecido I-EXPLORATION la I-EXPLORATION mayoría I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION hepáticas I-EXPLORATION y I-EXPLORATION óseas I-EXPLORATION metastásicas, I-EXPLORATION persistiendo I-EXPLORATION solo I-EXPLORATION algunos I-EXPLORATION nódulos I-EXPLORATION milimétricos I-EXPLORATION hepáticos. I-EXPLORATION Dada B-EVOLUTION la I-EVOLUTION buena I-EVOLUTION respuesta, I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION reiniciado I-EVOLUTION un I-EVOLUTION nuevo I-EVOLUTION ciclo I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION oncológico I-EVOLUTION cuyos I-EVOLUTION resultados I-EVOLUTION serán I-EVOLUTION evaluados I-EVOLUTION en I-EVOLUTION el I-EVOLUTION futuro I-EVOLUTION próximo. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 85 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colelitiasis I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS espalda, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hematoquecia. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION leucocitosis I-EXPLORATION (14.300, I-EXPLORATION neutrófilos I-EXPLORATION 84, I-EXPLORATION 5%), I-EXPLORATION hemoglobina I-EXPLORATION 7 I-EXPLORATION g/dl, I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 179 I-EXPLORATION mg/l, I-EXPLORATION amilasa I-EXPLORATION 648 I-EXPLORATION U/l, I-EXPLORATION lipasa I-EXPLORATION 1.417 I-EXPLORATION U/l I-EXPLORATION y I-EXPLORATION patrón I-EXPLORATION colestático. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION vesicular, I-EXPLORATION con I-EXPLORATION colelitiasis I-EXPLORATION y I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION pancreática. I-EXPLORATION Dado I-EXPLORATION que I-EXPLORATION la I-EXPLORATION HDA I-EXPLORATION y I-EXPLORATION la I-EXPLORATION anemia I-EXPLORATION continuaron, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION angio-TC I-EXPLORATION abdominal, I-EXPLORATION visualizándose I-EXPLORATION una I-EXPLORATION estructura I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION lobulados I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vesícula, I-EXPLORATION hiperdensa I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION arterial, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION cambiaba I-EXPLORATION su I-EXPLORATION morfología I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION venoso, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION pseudoaneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cística. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION final I-EXPLORATION fue I-EXPLORATION el I-EXPLORATION de I-EXPLORATION pancreatitis I-EXPLORATION aguda I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION hemobilia I-EXPLORATION por I-EXPLORATION sangrado I-EXPLORATION de I-EXPLORATION pseudoaneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cística. I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT embolización I-TREATMENT con B-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente. I-EVOLUTION I-EVOLUTION En B-PRESENT_ILLNESS primer I-PRESENT_ILLNESS lugar, I-PRESENT_ILLNESS presentamos I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS retroesternal, I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS oC. I-PRESENT_ILLNESS La B-EXPLORATION endoscopia I-EXPLORATION oral I-EXPLORATION mostraba I-EXPLORATION erosiones I-EXPLORATION longitudinales I-EXPLORATION profundas, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION y I-EXPLORATION sobreelevados, I-EXPLORATION desde I-EXPLORATION esófago I-EXPLORATION medio I-EXPLORATION hasta I-EXPLORATION distal. I-EXPLORATION Se B-TREATMENT pautó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT aciclovir I-TREATMENT por I-TREATMENT sospecha I-TREATMENT de I-TREATMENT EH I-TREATMENT que I-TREATMENT se I-TREATMENT confirmó I-TREATMENT histológicamente. I-TREATMENT Además, B-EXPLORATION el I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION eosinófilos I-EXPLORATION en I-EXPLORATION esófago I-EXPLORATION proximal I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION > I-EXPLORATION 15 I-EXPLORATION por I-EXPLORATION campo, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION EEo. I-EXPLORATION La I-EXPLORATION endoscopia I-EXPLORATION de I-EXPLORATION revisión I-EXPLORATION al I-EXPLORATION mes I-EXPLORATION de I-EXPLORATION finalizar I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION mantenía I-EXPLORATION signos I-EXPLORATION endoscópicos I-EXPLORATION e I-EXPLORATION histológicos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION EEo I-EXPLORATION sin I-EXPLORATION aislarse I-EXPLORATION VHS-I. I-EXPLORATION I-EXPLORATION Asimismo, B-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY asma, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY broncodilatador, I-PAST_MEDICAL_HISTORY corticoideo I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY antibiótico, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS aguda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION endoscopia I-EXPLORATION oral I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION ulcerada I-EXPLORATION longitudinal I-EXPLORATION subcentimétrica I-EXPLORATION en I-EXPLORATION cardias, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION la I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION presentaba I-EXPLORATION inclusiones I-EXPLORATION de I-EXPLORATION Cowdry I-EXPLORATION tipo I-EXPLORATION A I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION EH. I-EXPLORATION Histológicamente, I-EXPLORATION coexistían I-EXPLORATION una I-EXPLORATION candidiasis I-EXPLORATION esofágica I-EXPLORATION y I-EXPLORATION una I-EXPLORATION EEo. I-EXPLORATION A B-TREATMENT las I-TREATMENT ocho I-TREATMENT semanas I-TREATMENT de I-TREATMENT finalizar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT fluconazol, I-TREATMENT aciclovir I-TREATMENT y I-TREATMENT pantoprazol I-TREATMENT habían B-EVOLUTION desaparecido I-EVOLUTION las I-EVOLUTION alteraciones I-EVOLUTION sugestivas I-EVOLUTION de I-EVOLUTION esofagitis I-EVOLUTION infecciosa, I-EVOLUTION persistiendo I-EVOLUTION las I-EVOLUTION compatibles I-EVOLUTION con I-EVOLUTION EEo. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION inmunológico I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION pacientes. I-EXPLORATION I-EXPLORATION Mujer 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 personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS sugerente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS colangitis. I-PRESENT_ILLNESS Durante B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION colangio-RMN I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION litiasis I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 7 I-EXPLORATION mm I-EXPLORATION enclavada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION colédoco, I-EXPLORATION a I-EXPLORATION unos I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION papila, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intra I-EXPLORATION y I-EXPLORATION extrahepática. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION CPRE I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION consiguió I-EXPLORATION canular I-EXPLORATION la I-EXPLORATION papila I-EXPLORATION de I-EXPLORATION Vater. I-EXPLORATION Dos I-EXPLORATION días I-EXPLORATION después, I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ictericia, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION CPRE I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION coágulo I-EXPLORATION fresco I-EXPLORATION cubriendo I-EXPLORATION la I-EXPLORATION papila. I-EXPLORATION Tras I-EXPLORATION retirarlo, I-EXPLORATION se I-EXPLORATION accedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar, I-EXPLORATION observando I-EXPLORATION el I-EXPLORATION cálculo I-EXPLORATION descrito I-EXPLORATION en I-EXPLORATION la I-EXPLORATION colangiorresonancia, I-EXPLORATION que B-TREATMENT fue I-TREATMENT extraído I-TREATMENT tras I-TREATMENT realizar I-TREATMENT una I-TREATMENT esfinterotomía I-TREATMENT biliar. I-TREATMENT Finalmente, I-TREATMENT se I-TREATMENT inyectó I-TREATMENT adrenalina I-TREATMENT diluida I-TREATMENT en I-TREATMENT la I-TREATMENT papila, I-TREATMENT la I-TREATMENT cual I-TREATMENT continuaba I-TREATMENT con I-TREATMENT signos I-TREATMENT de I-TREATMENT hemorragia I-TREATMENT reciente. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION alta, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION acudió I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION por I-EVOLUTION fiebre, I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION astenia I-EVOLUTION intensa. I-EVOLUTION Analíticamente, B-EXPLORATION destacaba I-EXPLORATION Hb I-EXPLORATION 8, I-EXPLORATION 6 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION (Hto) I-EXPLORATION 27, I-EXPLORATION 2%, I-EXPLORATION leucocitos I-EXPLORATION 10.000 I-EXPLORATION U/ml I-EXPLORATION con I-EXPLORATION 68% I-EXPLORATION de I-EXPLORATION polimorfonucleares, I-EXPLORATION plaquetas I-EXPLORATION 627.000 I-EXPLORATION U/ml, I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C-reactiva I-EXPLORATION (PCR) I-EXPLORATION 187, I-EXPLORATION 4 I-EXPLORATION mg/l. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION ocupante I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION (LOE) I-EXPLORATION hepática I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 10 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION segmento I-EXPLORATION III, I-EXPLORATION con I-EXPLORATION características I-EXPLORATION ecográficas I-EXPLORATION de I-EXPLORATION absceso. I-EXPLORATION Se I-EXPLORATION intentó I-EXPLORATION el I-EXPLORATION drenaje I-EXPLORATION percutáneo, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION posible I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION material I-EXPLORATION obtenido I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION Enterobacter I-EXPLORATION cloacae. I-EXPLORATION I-EXPLORATION Una I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION control I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION antibiótico I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION descrita I-EXPLORATION previamente, I-EXPLORATION que I-EXPLORATION correspondía I-EXPLORATION a I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION hematoma I-EXPLORATION hepático. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT fiebre I-TREATMENT elevada I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT catéter I-TREATMENT de I-TREATMENT drenaje I-TREATMENT de I-TREATMENT 8 I-TREATMENT Fr. I-TREATMENT I-TREATMENT Tras B-EVOLUTION el I-EVOLUTION drenaje, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION asintomática, I-EVOLUTION apirética I-EVOLUTION y I-EVOLUTION hemodinámicamente I-EVOLUTION estable. I-EVOLUTION Se B-EXPLORATION realizaron I-EXPLORATION ecografías I-EXPLORATION abdominales I-EXPLORATION semanales I-EXPLORATION para I-EXPLORATION control I-EXPLORATION evolutivo I-EXPLORATION del I-EXPLORATION hematoma I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION la I-EXPLORATION disminución I-EXPLORATION progresiva I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION Tras B-EVOLUTION seis I-EVOLUTION semanas, I-EVOLUTION se I-EVOLUTION retiró I-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION sin I-EVOLUTION observar I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 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 pancreatitis I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY calcificante I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY reagudizaciones I-PAST_MEDICAL_HISTORY frecuentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY enólico. I-PAST_MEDICAL_HISTORY Tras B-PRESENT_ILLNESS una I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS abundante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alcohol I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS epigástrico I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cinturón I-PRESENT_ILLNESS que I-PRESENT_ILLNESS aumenta I-PRESENT_ILLNESS progresivamente. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION pálido, I-EXPLORATION sudoroso I-EXPLORATION y I-EXPLORATION taquicárdico. I-EXPLORATION Palpación I-EXPLORATION abdominal I-EXPLORATION dolorosa I-EXPLORATION en I-EXPLORATION epigastrio I-EXPLORATION e I-EXPLORATION hipocondrios. I-EXPLORATION En I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION destacan I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 8 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION del I-EXPLORATION 23, I-EXPLORATION 5% I-EXPLORATION y I-EXPLORATION amilasa I-EXPLORATION aumentada I-EXPLORATION (338 I-EXPLORATION U/l). I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION intravenoso I-EXPLORATION en I-EXPLORATION fases I-EXPLORATION arterial I-EXPLORATION tardía I-EXPLORATION y I-EXPLORATION portal I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION páncreas I-EXPLORATION atrófico I-EXPLORATION con I-EXPLORATION calcificaciones I-EXPLORATION dispersas, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION pseudoquiste I-EXPLORATION en I-EXPLORATION hilio I-EXPLORATION esplénico, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION su I-EXPLORATION cara I-EXPLORATION visceral I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION del I-EXPLORATION bazo. I-EXPLORATION Produce I-EXPLORATION una I-EXPLORATION sección I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION que I-EXPLORATION comunica I-EXPLORATION con I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION hematoma I-EXPLORATION subcapsular. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT punción-drenaje I-TREATMENT guiado I-TREATMENT por I-TREATMENT TC I-TREATMENT del I-TREATMENT hematoma I-TREATMENT periesplénico, I-TREATMENT evolucionando B-EVOLUTION de I-EVOLUTION forma I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY polivalvulopatía I-PAST_MEDICAL_HISTORY reumática I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS epigastrio I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS la I-PRESENT_ILLNESS espalda I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cinturón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS ictericia, I-PRESENT_ILLNESS coluria, I-PRESENT_ILLNESS acolia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (38, I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS oC). I-PRESENT_ILLNESS En B-EXPLORATION analítica I-EXPLORATION muestra I-EXPLORATION amilasa I-EXPLORATION 2.126 I-EXPLORATION U/l, I-EXPLORATION ALT I-EXPLORATION 124 I-EXPLORATION U/l, I-EXPLORATION AST I-EXPLORATION 169 I-EXPLORATION U/l, I-EXPLORATION GGT I-EXPLORATION 3.548 I-EXPLORATION U/l, I-EXPLORATION FA I-EXPLORATION 1.516 I-EXPLORATION U/l, I-EXPLORATION BrT I-EXPLORATION 12, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION BrD I-EXPLORATION 9, I-EXPLORATION 1 I-EXPLORATION mg/dl. I-EXPLORATION En I-EXPLORATION ecografía I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION colelitiasis I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION (DVB) I-EXPLORATION extrahepática I-EXPLORATION y I-EXPLORATION cambios I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION PAL. I-EXPLORATION Ingresa B-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT colangitis I-TREATMENT aguda I-TREATMENT y I-TREATMENT PAL, I-TREATMENT iniciándose I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT piperazilina-tazobactam. I-TREATMENT Al B-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION aparecen I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION piernas I-EVOLUTION nódulos I-EVOLUTION subcutáneos I-EVOLUTION dolorosos I-EVOLUTION y I-EVOLUTION eritematosos, I-EVOLUTION compatibles I-EVOLUTION histológicamente I-EVOLUTION con I-EVOLUTION PP. I-EVOLUTION Los B-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION para I-EXPLORATION R. I-EXPLORATION planticola I-EXPLORATION sensible I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION instaurado. I-EXPLORATION En I-EXPLORATION colangio-resonancia I-EXPLORATION magnética I-EXPLORATION (RNM) I-EXPLORATION se I-EXPLORATION descartan I-EXPLORATION DVB I-EXPLORATION y I-EXPLORATION coledocolitiasis. I-EXPLORATION Ante B-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION colestasis I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION patología I-EVOLUTION obstructiva, I-EVOLUTION y I-EVOLUTION asumiendo I-EVOLUTION la I-EVOLUTION salida I-EVOLUTION espontánea I-EVOLUTION de I-EVOLUTION coledocoliatiasis, I-EVOLUTION se I-EVOLUTION decide I-EVOLUTION no I-EVOLUTION realizar I-EVOLUTION CPRE. I-EVOLUTION Al I-EVOLUTION decimoprimer I-EVOLUTION día I-EVOLUTION se I-EVOLUTION da I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION por I-EVOLUTION buena I-EVOLUTION evolución. I-EVOLUTION I-EVOLUTION En B-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Crohn I-PAST_MEDICAL_HISTORY colónica I-PAST_MEDICAL_HISTORY se B-PRESENT_ILLNESS sospechó I-PRESENT_ILLNESS afectación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ID I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS indicó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS CE. I-PRESENT_ILLNESS Presentaba B-EXPLORATION síntomas I-EXPLORATION que I-EXPLORATION hicieron I-EXPLORATION sospechar I-EXPLORATION una I-EXPLORATION estenosis, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION comprobar I-EXPLORATION antes I-EXPLORATION la I-EXPLORATION permeabilidad I-EXPLORATION intestinal I-EXPLORATION mediante I-EXPLORATION una I-EXPLORATION cápsula I-EXPLORATION Agile®. I-EXPLORATION Aproximadamente B-EVOLUTION 30 I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION su I-EVOLUTION administración I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION intenso I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION distensión I-EVOLUTION y I-EVOLUTION vómitos. I-EVOLUTION Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC), I-EXPLORATION diagnosticándose I-EXPLORATION una I-EXPLORATION obstrucción I-EXPLORATION intestinal I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION la I-EXPLORATION impactación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Agile® I-EXPLORATION en I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION ileal, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION asas I-EXPLORATION proximales I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION paredes. I-EXPLORATION A B-TREATMENT pesar I-TREATMENT de I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT mejoró I-TREATMENT con I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT analgesia I-TREATMENT y I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT sonda I-TREATMENT nasogástrica, I-TREATMENT se I-TREATMENT decidió I-TREATMENT intervenirla, I-TREATMENT objetivándose I-TREATMENT la I-TREATMENT estenosis I-TREATMENT ileal I-TREATMENT con I-TREATMENT un I-TREATMENT discreto I-TREATMENT edema I-TREATMENT de I-TREATMENT asas I-TREATMENT proximales, I-TREATMENT ya I-TREATMENT sin I-TREATMENT dilatación I-TREATMENT de I-TREATMENT las I-TREATMENT mismas. I-TREATMENT Se I-TREATMENT resecó I-TREATMENT el I-TREATMENT segmento I-TREATMENT afecto I-TREATMENT y I-TREATMENT no I-TREATMENT se I-TREATMENT encontró I-TREATMENT la I-TREATMENT cápsula I-TREATMENT durante I-TREATMENT la I-TREATMENT intervención. I-TREATMENT I-TREATMENT Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS diarreicas, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS cólico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS kg. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION 23.660 I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION colonoscopia I-EXPLORATION con I-EXPLORATION pancolitis I-EXPLORATION moderada I-EXPLORATION por I-EXPLORATION CU. I-EXPLORATION Precozmente I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION hemorragia I-EXPLORATION digestiva I-EXPLORATION alta, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION gastroscopia I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION afectación I-EXPLORATION continua I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION gástrica, I-EXPLORATION pérdida I-EXPLORATION del I-EXPLORATION patrón I-EXPLORATION vascular I-EXPLORATION y I-EXPLORATION pliegues, I-EXPLORATION exudado I-EXPLORATION mucoso, I-EXPLORATION friabilidad I-EXPLORATION y I-EXPLORATION erosiones I-EXPLORATION en I-EXPLORATION duodeno. I-EXPLORATION Lesiones I-EXPLORATION que I-EXPLORATION impresionaban I-EXPLORATION de I-EXPLORATION CU. I-EXPLORATION La I-EXPLORATION anatomía-patológica I-EXPLORATION demostró I-EXPLORATION criptitis I-EXPLORATION aguda, I-EXPLORATION abscesos I-EXPLORATION crípticos I-EXPLORATION e I-EXPLORATION hiperplasia I-EXPLORATION foveolar, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION CU. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION Helicobacter I-EXPLORATION pylori I-EXPLORATION y I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION técnicas I-EXPLORATION inmunohistoquímicas I-EXPLORATION (ácido I-EXPLORATION peryódico I-EXPLORATION de I-EXPLORATION Schiff I-EXPLORATION [PAS], I-EXPLORATION Gram I-EXPLORATION y I-EXPLORATION CMV). I-EXPLORATION Ante B-TREATMENT la I-TREATMENT afectación I-TREATMENT proximal I-TREATMENT de I-TREATMENT la I-TREATMENT CU I-TREATMENT se I-TREATMENT continuó I-TREATMENT con I-TREATMENT corticoides I-TREATMENT intravenosos I-TREATMENT con B-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION resolución I-EVOLUTION sintomática I-EVOLUTION en I-EVOLUTION una I-EVOLUTION semana. I-EVOLUTION La I-EVOLUTION gastroscopia I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION fue I-EVOLUTION normal. I-EVOLUTION Actualmente, B-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT encuentra I-TREATMENT asintomático, I-TREATMENT con I-TREATMENT azatioprina I-TREATMENT 150 I-TREATMENT mg/24 I-TREATMENT h I-TREATMENT y I-TREATMENT mesalazina I-TREATMENT 4 I-TREATMENT g/24 I-TREATMENT h. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 64 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS estudiado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unas I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS acompañante. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION solo I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION GGT I-EXPLORATION discretamente I-EXPLORATION elevada I-EXPLORATION (70 I-EXPLORATION U/l) I-EXPLORATION con I-EXPLORATION un I-EXPLORATION CA I-EXPLORATION 19.9 I-EXPLORATION de I-EXPLORATION 170 I-EXPLORATION U/ml. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION analíticos I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION ya I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION izquierda, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION las I-EXPLORATION vías I-EXPLORATION biliares I-EXPLORATION principal I-EXPLORATION y I-EXPLORATION derechas I-EXPLORATION presentaban I-EXPLORATION características I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION practica I-EXPLORATION una I-EXPLORATION colangio-RMN I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION apreciar I-EXPLORATION una I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION biliar I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION polipoidea I-EXPLORATION en I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION hepático I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos. I-EXPLORATION Previo I-EXPLORATION a I-EXPLORATION plantear I-EXPLORATION un I-EXPLORATION tratamiento I-EXPLORATION se I-EXPLORATION practica I-EXPLORATION CPRE, I-EXPLORATION que I-EXPLORATION demuestra I-EXPLORATION la I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION izquierda I-EXPLORATION por I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION polipoidea I-EXPLORATION en I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION hepático I-EXPLORATION izquierdo, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION biopsiado. I-EXPLORATION Además, B-TREATMENT se I-TREATMENT coloca I-TREATMENT una I-TREATMENT prótesis I-TREATMENT plástica. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION papilar I-EXPLORATION con I-EXPLORATION displasia I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado. I-EXPLORATION Se B-TREATMENT plantea I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT y I-TREATMENT se I-TREATMENT practican I-TREATMENT colecistectomía, I-TREATMENT hepatectomía I-TREATMENT izquierda I-TREATMENT anatómica I-TREATMENT con I-TREATMENT resección I-TREATMENT del I-TREATMENT segmento I-TREATMENT I I-TREATMENT y I-TREATMENT exéresis I-TREATMENT del I-TREATMENT árbol I-TREATMENT biliar I-TREATMENT izquierdo I-TREATMENT hasta I-TREATMENT la I-TREATMENT confluencia I-TREATMENT con I-TREATMENT el I-TREATMENT derecho. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION intraoperatorio I-EXPLORATION del I-EXPLORATION borde I-EXPLORATION de I-EXPLORATION sección I-EXPLORATION biliar I-EXPLORATION no I-EXPLORATION demuestra I-EXPLORATION afectación. I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION transcurre I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION reseñables. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION papilar I-EXPLORATION biliar I-EXPLORATION intraductal I-EXPLORATION con I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION colangiocarcinoma I-EXPLORATION papilar I-EXPLORATION e I-EXPLORATION invasivo, I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION linfática. I-EXPLORATION Los I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION estaban I-EXPLORATION libres. I-EXPLORATION No B-TREATMENT se I-TREATMENT realiza I-TREATMENT tratamiento I-TREATMENT complementario I-TREATMENT y B-EVOLUTION tras I-EVOLUTION cinco I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS ingresado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS subictericia I-PRESENT_ILLNESS cutánea-mucosa. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destaca I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION GGT I-EXPLORATION y I-EXPLORATION discreta I-EXPLORATION de I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION con I-EXPLORATION un I-EXPLORATION CA I-EXPLORATION 19.9 I-EXPLORATION de I-EXPLORATION 1.973 I-EXPLORATION U/ml. I-EXPLORATION Al I-EXPLORATION igual I-EXPLORATION que I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION caso, I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION demuestra I-EXPLORATION una I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION izquierda. I-EXPLORATION En I-EXPLORATION este I-EXPLORATION caso, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION colangio-RMN I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION ver I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION biliar I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION ocupación I-EXPLORATION por I-EXPLORATION material I-EXPLORATION velloso I-EXPLORATION y I-EXPLORATION mucina. I-EXPLORATION La I-EXPLORATION CPRE I-EXPLORATION demuestra I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION mucina I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ocupación I-EXPLORATION vellosa I-EXPLORATION del I-EXPLORATION árbol I-EXPLORATION biliar I-EXPLORATION izquierdo, I-EXPLORATION del I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION toma I-EXPLORATION una I-EXPLORATION biopsia, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION coloca I-EXPLORATION una I-EXPLORATION prótesis I-EXPLORATION plástica. I-EXPLORATION La I-EXPLORATION histología I-EXPLORATION es I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION papilar I-EXPLORATION intraductal I-EXPLORATION con I-EXPLORATION displasia I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado. I-EXPLORATION También B-TREATMENT se I-TREATMENT le I-TREATMENT plantea I-TREATMENT tratamiento I-TREATMENT quirúrgico, I-TREATMENT practicando I-TREATMENT hepatectomía I-TREATMENT izquierda I-TREATMENT con I-TREATMENT resección I-TREATMENT del I-TREATMENT segmento I-TREATMENT I I-TREATMENT y I-TREATMENT del I-TREATMENT árbol I-TREATMENT biliar I-TREATMENT izquierdo, I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT linfadenectomía I-TREATMENT del I-TREATMENT hilio I-TREATMENT hepático. I-TREATMENT La B-EXPLORATION biopsia I-EXPLORATION intraoperatoria I-EXPLORATION demuestra I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION borde I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION biliar. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION definitivo I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION colangiocarcinoma I-EXPLORATION con I-EXPLORATION componente I-EXPLORATION microinfiltrante I-EXPLORATION aislado I-EXPLORATION y I-EXPLORATION focal I-EXPLORATION en I-EXPLORATION rama I-EXPLORATION distal I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION III I-EXPLORATION hepático I-EXPLORATION con I-EXPLORATION producción I-EXPLORATION de I-EXPLORATION moco. I-EXPLORATION Tampoco B-TREATMENT se I-TREATMENT realiza I-TREATMENT tratamiento I-TREATMENT adyuvante I-TREATMENT y B-EVOLUTION el I-EVOLUTION paciente, I-EVOLUTION tras I-EVOLUTION cuatro I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION recidiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY CEP I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2010. I-PAST_MEDICAL_HISTORY Tras B-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION se I-EXPLORATION estudió I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION asociación I-EXPLORATION con I-EXPLORATION CU I-EXPLORATION mediante I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION baja I-EXPLORATION completa I-EXPLORATION sin I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetivaran I-EXPLORATION alteraciones I-EXPLORATION macroscópicas I-EXPLORATION ni I-EXPLORATION histológicas. I-EXPLORATION En B-TREATMENT 2013 I-TREATMENT fue I-TREATMENT sometida I-TREATMENT a I-TREATMENT trasplante I-TREATMENT hepático I-TREATMENT cadavérico I-TREATMENT por I-TREATMENT insuficiencia I-TREATMENT hepatocelular I-TREATMENT y I-TREATMENT colangitis I-TREATMENT de I-TREATMENT repetición. I-TREATMENT No B-EVOLUTION presentó I-EVOLUTION complicaciones I-EVOLUTION inmediatas I-EVOLUTION postrasplante, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION función I-EVOLUTION del I-EVOLUTION injerto I-EVOLUTION y I-EVOLUTION régimen I-EVOLUTION de I-EVOLUTION inmunosupresión I-EVOLUTION basado I-EVOLUTION en I-EVOLUTION tacrolimus I-EVOLUTION de I-EVOLUTION liberación I-EVOLUTION prolongada. I-EVOLUTION Nueve I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION trasplante, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION debutó I-EVOLUTION con I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION diarrea I-EVOLUTION sanguinolenta, I-EVOLUTION con I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION CU I-EVOLUTION de I-EVOLUTION localización I-EVOLUTION extensa I-EVOLUTION y I-EVOLUTION con I-EVOLUTION actividad I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION endoscópica I-EVOLUTION moderada. I-EVOLUTION Desde I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION la I-EVOLUTION CU, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION cumplió I-EVOLUTION criterios I-EVOLUTION de I-EVOLUTION corticodependencia. I-EVOLUTION Ante B-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT discreta I-TREATMENT leucopenia, I-TREATMENT no I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT azatioprina I-TREATMENT y I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT biológico I-TREATMENT anti-TNFα I-TREATMENT con I-TREATMENT golimumab I-TREATMENT subcutáneo I-TREATMENT (dosis I-TREATMENT de I-TREATMENT inducción I-TREATMENT habitual I-TREATMENT 200 I-TREATMENT mg I-TREATMENT sc I-TREATMENT inicialmente, I-TREATMENT 100 I-TREATMENT mg I-TREATMENT a I-TREATMENT las I-TREATMENT dos I-TREATMENT semanas) I-TREATMENT y I-TREATMENT 50 I-TREATMENT mg I-TREATMENT mensualmente I-TREATMENT de I-TREATMENT mantenimiento I-TREATMENT (peso I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT 61 I-TREATMENT kg). I-TREATMENT La I-TREATMENT respuesta I-TREATMENT a I-TREATMENT golimumab I-TREATMENT fue I-TREATMENT solo I-TREATMENT parcial, I-TREATMENT precisando I-TREATMENT de I-TREATMENT intensificación I-TREATMENT a I-TREATMENT 100 I-TREATMENT mg I-TREATMENT mensuales I-TREATMENT desde I-TREATMENT el I-TREATMENT segundo I-TREATMENT mes I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT no I-TREATMENT consiguiendo I-TREATMENT suspender I-TREATMENT los I-TREATMENT esteroides I-TREATMENT orales, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT a I-TREATMENT los I-TREATMENT cuatro I-TREATMENT meses I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT golimumab I-TREATMENT se I-TREATMENT cambia I-TREATMENT a I-TREATMENT un I-TREATMENT agente I-TREATMENT anti-TNF I-TREATMENT intravenoso: I-TREATMENT infliximab I-TREATMENT (IFX). I-TREATMENT Tras B-EVOLUTION iniciar I-EVOLUTION IFX I-EVOLUTION a I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION inducción I-EVOLUTION convencionales I-EVOLUTION (5 I-EVOLUTION mg/kg I-EVOLUTION intravenoso I-EVOLUTION [iv], I-EVOLUTION semanas I-EVOLUTION 0, I-EVOLUTION 2 I-EVOLUTION y I-EVOLUTION 6), I-EVOLUTION no I-EVOLUTION se I-EVOLUTION alcanzó I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION ni I-EVOLUTION suspensión I-EVOLUTION de I-EVOLUTION esteroides I-EVOLUTION a I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento, I-EVOLUTION pese I-EVOLUTION a I-EVOLUTION la I-EVOLUTION intensificación I-EVOLUTION precoz I-EVOLUTION (5 I-EVOLUTION mg/kg I-EVOLUTION iv I-EVOLUTION cada I-EVOLUTION cuatro I-EVOLUTION semanas) I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION de I-EVOLUTION la I-EVOLUTION quinta I-EVOLUTION infusión. I-EVOLUTION La B-EXPLORATION monitorización I-EXPLORATION de I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION IFX I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION demostró I-EXPLORATION que I-EXPLORATION estaban I-EXPLORATION en I-EXPLORATION rango I-EXPLORATION terapéutico. I-EXPLORATION Ello, I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION anti-infliximab I-EXPLORATION y I-EXPLORATION de I-EXPLORATION infección I-EXPLORATION entérica I-EXPLORATION concomitante I-EXPLORATION o I-EXPLORATION sobreinfección I-EXPLORATION por I-EXPLORATION citomegalovirus I-EXPLORATION (CMV), I-EXPLORATION hizo I-EXPLORATION cambiar I-EXPLORATION de I-EXPLORATION diana I-EXPLORATION terapéutica. I-EXPLORATION En B-TREATMENT diciembre I-TREATMENT de I-TREATMENT 2016 I-TREATMENT (35 I-TREATMENT meses I-TREATMENT después I-TREATMENT del I-TREATMENT trasplante), I-TREATMENT se I-TREATMENT decide I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT vedolizumab I-TREATMENT (VDZ), I-TREATMENT según I-TREATMENT pauta I-TREATMENT de I-TREATMENT inducción I-TREATMENT habitual I-TREATMENT (300 I-TREATMENT mg I-TREATMENT iv I-TREATMENT en I-TREATMENT semanas I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT y I-TREATMENT 6), I-TREATMENT y I-TREATMENT mantenimiento I-TREATMENT con I-TREATMENT 300 I-TREATMENT mg I-TREATMENT VDZ I-TREATMENT iv I-TREATMENT cada I-TREATMENT ocho I-TREATMENT semanas. I-TREATMENT Justo I-TREATMENT antes I-TREATMENT del I-TREATMENT inicio I-TREATMENT de I-TREATMENT VDZ, I-TREATMENT la I-TREATMENT paciente I-TREATMENT presentaba I-TREATMENT un I-TREATMENT índice I-TREATMENT de I-TREATMENT Mayo I-TREATMENT total I-TREATMENT de I-TREATMENT 7. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION segunda I-EVOLUTION infusión I-EVOLUTION se I-EVOLUTION asistió I-EVOLUTION a I-EVOLUTION un I-EVOLUTION respuesta I-EVOLUTION clínica I-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION del I-EVOLUTION hábito I-EVOLUTION deposicional I-EVOLUTION pero I-EVOLUTION manteniendo I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION actividad I-EVOLUTION biológica I-EVOLUTION elevados I-EVOLUTION (calprotectina I-EVOLUTION fecal I-EVOLUTION 805 I-EVOLUTION mcg/g I-EVOLUTION y I-EVOLUTION proteína I-EVOLUTION C I-EVOLUTION reactiva I-EVOLUTION [PCR] I-EVOLUTION 8 I-EVOLUTION mg/l). I-EVOLUTION A B-TREATMENT los I-TREATMENT tres I-TREATMENT meses I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT logró I-TREATMENT suspender I-TREATMENT los I-TREATMENT esteroides, I-TREATMENT y I-TREATMENT un I-TREATMENT mes I-TREATMENT después I-TREATMENT de I-TREATMENT su I-TREATMENT retirada I-TREATMENT fue I-TREATMENT precisa I-TREATMENT una I-TREATMENT intensificación I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT VDZ, I-TREATMENT acortando I-TREATMENT el I-TREATMENT intervalo I-TREATMENT de I-TREATMENT infusiones I-TREATMENT a I-TREATMENT cuatro I-TREATMENT semanas. I-TREATMENT Al B-EVOLUTION año I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION su I-EVOLUTION puntuación I-EVOLUTION de I-EVOLUTION Mayo I-EVOLUTION total I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION (subpuntuación I-EVOLUTION endoscópica I-EVOLUTION 1), I-EVOLUTION la I-EVOLUTION calprotectina I-EVOLUTION descendió I-EVOLUTION a I-EVOLUTION 270 I-EVOLUTION mcg/g I-EVOLUTION y I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION PCR I-EVOLUTION se I-EVOLUTION normalizaron. I-EVOLUTION Los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION tacrolimus I-EVOLUTION permanecieron I-EVOLUTION estables, I-EVOLUTION dentro I-EVOLUTION del I-EVOLUTION rango I-EVOLUTION pretendido I-EVOLUTION (5-10 I-EVOLUTION ng/ml) I-EVOLUTION y B-TREATMENT sin I-TREATMENT requerir I-TREATMENT ajustes I-TREATMENT de I-TREATMENT dosis. I-TREATMENT La B-EVOLUTION bioquímica I-EVOLUTION hepática I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION estable I-EVOLUTION durante I-EVOLUTION todo I-EVOLUTION este I-EVOLUTION periodo. I-EVOLUTION No I-EVOLUTION se I-EVOLUTION han I-EVOLUTION registrado I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION fecha I-EVOLUTION efectos I-EVOLUTION adversos I-EVOLUTION infecciosos I-EVOLUTION ni I-EVOLUTION interacciones I-EVOLUTION farmacológicas. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY VIH, I-PAST_MEDICAL_HISTORY estudiado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS proctitis I-PRESENT_ILLNESS en B-EXPLORATION cuya I-EXPLORATION colonoscopia I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION mucosa I-EXPLORATION patológica I-EXPLORATION con I-EXPLORATION exudado I-EXPLORATION purulento I-EXPLORATION en I-EXPLORATION rectosigma. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION proceso I-EXPLORATION maligno I-EXPLORATION y I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION heces I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simple I-EXPLORATION tipo I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION Chalmydia I-EXPLORATION trachomatis. I-EXPLORATION Fue B-TREATMENT tratado I-TREATMENT con I-TREATMENT valganciclovir I-TREATMENT y I-TREATMENT azitromicina, I-TREATMENT con I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT clínica I-TREATMENT infecciosa I-TREATMENT pero I-TREATMENT con I-TREATMENT estreñimiento I-TREATMENT progresivo. I-TREATMENT Una B-EXPLORATION nueva I-EXPLORATION rectoscopia I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION fibrótica I-EXPLORATION y I-EXPLORATION ulcerada I-EXPLORATION en I-EXPLORATION recto I-EXPLORATION distal, I-EXPLORATION con I-EXPLORATION biopsias I-EXPLORATION y I-EXPLORATION análisis I-EXPLORATION microbiológico I-EXPLORATION negativos. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT la I-TREATMENT clínica I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT conservador, I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT resección I-TREATMENT anterior I-TREATMENT de I-TREATMENT recto I-TREATMENT ultrabaja I-TREATMENT con I-TREATMENT reservorio I-TREATMENT coloanal I-TREATMENT e I-TREATMENT ileostomía. I-TREATMENT Tras B-EVOLUTION posoperatorio I-EVOLUTION complicado, I-EVOLUTION se I-EVOLUTION reconstruye I-EVOLUTION el I-EVOLUTION tránsito I-EVOLUTION sin I-EVOLUTION incidencias, I-EVOLUTION con I-EVOLUTION seguimiento I-EVOLUTION actual I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS presenta I-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 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardiaca I-PAST_MEDICAL_HISTORY grave, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY Debutó B-PRESENT_ILLNESS con I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS eritematosa, I-PRESENT_ILLNESS dura I-PRESENT_ILLNESS y I-PRESENT_ILLNESS no I-PRESENT_ILLNESS dolorosa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS subcutáneo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS esternal I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS extirpó. I-PRESENT_ILLNESS El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION subcutánea I-EXPLORATION de I-EXPLORATION cistoadenocarcinoma I-EXPLORATION mucinoso I-EXPLORATION de I-EXPLORATION origen I-EXPLORATION biliar. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION abdominal I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hepática I-EXPLORATION central I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION colangiocarcinoma I-EXPLORATION hiliar I-EXPLORATION o I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION Klatskin. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT situación I-TREATMENT basal I-TREATMENT se I-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT paliativo. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS estenosis I-PRESENT_ILLNESS esofágica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS accidental I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cáustico. I-PRESENT_ILLNESS El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO institución I-DERIVED_FROM/TO siendo I-DERIVED_FROM/TO portador I-DERIVED_FROM/TO de I-DERIVED_FROM/TO gastrostomía I-DERIVED_FROM/TO y I-DERIVED_FROM/TO una I-DERIVED_FROM/TO sutura I-DERIVED_FROM/TO nasogástrica I-DERIVED_FROM/TO (stringing) I-DERIVED_FROM/TO que I-DERIVED_FROM/TO permitía I-DERIVED_FROM/TO dilataciones I-DERIVED_FROM/TO retrógradas. I-DERIVED_FROM/TO El B-EXPLORATION esofagograma I-EXPLORATION de I-EXPLORATION bario I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION longitud I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION nivel I-EXPLORATION cricotraqueal I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION esófago. I-EXPLORATION Se B-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT un I-TREATMENT programa I-TREATMENT de I-TREATMENT dilataciones I-TREATMENT esofágicas I-TREATMENT retrógradas I-TREATMENT cada I-TREATMENT dos I-TREATMENT semanas I-TREATMENT sin I-TREATMENT ninguna I-TREATMENT mejora, I-TREATMENT por I-TREATMENT lo I-TREATMENT que, I-TREATMENT a I-TREATMENT los I-TREATMENT cinco I-TREATMENT meses I-TREATMENT postingesta I-TREATMENT del I-TREATMENT agente I-TREATMENT corrosivo, I-TREATMENT se I-TREATMENT colocaron I-TREATMENT del I-TREATMENT mismo I-TREATMENT modo I-TREATMENT tres I-TREATMENT stents I-TREATMENT autoexpandibles I-TREATMENT de I-TREATMENT nitinol I-TREATMENT cubiertos I-TREATMENT de I-TREATMENT silicona I-TREATMENT internamente I-TREATMENT (Stents I-TREATMENT MI I-TREATMENT Tech, I-TREATMENT Izasa); I-TREATMENT dos I-TREATMENT de I-TREATMENT 16 I-TREATMENT x I-TREATMENT 60 I-TREATMENT mm I-TREATMENT y I-TREATMENT uno I-TREATMENT de I-TREATMENT 16 I-TREATMENT x I-TREATMENT 40 I-TREATMENT mm. I-TREATMENT El I-TREATMENT más I-TREATMENT craneal I-TREATMENT se I-TREATMENT colocó I-TREATMENT primero, I-TREATMENT introduciendo I-TREATMENT los I-TREATMENT otros I-TREATMENT en I-TREATMENT dirección I-TREATMENT caudal I-TREATMENT y I-TREATMENT manteniendo I-TREATMENT una I-TREATMENT distancia I-TREATMENT de I-TREATMENT superposición I-TREATMENT de I-TREATMENT 1-2 I-TREATMENT cm I-TREATMENT para I-TREATMENT evitar I-TREATMENT el I-TREATMENT desplazamiento I-TREATMENT de I-TREATMENT los I-TREATMENT mismos. I-TREATMENT Este B-EVOLUTION procedimiento I-EVOLUTION logró I-EVOLUTION una I-EVOLUTION dilatación I-EVOLUTION completa I-EVOLUTION durante I-EVOLUTION un I-EVOLUTION mes. I-EVOLUTION I-EVOLUTION El I-EVOLUTION niño I-EVOLUTION refirió I-EVOLUTION dolor I-EVOLUTION como I-EVOLUTION único I-EVOLUTION síntoma I-EVOLUTION postoperatorio I-EVOLUTION que I-EVOLUTION remitió I-EVOLUTION espontáneamente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION cuatro I-EVOLUTION días. I-EVOLUTION No B-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION ni I-EXPLORATION migración I-EXPLORATION ni I-EXPLORATION otras I-EXPLORATION complicaciones I-EXPLORATION a I-EXPLORATION corto I-EXPLORATION plazo. I-EXPLORATION Tolerando B-TREATMENT su I-TREATMENT alimentación I-TREATMENT habitual I-TREATMENT vía I-TREATMENT oral I-TREATMENT de I-TREATMENT manera I-TREATMENT adecuada, I-TREATMENT fue I-TREATMENT dado I-TREATMENT de I-TREATMENT alta I-TREATMENT con I-TREATMENT omeprazol I-TREATMENT pautado I-TREATMENT (15 I-TREATMENT mg/24 I-TREATMENT horas I-TREATMENT vía I-TREATMENT oral) I-TREATMENT y I-TREATMENT seguimiento I-TREATMENT en I-TREATMENT consultas I-TREATMENT externas. I-TREATMENT I-TREATMENT Los I-TREATMENT stents I-TREATMENT se I-TREATMENT retiraron I-TREATMENT a I-TREATMENT las I-TREATMENT cuatro I-TREATMENT semanas I-TREATMENT y I-TREATMENT en I-TREATMENT el I-TREATMENT mismo I-TREATMENT procedimiento I-TREATMENT se I-TREATMENT pulverizó I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT mitomicina I-TREATMENT (0, I-TREATMENT 4 I-TREATMENT ml/kg) I-TREATMENT sobre I-TREATMENT el I-TREATMENT área I-TREATMENT dilatada I-TREATMENT a I-TREATMENT través I-TREATMENT del I-TREATMENT irrigador I-TREATMENT del I-TREATMENT endoscopio. I-TREATMENT Se B-EXPLORATION identificaron I-EXPLORATION dos I-EXPLORATION estenosis I-EXPLORATION residuales I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION largo I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION esfínter I-EXPLORATION cricofaríngeo I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION cardias I-EXPLORATION respectivamente. I-EXPLORATION La I-EXPLORATION primera I-EXPLORATION ya I-EXPLORATION había I-EXPLORATION sido I-EXPLORATION visualizada I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION endoscópica I-EXPLORATION previa, I-EXPLORATION cuando I-EXPLORATION fue I-EXPLORATION imposible I-EXPLORATION la I-EXPLORATION colocación I-EXPLORATION de I-EXPLORATION un I-EXPLORATION stent I-EXPLORATION en I-EXPLORATION dicha I-EXPLORATION región I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION compresión I-EXPLORATION traqueal. I-EXPLORATION La B-TREATMENT estenosis I-TREATMENT esofágica I-TREATMENT distal I-TREATMENT requirió I-TREATMENT otro I-TREATMENT stent I-TREATMENT (16 I-TREATMENT x I-TREATMENT 40 I-TREATMENT mm), I-TREATMENT obteniendo I-TREATMENT la I-TREATMENT dilatación I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT después I-TREATMENT de I-TREATMENT un I-TREATMENT mes I-TREATMENT desde I-TREATMENT su I-TREATMENT colocación. I-TREATMENT Las I-TREATMENT dilataciones I-TREATMENT con I-TREATMENT balón I-TREATMENT posteriores I-TREATMENT se I-TREATMENT realizaron I-TREATMENT a I-TREATMENT intervalos I-TREATMENT de I-TREATMENT cuatro I-TREATMENT semanas, I-TREATMENT consiguiéndose I-TREATMENT un I-TREATMENT esófago I-TREATMENT elástico I-TREATMENT con I-TREATMENT aspecto I-TREATMENT normal I-TREATMENT de I-TREATMENT su I-TREATMENT mucosa. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT la I-TREATMENT estenosis I-TREATMENT del I-TREATMENT esófago I-TREATMENT proximal I-TREATMENT mencionada I-TREATMENT con I-TREATMENT anterioridad I-TREATMENT tuvo I-TREATMENT una I-TREATMENT respuesta I-TREATMENT pobre, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT resección I-TREATMENT quirúrgica I-TREATMENT y I-TREATMENT anastomosis I-TREATMENT mediante I-TREATMENT un I-TREATMENT abordaje I-TREATMENT laterocervical I-TREATMENT inferior I-TREATMENT izquierdo I-TREATMENT seguida I-TREATMENT de I-TREATMENT dilataciones I-TREATMENT neumáticas I-TREATMENT dos I-TREATMENT veces I-TREATMENT al I-TREATMENT mes I-TREATMENT con I-TREATMENT intervalos I-TREATMENT progresivamente I-TREATMENT más I-TREATMENT largos I-TREATMENT durante I-TREATMENT cinco I-TREATMENT meses. I-TREATMENT I-TREATMENT Después B-EVOLUTION de I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION totalmente I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION con I-EVOLUTION un I-EVOLUTION excelente I-EVOLUTION aspecto I-EVOLUTION macroscópico I-EVOLUTION del I-EVOLUTION esófago I-EVOLUTION valorado I-EVOLUTION endoscópicamente I-EVOLUTION y I-EVOLUTION mediante I-EVOLUTION un I-EVOLUTION esofagograma I-EVOLUTION baritado I-EVOLUTION de I-EVOLUTION control. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS sano, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS precisó I-PRESENT_ILLNESS hospitalización I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otras I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS exploración. I-PRESENT_ILLNESS Confesó B-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY usado I-PAST_MEDICAL_HISTORY estanozolol I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg/48 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY (Winstrol®), I-PAST_MEDICAL_HISTORY enantato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY metenolona I-PAST_MEDICAL_HISTORY (Primobolan®) I-PAST_MEDICAL_HISTORY 100 I-PAST_MEDICAL_HISTORY mg/96 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY propionato I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY drostanolona I-PAST_MEDICAL_HISTORY (Masteron®) I-PAST_MEDICAL_HISTORY 200 I-PAST_MEDICAL_HISTORY mg/96 I-PAST_MEDICAL_HISTORY h, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY intramuscular, I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 56 I-PAST_MEDICAL_HISTORY días, I-PAST_MEDICAL_HISTORY interrumpiendo I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY diez I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ingreso. I-PAST_MEDICAL_HISTORY Destacaba B-EXPLORATION una I-EXPLORATION bilirrubina I-EXPLORATION de I-EXPLORATION 41, I-EXPLORATION 9 I-EXPLORATION mg/dl I-EXPLORATION con I-EXPLORATION GPT I-EXPLORATION 114 I-EXPLORATION UI/l I-EXPLORATION y I-EXPLORATION GGT I-EXPLORATION normal; I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION máxima I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION mg/dl I-EXPLORATION (día I-EXPLORATION +39). I-EXPLORATION Se I-EXPLORATION excluyeron I-EXPLORATION otras I-EXPLORATION causas I-EXPLORATION de I-EXPLORATION hepatopatía, I-EXPLORATION patología I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION trastornos I-EXPLORATION vasculares. I-EXPLORATION Una I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION marcada I-EXPLORATION colestasis I-EXPLORATION parenquimatosa I-EXPLORATION y I-EXPLORATION canalicular I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION centrolobulillar. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION lentamente I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION resolución I-EVOLUTION espontánea I-EVOLUTION ad I-EVOLUTION integrum I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Recientemente, B-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS colecistectomizada I-PRESENT_ILLNESS se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION CPRE I-EXPLORATION por I-EXPLORATION coledocolitiasis. I-EXPLORATION Horas B-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION misma, I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION derecho I-EVOLUTION y I-EVOLUTION anemización. I-EVOLUTION Se B-EXPLORATION solicitó I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION subcapsular I-EXPLORATION hepático I-EXPLORATION de I-EXPLORATION 16 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 16 I-EXPLORATION cm, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION comprimía I-EXPLORATION y I-EXPLORATION desplazaba I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION hepático. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION a I-EXPLORATION continuación I-EXPLORATION angio-TC, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION extravasación I-EXPLORATION del I-EXPLORATION contraste. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT estabilidad I-TREATMENT clínica I-TREATMENT y I-TREATMENT ausencia I-TREATMENT de I-TREATMENT sangrado I-TREATMENT activo, I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT un I-TREATMENT manejo I-TREATMENT conservador I-TREATMENT con I-TREATMENT vigilancia I-TREATMENT en I-TREATMENT la I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Cuidados I-TREATMENT Intensivos I-TREATMENT (UCI), I-TREATMENT donde I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT hemodinámicamente I-TREATMENT estable. I-TREATMENT A B-EVOLUTION los I-EVOLUTION diez I-EVOLUTION días, I-EVOLUTION un I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION mostró I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION colección, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT efectuó I-TREATMENT drenaje I-TREATMENT percutáneo I-TREATMENT en I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT extrajeron I-TREATMENT 1.000 I-TREATMENT ml I-TREATMENT de I-TREATMENT contenido I-TREATMENT hemático. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION alta I-EVOLUTION 12 I-EVOLUTION días I-EVOLUTION después. I-EVOLUTION No B-TREATMENT obstante, I-TREATMENT fue I-TREATMENT necesario I-TREATMENT un I-TREATMENT nuevo I-TREATMENT drenaje I-TREATMENT de I-TREATMENT unos I-TREATMENT 1.100 I-TREATMENT ml I-TREATMENT días I-TREATMENT más I-TREATMENT tarde, I-TREATMENT tras B-EVOLUTION el I-EVOLUTION cual I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY país I-PAST_MEDICAL_HISTORY africano I-PAST_MEDICAL_HISTORY que B-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO a I-DERIVED_FROM/TO través I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO ONG. I-DERIVED_FROM/TO Presentaba B-PRESENT_ILLNESS una I-PRESENT_ILLNESS limitación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS apertura I-PRESENT_ILLNESS oral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS mm I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consecuencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS casual I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS bicondílea. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION hipoplasia I-EXPLORATION mandibular I-EXPLORATION sin I-EXPLORATION asimetría, I-EXPLORATION oclusión I-EXPLORATION en I-EXPLORATION clase I-EXPLORATION II I-EXPLORATION con I-EXPLORATION compensación I-EXPLORATION de I-EXPLORATION incisivos I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION deficiente I-EXPLORATION higiene I-EXPLORATION bucal I-EXPLORATION con I-EXPLORATION caries. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ortopantomografía I-EXPLORATION y I-EXPLORATION una I-EXPLORATION telerradiografía I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION anquilosis I-EXPLORATION temporomandibular I-EXPLORATION bilateral. I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION con I-EXPLORATION reconstrucción I-EXPLORATION 3D, I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION fotografías I-EXPLORATION y I-EXPLORATION valoración I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Anestesiología. I-EXPLORATION Las B-TREATMENT características I-TREATMENT sociales I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT impidieron I-TREATMENT indicar I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT ortodóncico. I-TREATMENT I-TREATMENT Se I-TREATMENT planificó I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT contando I-TREATMENT con I-TREATMENT el I-TREATMENT consentimiento I-TREATMENT de I-TREATMENT su I-TREATMENT familia I-TREATMENT de I-TREATMENT acogida. I-TREATMENT La I-TREATMENT intubación I-TREATMENT nasotraqueal I-TREATMENT se I-TREATMENT efectuó I-TREATMENT con I-TREATMENT fibroscopio. I-TREATMENT Realizamos I-TREATMENT un I-TREATMENT abordaje I-TREATMENT preauricular I-TREATMENT con I-TREATMENT exposición I-TREATMENT del I-TREATMENT bloque I-TREATMENT anquilótico, I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT resecó I-TREATMENT ampliamente I-TREATMENT creando I-TREATMENT una I-TREATMENT nueva I-TREATMENT cavidad I-TREATMENT glenoidea, I-TREATMENT sin I-TREATMENT interponer I-TREATMENT ningún I-TREATMENT material I-TREATMENT en I-TREATMENT el I-TREATMENT espacio I-TREATMENT creado. I-TREATMENT Se I-TREATMENT completó I-TREATMENT con I-TREATMENT una I-TREATMENT coronoidectomía I-TREATMENT con I-TREATMENT desinserción I-TREATMENT del I-TREATMENT músculo I-TREATMENT temporal I-TREATMENT bilateral. I-TREATMENT Seguidamente, I-TREATMENT tras I-TREATMENT comprobar I-TREATMENT una I-TREATMENT apertura I-TREATMENT oral I-TREATMENT de I-TREATMENT 30 I-TREATMENT mm, I-TREATMENT colocamos I-TREATMENT un I-TREATMENT distractor I-TREATMENT extraoral I-TREATMENT de I-TREATMENT Molina I-TREATMENT fijado I-TREATMENT en I-TREATMENT el I-TREATMENT arco I-TREATMENT cigomático I-TREATMENT y I-TREATMENT en I-TREATMENT la I-TREATMENT rama I-TREATMENT mandibular I-TREATMENT ascendente, I-TREATMENT con I-TREATMENT la I-TREATMENT finalidad I-TREATMENT de I-TREATMENT elongar I-TREATMENT el I-TREATMENT tejido I-TREATMENT blando I-TREATMENT y I-TREATMENT prevenir I-TREATMENT la I-TREATMENT reanquilosis, I-TREATMENT manteniendo I-TREATMENT separadas I-TREATMENT las I-TREATMENT superficies I-TREATMENT cruentas I-TREATMENT de I-TREATMENT la I-TREATMENT resección. I-TREATMENT La I-TREATMENT misma I-TREATMENT intervención I-TREATMENT se I-TREATMENT realizó I-TREATMENT en I-TREATMENT la I-TREATMENT articulación I-TREATMENT contralateral. I-TREATMENT I-TREATMENT Tras I-TREATMENT un I-TREATMENT período I-TREATMENT de I-TREATMENT latencia I-TREATMENT de I-TREATMENT 5 I-TREATMENT días, I-TREATMENT iniciamos I-TREATMENT la I-TREATMENT distracción I-TREATMENT a I-TREATMENT 1 I-TREATMENT mm I-TREATMENT diario I-TREATMENT y I-TREATMENT la I-TREATMENT fisioterapia, I-TREATMENT la I-TREATMENT cual I-TREATMENT implicaba I-TREATMENT desactivar I-TREATMENT el I-TREATMENT distractor I-TREATMENT mientras I-TREATMENT se I-TREATMENT realizaban I-TREATMENT los I-TREATMENT ejercicios. I-TREATMENT La I-TREATMENT distracción I-TREATMENT se I-TREATMENT completó I-TREATMENT al I-TREATMENT conseguir I-TREATMENT una I-TREATMENT clase I-TREATMENT I. I-TREATMENT Durante I-TREATMENT el I-TREATMENT período I-TREATMENT de I-TREATMENT «consolidación» I-TREATMENT la I-TREATMENT paciente I-TREATMENT sufrió I-TREATMENT un I-TREATMENT accidente I-TREATMENT de I-TREATMENT tráfico I-TREATMENT que I-TREATMENT supuso I-TREATMENT el I-TREATMENT desanclaje I-TREATMENT del I-TREATMENT distractor I-TREATMENT derecho I-TREATMENT que I-TREATMENT se I-TREATMENT recolocó I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT y I-TREATMENT mascarilla I-TREATMENT laríngea. I-TREATMENT La I-TREATMENT retirada I-TREATMENT definitiva I-TREATMENT de I-TREATMENT los I-TREATMENT distratores I-TREATMENT se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT local I-TREATMENT 11 I-TREATMENT semanas I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía. I-TREATMENT El B-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION mensual I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION retirada I-EVOLUTION de I-EVOLUTION los I-EVOLUTION distractores, I-EVOLUTION hasta I-EVOLUTION que I-EVOLUTION tuvo I-EVOLUTION que I-EVOLUTION regresar I-EVOLUTION a I-EVOLUTION su I-EVOLUTION país I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION manteniendo I-EVOLUTION la I-EVOLUTION apertura I-EVOLUTION oral I-EVOLUTION de I-EVOLUTION 30 I-EVOLUTION mm.. I-EVOLUTION No I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION posible I-EVOLUTION realizar I-EVOLUTION un I-EVOLUTION seguimiento I-EVOLUTION a I-EVOLUTION largo I-EVOLUTION plazo. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que B-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Oral I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Maxilofacial I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Oftalmología I-DERIVED_FROM/TO para B-PRESENT_ILLNESS valoración I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS exoftalmos I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY yodo. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY 1980 I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertiroidismo I-PAST_MEDICAL_HISTORY originado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Graves-Basedow, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY operada I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY después, I-PAST_MEDICAL_HISTORY realizándose I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY subtotal, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY pauta I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Levotiroxina I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg/día. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY 1999 I-PAST_MEDICAL_HISTORY acude I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Oftalmología I-PAST_MEDICAL_HISTORY refiriendo I-PAST_MEDICAL_HISTORY lento I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY progresivo I-PAST_MEDICAL_HISTORY empeoramiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY exoftalmos, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY signos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY queratitis. I-PAST_MEDICAL_HISTORY Tras I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY megadosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esteroides I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY desestimar I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY radioterapia, I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY dicho I-PAST_MEDICAL_HISTORY Servicio I-PAST_MEDICAL_HISTORY realizándose I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY descompresión I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY (pared I-PAST_MEDICAL_HISTORY medial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY suelo) I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY abordaje I-PAST_MEDICAL_HISTORY subciliar. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY Marzo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2002 I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realiza I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY total. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS Junio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2003 I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS Consulta, I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS retracción I-PRESENT_ILLNESS palpebral I-PRESENT_ILLNESS severa, I-PRESENT_ILLNESS más I-PRESENT_ILLNESS acentuada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tercio I-PRESENT_ILLNESS externo I-PRESENT_ILLNESS o I-PRESENT_ILLNESS temporal I-PRESENT_ILLNESS del I-PRESENT_ILLNESS párpado I-PRESENT_ILLNESS superior; I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS del I-PRESENT_ILLNESS limbo I-PRESENT_ILLNESS corneal I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS queda I-PRESENT_ILLNESS al I-PRESENT_ILLNESS descubierto, I-PRESENT_ILLNESS dejando I-PRESENT_ILLNESS porción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esclera I-PRESENT_ILLNESS expuesta. I-PRESENT_ILLNESS Se B-EXPLORATION objetiva I-EXPLORATION hipertrofia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION suborbicular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION subciliar I-EXPLORATION del I-EXPLORATION párpado I-EXPLORATION inferior. I-EXPLORATION I-EXPLORATION Es I-EXPLORATION evidente I-EXPLORATION el I-EXPLORATION exoftalmos, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION bilateral. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION queja I-EXPLORATION de I-EXPLORATION incapacidad I-EXPLORATION para I-EXPLORATION mantener I-EXPLORATION la I-EXPLORATION lectura I-EXPLORATION durante I-EXPLORATION un I-EXPLORATION tiempo I-EXPLORATION prolongado, I-EXPLORATION con I-EXPLORATION fatiga I-EXPLORATION y I-EXPLORATION disconfort, I-EXPLORATION síntomas I-EXPLORATION de I-EXPLORATION restricción I-EXPLORATION de I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION ocular. I-EXPLORATION La I-EXPLORATION enfermedad I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION no I-EXPLORATION inflamatoria, I-EXPLORATION no I-EXPLORATION presentando I-EXPLORATION queratitis I-EXPLORATION severa, I-EXPLORATION hiperemia, I-EXPLORATION quemosis I-EXPLORATION conjuntival, I-EXPLORATION ni I-EXPLORATION diplopia. I-EXPLORATION I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION orbitario I-EXPLORATION muestra I-EXPLORATION exoftalmos, I-EXPLORATION engrosamiento I-EXPLORATION muscular, I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION volumen I-EXPLORATION graso I-EXPLORATION orbitario I-EXPLORATION y I-EXPLORATION rectificación I-EXPLORATION del I-EXPLORATION nervio I-EXPLORATION óptico. I-EXPLORATION Tiene I-EXPLORATION la I-EXPLORATION ventaja I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION el I-EXPLORATION detalle I-EXPLORATION óseo, I-EXPLORATION que I-EXPLORATION tiene I-EXPLORATION un I-EXPLORATION gran I-EXPLORATION valor I-EXPLORATION para I-EXPLORATION la I-EXPLORATION planificación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION procedimientos I-EXPLORATION quirúrgicos I-EXPLORATION de I-EXPLORATION descompresión. I-EXPLORATION La I-EXPLORATION RM I-EXPLORATION muestra I-EXPLORATION exoftalmos, I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION muscular I-EXPLORATION severo I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION ventral I-EXPLORATION y I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION graso. I-EXPLORATION I-EXPLORATION Con B-TREATMENT los I-TREATMENT antecedentes I-TREATMENT descritos, I-TREATMENT la I-TREATMENT clínica I-TREATMENT y I-TREATMENT las I-TREATMENT pruebas I-TREATMENT de I-TREATMENT imagen I-TREATMENT se I-TREATMENT decide I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT mediante I-TREATMENT la I-TREATMENT remoción I-TREATMENT parcial I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT lateral I-TREATMENT y I-TREATMENT del I-TREATMENT suelo I-TREATMENT orbitario, I-TREATMENT junto I-TREATMENT a I-TREATMENT lipectomía I-TREATMENT y I-TREATMENT osteotomía I-TREATMENT con I-TREATMENT avance I-TREATMENT del I-TREATMENT marco I-TREATMENT orbitario I-TREATMENT superior, I-TREATMENT lateral I-TREATMENT e I-TREATMENT inferior. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT abordaje I-TREATMENT bicoronal, I-TREATMENT con I-TREATMENT un I-TREATMENT colgajo I-TREATMENT subgaleal I-TREATMENT hasta I-TREATMENT aproximadamente I-TREATMENT 2 I-TREATMENT cm. I-TREATMENT del I-TREATMENT reborde I-TREATMENT supraorbitario, I-TREATMENT donde I-TREATMENT se I-TREATMENT realiza I-TREATMENT una I-TREATMENT incisión I-TREATMENT del I-TREATMENT periostio I-TREATMENT y I-TREATMENT se I-TREATMENT continúa I-TREATMENT hasta I-TREATMENT la I-TREATMENT órbita I-TREATMENT por I-TREATMENT el I-TREATMENT plano I-TREATMENT subperióstico. I-TREATMENT La I-TREATMENT porción I-TREATMENT anterior I-TREATMENT del I-TREATMENT músculo I-TREATMENT temporal I-TREATMENT fue I-TREATMENT liberada I-TREATMENT de I-TREATMENT su I-TREATMENT inserción I-TREATMENT para I-TREATMENT permitir I-TREATMENT un I-TREATMENT mejor I-TREATMENT acceso I-TREATMENT a I-TREATMENT la I-TREATMENT pared I-TREATMENT lateral I-TREATMENT orbitaria. I-TREATMENT El I-TREATMENT abordaje I-TREATMENT se I-TREATMENT completó I-TREATMENT con I-TREATMENT una I-TREATMENT incisión I-TREATMENT subciliar I-TREATMENT bilateral I-TREATMENT que I-TREATMENT permitió I-TREATMENT el I-TREATMENT acceso I-TREATMENT al I-TREATMENT reborde I-TREATMENT infraorbitario I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT región I-TREATMENT medial I-TREATMENT del I-TREATMENT suelo I-TREATMENT orbitario. I-TREATMENT I-TREATMENT Realizamos I-TREATMENT una I-TREATMENT osteotomía I-TREATMENT bilateral I-TREATMENT -orbitotomía- I-TREATMENT del I-TREATMENT marco I-TREATMENT orbitario I-TREATMENT superior, I-TREATMENT lateral I-TREATMENT e I-TREATMENT inferior; I-TREATMENT que I-TREATMENT se I-TREATMENT avanza I-TREATMENT 8 I-TREATMENT mm I-TREATMENT respecto I-TREATMENT a I-TREATMENT su I-TREATMENT posición I-TREATMENT de I-TREATMENT origen. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT la I-TREATMENT osteosíntesis I-TREATMENT con I-TREATMENT miniplacas I-TREATMENT 2, I-TREATMENT 0. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT eliminación I-TREATMENT de I-TREATMENT la I-TREATMENT pared I-TREATMENT lateral I-TREATMENT orbitaria I-TREATMENT y I-TREATMENT del I-TREATMENT suelo I-TREATMENT en I-TREATMENT su I-TREATMENT porción I-TREATMENT medial I-TREATMENT y I-TREATMENT lateral, I-TREATMENT respetando I-TREATMENT el I-TREATMENT trayecto I-TREATMENT del I-TREATMENT nervio I-TREATMENT infraorbitario. I-TREATMENT Se I-TREATMENT realizan I-TREATMENT incisiones I-TREATMENT en I-TREATMENT la I-TREATMENT periórbita I-TREATMENT y I-TREATMENT lipectomía I-TREATMENT tras I-TREATMENT la I-TREATMENT liberación I-TREATMENT de I-TREATMENT la I-TREATMENT grasa I-TREATMENT periorbitaria. I-TREATMENT I-TREATMENT Se I-TREATMENT colocó I-TREATMENT un I-TREATMENT drenaje I-TREATMENT aspirativo I-TREATMENT subgaleal I-TREATMENT que I-TREATMENT fue I-TREATMENT retirado I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT horas. I-TREATMENT I-TREATMENT Se I-TREATMENT mantuvo I-TREATMENT una I-TREATMENT tarsorrafia I-TREATMENT temporal I-TREATMENT (punto I-TREATMENT de I-TREATMENT Frost) I-TREATMENT las I-TREATMENT primeras I-TREATMENT 48 I-TREATMENT horas. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION horas I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION dolor I-EVOLUTION intenso I-EVOLUTION en I-EVOLUTION región I-EVOLUTION posterior I-EVOLUTION de I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION izquierda, I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION diagnosticado I-EVOLUTION como I-EVOLUTION trombosis I-EVOLUTION del I-EVOLUTION lago I-EVOLUTION gemelar I-EVOLUTION y I-EVOLUTION tratada I-EVOLUTION con I-EVOLUTION heparina. I-EVOLUTION La I-EVOLUTION sutura I-EVOLUTION subciliar I-EVOLUTION se I-EVOLUTION retiró I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION la I-EVOLUTION coronal I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 44 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO médico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cabecera I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Oral I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Maxilofacial I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO una I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO parotídea, I-DERIVED_FROM/TO que I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO palpación I-DERIVED_FROM/TO parecía I-DERIVED_FROM/TO constar I-DERIVED_FROM/TO de I-DERIVED_FROM/TO un I-DERIVED_FROM/TO único I-DERIVED_FROM/TO nódulo. I-DERIVED_FROM/TO Con B-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION tumoración I-EXPLORATION benigna I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION punción I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION de I-EXPLORATION 23-G I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Anatomía I-EXPLORATION Patológica, I-EXPLORATION fijando I-EXPLORATION el I-EXPLORATION material I-EXPLORATION obtenido, I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION inmediata, I-EXPLORATION en I-EXPLORATION alcohol I-EXPLORATION de I-EXPLORATION 95% I-EXPLORATION y I-EXPLORATION reservando I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION aspirados I-EXPLORATION para I-EXPLORATION secado I-EXPLORATION al I-EXPLORATION aire. I-EXPLORATION Las I-EXPLORATION muestras I-EXPLORATION fijadas I-EXPLORATION en I-EXPLORATION alcohol I-EXPLORATION se I-EXPLORATION tiñeron I-EXPLORATION siguiendo I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Papanicolaou, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION los I-EXPLORATION secados I-EXPLORATION al I-EXPLORATION aire I-EXPLORATION se I-EXPLORATION colorean I-EXPLORATION con I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Diff- I-EXPLORATION Quick. I-EXPLORATION I-EXPLORATION Citológicamente I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION compuesta I-EXPLORATION de I-EXPLORATION células I-EXPLORATION epiteliales I-EXPLORATION y I-EXPLORATION ductales I-EXPLORATION sobre I-EXPLORATION un I-EXPLORATION fondo I-EXPLORATION basofílico I-EXPLORATION fibrilar I-EXPLORATION y I-EXPLORATION mixomatoso, I-EXPLORATION además I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION material I-EXPLORATION condroide I-EXPLORATION y I-EXPLORATION fragmentos I-EXPLORATION de I-EXPLORATION estroma I-EXPLORATION eosinófilo I-EXPLORATION fibrilar. I-EXPLORATION El B-TREATMENT diagnóstico I-TREATMENT citológico I-TREATMENT fue I-TREATMENT de I-TREATMENT adenoma I-TREATMENT pleomorfo I-TREATMENT (AP) I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT parotidectomía I-TREATMENT total I-TREATMENT con I-TREATMENT preservación I-TREATMENT del I-TREATMENT nervio I-TREATMENT facial. I-TREATMENT I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION se I-EXPLORATION incluyó I-EXPLORATION en I-EXPLORATION formaldehído I-EXPLORATION al I-EXPLORATION 10% I-EXPLORATION observando I-EXPLORATION macroscópicamente I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION 2x2 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION blando-elástica I-EXPLORATION y I-EXPLORATION coloración I-EXPLORATION blanquecina, I-EXPLORATION parcialmente I-EXPLORATION encapsulado, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION nodular I-EXPLORATION polilobulada I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION linfoide, I-EXPLORATION separada I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION principal I-EXPLORATION por I-EXPLORATION un I-EXPLORATION fino I-EXPLORATION cordón I-EXPLORATION estromal. I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION fijación I-EXPLORATION se I-EXPLORATION secciona I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION en I-EXPLORATION su I-EXPLORATION totalidad I-EXPLORATION y I-EXPLORATION se I-EXPLORATION procesa I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION rutinaria I-EXPLORATION para I-EXPLORATION obtener I-EXPLORATION los I-EXPLORATION bloques I-EXPLORATION de I-EXPLORATION parafina. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION empleada I-EXPLORATION para I-EXPLORATION la I-EXPLORATION observación I-EXPLORATION microscópica I-EXPLORATION es I-EXPLORATION hematoxilina-eosina I-EXPLORATION clásica. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION principal I-EXPLORATION bien I-EXPLORATION circunscrito, I-EXPLORATION rodeado I-EXPLORATION por I-EXPLORATION una I-EXPLORATION pseudocápsula I-EXPLORATION conectiva, I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION una I-EXPLORATION población I-EXPLORATION celular I-EXPLORATION bifásica I-EXPLORATION de I-EXPLORATION epitelio I-EXPLORATION glandular I-EXPLORATION y I-EXPLORATION células I-EXPLORATION mioepiteliales I-EXPLORATION rodeadas I-EXPLORATION por I-EXPLORATION un I-EXPLORATION material I-EXPLORATION fibrilar I-EXPLORATION mixoide, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION pleomorfo. I-EXPLORATION Los I-EXPLORATION otros I-EXPLORATION nódulos I-EXPLORATION eran I-EXPLORATION ganglios I-EXPLORATION linfáticos, I-EXPLORATION pero I-EXPLORATION apareció I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION lesión, I-EXPLORATION de I-EXPLORATION pequeña I-EXPLORATION talla, I-EXPLORATION muy I-EXPLORATION cercana I-EXPLORATION al I-EXPLORATION tumor I-EXPLORATION mixto, I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION quística I-EXPLORATION y I-EXPLORATION papilar, I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION una I-EXPLORATION doble I-EXPLORATION hilera I-EXPLORATION de I-EXPLORATION células I-EXPLORATION oncocíticas I-EXPLORATION rodeando I-EXPLORATION los I-EXPLORATION espacios I-EXPLORATION quísticos I-EXPLORATION con I-EXPLORATION estroma I-EXPLORATION linfoide I-EXPLORATION adyacente. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION histopatológico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION pleomorfo I-EXPLORATION y I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION Warthin I-EXPLORATION sincrónicos I-EXPLORATION de I-EXPLORATION parótida I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 84 I-PRESENT_ILLNESS enviada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS epidermoide I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS preauricular I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS tratada I-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS y I-PRESENT_ILLNESS RT. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION TC I-EXPLORATION facial I-EXPLORATION aparece I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION región I-EXPLORATION preauricular I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION hacia I-EXPLORATION las I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION malar, I-EXPLORATION contactando I-EXPLORATION con I-EXPLORATION el I-EXPLORATION músculo I-EXPLORATION masetero I-EXPLORATION y I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION parótida. I-EXPLORATION El I-EXPLORATION tratamiento I-EXPLORATION quirúrgico I-EXPLORATION consistió I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extirpación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION incluyendo I-EXPLORATION el I-EXPLORATION pabellón I-EXPLORATION auricular I-EXPLORATION derecho, I-EXPLORATION CAE I-EXPLORATION y I-EXPLORATION parotidectomía I-EXPLORATION total I-EXPLORATION radical. I-EXPLORATION La I-EXPLORATION reconstrucción I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION con I-EXPLORATION colgajo I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION temporal I-EXPLORATION que I-EXPLORATION desinsertado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cresta I-EXPLORATION temporal I-EXPLORATION y I-EXPLORATION pediculado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION coronoides, I-EXPLORATION fue I-EXPLORATION rotado I-EXPLORATION en I-EXPLORATION dirección I-EXPLORATION caudal I-EXPLORATION para I-EXPLORATION cubrir I-EXPLORATION el I-EXPLORATION defecto. I-EXPLORATION La I-EXPLORATION porción I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fascia I-EXPLORATION temporal I-EXPLORATION profunda I-EXPLORATION fue I-EXPLORATION disecada I-EXPLORATION y I-EXPLORATION dividida I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION láminas I-EXPLORATION cuyos I-EXPLORATION extremos I-EXPLORATION libres I-EXPLORATION fueron I-EXPLORATION suturados I-EXPLORATION a I-EXPLORATION la I-EXPLORATION comisura I-EXPLORATION y I-EXPLORATION musculatura I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION superior. I-EXPLORATION El I-EXPLORATION músculo I-EXPLORATION temporal I-EXPLORATION traspuesto I-EXPLORATION se I-EXPLORATION cubrió I-EXPLORATION con I-EXPLORATION un I-EXPLORATION injerto I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION piel. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION postoperatorio I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION cómo I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION consigue I-EVOLUTION elevar I-EVOLUTION la I-EVOLUTION comisura I-EVOLUTION bucal I-EVOLUTION y I-EVOLUTION una I-EVOLUTION estética I-EVOLUTION aceptable I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION reconstruida. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 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-DERIVED_FROM/TO acude I-DERIVED_FROM/TO a I-DERIVED_FROM/TO consultas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Oral I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Maxilofacial I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Infanta I-DERIVED_FROM/TO Cristina I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Badajoz, I-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO Médico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Familia. I-DERIVED_FROM/TO La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tensión I-PRESENT_ILLNESS hemifacial I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS palpación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dicha I-PRESENT_ILLNESS región. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolorinflamación I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedieron I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antibióticos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS antiinflamatorios. I-PRESENT_ILLNESS Describe I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS como I-PRESENT_ILLNESS de I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS una I-PRESENT_ILLNESS discreta I-PRESENT_ILLNESS asimetría I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS ido I-PRESENT_ILLNESS evolucionando I-PRESENT_ILLNESS progresivamente I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS hacerse I-PRESENT_ILLNESS más I-PRESENT_ILLNESS patente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION abombamiento I-EXPLORATION de I-EXPLORATION vestíbulo I-EXPLORATION superior I-EXPLORATION derecho, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION ortopantomografía I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION facial I-EXPLORATION apreciándose I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION un I-EXPLORATION tercer I-EXPLORATION molar I-EXPLORATION (18) I-EXPLORATION incluido I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION techo I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho I-EXPLORATION - I-EXPLORATION región I-EXPLORATION infraorbitaria I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT sintomatología I-TREATMENT clínica I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT realizar I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT mediante I-TREATMENT abordaje I-TREATMENT de I-TREATMENT Caldwell- I-TREATMENT Luc.13-21 I-TREATMENT Bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT e I-TREATMENT intubación I-TREATMENT oro-traqueal I-TREATMENT se I-TREATMENT realizó I-TREATMENT incisión I-TREATMENT de I-TREATMENT Neumann I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT vestíbulo I-TREATMENT superior I-TREATMENT derecho. I-TREATMENT Tras I-TREATMENT elevación I-TREATMENT de I-TREATMENT colgajo I-TREATMENT mucoperióstico I-TREATMENT se I-TREATMENT visualizó I-TREATMENT la I-TREATMENT cápsula I-TREATMENT quística I-TREATMENT y I-TREATMENT la I-TREATMENT cortical I-TREATMENT maxilar I-TREATMENT de I-TREATMENT aspecto I-TREATMENT papiráceo I-TREATMENT con I-TREATMENT adherencias I-TREATMENT y I-TREATMENT fibrosis. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT cavidad I-TREATMENT quística I-TREATMENT y I-TREATMENT exodoncia I-TREATMENT del I-TREATMENT cordal I-TREATMENT mediante I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT fórceps. I-TREATMENT Finalmente I-TREATMENT se I-TREATMENT realizó I-TREATMENT legrado I-TREATMENT intenso I-TREATMENT de I-TREATMENT la I-TREATMENT cavidad I-TREATMENT y I-TREATMENT sutura I-TREATMENT del I-TREATMENT colgajo I-TREATMENT mediante I-TREATMENT material I-TREATMENT reabsorbible. I-TREATMENT B-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION quiste I-EXPLORATION radicular. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS género I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS desdentada I-PRESENT_ILLNESS parcial I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS clase I-PRESENT_ILLNESS I I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Kennedy I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS remanencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS piezas I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS en I-PRESENT_ILLNESS boca, I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS rehabilitar I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sector I-PRESENT_ILLNESS posterior. I-PRESENT_ILLNESS De B-EXPLORATION acuerdo I-EXPLORATION al I-EXPLORATION estudio I-EXPLORATION radiográfico I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION reabsorción I-EXPLORATION bilateral I-EXPLORATION por I-EXPLORATION neumatización I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION planifica I-EXPLORATION una I-EXPLORATION reconstrucción I-EXPLORATION con I-EXPLORATION injerto I-EXPLORATION de I-EXPLORATION calota I-EXPLORATION e I-EXPLORATION implantes I-EXPLORATION en I-EXPLORATION un I-EXPLORATION segundo I-EXPLORATION tiempo, I-EXPLORATION tratamiento I-EXPLORATION que I-EXPLORATION rechaza I-EXPLORATION por I-EXPLORATION su I-EXPLORATION alta I-EXPLORATION morbilidad. I-EXPLORATION Por B-TREATMENT esta I-TREATMENT razón I-TREATMENT se I-TREATMENT planifica I-TREATMENT la I-TREATMENT rehabilitación I-TREATMENT en I-TREATMENT base I-TREATMENT a I-TREATMENT implantes I-TREATMENT cigomáticos, I-TREATMENT para I-TREATMENT reemplazar I-TREATMENT hasta I-TREATMENT el I-TREATMENT primer I-TREATMENT molar. I-TREATMENT Para I-TREATMENT esto I-TREATMENT se I-TREATMENT instalan I-TREATMENT dos I-TREATMENT implantes I-TREATMENT cigomáticos I-TREATMENT a I-TREATMENT cada I-TREATMENT lado, I-TREATMENT 3 I-TREATMENT de I-TREATMENT 45 I-TREATMENT mm I-TREATMENT y I-TREATMENT uno I-TREATMENT de I-TREATMENT 40 I-TREATMENT mm. I-TREATMENT I-TREATMENT Para I-TREATMENT rehabilitar I-TREATMENT en I-TREATMENT base I-TREATMENT a I-TREATMENT prótesis I-TREATMENT fija I-TREATMENT se I-TREATMENT requería I-TREATMENT la I-TREATMENT emergencia I-TREATMENT de I-TREATMENT los I-TREATMENT implantes I-TREATMENT sobre I-TREATMENT el I-TREATMENT reborde I-TREATMENT alveolar, I-TREATMENT para I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT modificó I-TREATMENT la I-TREATMENT técnica I-TREATMENT original. I-TREATMENT Los I-TREATMENT implantes I-TREATMENT del I-TREATMENT lado I-TREATMENT derecho I-TREATMENT se I-TREATMENT instalaron I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT las I-TREATMENT piezas I-TREATMENT dentarias I-TREATMENT 3 I-TREATMENT y I-TREATMENT 4. I-TREATMENT El I-TREATMENT implante I-TREATMENT posterior I-TREATMENT se I-TREATMENT ubicó I-TREATMENT por I-TREATMENT fuera I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT y I-TREATMENT el I-TREATMENT anterior I-TREATMENT por I-TREATMENT dentro I-TREATMENT pero I-TREATMENT con I-TREATMENT una I-TREATMENT angulación I-TREATMENT mayor I-TREATMENT con I-TREATMENT respecto I-TREATMENT al I-TREATMENT plano I-TREATMENT oclusal. I-TREATMENT En I-TREATMENT el I-TREATMENT lado I-TREATMENT izquierdo, I-TREATMENT en I-TREATMENT posición I-TREATMENT de I-TREATMENT las I-TREATMENT piezas I-TREATMENT dentarias I-TREATMENT 13 I-TREATMENT y I-TREATMENT 14, I-TREATMENT el I-TREATMENT implante I-TREATMENT anterior I-TREATMENT se I-TREATMENT posicionó I-TREATMENT por I-TREATMENT fuera I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT y I-TREATMENT el I-TREATMENT implante I-TREATMENT posterior I-TREATMENT por I-TREATMENT dentro I-TREATMENT con I-TREATMENT mayor I-TREATMENT angulación. I-TREATMENT Con I-TREATMENT esto I-TREATMENT se I-TREATMENT logró I-TREATMENT que I-TREATMENT los I-TREATMENT cuatro I-TREATMENT implantes I-TREATMENT emergieran I-TREATMENT en I-TREATMENT el I-TREATMENT reborde I-TREATMENT alveolar I-TREATMENT con I-TREATMENT una I-TREATMENT angulación I-TREATMENT dentro I-TREATMENT de I-TREATMENT límites I-TREATMENT aceptables. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS RGP, I-PRESENT_ILLNESS HC: I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS del I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tiene I-PRESENT_ILLNESS como I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS del I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS inferior. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY remonta I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY mordisco I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY labio I-PAST_MEDICAL_HISTORY inferior I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY intensa I-PAST_MEDICAL_HISTORY hemorragia. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY partir I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY apareció I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY central I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY labio I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY progresivo, I-PAST_MEDICAL_HISTORY indoloro, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY color I-PAST_MEDICAL_HISTORY azul I-PAST_MEDICAL_HISTORY violáceo, I-PAST_MEDICAL_HISTORY pulsátil, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diámetro. I-PAST_MEDICAL_HISTORY Clasificada I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY lesión I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY hemangioma I-PAST_MEDICAL_HISTORY traumático, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY inyecciones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY betametasona. I-PAST_MEDICAL_HISTORY Luego I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY betametasona, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY exéresis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY tumoración I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY bucal. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY histopatológico I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hemangioma I-PAST_MEDICAL_HISTORY traumático. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS este I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS nos I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS nuevamente, I-PRESENT_ILLNESS ya I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS labial I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS más I-PRESENT_ILLNESS voluminoso, I-PRESENT_ILLNESS pulsátil, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS soplo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS frenito. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION intrabucal I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION los I-EXPLORATION relieves I-EXPLORATION vasculares I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION inferior I-EXPLORATION Indicamos I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION y B-TREATMENT ejecutamos I-TREATMENT una I-TREATMENT disección I-TREATMENT de I-TREATMENT la I-TREATMENT carótida I-TREATMENT derecha I-TREATMENT para I-TREATMENT arteriografía I-TREATMENT la I-TREATMENT cual I-TREATMENT informa I-TREATMENT de I-TREATMENT un I-TREATMENT saco I-TREATMENT aneurismático I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT las I-TREATMENT regiones I-TREATMENT labial I-TREATMENT inferior I-TREATMENT y I-TREATMENT mentoniana. I-TREATMENT I-TREATMENT Se I-TREATMENT ligó I-TREATMENT la I-TREATMENT arteria I-TREATMENT carótida I-TREATMENT externa I-TREATMENT entre I-TREATMENT la I-TREATMENT tiroidea I-TREATMENT superior I-TREATMENT y I-TREATMENT la I-TREATMENT lingual, I-TREATMENT por I-TREATMENT incisión I-TREATMENT submentoniana I-TREATMENT se I-TREATMENT ligaron I-TREATMENT los I-TREATMENT vasos I-TREATMENT venosos I-TREATMENT del I-TREATMENT aneurisma, I-TREATMENT para I-TREATMENT aislar I-TREATMENT esta I-TREATMENT cavidad I-TREATMENT de I-TREATMENT la I-TREATMENT circulación. I-TREATMENT I-TREATMENT Al I-TREATMENT final I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT se I-TREATMENT inyectaron I-TREATMENT 4cc I-TREATMENT de I-TREATMENT betametasona I-TREATMENT en I-TREATMENT la I-TREATMENT tumoración I-TREATMENT y I-TREATMENT se I-TREATMENT aplicó I-TREATMENT un I-TREATMENT esparadrapo I-TREATMENT elástico. I-TREATMENT I-TREATMENT Se I-TREATMENT aplicaron I-TREATMENT 4 I-TREATMENT inyecciones I-TREATMENT adicionales I-TREATMENT con I-TREATMENT triancinolona I-TREATMENT a I-TREATMENT intervalos I-TREATMENT de I-TREATMENT 3 I-TREATMENT semanas, I-TREATMENT notándose I-TREATMENT una I-TREATMENT progresiva I-TREATMENT reducción I-TREATMENT y I-TREATMENT fibrosis I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT no I-TREATMENT constatándose I-TREATMENT soplo. I-TREATMENT I-TREATMENT A I-TREATMENT los I-TREATMENT tres I-TREATMENT meses I-TREATMENT de I-TREATMENT la I-TREATMENT ligadura I-TREATMENT de I-TREATMENT los I-TREATMENT vasos I-TREATMENT se I-TREATMENT practicó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT fibrosis I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT labial. I-TREATMENT El B-EVOLUTION resultado I-EVOLUTION estético I-EVOLUTION final I-EVOLUTION fue I-EVOLUTION aceptable. I-EVOLUTION En I-EVOLUTION estos I-EVOLUTION momentos I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION lleva I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION ultima I-EVOLUTION intervención, I-EVOLUTION no I-EVOLUTION apareciendo I-EVOLUTION recidiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION lesión. 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 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS remitida B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO odontólogo, I-DERIVED_FROM/TO quejándose I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO masa I-DERIVED_FROM/TO dolorosa I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO región I-DERIVED_FROM/TO del I-DERIVED_FROM/TO canino I-DERIVED_FROM/TO inferior I-DERIVED_FROM/TO derecho, I-DERIVED_FROM/TO que I-DERIVED_FROM/TO había I-DERIVED_FROM/TO descubierto I-DERIVED_FROM/TO cuatro I-DERIVED_FROM/TO semanas I-DERIVED_FROM/TO antes. I-DERIVED_FROM/TO Negaba B-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alteración I-PRESENT_ILLNESS neurosensorial, I-PRESENT_ILLNESS disfagia, I-PRESENT_ILLNESS odinofagia, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS o I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION demostraba I-EXPLORATION una I-EXPLORATION mínima I-EXPLORATION tumefacción I-EXPLORATION facial I-EXPLORATION y I-EXPLORATION asimetría. I-EXPLORATION Intraoralmente, I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION un I-EXPLORATION abombamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION lingual I-EXPLORATION derecha I-EXPLORATION mandibular I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION canino, I-EXPLORATION con I-EXPLORATION vestibulización I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenopatías I-EXPLORATION cervicales. I-EXPLORATION La I-EXPLORATION ortopantomografía I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION area I-EXPLORATION radiolúcida, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION regulares, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION canino, I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo. I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION como I-EXPLORATION patología I-EXPLORATION quística I-EXPLORATION benigna. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION bajo I-EXPLORATION anestesia I-EXPLORATION local. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION microscópicos I-EXPLORATION concluyeron I-EXPLORATION que I-EXPLORATION era I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION maligna I-EXPLORATION de I-EXPLORATION células I-EXPLORATION fusiformes. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION de I-EXPLORATION pelvis, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION absolutamente I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT intervenida I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT tres I-TREATMENT semanas I-TREATMENT después I-TREATMENT de I-TREATMENT su I-TREATMENT primera I-TREATMENT visita. I-TREATMENT En B-EXPLORATION ese I-EXPLORATION momento, I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION que I-EXPLORATION había I-EXPLORATION emergido I-EXPLORATION por I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION vestibular, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT disección I-TREATMENT cervical I-TREATMENT supraomohioidea I-TREATMENT derecha, I-TREATMENT con I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT glándula I-TREATMENT submaxilar I-TREATMENT y I-TREATMENT los I-TREATMENT ganglios I-TREATMENT linfáticos I-TREATMENT regionales. I-TREATMENT La I-TREATMENT mandíbula I-TREATMENT fue I-TREATMENT resecada I-TREATMENT desde I-TREATMENT la I-TREATMENT sínfisis I-TREATMENT hasta I-TREATMENT el I-TREATMENT primer I-TREATMENT molar I-TREATMENT inferior I-TREATMENT derecho. I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION y I-EXPLORATION el I-EXPLORATION vaciamiento I-EXPLORATION cervical I-EXPLORATION estaban, I-EXPLORATION macroscópicamente, I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION tumor. I-EXPLORATION Para B-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT primaria I-TREATMENT del I-TREATMENT defecto I-TREATMENT se I-TREATMENT utilizó I-TREATMENT una I-TREATMENT placa I-TREATMENT de I-TREATMENT reconstrucción. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION desarrolló I-EVOLUTION una I-EVOLUTION infección I-EVOLUTION cervical, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION comunicación I-EVOLUTION orocervical, I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sonda I-EVOLUTION nasogástrica I-EVOLUTION colocada I-EVOLUTION en I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION A B-TREATMENT pesar I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT intravenoso, I-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT mejoró, I-TREATMENT con I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT retiró I-TREATMENT la I-TREATMENT placa I-TREATMENT de I-TREATMENT reconstrucción I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general. I-TREATMENT Posteriormente, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION el I-EVOLUTION 20 I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION mostraban I-EXPLORATION que I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION eran I-EXPLORATION reactivas I-EXPLORATION para I-EXPLORATION vimentina I-EXPLORATION y I-EXPLORATION actina I-EXPLORATION músculo-específica. I-EXPLORATION Asimismo, I-EXPLORATION también I-EXPLORATION eran I-EXPLORATION reactivas I-EXPLORATION para I-EXPLORATION desmina. I-EXPLORATION Finalmente, I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION de I-EXPLORATION leiomiosarcoma I-EXPLORATION grado I-EXPLORATION II. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION seguimientos I-EVOLUTION periódicos I-EVOLUTION en I-EVOLUTION nuestra I-EVOLUTION consulta, I-EVOLUTION hace I-EVOLUTION ya I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico, I-EVOLUTION y I-EVOLUTION está I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION recidivas I-EVOLUTION o I-EVOLUTION metástasis. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS cutánea I-PRESENT_ILLNESS nodular, I-PRESENT_ILLNESS eritematosa, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS superficie I-PRESENT_ILLNESS brillante, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS rápido, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mejilla I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS mejorado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS tópico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS corticoides I-PRESENT_ILLNESS de I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS potencia I-PRESENT_ILLNESS pautado I-PRESENT_ILLNESS progresivamente I-PRESENT_ILLNESS por I-PRESENT_ILLNESS su I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cabecera. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION que I-EXPLORATION arrojó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION Tumor I-EXPLORATION de I-EXPLORATION Merkel. I-EXPLORATION I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenopatías I-EXPLORATION cervicales. I-EXPLORATION Analítica I-EXPLORATION preoperatoria, I-EXPLORATION incluyendo I-EXPLORATION marcadores I-EXPLORATION tumorales, I-EXPLORATION normal I-EXPLORATION salvo I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glucemia I-EXPLORATION de I-EXPLORATION 177. I-EXPLORATION TC I-EXPLORATION cervical I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION ganglionar I-EXPLORATION cervical I-EXPLORATION donde I-EXPLORATION únicamente I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cuánea I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION malar I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION coincide I-EXPLORATION con I-EXPLORATION la I-EXPLORATION localización I-EXPLORATION externa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION afectación I-EXPLORATION ósea. I-EXPLORATION Rastreo I-EXPLORATION corporal I-EXPLORATION con I-EXPLORATION TC I-EXPLORATION toraco-abdominal I-EXPLORATION igualmente I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION susceptibles I-EXPLORATION de I-EXPLORATION invasión I-EXPLORATION sistémica. I-EXPLORATION I-EXPLORATION Bajo B-TREATMENT Anestesia I-TREATMENT General I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT extirpación I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT con I-TREATMENT márgenes I-TREATMENT oncológicos I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT colgajo I-TREATMENT cutáneo I-TREATMENT de I-TREATMENT rotación-deslizamiento I-TREATMENT cérvicofacial. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT administró I-TREATMENT Radioterapia I-TREATMENT externa I-TREATMENT con I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT acumulada I-TREATMENT de I-TREATMENT 60 I-TREATMENT Gy. I-TREATMENT 12 B-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION en I-EVOLUTION una I-EVOLUTION revisión I-EVOLUTION programada, I-EVOLUTION una I-EVOLUTION tumoración I-EVOLUTION submandibular I-EVOLUTION cuya I-EVOLUTION PAAF I-EVOLUTION fue I-EVOLUTION informada I-EVOLUTION como I-EVOLUTION metástasis I-EVOLUTION cervical I-EVOLUTION de I-EVOLUTION Carcinoma I-EVOLUTION cutáneo I-EVOLUTION de I-EVOLUTION células I-EVOLUTION de I-EVOLUTION Merkel. I-EVOLUTION Se B-TREATMENT realizó I-TREATMENT Disección I-TREATMENT cervical I-TREATMENT Radical, I-TREATMENT cuyo I-TREATMENT resultado I-TREATMENT fue I-TREATMENT de I-TREATMENT 2 I-TREATMENT ganglios I-TREATMENT afectos, I-TREATMENT ninguno I-TREATMENT de I-TREATMENT ellos I-TREATMENT presentando I-TREATMENT afectación I-TREATMENT extracapsular. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Hepatitis I-PAST_MEDICAL_HISTORY C. I-PAST_MEDICAL_HISTORY Diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY plasmocitoma I-PAST_MEDICAL_HISTORY óseo I-PAST_MEDICAL_HISTORY solitario I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY undécima I-PAST_MEDICAL_HISTORY costilla, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY evolucionó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Mieloma I-PAST_MEDICAL_HISTORY Múltiple I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY Bence I-PAST_MEDICAL_HISTORY Jones I-PAST_MEDICAL_HISTORY Lambda. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diálisis I-PAST_MEDICAL_HISTORY peritoneal I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nefropatía I-PAST_MEDICAL_HISTORY asociada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Mieloma I-PAST_MEDICAL_HISTORY Múltiple. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS lengua I-PRESENT_ILLNESS y I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS producían I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS escozor. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION cinco I-EXPLORATION lesiones I-EXPLORATION nodulares I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION punta I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua, I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION y I-EXPLORATION labio I-EXPLORATION izquierdo. I-EXPLORATION Tres I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nódulos, I-EXPLORATION presentaban I-EXPLORATION un I-EXPLORATION color I-EXPLORATION violáceo I-EXPLORATION con I-EXPLORATION el I-EXPLORATION centro I-EXPLORATION ligeramente I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION los I-EXPLORATION otros I-EXPLORATION dos, I-EXPLORATION más I-EXPLORATION claros, I-EXPLORATION sin I-EXPLORATION tonalidad I-EXPLORATION violácea. I-EXPLORATION La I-EXPLORATION consistencia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION era I-EXPLORATION algo I-EXPLORATION indurada. I-EXPLORATION El I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION diámetro I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION labio, I-EXPLORATION el I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION ellos, I-EXPLORATION tenía I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tamaño I-EXPLORATION del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nódulos I-EXPLORATION era I-EXPLORATION inferior I-EXPLORATION a I-EXPLORATION estas I-EXPLORATION medidas. I-EXPLORATION Al B-EVOLUTION mes I-EVOLUTION de I-EVOLUTION la I-EVOLUTION exploración I-EVOLUTION oral, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION de I-EVOLUTION nuevo, I-EVOLUTION presentando I-EVOLUTION lesiones I-EVOLUTION de I-EVOLUTION color I-EVOLUTION púrpura I-EVOLUTION perioculares I-EVOLUTION bilaterales. I-EVOLUTION I-EVOLUTION Se B-EXPLORATION procede I-EXPLORATION a I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION biopsias, I-EXPLORATION una I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION linguales. I-EXPLORATION Dichas I-EXPLORATION biopsias I-EXPLORATION se I-EXPLORATION describien I-EXPLORATION como I-EXPLORATION depósitos I-EXPLORATION densos I-EXPLORATION de I-EXPLORATION material I-EXPLORATION hialino, I-EXPLORATION acelular, I-EXPLORATION homogéneo I-EXPLORATION que I-EXPLORATION ocupa I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION submucosa I-EXPLORATION separando I-EXPLORATION haces I-EXPLORATION musculares I-EXPLORATION y I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION vasculares. I-EXPLORATION Estos I-EXPLORATION depósitos I-EXPLORATION se I-EXPLORATION tiñen I-EXPLORATION con I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Rojo I-EXPLORATION Congo I-EXPLORATION presentado I-EXPLORATION una I-EXPLORATION birrefringencia I-EXPLORATION verde I-EXPLORATION manzana. I-EXPLORATION Además I-EXPLORATION con I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION tioflavina I-EXPLORATION T I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION fluorescencia I-EXPLORATION verde-amarillenta. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION acantosis I-EXPLORATION con I-EXPLORATION paraqueratosis I-EXPLORATION y I-EXPLORATION un I-EXPLORATION leve I-EXPLORATION infiltrado I-EXPLORATION linfoplasmocitario. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION observados, I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION Puncion I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF) I-EXPLORATION de I-EXPLORATION grasa I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION resulto I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION material I-EXPLORATION amiloide I-EXPLORATION con I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Rojo I-EXPLORATION Congo. I-EXPLORATION Se I-EXPLORATION confirma I-EXPLORATION con I-EXPLORATION esto I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION Amiloidosis I-EXPLORATION Sistémica, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizan I-EXPLORATION diferentes I-EXPLORATION pruebas I-EXPLORATION que I-EXPLORATION objetivan I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION multiorgánica, I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION piel, I-EXPLORATION tejido I-EXPLORATION nervioso, I-EXPLORATION aparato I-EXPLORATION gastrointestinal, I-EXPLORATION corazón I-EXPLORATION y I-EXPLORATION riñón. I-EXPLORATION I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnostico I-EVOLUTION de I-EVOLUTION la I-EVOLUTION Amiloidosis, I-EVOLUTION fallece I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION como I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION un I-EVOLUTION megacolon I-EVOLUTION y I-EVOLUTION por I-EVOLUTION fallo I-EVOLUTION multiorgánico. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 54 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disfagia, I-PRESENT_ILLNESS dislalia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS extraño I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cavidad I-PRESENT_ILLNESS oral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY habitual. I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION intraoral I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION exofítica I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION máximo, I-EXPLORATION carnosa, I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION pediculada I-EXPLORATION a I-EXPLORATION paladar I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION la I-EXPLORATION orofaringe. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenopatías I-EXPLORATION cervicales. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION cervicofacial I-EXPLORATION objetivaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION y I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION definidos I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION originarse I-EXPLORATION en I-EXPLORATION el I-EXPLORATION paladar I-EXPLORATION blando, I-EXPLORATION creciendo I-EXPLORATION exofíticamente I-EXPLORATION y I-EXPLORATION ocupando I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION la I-EXPLORATION orofaringe. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION adenopatías I-EXPLORATION de I-EXPLORATION características I-EXPLORATION patológicas. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION y I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION toracoabdominal I-EXPLORATION no I-EXPLORATION objetivaron I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION a I-EXPLORATION distancia. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION fusocelular I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION una I-EXPLORATION población I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION hábito I-EXPLORATION fibrohistiocitario I-EXPLORATION con I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION tipo I-EXPLORATION estoriforme, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION fibrohistiocitoma I-EXPLORATION maligno. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT obstrucción I-TREATMENT rápidamente I-TREATMENT progresiva I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea I-TREATMENT superior, I-TREATMENT el I-TREATMENT paciente I-TREATMENT requirió I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT una I-TREATMENT traqueostomía I-TREATMENT previamente I-TREATMENT a I-TREATMENT la I-TREATMENT cirugía I-TREATMENT definitiva. I-TREATMENT El I-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT cirugía I-TREATMENT realizándose I-TREATMENT un I-TREATMENT abordaje I-TREATMENT mediante I-TREATMENT labiomandibulotomía I-TREATMENT media, I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT con I-TREATMENT márgenes I-TREATMENT de I-TREATMENT seguridad I-TREATMENT -lo I-TREATMENT que I-TREATMENT supuso I-TREATMENT la I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT totalidad I-TREATMENT del I-TREATMENT paladar I-TREATMENT blando, I-TREATMENT pilares I-TREATMENT amigdalinos I-TREATMENT y I-TREATMENT la I-TREATMENT pared I-TREATMENT de I-TREATMENT orofaringe I-TREATMENT izquierda- I-TREATMENT y I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT inmediata I-TREATMENT con I-TREATMENT un I-TREATMENT colgajo I-TREATMENT fasciocutáneo I-TREATMENT radial I-TREATMENT del I-TREATMENT lado I-TREATMENT izquierdo. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION fusocelular I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION una I-EXPLORATION población I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION hábito I-EXPLORATION fibrohistiocitario, I-EXPLORATION de I-EXPLORATION núcleos I-EXPLORATION ovalados, I-EXPLORATION pleomórficos I-EXPLORATION y I-EXPLORATION citoplasmas I-EXPLORATION fusiformes, I-EXPLORATION que I-EXPLORATION alternaba I-EXPLORATION con I-EXPLORATION otras I-EXPLORATION de I-EXPLORATION hábito I-EXPLORATION epitelioide, I-EXPLORATION dispuestas I-EXPLORATION formando I-EXPLORATION haces I-EXPLORATION entrecruzados I-EXPLORATION y I-EXPLORATION adoptando I-EXPLORATION en I-EXPLORATION zonas I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION tipo I-EXPLORATION estoriforme, I-EXPLORATION confirmando I-EXPLORATION así I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION inicial. I-EXPLORATION Se I-EXPLORATION identificaron I-EXPLORATION frecuentes I-EXPLORATION figuras I-EXPLORATION de I-EXPLORATION mitosis, I-EXPLORATION algunas I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION atípicas. I-EXPLORATION Las I-EXPLORATION tinciones I-EXPLORATION para I-EXPLORATION vimentina I-EXPLORATION y I-EXPLORATION proteina I-EXPLORATION CD68 I-EXPLORATION fueron I-EXPLORATION positivas. I-EXPLORATION La I-EXPLORATION neoplasia I-EXPLORATION respetaba I-EXPLORATION ampliamente I-EXPLORATION los I-EXPLORATION márgenes I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION quirúrgicos. I-EXPLORATION Dado B-TREATMENT el I-TREATMENT gran I-TREATMENT tamaño I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT fue I-TREATMENT administrado I-TREATMENT tratamiento I-TREATMENT radioterápico I-TREATMENT complementario. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION permanecido I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION local I-EVOLUTION o I-EVOLUTION a I-EVOLUTION distancia I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION actual I-EVOLUTION y I-EVOLUTION presenta I-EVOLUTION un I-EVOLUTION excelente I-EVOLUTION resultado I-EVOLUTION estético I-EVOLUTION y I-EVOLUTION funcional, I-EVOLUTION con I-EVOLUTION deglución I-EVOLUTION y I-EVOLUTION fonación I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS centrofacial I-PRESENT_ILLNESS por I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tráfico. I-PRESENT_ILLNESS Presentaba B-EXPLORATION fractura I-EXPLORATION tipo I-EXPLORATION Le I-EXPLORATION Fort I-EXPLORATION II I-EXPLORATION y I-EXPLORATION nasoetmoidal I-EXPLORATION derecha I-EXPLORATION tipo I-EXPLORATION II I-EXPLORATION e I-EXPLORATION izquierda I-EXPLORATION tipo I-EXPLORATION I I-EXPLORATION que I-EXPLORATION le I-EXPLORATION produce I-EXPLORATION una I-EXPLORATION mordida I-EXPLORATION abierta I-EXPLORATION anterior, I-EXPLORATION hipertelorismo I-EXPLORATION y I-EXPLORATION equimosis I-EXPLORATION orbitaria I-EXPLORATION bilateral. I-EXPLORATION Tras B-TREATMENT proceder I-TREATMENT a I-TREATMENT la I-TREATMENT ferulización I-TREATMENT de I-TREATMENT ambas I-TREATMENT arcadas I-TREATMENT se I-TREATMENT reduce I-TREATMENT el I-TREATMENT maxilar I-TREATMENT y I-TREATMENT se I-TREATMENT lleva I-TREATMENT a I-TREATMENT bloqueo I-TREATMENT rígido. I-TREATMENT Se I-TREATMENT exponen I-TREATMENT las I-TREATMENT fracturas I-TREATMENT desde I-TREATMENT abordajes I-TREATMENT inferiores I-TREATMENT bilateralmente. I-TREATMENT Se I-TREATMENT consigue I-TREATMENT una I-TREATMENT buena I-TREATMENT estabilización I-TREATMENT del I-TREATMENT maxilar I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT fractura I-TREATMENT nasoetmoidal I-TREATMENT en I-TREATMENT el I-TREATMENT lado I-TREATMENT izquierdo. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT una I-TREATMENT incisión I-TREATMENT transconjuntival I-TREATMENT en I-TREATMENT el I-TREATMENT derecho I-TREATMENT que I-TREATMENT se I-TREATMENT amplia I-TREATMENT con I-TREATMENT una I-TREATMENT transcaruncular. I-TREATMENT Ambos I-TREATMENT abordajes I-TREATMENT se I-TREATMENT unen I-TREATMENT tras I-TREATMENT la I-TREATMENT desinserción I-TREATMENT del I-TREATMENT oblícuo I-TREATMENT inferior. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT reducción I-TREATMENT de I-TREATMENT los I-TREATMENT fragmentos I-TREATMENT comprobando I-TREATMENT el I-TREATMENT plano I-TREATMENT de I-TREATMENT reducción I-TREATMENT en I-TREATMENT la I-TREATMENT pared I-TREATMENT medial. I-TREATMENT Osteosíntesis I-TREATMENT con I-TREATMENT microplacas I-TREATMENT en I-TREATMENT reborde I-TREATMENT infraorbitario. I-TREATMENT Colocamos I-TREATMENT injertos I-TREATMENT de I-TREATMENT PDS I-TREATMENT de I-TREATMENT 20 I-TREATMENT mm I-TREATMENT por I-TREATMENT 25 I-TREATMENT mm I-TREATMENT en I-TREATMENT pared I-TREATMENT medial I-TREATMENT hasta I-TREATMENT la I-TREATMENT adecuada I-TREATMENT restitución I-TREATMENT volumétrica. I-TREATMENT Con I-TREATMENT Vicryl I-TREATMENT 5/0 I-TREATMENT de I-TREATMENT aguja I-TREATMENT de I-TREATMENT 13 I-TREATMENT mm I-TREATMENT se I-TREATMENT realiza I-TREATMENT la I-TREATMENT sutura I-TREATMENT del I-TREATMENT periostio I-TREATMENT y I-TREATMENT se I-TREATMENT reinserta I-TREATMENT el I-TREATMENT oblícuo I-TREATMENT inferior. I-TREATMENT No I-TREATMENT se I-TREATMENT cierra I-TREATMENT abordaje I-TREATMENT transconjuntival. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION refiere I-EVOLUTION diplopia I-EVOLUTION ni I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION déficit I-EVOLUTION o I-EVOLUTION sobreacción I-EVOLUTION del I-EVOLUTION oblícuo I-EVOLUTION inferior I-EVOLUTION ni I-EVOLUTION del I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION musculatura I-EVOLUTION extrínseca, I-EVOLUTION en I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION oftalmológicos I-EVOLUTION a I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS placa I-PRESENT_ILLNESS violácea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ocupaba I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS parte I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS punta I-PRESENT_ILLNESS nasal; I-PRESENT_ILLNESS es I-PRESENT_ILLNESS valorada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS mantiene I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS expectante I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS observar I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS continuaba I-PRESENT_ILLNESS progresando, I-PRESENT_ILLNESS ocasionándole I-PRESENT_ILLNESS deformidad I-PRESENT_ILLNESS facial, I-PRESENT_ILLNESS decide I-PRESENT_ILLNESS remitirla I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS servicio. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION ser I-EXPLORATION valorada, I-EXPLORATION detectamos I-EXPLORATION deformidad I-EXPLORATION del I-EXPLORATION cartílago I-EXPLORATION y I-EXPLORATION discreta I-EXPLORATION dificultad I-EXPLORATION respiratoria. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT esclerosante I-TREATMENT con I-TREATMENT Betametazona I-TREATMENT 4 I-TREATMENT mg I-TREATMENT intralesional, I-TREATMENT cuando I-TREATMENT se I-TREATMENT logró I-TREATMENT la I-TREATMENT fibrosis I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT su I-TREATMENT exéresis I-TREATMENT quirúrgica I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT por I-TREATMENT una I-TREATMENT incisión I-TREATMENT en I-TREATMENT ala I-TREATMENT de I-TREATMENT gaviota I-TREATMENT invertida. I-TREATMENT I-TREATMENT Paciente B-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS atendido I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS de I-PRESENT_ILLNESS trauma I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS por I-PRESENT_ILLNESS violencia, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS mentoniana. I-PRESENT_ILLNESS La B-EXPLORATION imagen I-EXPLORATION radiográfica I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION fractura I-EXPLORATION sinfisiaria I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION radio I-EXPLORATION lúcida I-EXPLORATION periapical. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT enucleación I-TREATMENT del I-TREATMENT quiste I-TREATMENT e I-TREATMENT inmovilización I-TREATMENT de I-TREATMENT fragmentos I-TREATMENT por I-TREATMENT bloqueo I-TREATMENT intermaxilar I-TREATMENT y I-TREATMENT terapia I-TREATMENT endodóntica I-TREATMENT posterior I-TREATMENT a I-TREATMENT la I-TREATMENT intervención. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION comprobó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION radicular. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION panorámica I-EXPLORATION realizada I-EXPLORATION a I-EXPLORATION un I-EXPLORATION mes I-EXPLORATION de I-EXPLORATION post I-EXPLORATION operatorio, I-EXPLORATION evidenció I-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION favorable I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION lesiones. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS ingresado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ángulo I-PRESENT_ILLNESS mandibular I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS mandibular I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS larga I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS radiolúcida. I-PRESENT_ILLNESS Esta B-TREATMENT fue I-TREATMENT enucleada I-TREATMENT por I-TREATMENT vía I-TREATMENT intraoral I-TREATMENT al I-TREATMENT igual I-TREATMENT que I-TREATMENT las I-TREATMENT raíces I-TREATMENT dentarias I-TREATMENT asociadas, I-TREATMENT seguido I-TREATMENT de I-TREATMENT estabilización I-TREATMENT de I-TREATMENT fragmentos I-TREATMENT mediante I-TREATMENT bloqueo I-TREATMENT intermaxilar I-TREATMENT utilizando I-TREATMENT ligaduras I-TREATMENT Ivy. I-TREATMENT La B-EXPLORATION histología I-EXPLORATION confirmó I-EXPLORATION su I-EXPLORATION naturaleza I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION radicular. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tercer I-PRESENT_ILLNESS molar I-PRESENT_ILLNESS fusionado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuarto I-PRESENT_ILLNESS molar I-PRESENT_ILLNESS supernumerario I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Departamento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Medicina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Cirugía I-PRESENT_ILLNESS Bucofacial I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor, I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS trismo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS repetición I-PRESENT_ILLNESS causados I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tercer I-PRESENT_ILLNESS molar I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS semierupcionado. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION tercer I-EXPLORATION molar I-EXPLORATION de I-EXPLORATION grandes I-EXPLORATION dimensiones I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION mesioangular I-EXPLORATION semierupcionado, I-EXPLORATION responsable I-EXPLORATION de I-EXPLORATION los I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION pericoronaritis. I-EXPLORATION Realizamos I-EXPLORATION una I-EXPLORATION ortopantomografía I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION el I-EXPLORATION tercer I-EXPLORATION molar I-EXPLORATION unido I-EXPLORATION a I-EXPLORATION un I-EXPLORATION supernumerario I-EXPLORATION por I-EXPLORATION la I-EXPLORATION corona I-EXPLORATION y I-EXPLORATION la I-EXPLORATION raíz. I-EXPLORATION Se I-EXPLORATION da I-EXPLORATION la I-EXPLORATION circunstancia I-EXPLORATION de I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION otro I-EXPLORATION molar I-EXPLORATION supernumerario I-EXPLORATION en I-EXPLORATION el I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION lado I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Tras B-PAST_MEDICAL_HISTORY realizar I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY (sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés), I-PAST_MEDICAL_HISTORY se B-TREATMENT explica I-TREATMENT al I-TREATMENT paciente I-TREATMENT el I-TREATMENT propósito I-TREATMENT y I-TREATMENT los I-TREATMENT riesgos I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT y I-TREATMENT firma I-TREATMENT el I-TREATMENT consentimiento I-TREATMENT informado. I-TREATMENT El B-EXPLORATION paciente I-EXPLORATION rechaza I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION escáner I-EXPLORATION para I-EXPLORATION conocer I-EXPLORATION la I-EXPLORATION relación I-EXPLORATION del I-EXPLORATION molar I-EXPLORATION con I-EXPLORATION el I-EXPLORATION conducto I-EXPLORATION del I-EXPLORATION nervio I-EXPLORATION dentario I-EXPLORATION inferior. I-EXPLORATION Se B-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT extracción I-TREATMENT quirúrgica I-TREATMENT del I-TREATMENT tercer I-TREATMENT y I-TREATMENT cuarto I-TREATMENT molar, I-TREATMENT con I-TREATMENT anestesia I-TREATMENT local, I-TREATMENT siendo I-TREATMENT necesario I-TREATMENT hacer I-TREATMENT odontosección I-TREATMENT por I-TREATMENT el I-TREATMENT gran I-TREATMENT tamaño I-TREATMENT del I-TREATMENT molar I-TREATMENT fusionado. I-TREATMENT I-TREATMENT No B-EVOLUTION hubo I-EVOLUTION complicaciones I-EVOLUTION ni I-EVOLUTION intra I-EVOLUTION ni I-EVOLUTION postoperatorias. I-EVOLUTION I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION revisión I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses, I-EVOLUTION descartándose I-EVOLUTION problemas I-EVOLUTION periodontales I-EVOLUTION y I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION caries I-EVOLUTION en I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION molar. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS enoftalmos, I-PRESENT_ILLNESS diplopia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS distopia I-PRESENT_ILLNESS derechas I-PRESENT_ILLNESS posteriores I-PRESENT_ILLNESS a I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tránsito I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS blow-out I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Se B-TREATMENT realiza I-TREATMENT la I-TREATMENT corrección I-TREATMENT de I-TREATMENT dichas I-TREATMENT secuelas I-TREATMENT realizando I-TREATMENT injerto I-TREATMENT escalonado I-TREATMENT de I-TREATMENT calota I-TREATMENT en I-TREATMENT piso I-TREATMENT de I-TREATMENT orbita I-TREATMENT derecho I-TREATMENT y I-TREATMENT adición I-TREATMENT de I-TREATMENT gel I-TREATMENT de I-TREATMENT plasma I-TREATMENT rico I-TREATMENT en I-TREATMENT plaquetas, I-TREATMENT 11 I-TREATMENT meses I-TREATMENT posterior I-TREATMENT al I-TREATMENT accidente, I-TREATMENT mediante I-TREATMENT abordaje I-TREATMENT infraorbitario I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT cicatriz I-TREATMENT previa. I-TREATMENT Tanto B-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio, I-EVOLUTION como I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 16 I-EVOLUTION semanas, I-EVOLUTION se I-EVOLUTION observan I-EVOLUTION ejes I-EVOLUTION pupilares I-EVOLUTION más I-EVOLUTION simétricos I-EVOLUTION y I-EVOLUTION mejoría I-EVOLUTION importante I-EVOLUTION de I-EVOLUTION la I-EVOLUTION proyección I-EVOLUTION del I-EVOLUTION globo I-EVOLUTION ocular I-EVOLUTION derecho I-EVOLUTION y I-EVOLUTION especialmente I-EVOLUTION de I-EVOLUTION la I-EVOLUTION diplopia I-EVOLUTION postraumática. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS secuelas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS trauma I-PRESENT_ILLNESS contundente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemicara I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS blow-out I-PRESENT_ILLNESS no I-PRESENT_ILLNESS tratada. I-PRESENT_ILLNESS Como B-EXPLORATION consecuencia I-EXPLORATION presentó I-EXPLORATION enoftalmos, I-EXPLORATION distopia I-EXPLORATION y I-EXPLORATION diplopia I-EXPLORATION izquierdas I-EXPLORATION ; I-EXPLORATION 18 B-TREATMENT meses I-TREATMENT posterior I-TREATMENT al I-TREATMENT trauma I-TREATMENT se I-TREATMENT realiza I-TREATMENT la I-TREATMENT corrección I-TREATMENT de I-TREATMENT dichas I-TREATMENT secuelas I-TREATMENT mediante I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT injerto I-TREATMENT escalonado I-TREATMENT de I-TREATMENT calota I-TREATMENT en I-TREATMENT suelo I-TREATMENT de I-TREATMENT órbita, I-TREATMENT previo I-TREATMENT abordaje I-TREATMENT transconjuntival I-TREATMENT izquierdo. I-TREATMENT Observándose B-EVOLUTION en I-EVOLUTION la I-EVOLUTION evaluación I-EVOLUTION postoperatoria I-EVOLUTION mejoría I-EVOLUTION estética I-EVOLUTION y I-EVOLUTION funcional I-EVOLUTION importante I-EVOLUTION de I-EVOLUTION las I-EVOLUTION condiciones I-EVOLUTION ya I-EVOLUTION descritas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitido I-PRESENT_ILLNESS a B-DERIVED_FROM/TO nuestras I-DERIVED_FROM/TO consultas I-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO oftalmología I-DERIVED_FROM/TO por B-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS exoftalmos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS globo I-PRESENT_ILLNESS ocular I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS seno I-PRESENT_ILLNESS maxilar I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY máxilo-malar I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY 28 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY reducción I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fijación I-PAST_MEDICAL_HISTORY alámbrica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY reborde I-PAST_MEDICAL_HISTORY infraorbitario I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY arbotante I-PAST_MEDICAL_HISTORY frontomalar. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION encontramos I-EXPLORATION exoftalmos, I-EXPLORATION distopia I-EXPLORATION vertical I-EXPLORATION del I-EXPLORATION globo I-EXPLORATION ocular I-EXPLORATION y I-EXPLORATION oftalmoplejia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mirada I-EXPLORATION vertical. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION falta I-EXPLORATION de I-EXPLORATION proyección I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION infraorbitario I-EXPLORATION que I-EXPLORATION permitía I-EXPLORATION palpar I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION blanda I-EXPLORATION a I-EXPLORATION dicho I-EXPLORATION nivel. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ortopantomografía I-EXPLORATION no I-EXPLORATION se I-EXPLORATION vió I-EXPLORATION relación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION con I-EXPLORATION dientes. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION derecho, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION con I-EXPLORATION remodelación I-EXPLORATION ósea I-EXPLORATION y I-EXPLORATION destrucción I-EXPLORATION del I-EXPLORATION suelo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION y I-EXPLORATION desplazamiento I-EXPLORATION del I-EXPLORATION músculo I-EXPLORATION recto I-EXPLORATION inferior, I-EXPLORATION provocando I-EXPLORATION un I-EXPLORATION exoftalmos I-EXPLORATION secundario. I-EXPLORATION I-EXPLORATION La B-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT consistió I-TREATMENT en I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT asociada I-TREATMENT a I-TREATMENT la I-TREATMENT extracción I-TREATMENT de I-TREATMENT las I-TREATMENT fijaciones I-TREATMENT alámbricas I-TREATMENT vía I-TREATMENT subciliar I-TREATMENT figura I-TREATMENT 3), I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT prótesis I-TREATMENT de I-TREATMENT Medpor I-TREATMENT del I-TREATMENT complejo I-TREATMENT máxilomalar I-TREATMENT destruido I-TREATMENT (reborde I-TREATMENT infraorbitario, I-TREATMENT suelo I-TREATMENT de I-TREATMENT órbita, I-TREATMENT arbotante I-TREATMENT frontomalar). I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION mucocele I-EXPLORATION maxilar. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION enfermo I-EVOLUTION fue I-EVOLUTION satisfactoria, I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION motilidad I-EVOLUTION ocular, I-EVOLUTION sin I-EVOLUTION diplopia I-EVOLUTION y I-EVOLUTION con I-EVOLUTION un I-EVOLUTION correcto I-EVOLUTION resultado I-EVOLUTION estético. I-EVOLUTION El I-EVOLUTION seguimiento I-EVOLUTION actual I-EVOLUTION tras I-EVOLUTION tres I-EVOLUTION años I-EVOLUTION continúa I-EVOLUTION siendo I-EVOLUTION satisfactorio I-EVOLUTION sin I-EVOLUTION recidiva I-EVOLUTION ni I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS ingresada I-PRESENT_ILLNESS para I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS quirúrgico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS deformidad I-PRESENT_ILLNESS dentofacial. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY ferropénica, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY ninguna I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY medicamentosa I-PAST_MEDICAL_HISTORY conocida. I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION prognatismo I-EXPLORATION marcado I-EXPLORATION con I-EXPLORATION una I-EXPLORATION clase I-EXPLORATION III I-EXPLORATION molar I-EXPLORATION y I-EXPLORATION pseudohipoplasia I-EXPLORATION de I-EXPLORATION maxilar I-EXPLORATION superior. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ortopantomografía I-EXPLORATION y I-EXPLORATION telerradiografía I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION iniciando I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION cefalométrico I-EXPLORATION correspondiente. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT tratamiento I-TREATMENT ortodóncico I-TREATMENT y I-TREATMENT extracción I-TREATMENT de I-TREATMENT los I-TREATMENT 4 I-TREATMENT cordales I-TREATMENT se I-TREATMENT somete I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT a I-TREATMENT intervención I-TREATMENT de I-TREATMENT cirugía I-TREATMENT ortognática I-TREATMENT convencional I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT e I-TREATMENT intubación I-TREATMENT nasotraqueal I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT realiza I-TREATMENT osteotomía I-TREATMENT tipo I-TREATMENT LeFort I-TREATMENT I I-TREATMENT fijada I-TREATMENT con I-TREATMENT dos I-TREATMENT placas I-TREATMENT preformadas I-TREATMENT de I-TREATMENT titanio I-TREATMENT en I-TREATMENT ambos I-TREATMENT arbotantes I-TREATMENT naso I-TREATMENT maxilares I-TREATMENT con I-TREATMENT avance I-TREATMENT de I-TREATMENT 7 I-TREATMENT mm, I-TREATMENT impactación I-TREATMENT anterior I-TREATMENT de I-TREATMENT 3 I-TREATMENT mm I-TREATMENT y I-TREATMENT posterior I-TREATMENT de I-TREATMENT 5 I-TREATMENT mm, I-TREATMENT rotación I-TREATMENT izquierda I-TREATMENT de I-TREATMENT 1mm, I-TREATMENT resección I-TREATMENT parcial I-TREATMENT inferior I-TREATMENT de I-TREATMENT septum I-TREATMENT nasal, I-TREATMENT cincha I-TREATMENT de I-TREATMENT alares I-TREATMENT y I-TREATMENT cierre I-TREATMENT labial I-TREATMENT en I-TREATMENT V-Y. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION y I-EVOLUTION seguida I-EVOLUTION en I-EVOLUTION revisiones I-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION externas I-EVOLUTION evidenciándose I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION celulitis I-EVOLUTION genianas I-EVOLUTION bilaterales I-EVOLUTION de I-EVOLUTION repetición. I-EVOLUTION Su I-EVOLUTION inicio I-EVOLUTION se I-EVOLUTION produjo I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6-9 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION inicial. I-EVOLUTION Se B-TREATMENT decide I-TREATMENT reintervenir I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT 1 I-TREATMENT año I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT primera I-TREATMENT intervención I-TREATMENT y I-TREATMENT retirar I-TREATMENT el I-TREATMENT material I-TREATMENT de I-TREATMENT osteosíntesis I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT osteotomía I-TREATMENT LeFort I-TREATMENT I I-TREATMENT tras I-TREATMENT reapertura I-TREATMENT del I-TREATMENT abordaje I-TREATMENT sublabial I-TREATMENT superior I-TREATMENT bilateral I-TREATMENT previo. I-TREATMENT Intraoperatoriamente I-TREATMENT no I-TREATMENT se I-TREATMENT objetiva I-TREATMENT movilidad I-TREATMENT del I-TREATMENT tercio I-TREATMENT medio I-TREATMENT facial I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT osteotomía I-TREATMENT tipo I-TREATMENT LeFort I-TREATMENT I I-TREATMENT y I-TREATMENT se I-TREATMENT cataloga I-TREATMENT dicho I-TREATMENT episodio I-TREATMENT quirúrgico I-TREATMENT como I-TREATMENT una I-TREATMENT intolerancia I-TREATMENT al I-TREATMENT material I-TREATMENT de I-TREATMENT osteosíntesis. I-TREATMENT I-TREATMENT Tras B-EVOLUTION seguir I-EVOLUTION revisiones I-EVOLUTION periódicas I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad I-EVOLUTION tanto I-EVOLUTION en I-EVOLUTION nuestras I-EVOLUTION consultas I-EVOLUTION externas I-EVOLUTION como I-EVOLUTION con I-EVOLUTION el I-EVOLUTION ortodoncista, I-EVOLUTION un I-EVOLUTION año I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION última I-EVOLUTION intervención I-EVOLUTION quirúrgica I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION fuerza I-EVOLUTION con I-EVOLUTION la I-EVOLUTION masticación, I-EVOLUTION impidiendo I-EVOLUTION la I-EVOLUTION práctica I-EVOLUTION de I-EVOLUTION una I-EVOLUTION dieta I-EVOLUTION con I-EVOLUTION alimentos I-EVOLUTION sólidos. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION leve I-EXPLORATION movilidad I-EXPLORATION del I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION LeFort I-EXPLORATION I, I-EXPLORATION manteniendo I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION una I-EXPLORATION oclusión I-EXPLORATION correcta I-EXPLORATION en I-EXPLORATION clase I-EXPLORATION I. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION facial I-EXPLORATION solicitado I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION consolidación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION con I-EXPLORATION solución I-EXPLORATION de I-EXPLORATION continuidad I-EXPLORATION ósea I-EXPLORATION en I-EXPLORATION la I-EXPLORATION osteotomía I-EXPLORATION LeFort I-EXPLORATION I. I-EXPLORATION Dado B-EVOLUTION el I-EVOLUTION tiempo I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION intervención I-EVOLUTION se I-EVOLUTION establece I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION presunción I-EVOLUTION de I-EVOLUTION pseudoartrosis I-EVOLUTION de I-EVOLUTION maxilar I-EVOLUTION superior I-EVOLUTION en I-EVOLUTION dicha I-EVOLUTION osteotomía. I-EVOLUTION I-EVOLUTION Se B-TREATMENT decide I-TREATMENT reintervenir I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT para I-TREATMENT el I-TREATMENT manejo I-TREATMENT definitivo I-TREATMENT de I-TREATMENT dicha I-TREATMENT complicación. I-TREATMENT Tras I-TREATMENT realizar I-TREATMENT un I-TREATMENT bloqueo I-TREATMENT intermaxilar I-TREATMENT elástico I-TREATMENT en I-TREATMENT clase I-TREATMENT I I-TREATMENT y I-TREATMENT reabrir I-TREATMENT de I-TREATMENT nuevo I-TREATMENT el I-TREATMENT abordaje I-TREATMENT sublabial I-TREATMENT superior I-TREATMENT previo, I-TREATMENT se I-TREATMENT retira I-TREATMENT el I-TREATMENT tejido I-TREATMENT fibroso I-TREATMENT interpuesto I-TREATMENT en I-TREATMENT los I-TREATMENT márgenes I-TREATMENT óseos I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT osteotomía I-TREATMENT maxilar I-TREATMENT superior. I-TREATMENT Se I-TREATMENT fija I-TREATMENT la I-TREATMENT osteotomía I-TREATMENT maxilar I-TREATMENT superior I-TREATMENT mediante I-TREATMENT dos I-TREATMENT placas I-TREATMENT preformadas I-TREATMENT de I-TREATMENT titanio I-TREATMENT con I-TREATMENT el I-TREATMENT avance I-TREATMENT inicialmente I-TREATMENT establecido. I-TREATMENT Se I-TREATMENT obtienen I-TREATMENT injertos I-TREATMENT óseos I-TREATMENT esponjosos I-TREATMENT de I-TREATMENT tibia I-TREATMENT derecha I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT un I-TREATMENT abordaje I-TREATMENT medial I-TREATMENT y I-TREATMENT se I-TREATMENT colocan I-TREATMENT los I-TREATMENT mismos I-TREATMENT en I-TREATMENT el I-TREATMENT gap I-TREATMENT óseo I-TREATMENT de I-TREATMENT la I-TREATMENT osteotomía I-TREATMENT Le-Fort I-TREATMENT I I-TREATMENT sellando I-TREATMENT dicho I-TREATMENT defecto. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION foco I-EXPLORATION interfracturario I-EXPLORATION revela I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION cartilaginosas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION con I-EXPLORATION predominante I-EXPLORATION proliferación I-EXPLORATION fibroblástica. I-EXPLORATION I-EXPLORATION Tras B-EVOLUTION dicha I-EVOLUTION intervención I-EVOLUTION es I-EVOLUTION seguida I-EVOLUTION en I-EVOLUTION nuestras I-EVOLUTION consultas I-EVOLUTION apreciándose I-EVOLUTION la I-EVOLUTION consolidación I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION la I-EVOLUTION osteotomía, I-EVOLUTION sin I-EVOLUTION movilidad I-EVOLUTION de I-EVOLUTION la I-EVOLUTION misma, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION oclusión I-EVOLUTION estable I-EVOLUTION y I-EVOLUTION aspecto I-EVOLUTION estético I-EVOLUTION favorable. I-EVOLUTION Asimismo I-EVOLUTION no I-EVOLUTION se I-EVOLUTION apreciaron I-EVOLUTION complicaciones I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION toma I-EVOLUTION del I-EVOLUTION injerto I-EVOLUTION tibial, I-EVOLUTION siendo I-EVOLUTION favorable I-EVOLUTION su I-EVOLUTION Rx I-EVOLUTION de I-EVOLUTION control. I-EVOLUTION I-EVOLUTION El B-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS es I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS al I-PRESENT_ILLNESS cerrar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS boca. I-PRESENT_ILLNESS El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO valorado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO pediatría I-DERIVED_FROM/TO y I-DERIVED_FROM/TO diagnosticado I-DERIVED_FROM/TO de I-DERIVED_FROM/TO luxación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ATM, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO es I-DERIVED_FROM/TO referido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO cirujano I-DERIVED_FROM/TO maxilofacial I-DERIVED_FROM/TO de I-DERIVED_FROM/TO guardia. I-DERIVED_FROM/TO En B-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION el I-EXPLORATION niño I-EXPLORATION estaba I-EXPLORATION inquieto I-EXPLORATION y I-EXPLORATION con I-EXPLORATION la I-EXPLORATION boca I-EXPLORATION semiabierta, I-EXPLORATION sin I-EXPLORATION embargo I-EXPLORATION al I-EXPLORATION forzar I-EXPLORATION el I-EXPLORATION cierre I-EXPLORATION la I-EXPLORATION oclusión I-EXPLORATION dentaria I-EXPLORATION era I-EXPLORATION buena I-EXPLORATION aunque I-EXPLORATION muy I-EXPLORATION dolorosa. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION fiebre I-EXPLORATION ni I-EXPLORATION supuración I-EXPLORATION de I-EXPLORATION oídos. I-EXPLORATION En B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY duración I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY síntomas I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY unas I-PAST_MEDICAL_HISTORY horas, I-PAST_MEDICAL_HISTORY pues I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY acompañaba I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY maestra I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY guardería. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY interrogó I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY maestra I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY busca I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY infecciosos I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY traumáticos, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY nos I-PAST_MEDICAL_HISTORY informó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY habían I-PAST_MEDICAL_HISTORY faltado I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY niños I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY porque I-PAST_MEDICAL_HISTORY estaban I-PAST_MEDICAL_HISTORY enfermos. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ortopantomografía, I-EXPLORATION sin I-EXPLORATION evidenciarse I-EXPLORATION patología I-EXPLORATION articular. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION otoscopia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION otitis I-EXPLORATION externa I-EXPLORATION aguda. I-EXPLORATION Tras B-TREATMENT el I-TREATMENT tratamiento I-TREATMENT adecuado I-TREATMENT se B-EVOLUTION produjo I-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION situación I-EVOLUTION clínica. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS japonesa, B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médico-quirúrgicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY bebedora, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS maxilar I-PRESENT_ILLNESS indolora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION que I-EXPLORATION hace I-EXPLORATION prominencia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION vestibular I-EXPLORATION premolar I-EXPLORATION izquierda I-EXPLORATION del I-EXPLORATION maxilar I-EXPLORATION superior, I-EXPLORATION manteniéndose I-EXPLORATION la I-EXPLORATION integridad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa. I-EXPLORATION No I-EXPLORATION presenta I-EXPLORATION alteraciones I-EXPLORATION sensitivas I-EXPLORATION asociadas I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION cervical I-EXPLORATION es I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION panorámica I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION mixta I-EXPLORATION radioopaca-radiolúcida I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION "panal I-EXPLORATION de I-EXPLORATION abejas" I-EXPLORATION que I-EXPLORATION se I-EXPLORATION expande I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION canino I-EXPLORATION y I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION bicúspide I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION que I-EXPLORATION origina I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION separación I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION raíces I-EXPLORATION de I-EXPLORATION esas I-EXPLORATION piezas I-EXPLORATION dentarias, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION ligero I-EXPLORATION desplazamiento I-EXPLORATION en I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION y I-EXPLORATION escotadura I-EXPLORATION piriforme. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION delimita I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION precisión I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION tumoración, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION por I-EXPLORATION la I-EXPLORATION región I-EXPLORATION palatina I-EXPLORATION sin I-EXPLORATION llegar I-EXPLORATION a I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media; I-EXPLORATION en I-EXPLORATION su I-EXPLORATION zona I-EXPLORATION central I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION clara I-EXPLORATION imagen I-EXPLORATION radiolúcida I-EXPLORATION rodeada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION punteado I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION alternantes I-EXPLORATION radiolúcidas I-EXPLORATION y I-EXPLORATION radioopacas I-EXPLORATION que I-EXPLORATION configuran I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION tumoral. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION diagnósticos I-EXPLORATION diferenciales I-EXPLORATION barajados, I-EXPLORATION en I-EXPLORATION espera I-EXPLORATION de I-EXPLORATION la I-EXPLORATION confirmación I-EXPLORATION histológica, I-EXPLORATION fueron: I-EXPLORATION lesión I-EXPLORATION fibroósea I-EXPLORATION benigna, I-EXPLORATION sarcoma I-EXPLORATION osteogénico, I-EXPLORATION tumor I-EXPLORATION epitelial I-EXPLORATION calcificante, I-EXPLORATION etc. I-EXPLORATION I-EXPLORATION La I-EXPLORATION primera I-EXPLORATION biopsia I-EXPLORATION realizada I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION ameloblastoma, I-EXPLORATION pero I-EXPLORATION la I-EXPLORATION falta I-EXPLORATION de I-EXPLORATION concordancia I-EXPLORATION clínico-radiológica I-EXPLORATION con I-EXPLORATION el I-EXPLORATION ameloblastoma I-EXPLORATION común I-EXPLORATION apoyó I-EXPLORATION la I-EXPLORATION indicación I-EXPLORATION de I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION biopsia. I-EXPLORATION En I-EXPLORATION esta I-EXPLORATION se I-EXPLORATION podían I-EXPLORATION observar I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION claridad I-EXPLORATION escasos I-EXPLORATION nidos I-EXPLORATION y I-EXPLORATION cordones I-EXPLORATION de I-EXPLORATION células I-EXPLORATION basaloides, I-EXPLORATION sin I-EXPLORATION atipia, I-EXPLORATION dispuestas I-EXPLORATION en I-EXPLORATION un I-EXPLORATION estroma I-EXPLORATION fibroso I-EXPLORATION densamente I-EXPLORATION colagenizado, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION consideró I-EXPLORATION característico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION variante I-EXPLORATION desmoplásica I-EXPLORATION del I-EXPLORATION ameloblastoma. I-EXPLORATION I-EXPLORATION Bajo B-TREATMENT anestesia I-TREATMENT general I-TREATMENT se I-TREATMENT realiza I-TREATMENT la I-TREATMENT disección I-TREATMENT de I-TREATMENT un I-TREATMENT colgajo I-TREATMENT mucoso I-TREATMENT palatino I-TREATMENT y I-TREATMENT vestibular I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT peritumoral, I-TREATMENT así I-TREATMENT como I-TREATMENT la I-TREATMENT separación I-TREATMENT de I-TREATMENT la I-TREATMENT mucosa I-TREATMENT nasal I-TREATMENT y I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar, I-TREATMENT que I-TREATMENT en I-TREATMENT ningún I-TREATMENT momento I-TREATMENT se I-TREATMENT encontraban I-TREATMENT adheridas I-TREATMENT al I-TREATMENT tumor. I-TREATMENT Expuesta I-TREATMENT la I-TREATMENT zona I-TREATMENT a I-TREATMENT resecar, I-TREATMENT y I-TREATMENT siguiendo I-TREATMENT los I-TREATMENT límites I-TREATMENT macroscópicos I-TREATMENT del I-TREATMENT tumor, I-TREATMENT se I-TREATMENT practica I-TREATMENT una I-TREATMENT maxilectomía I-TREATMENT en I-TREATMENT bloque I-TREATMENT que I-TREATMENT abarca I-TREATMENT desde I-TREATMENT distal I-TREATMENT del I-TREATMENT incisivo I-TREATMENT lateral, I-TREATMENT hasta I-TREATMENT mesial I-TREATMENT del I-TREATMENT segundo I-TREATMENT molar, I-TREATMENT incluyendo I-TREATMENT en I-TREATMENT la I-TREATMENT pieza I-TREATMENT la I-TREATMENT pared I-TREATMENT lateral I-TREATMENT de I-TREATMENT la I-TREATMENT fosa I-TREATMENT nasal I-TREATMENT izquierda, I-TREATMENT el I-TREATMENT suelo I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT la I-TREATMENT porción I-TREATMENT palatina I-TREATMENT afectada. I-TREATMENT Una I-TREATMENT vez I-TREATMENT retirado I-TREATMENT el I-TREATMENT bloque I-TREATMENT tumoral I-TREATMENT se I-TREATMENT amplían I-TREATMENT los I-TREATMENT límites I-TREATMENT de I-TREATMENT seguridad I-TREATMENT de I-TREATMENT la I-TREATMENT resección I-TREATMENT sobre I-TREATMENT hueso I-TREATMENT clínicamente I-TREATMENT sano. I-TREATMENT En I-TREATMENT el I-TREATMENT mismo I-TREATMENT acto I-TREATMENT operatorio I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT del I-TREATMENT defecto I-TREATMENT resultante I-TREATMENT mediante I-TREATMENT interposición I-TREATMENT de I-TREATMENT un I-TREATMENT bloque I-TREATMENT de I-TREATMENT autoinjerto I-TREATMENT córtico-esponjoso I-TREATMENT libre I-TREATMENT de I-TREATMENT cadera, I-TREATMENT fijándolo I-TREATMENT con I-TREATMENT miniplacas I-TREATMENT de I-TREATMENT osteosíntesis I-TREATMENT al I-TREATMENT hueso I-TREATMENT maxilar. I-TREATMENT I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION macroscópico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION que I-EXPLORATION medía I-EXPLORATION 3 I-EXPLORATION x I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION relativamente I-EXPLORATION bien I-EXPLORATION delimitada I-EXPLORATION aunque I-EXPLORATION infiltrante I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hueso I-EXPLORATION maxilar, I-EXPLORATION y I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION al I-EXPLORATION hueso I-EXPLORATION limítrofe. I-EXPLORATION Histológicamente I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION estaba I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION nidos I-EXPLORATION irregulares I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION basaloide, I-EXPLORATION con I-EXPLORATION escaso I-EXPLORATION citoplasma I-EXPLORATION y I-EXPLORATION núcleos I-EXPLORATION monomorfos I-EXPLORATION carentes I-EXPLORATION de I-EXPLORATION atipia. I-EXPLORATION Los I-EXPLORATION nidos I-EXPLORATION celulares I-EXPLORATION estaban I-EXPLORATION dispuestos I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION salpicada I-EXPLORATION sobre I-EXPLORATION un I-EXPLORATION abundante I-EXPLORATION estroma I-EXPLORATION muy I-EXPLORATION colagenizado. I-EXPLORATION Se I-EXPLORATION emitió I-EXPLORATION un I-EXPLORATION informe I-EXPLORATION de I-EXPLORATION ameloblastoma I-EXPLORATION variante I-EXPLORATION desmoplásica I-EXPLORATION que I-EXPLORATION respetaba I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION óseos. I-EXPLORATION I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION cursa I-EVOLUTION sin I-EVOLUTION complicaciones; I-EVOLUTION se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT una I-TREATMENT prótesis I-TREATMENT dentaria I-TREATMENT provisional I-TREATMENT removible I-TREATMENT al I-TREATMENT cabo I-TREATMENT de I-TREATMENT unas I-TREATMENT semanas. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION último I-EVOLUTION control I-EVOLUTION clínico-radiológico I-EVOLUTION realizado I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION años I-EVOLUTION no I-EVOLUTION existen I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION recidiva; I-EVOLUTION un B-EXPLORATION año I-EXPLORATION y I-EXPLORATION medio I-EXPLORATION después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION se I-EXPLORATION realizó, I-EXPLORATION para I-EXPLORATION mayor I-EXPLORATION seguridad, I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION histológico I-EXPLORATION del I-EXPLORATION hueso I-EXPLORATION remanente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION distal I-EXPLORATION del I-EXPLORATION incisivo I-EXPLORATION lateral I-EXPLORATION por I-EXPLORATION hallarse I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION muy I-EXPLORATION próxima I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION residual. I-EXPLORATION Se B-EVOLUTION mantienen I-EVOLUTION revisiones I-EVOLUTION periódicas. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY ni B-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS valorar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS latero-cervical I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS produce I-PRESENT_ILLNESS disfonía, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS seca I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea. I-PRESENT_ILLNESS Niega I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS o I-PRESENT_ILLNESS anorexia, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuenta I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS profusa I-PRESENT_ILLNESS nocturna, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS holocraneal I-PRESENT_ILLNESS frecuente. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION dura, I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION profundos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION cervical I-EXPLORATION izquierdo, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media, I-EXPLORATION sin I-EXPLORATION palparse I-EXPLORATION adenopatías I-EXPLORATION locorregionales. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION revela I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION cm, I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION tiroideo I-EXPLORATION izquierdo I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION cayado I-EXPLORATION aórtico, I-EXPLORATION que I-EXPLORATION produce I-EXPLORATION cierta I-EXPLORATION estenosis I-EXPLORATION traqueal I-EXPLORATION y I-EXPLORATION desplazamiento I-EXPLORATION del I-EXPLORATION esófago. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION cortes I-EXPLORATION histológicos I-EXPLORATION muestran I-EXPLORATION un I-EXPLORATION tejido I-EXPLORATION conjuntivo I-EXPLORATION infiltrado I-EXPLORATION en I-EXPLORATION ciertas I-EXPLORATION zonas I-EXPLORATION por I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION que I-EXPLORATION se I-EXPLORATION dispone I-EXPLORATION formando I-EXPLORATION grandes I-EXPLORATION nidos I-EXPLORATION de I-EXPLORATION células I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION pequeño I-EXPLORATION o I-EXPLORATION intermedio. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION son I-EXPLORATION reactivas I-EXPLORATION exclusivamente I-EXPLORATION para I-EXPLORATION CD99, I-EXPLORATION enolasa I-EXPLORATION neuroespecífica I-EXPLORATION y, I-EXPLORATION débilmente, I-EXPLORATION para I-EXPLORATION sinaptofisina. I-EXPLORATION La I-EXPLORATION positividad I-EXPLORATION nuclear I-EXPLORATION para I-EXPLORATION el I-EXPLORATION anticuerpo I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION Ki-67 I-EXPLORATION oscila I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION 25 I-EXPLORATION y I-EXPLORATION el I-EXPLORATION 50% I-EXPLORATION de I-EXPLORATION los I-EXPLORATION núcleos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION tumorales. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT obtenido I-TREATMENT mediante I-TREATMENT la I-TREATMENT biopsia, I-TREATMENT se I-TREATMENT programa I-TREATMENT al I-TREATMENT paciente I-TREATMENT para I-TREATMENT recibir I-TREATMENT tratamiento I-TREATMENT quimiorradioterápico. I-TREATMENT Recibió I-TREATMENT 4 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia, I-TREATMENT seguidos I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT radioterápico I-TREATMENT con I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT administrada I-TREATMENT de I-TREATMENT 55, I-TREATMENT 8 I-TREATMENT Gy, I-TREATMENT tras I-TREATMENT el I-TREATMENT cual I-TREATMENT presentó I-TREATMENT esofagitis I-TREATMENT y I-TREATMENT epitelitis I-TREATMENT de I-TREATMENT grado I-TREATMENT 2. I-TREATMENT Tras I-TREATMENT la I-TREATMENT radioterapia, I-TREATMENT el I-TREATMENT paciente I-TREATMENT recibió I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT poliquimioterapia. I-TREATMENT I-TREATMENT Los B-EVOLUTION días I-EVOLUTION siguientes I-EVOLUTION al I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION su I-EVOLUTION estridor I-EVOLUTION respiratorio, I-EVOLUTION que I-EVOLUTION desapareció I-EVOLUTION por I-EVOLUTION completo, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION la I-EVOLUTION tumoración I-EVOLUTION latero-cervical I-EVOLUTION mayor I-EVOLUTION de I-EVOLUTION un I-EVOLUTION 50%. I-EVOLUTION Tras I-EVOLUTION finalizar I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION ciclos I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION remisión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION asintomático I-EVOLUTION durante I-EVOLUTION 7 I-EVOLUTION años I-EVOLUTION hasta I-EVOLUTION que I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION la I-EVOLUTION consulta I-EVOLUTION refiriendo I-EVOLUTION disnea I-EVOLUTION y I-EVOLUTION tos I-EVOLUTION de I-EVOLUTION un I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION y B-EXPLORATION en I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION recidiva I-EXPLORATION mediastínica I-EXPLORATION con I-EXPLORATION extensión I-EXPLORATION pulmonar. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT traqueostomía I-TREATMENT por I-TREATMENT compresión I-TREATMENT traqueal I-TREATMENT del I-TREATMENT tumor I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT citotóxico I-TREATMENT con I-TREATMENT 4 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT poliquimioterapia. I-TREATMENT Presentó B-EVOLUTION una I-EVOLUTION supervivencia I-EVOLUTION de I-EVOLUTION un I-EVOLUTION año I-EVOLUTION hasta I-EVOLUTION su I-EVOLUTION fallecimiento I-EVOLUTION por I-EVOLUTION causa I-EVOLUTION tumoral. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS nota I-PRESENT_ILLNESS un I-PRESENT_ILLNESS chasquido I-PRESENT_ILLNESS mandibular I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS apertura I-PRESENT_ILLNESS mandibular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS palpable I-PRESENT_ILLNESS preauricular I-PRESENT_ILLNESS dolorosa I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS mejoró I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antiinflamatorios I-PRESENT_ILLNESS no I-PRESENT_ILLNESS esteroideos, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cirugía I-PRESENT_ILLNESS Maxilofacial. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presenta I-EXPLORATION asimetría I-EXPLORATION facial, I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION en I-EXPLORATION región I-EXPLORATION preauricular I-EXPLORATION izquierda, I-EXPLORATION arco I-EXPLORATION cigomático I-EXPLORATION y I-EXPLORATION ángulo I-EXPLORATION mandibular I-EXPLORATION izquierdo. I-EXPLORATION Este I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION se I-EXPLORATION halla I-EXPLORATION mal I-EXPLORATION delimitado, I-EXPLORATION sin I-EXPLORATION poderse I-EXPLORATION definir I-EXPLORATION clara I-EXPLORATION tumoración. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION oral I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION induración I-EXPLORATION irregular I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION masticador I-EXPLORATION izquierdo, I-EXPLORATION sospechosa I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION tumoral. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION apertura I-EXPLORATION oral I-EXPLORATION de I-EXPLORATION 40 I-EXPLORATION mm. I-EXPLORATION No I-EXPLORATION presentaba I-EXPLORATION adenopatías I-EXPLORATION cervicales I-EXPLORATION ni I-EXPLORATION supraclaviculares I-EXPLORATION palpables. I-EXPLORATION I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION aparece I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION sólido I-EXPLORATION en I-EXPLORATION hemimandíbula I-EXPLORATION izquierda, I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION x I-EXPLORATION 1, I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION del I-EXPLORATION cóndilo I-EXPLORATION mandibular, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION delimitados, I-EXPLORATION que I-EXPLORATION sugiere I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION agresiva, I-EXPLORATION de I-EXPLORATION probable I-EXPLORATION origen I-EXPLORATION óseo, I-EXPLORATION objetivándose I-EXPLORATION destrucción I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION mandibular I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION lítico. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION punción-aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION con I-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION células I-EXPLORATION redondas, I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION citoqueratinas, I-EXPLORATION antígeno I-EXPLORATION leucocitario I-EXPLORATION común, I-EXPLORATION sinaptofisina I-EXPLORATION y I-EXPLORATION CD99. I-EXPLORATION I-EXPLORATION Finalmente I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION PNET I-EXPLORATION con I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION tumoral I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION mandaron I-EXPLORATION 5 I-EXPLORATION fragmentos I-EXPLORATION irregulares I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION color I-EXPLORATION rojizo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION diagnosticaron I-EXPLORATION como I-EXPLORATION "tumoración I-EXPLORATION de I-EXPLORATION células I-EXPLORATION redondas I-EXPLORATION y I-EXPLORATION pequeñas I-EXPLORATION infiltrando I-EXPLORATION hueso". I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION material I-EXPLORATION fijado I-EXPLORATION en I-EXPLORATION formol I-EXPLORATION incluido I-EXPLORATION en I-EXPLORATION parafina I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION tan I-EXPLORATION solo I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION positividad I-EXPLORATION con I-EXPLORATION vimentina I-EXPLORATION y I-EXPLORATION CD99. I-EXPLORATION El I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION medido I-EXPLORATION como I-EXPLORATION positividad I-EXPLORATION nuclear I-EXPLORATION con I-EXPLORATION MIB-1 I-EXPLORATION era I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION el I-EXPLORATION 15% I-EXPLORATION de I-EXPLORATION la I-EXPLORATION celularidad I-EXPLORATION tumoral. I-EXPLORATION Dado I-EXPLORATION el I-EXPLORATION escaso I-EXPLORATION material I-EXPLORATION examinado, I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION posible I-EXPLORATION determinar I-EXPLORATION si I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION correspondía I-EXPLORATION a I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION Ewing I-EXPLORATION o I-EXPLORATION a I-EXPLORATION un I-EXPLORATION neuroepitelioma I-EXPLORATION periférico. I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION citogenético I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION realizado. I-EXPLORATION I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION y I-EXPLORATION la I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION metastásica. I-EXPLORATION I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT comenzar I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT y I-TREATMENT valorar I-TREATMENT tratamiento I-TREATMENT quirúrgico/radioterápico I-TREATMENT según I-TREATMENT la I-TREATMENT respuesta. I-TREATMENT Se I-TREATMENT dieron I-TREATMENT 5 I-TREATMENT ciclos I-TREATMENT durante I-TREATMENT 4 I-TREATMENT meses. I-TREATMENT Tras B-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION ciclo I-EVOLUTION precisó I-EVOLUTION ingreso I-EVOLUTION por I-EVOLUTION neutropenia I-EVOLUTION febril. I-EVOLUTION I-EVOLUTION La B-TREATMENT resonancia I-TREATMENT magnética I-TREATMENT nuclear I-TREATMENT (RMN) I-TREATMENT tras I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT sugería I-TREATMENT la I-TREATMENT posible I-TREATMENT progresión I-TREATMENT del I-TREATMENT tumor, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT dar I-TREATMENT tratamiento I-TREATMENT radioterápico I-TREATMENT planificado I-TREATMENT con I-TREATMENT intención I-TREATMENT radical, I-TREATMENT durante I-TREATMENT un I-TREATMENT mes I-TREATMENT y I-TREATMENT medio. I-TREATMENT La I-TREATMENT irradiación I-TREATMENT se I-TREATMENT hizo I-TREATMENT en I-TREATMENT dos I-TREATMENT fases, I-TREATMENT con I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT sobre I-TREATMENT tumor I-TREATMENT y I-TREATMENT margen I-TREATMENT reducido I-TREATMENT de I-TREATMENT 60 I-TREATMENT Gy. I-TREATMENT Después B-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION radioterápico I-EVOLUTION presentó I-EVOLUTION mucositis I-EVOLUTION grado I-EVOLUTION 2, I-EVOLUTION otitis I-EVOLUTION externa I-EVOLUTION y I-EVOLUTION epitelitis I-EVOLUTION grado I-EVOLUTION 2 I-EVOLUTION en I-EVOLUTION el I-EVOLUTION campo I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION En B-TREATMENT la I-TREATMENT TAC I-TREATMENT de I-TREATMENT control I-TREATMENT se I-TREATMENT objetivaron I-TREATMENT hallazgos I-TREATMENT compatibles I-TREATMENT con I-TREATMENT restos/recidiva I-TREATMENT del I-TREATMENT PNET I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratar I-TREATMENT con I-TREATMENT otros I-TREATMENT 5 I-TREATMENT ciclos I-TREATMENT más I-TREATMENT de I-TREATMENT quimioterapia, I-TREATMENT siguiendo I-TREATMENT el I-TREATMENT mismo I-TREATMENT esquema I-TREATMENT anterior, I-TREATMENT durante I-TREATMENT otros I-TREATMENT 4 I-TREATMENT meses. I-TREATMENT I-TREATMENT Actualmente B-EVOLUTION han I-EVOLUTION pasado I-EVOLUTION 6 I-EVOLUTION años I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad, I-EVOLUTION en I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION rehabilitación I-EVOLUTION dental. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS recurrente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS hemimandíbula I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS parestesia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS mencionada, I-PRESENT_ILLNESS especialmente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS labio I-PRESENT_ILLNESS inferior. I-PRESENT_ILLNESS Además, I-PRESENT_ILLNESS describe I-PRESENT_ILLNESS un I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS al I-PRESENT_ILLNESS masticar I-PRESENT_ILLNESS en I-PRESENT_ILLNESS molares I-PRESENT_ILLNESS y I-PRESENT_ILLNESS premolares I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS afectado. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION leve I-EXPLORATION asimetría I-EXPLORATION facial I-EXPLORATION por I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION ubicado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION más I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION mandibular I-EXPLORATION y I-EXPLORATION rama I-EXPLORATION ascendente I-EXPLORATION izquierda. I-EXPLORATION El I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION es I-EXPLORATION indoloro. I-EXPLORATION Intrabucalmente I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION tabla I-EXPLORATION ósea I-EXPLORATION externa I-EXPLORATION abombada I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION del I-EXPLORATION segundo I-EXPLORATION molar. I-EXPLORATION Situación I-EXPLORATION similar, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION expansión I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION tablas, I-EXPLORATION se I-EXPLORATION pesquisa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION ascendente I-EXPLORATION mandibular. I-EXPLORATION Tercer I-EXPLORATION molar I-EXPLORATION ausente I-EXPLORATION clínicamente. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION hipótesis I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION mandibular I-EXPLORATION odontogénico I-EXPLORATION o I-EXPLORATION tumor I-EXPLORATION odontogénico, I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION estudio I-EXPLORATION imagenológico I-EXPLORATION previo I-EXPLORATION a I-EXPLORATION biopsia. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION panorámica I-EXPLORATION revela I-EXPLORATION una I-EXPLORATION extensa I-EXPLORATION lesión I-EXPLORATION radiolúcida I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION netos, I-EXPLORATION uniloculada I-EXPLORATION y I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rama I-EXPLORATION ascendente I-EXPLORATION mandibular. I-EXPLORATION Asociada I-EXPLORATION a I-EXPLORATION la I-EXPLORATION lesión, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION el I-EXPLORATION tercer I-EXPLORATION molar I-EXPLORATION incluido I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION baja I-EXPLORATION y I-EXPLORATION en I-EXPLORATION distoversión. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION programa I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional, I-EXPLORATION durante B-TREATMENT la I-TREATMENT cual, I-TREATMENT y I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT a I-TREATMENT las I-TREATMENT características I-TREATMENT clínicas I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT se I-TREATMENT instala I-TREATMENT una I-TREATMENT cánula I-TREATMENT de I-TREATMENT descompresión. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION histopatológico I-EXPLORATION informa I-EXPLORATION ameloblastoma I-EXPLORATION uniquístico I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION intramural I-EXPLORATION tipo I-EXPLORATION IIIa I-EXPLORATION de I-EXPLORATION Ackerman9. I-EXPLORATION I-EXPLORATION Después B-TREATMENT de I-TREATMENT 10 I-TREATMENT meses I-TREATMENT de I-TREATMENT seguimiento I-TREATMENT clínico-radiográfico, I-TREATMENT con I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT una I-TREATMENT cánula I-TREATMENT de I-TREATMENT descompresión I-TREATMENT cuya I-TREATMENT longitud I-TREATMENT se I-TREATMENT reduce I-TREATMENT de I-TREATMENT forma I-TREATMENT gradual, I-TREATMENT se I-TREATMENT constata I-TREATMENT reducción I-TREATMENT casi I-TREATMENT total I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT quística I-TREATMENT ameloblástica, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT efectúa I-TREATMENT cirugía I-TREATMENT de I-TREATMENT enucleación I-TREATMENT y I-TREATMENT curetaje I-TREATMENT de I-TREATMENT la I-TREATMENT cavidad I-TREATMENT residual, I-TREATMENT además I-TREATMENT de I-TREATMENT exodoncia I-TREATMENT del I-TREATMENT tercer I-TREATMENT molar I-TREATMENT involucrado. I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS derivado B-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO máxilofacial I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Luis I-DERIVED_FROM/TO Calvo I-DERIVED_FROM/TO Mackenna, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO una I-DERIVED_FROM/TO lesión I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO zona I-DERIVED_FROM/TO malar I-DERIVED_FROM/TO derecha. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos, I-PAST_MEDICAL_HISTORY relata I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY volumen I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY malar I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY persiste I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY fecha.. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen, I-EXPLORATION asintomático, I-EXPLORATION circunscrito, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION con I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION evolución I-EXPLORATION indeterminado. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION intraoral I-EXPLORATION el I-EXPLORATION vestíbulo I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION desocupado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION óseo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION más I-EXPLORATION alta. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION que I-EXPLORATION compromete I-EXPLORATION la I-EXPLORATION región I-EXPLORATION malar I-EXPLORATION derecha, I-EXPLORATION destruyendo I-EXPLORATION el I-EXPLORATION hueso I-EXPLORATION cigomático, I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION piso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION y I-EXPLORATION el I-EXPLORATION arco I-EXPLORATION cigomático. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION I-EXPLORATION De I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION se I-EXPLORATION obtuvo I-EXPLORATION como I-EXPLORATION resultado I-EXPLORATION HCL, I-EXPLORATION con I-EXPLORATION marcadores I-EXPLORATION inmunohistoquímicos I-EXPLORATION CD1a I-EXPLORATION y I-EXPLORATION S100 I-EXPLORATION intensamente I-EXPLORATION positivos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION completo I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION paciente, I-EXPLORATION sin I-EXPLORATION evidenciar I-EXPLORATION compromiso I-EXPLORATION en I-EXPLORATION otras I-EXPLORATION áreas I-EXPLORATION del I-EXPLORATION cuerpo. I-EXPLORATION I-EXPLORATION La B-TREATMENT lesión I-TREATMENT fue I-TREATMENT clasificada I-TREATMENT como I-TREATMENT lesión I-TREATMENT ósea I-TREATMENT única I-TREATMENT de I-TREATMENT sitio I-TREATMENT especial I-TREATMENT y I-TREATMENT tratada I-TREATMENT con I-TREATMENT el I-TREATMENT protocolo I-TREATMENT correspondiente, I-TREATMENT recibiendo I-TREATMENT 4 I-TREATMENT semanas I-TREATMENT de I-TREATMENT prednisona I-TREATMENT y I-TREATMENT 6 I-TREATMENT dosis I-TREATMENT de I-TREATMENT vinblastina. I-TREATMENT I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT realizó I-TREATMENT como I-TREATMENT tratamiento I-TREATMENT local, I-TREATMENT infiltración I-TREATMENT con I-TREATMENT triamcinolona I-TREATMENT y I-TREATMENT curetaje I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT tercera I-TREATMENT infiltración. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION realizado I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático, I-EVOLUTION sin I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION facial I-EVOLUTION ni I-EVOLUTION del I-EVOLUTION reborde I-EVOLUTION óseo. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION control I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION la I-EXPLORATION regeneración I-EXPLORATION ósea I-EXPLORATION del I-EXPLORATION hueso I-EXPLORATION malar, I-EXPLORATION el I-EXPLORATION arco I-EXPLORATION cigomático I-EXPLORATION y I-EXPLORATION el I-EXPLORATION piso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS trasladado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS intubación I-PRESENT_ILLNESS orotraqueal I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS severo I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS intento I-PRESENT_ILLNESS autolítico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS arma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuego. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION traumática I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION tercios I-EXPLORATION medio I-EXPLORATION e I-EXPLORATION inferior I-EXPLORATION faciales, I-EXPLORATION con I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION óseos I-EXPLORATION y I-EXPLORATION blandos I-EXPLORATION (pérdida I-EXPLORATION total I-EXPLORATION de I-EXPLORATION espesor I-EXPLORATION completo I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION inferior, I-EXPLORATION región I-EXPLORATION perioral, I-EXPLORATION mentoniana I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION parcial I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION labio I-EXPLORATION superior). I-EXPLORATION Se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION craneofacial, I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION daño I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION pérdida I-EXPLORATION extensa I-EXPLORATION de I-EXPLORATION sustancia I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION mandibular, I-EXPLORATION con I-EXPLORATION fracturas I-EXPLORATION múltiples I-EXPLORATION maxilares, I-EXPLORATION fractura I-EXPLORATION de I-EXPLORATION suelos I-EXPLORATION orbitarios, I-EXPLORATION fractura I-EXPLORATION de I-EXPLORATION huesos I-EXPLORATION propios I-EXPLORATION y I-EXPLORATION tabique I-EXPLORATION nasal I-EXPLORATION óseo. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT trasladado I-TREATMENT a I-TREATMENT quirófano, I-TREATMENT donde I-TREATMENT se I-TREATMENT realizó I-TREATMENT traqueostomía I-TREATMENT reglada, I-TREATMENT limpieza I-TREATMENT y I-TREATMENT hemostasia I-TREATMENT de I-TREATMENT heridas I-TREATMENT faciales I-TREATMENT y I-TREATMENT retirada I-TREATMENT de I-TREATMENT fragmentos I-TREATMENT óseos I-TREATMENT conminutos I-TREATMENT y I-TREATMENT cuerpos I-TREATMENT extraños. I-TREATMENT Seguidamente I-TREATMENT se I-TREATMENT realizó I-TREATMENT puenteo I-TREATMENT del I-TREATMENT defecto I-TREATMENT óseo I-TREATMENT mediante I-TREATMENT una I-TREATMENT placa I-TREATMENT de I-TREATMENT reconstrucción I-TREATMENT mandibular I-TREATMENT de I-TREATMENT 2, I-TREATMENT 5mm I-TREATMENT y I-TREATMENT cierre I-TREATMENT primario I-TREATMENT de I-TREATMENT tejidos I-TREATMENT blados. I-TREATMENT Se I-TREATMENT comprobó I-TREATMENT la I-TREATMENT estabilidad I-TREATMENT de I-TREATMENT fracturas I-TREATMENT en I-TREATMENT tercio I-TREATMENT medio, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT adoptó I-TREATMENT una I-TREATMENT actitud I-TREATMENT expectante. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT reducción I-TREATMENT nasal I-TREATMENT cerrada. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos I-EVOLUTION durante I-EVOLUTION cuatro I-EVOLUTION días. I-EVOLUTION I-EVOLUTION Diez B-TREATMENT días I-TREATMENT más I-TREATMENT tarde I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT secundaria, I-TREATMENT con I-TREATMENT retirada I-TREATMENT de I-TREATMENT la I-TREATMENT placa I-TREATMENT de I-TREATMENT reconstrucción I-TREATMENT mandibular, I-TREATMENT tallado I-TREATMENT de I-TREATMENT colgajo I-TREATMENT osteofasciocutáneo I-TREATMENT microvascularizado I-TREATMENT de I-TREATMENT peroné I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT preformado I-TREATMENT in I-TREATMENT situ I-TREATMENT por I-TREATMENT medio I-TREATMENT de I-TREATMENT adaptación I-TREATMENT a I-TREATMENT la I-TREATMENT placa I-TREATMENT de I-TREATMENT reconstrucción I-TREATMENT mandibular I-TREATMENT previamente I-TREATMENT retirada, I-TREATMENT y I-TREATMENT fijación I-TREATMENT a I-TREATMENT remanentes I-TREATMENT mandibulares I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT ambos I-TREATMENT ángulos I-TREATMENT goniacos I-TREATMENT y I-TREATMENT ramas I-TREATMENT mandibulares. I-TREATMENT La I-TREATMENT cobertura I-TREATMENT externa I-TREATMENT del I-TREATMENT peroné I-TREATMENT fue I-TREATMENT realizada I-TREATMENT mediante I-TREATMENT su I-TREATMENT paleta I-TREATMENT cutánea, I-TREATMENT dispuesta I-TREATMENT a I-TREATMENT nivel I-TREATMENT mentoniano I-TREATMENT y I-TREATMENT submental, I-TREATMENT y I-TREATMENT la I-TREATMENT cobertura I-TREATMENT interna I-TREATMENT mediante I-TREATMENT despegamiento I-TREATMENT y I-TREATMENT avance I-TREATMENT de I-TREATMENT mucosa I-TREATMENT del I-TREATMENT suelo I-TREATMENT de I-TREATMENT la I-TREATMENT boca I-TREATMENT anterior. I-TREATMENT Finalmente, I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT microanastomosis I-TREATMENT de I-TREATMENT vasos I-TREATMENT peroneos I-TREATMENT a I-TREATMENT vasos I-TREATMENT faciales. I-TREATMENT Se I-TREATMENT levantaron I-TREATMENT colgajos I-TREATMENT de I-TREATMENT espesor I-TREATMENT completo I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT remanente I-TREATMENT de I-TREATMENT mentón I-TREATMENT pediculados I-TREATMENT de I-TREATMENT base I-TREATMENT superior I-TREATMENT a I-TREATMENT modo I-TREATMENT de I-TREATMENT colgajos I-TREATMENT de I-TREATMENT Karapandzic I-TREATMENT modificado, I-TREATMENT con I-TREATMENT preservación I-TREATMENT del I-TREATMENT pedículo I-TREATMENT facial, I-TREATMENT y I-TREATMENT tallado I-TREATMENT de I-TREATMENT colgajos I-TREATMENT de I-TREATMENT avance I-TREATMENT de I-TREATMENT mucosa I-TREATMENT para I-TREATMENT creación I-TREATMENT de I-TREATMENT neo-bermellón. I-TREATMENT Ambos I-TREATMENT colgajos I-TREATMENT mucocutáneos I-TREATMENT fueron I-TREATMENT rotados I-TREATMENT medialmente I-TREATMENT para I-TREATMENT su I-TREATMENT unión I-TREATMENT a I-TREATMENT nivel I-TREATMENT central, I-TREATMENT neoformando I-TREATMENT el I-TREATMENT labio I-TREATMENT inferior I-TREATMENT de I-TREATMENT espesor I-TREATMENT completo I-TREATMENT y I-TREATMENT creando I-TREATMENT el I-TREATMENT vestíbulo I-TREATMENT labial I-TREATMENT inferior. I-TREATMENT Seguidamente I-TREATMENT se I-TREATMENT empleó I-TREATMENT un I-TREATMENT colgajo I-TREATMENT de I-TREATMENT Webster I-TREATMENT izquierdo I-TREATMENT para I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT del I-TREATMENT defecto I-TREATMENT labial I-TREATMENT superior. I-TREATMENT Además I-TREATMENT de I-TREATMENT la I-TREATMENT reconstrucción I-TREATMENT de I-TREATMENT tejidos I-TREATMENT blandos I-TREATMENT y I-TREATMENT óseos, I-TREATMENT en I-TREATMENT nuestro I-TREATMENT caso I-TREATMENT el I-TREATMENT paciente I-TREATMENT presentaba I-TREATMENT una I-TREATMENT macroglosia I-TREATMENT constitucional, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT realizamos I-TREATMENT una I-TREATMENT glosectomía I-TREATMENT media I-TREATMENT (resecando I-TREATMENT el I-TREATMENT tercio I-TREATMENT medio I-TREATMENT de I-TREATMENT lengua I-TREATMENT libre) I-TREATMENT como I-TREATMENT procedimiento I-TREATMENT complementario I-TREATMENT con I-TREATMENT el I-TREATMENT objetivo I-TREATMENT de I-TREATMENT facilitar I-TREATMENT la I-TREATMENT competencia I-TREATMENT labial, I-TREATMENT deglución I-TREATMENT y I-TREATMENT fonación. I-TREATMENT I-TREATMENT Durante B-EXPLORATION el I-EXPLORATION postoperatorio, I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION fueron I-EXPLORATION evaluados I-EXPLORATION en I-EXPLORATION términos I-EXPLORATION de I-EXPLORATION competencia I-EXPLORATION labial, I-EXPLORATION habla, I-EXPLORATION alimentación I-EXPLORATION y I-EXPLORATION estética. I-EXPLORATION La I-EXPLORATION competencia I-EXPLORATION labial I-EXPLORATION fue I-EXPLORATION óptima, I-EXPLORATION sin I-EXPLORATION conseguir I-EXPLORATION el I-EXPLORATION cierre I-EXPLORATION hermético I-EXPLORATION de I-EXPLORATION los I-EXPLORATION labios, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION líquidos I-EXPLORATION al I-EXPLORATION beber. I-EXPLORATION El I-EXPLORATION habla I-EXPLORATION fue I-EXPLORATION evaluada I-EXPLORATION en I-EXPLORATION función I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inteligibilidad I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION por I-EXPLORATION teléfono, I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION positiva. I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION capacidad I-EXPLORATION de I-EXPLORATION alimentarse, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION tiene I-EXPLORATION una I-EXPLORATION dieta I-EXPLORATION normal I-EXPLORATION (triturada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION falta I-EXPLORATION de I-EXPLORATION dentición). I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION estético I-EXPLORATION fue I-EXPLORATION aceptable. I-EXPLORATION Durante B-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION posterior I-EVOLUTION no I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION producido I-EVOLUTION ninguna I-EVOLUTION complicación I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION seguimiento I-EVOLUTION y I-EVOLUTION tratamiento I-EVOLUTION por I-EVOLUTION parte I-EVOLUTION de I-EVOLUTION psiquiatría. I-EVOLUTION En I-EVOLUTION un I-EVOLUTION futuro I-EVOLUTION próximo I-EVOLUTION se I-EVOLUTION prevee I-EVOLUTION la I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION realizar I-EVOLUTION alguna I-EVOLUTION intervención I-EVOLUTION adicional I-EVOLUTION (refinamiento I-EVOLUTION estético I-EVOLUTION labial, I-EVOLUTION rehabilitación I-EVOLUTION protésica I-EVOLUTION dental, I-EVOLUTION etc.). I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS año I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS vista I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Carabineros I-PRESENT_ILLNESS Santiago, I-PRESENT_ILLNESS Chile, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS parto I-PRESENT_ILLNESS en I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cesárea. I-PRESENT_ILLNESS Con B-EXPLORATION un I-EXPLORATION peso I-EXPLORATION de I-EXPLORATION 3.163 I-EXPLORATION gramos, I-EXPLORATION talla I-EXPLORATION 49cm I-EXPLORATION y I-EXPLORATION perímetro I-EXPLORATION craneal I-EXPLORATION cercano I-EXPLORATION a I-EXPLORATION 35cm. I-EXPLORATION Al I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION nacimiento I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION lesiones I-EXPLORATION vesiculosas I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION inferiores, I-EXPLORATION zona I-EXPLORATION glútea I-EXPLORATION y I-EXPLORATION axilas I-EXPLORATION que I-EXPLORATION se I-EXPLORATION rompen I-EXPLORATION al I-EXPLORATION retirar I-EXPLORATION el I-EXPLORATION unto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION quedando I-EXPLORATION lesiones I-EXPLORATION eritematosas I-EXPLORATION y I-EXPLORATION descamativas. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION diagnosticó I-EXPLORATION en I-EXPLORATION primera I-EXPLORATION instancia I-EXPLORATION epidermolisis I-EXPLORATION bulosa, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION posteriormente I-EXPLORATION fue I-EXPLORATION descartada. I-EXPLORATION Destacaba I-EXPLORATION además I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION alopecia I-EXPLORATION en I-EXPLORATION vértex I-EXPLORATION y I-EXPLORATION paladar I-EXPLORATION fisurado. I-EXPLORATION I-EXPLORATION Se B-DERIVED_FROM/TO da I-DERIVED_FROM/TO refiere I-DERIVED_FROM/TO a I-DERIVED_FROM/TO oftalmología I-DERIVED_FROM/TO que I-DERIVED_FROM/TO realiza I-DERIVED_FROM/TO examen I-DERIVED_FROM/TO de I-DERIVED_FROM/TO fondo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ojo I-DERIVED_FROM/TO observándose I-DERIVED_FROM/TO epitelio I-DERIVED_FROM/TO pigmentario I-DERIVED_FROM/TO con I-DERIVED_FROM/TO poco I-DERIVED_FROM/TO pigmento I-DERIVED_FROM/TO en I-DERIVED_FROM/TO forma I-DERIVED_FROM/TO generalizada, I-DERIVED_FROM/TO resto I-DERIVED_FROM/TO normal. I-DERIVED_FROM/TO Evaluación B-EXPLORATION por I-EXPLORATION neurólogo I-EXPLORATION normal. I-EXPLORATION Dermatólogo I-EXPLORATION plantea I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION IP I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION encontrándose I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION limites I-EXPLORATION histológicos I-EXPLORATION normales, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION recomienda I-EXPLORATION otra I-EXPLORATION nueva I-EXPLORATION muestra. I-EXPLORATION Visto I-EXPLORATION por I-EXPLORATION genetista I-EXPLORATION clínicamente I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION herencia I-EXPLORATION ligada I-EXPLORATION a I-EXPLORATION X I-EXPLORATION dominante, I-EXPLORATION ya B-FAMILY_HISTORY que I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY presentó I-FAMILY_HISTORY las I-FAMILY_HISTORY mismas I-FAMILY_HISTORY lesiones I-FAMILY_HISTORY al I-FAMILY_HISTORY nacimiento. I-FAMILY_HISTORY Se B-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO también I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO maxilofacial I-DERIVED_FROM/TO por I-DERIVED_FROM/TO CP. I-DERIVED_FROM/TO A B-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION edad I-EVOLUTION fue I-EVOLUTION operada I-EVOLUTION de I-EVOLUTION paladar I-EVOLUTION fisurado, I-EVOLUTION reconstituyendo I-EVOLUTION funcionalmente I-EVOLUTION los I-EVOLUTION anillos I-EVOLUTION musculares I-EVOLUTION del I-EVOLUTION velo I-EVOLUTION palatino I-EVOLUTION y I-EVOLUTION evolucionó I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION complicaciones I-EVOLUTION postoperatorias. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médico-quirúrgicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY remitida B-DERIVED_FROM/TO a I-DERIVED_FROM/TO consultas I-DERIVED_FROM/TO externas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Maxilofacial I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Universitario I-DERIVED_FROM/TO Marqués I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Valdecilla I-DERIVED_FROM/TO en I-DERIVED_FROM/TO noviembre I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2004 I-DERIVED_FROM/TO por I-DERIVED_FROM/TO una I-DERIVED_FROM/TO masa I-DERIVED_FROM/TO indolora I-DERIVED_FROM/TO en I-DERIVED_FROM/TO región I-DERIVED_FROM/TO anterior I-DERIVED_FROM/TO de I-DERIVED_FROM/TO suelo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO boca I-DERIVED_FROM/TO de I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evolución. I-DERIVED_FROM/TO A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION dentición I-EXPLORATION mixta I-EXPLORATION y I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION sínfisis I-EXPLORATION mandibular, I-EXPLORATION con I-EXPLORATION mucosa I-EXPLORATION oral I-EXPLORATION respetada I-EXPLORATION y I-EXPLORATION abombamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION corticales I-EXPLORATION lingual I-EXPLORATION y I-EXPLORATION vestibular, I-EXPLORATION y I-EXPLORATION dientes I-EXPLORATION deciduos I-EXPLORATION estables I-EXPLORATION a I-EXPLORATION ese I-EXPLORATION nivel. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION presenta I-EXPLORATION alteraciones I-EXPLORATION neurológicas I-EXPLORATION significativas. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ortopantomografía I-EXPLORATION (OPG) I-EXPLORATION revela I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION radiolúcida I-EXPLORATION de I-EXPLORATION márgenes I-EXPLORATION mal I-EXPLORATION definidos I-EXPLORATION en I-EXPLORATION sínfisis I-EXPLORATION mandibular I-EXPLORATION -de I-EXPLORATION 73 I-EXPLORATION a I-EXPLORATION 83-, I-EXPLORATION con I-EXPLORATION basilar I-EXPLORATION desestructurada I-EXPLORATION a I-EXPLORATION ese I-EXPLORATION nivel. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION 3 I-EXPLORATION dientes I-EXPLORATION definitivos I-EXPLORATION incluidos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION y I-EXPLORATION cierto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION rizólisis I-EXPLORATION y I-EXPLORATION desplazamientos I-EXPLORATION dentales. I-EXPLORATION Se I-EXPLORATION solicita I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC), I-EXPLORATION que I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION osteolítica, I-EXPLORATION insuflante I-EXPLORATION y I-EXPLORATION multilocular I-EXPLORATION de I-EXPLORATION 3×1, I-EXPLORATION 8cm, I-EXPLORATION con I-EXPLORATION corticales I-EXPLORATION expandidas I-EXPLORATION y I-EXPLORATION adelgazadas, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas; I-EXPLORATION asimismo, I-EXPLORATION se I-EXPLORATION describe I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION sólida, I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION óseo I-EXPLORATION aneurismático I-EXPLORATION sólido. I-EXPLORATION La I-EXPLORATION punción-aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF) I-EXPLORATION no I-EXPLORATION es I-EXPLORATION concluyente. I-EXPLORATION I-EXPLORATION Bajo I-EXPLORATION anestesia I-EXPLORATION general I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION abordaje I-EXPLORATION vestibular, I-EXPLORATION que I-EXPLORATION permite I-EXPLORATION visualizar I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION expandida I-EXPLORATION y I-EXPLORATION adelgazada I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION continuidad, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION típico I-EXPLORATION aspecto I-EXPLORATION en I-EXPLORATION «cáscara I-EXPLORATION de I-EXPLORATION huevo». I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION expuesta I-EXPLORATION la I-EXPLORATION lesión, I-EXPLORATION se I-EXPLORATION toma I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION intraoperatoria I-EXPLORATION que I-EXPLORATION descarta I-EXPLORATION patología I-EXPLORATION ósea I-EXPLORATION maligna. I-EXPLORATION Con B-TREATMENT la I-TREATMENT firme I-TREATMENT sospecha I-TREATMENT de I-TREATMENT QOA I-TREATMENT sólido, I-TREATMENT se I-TREATMENT realiza I-TREATMENT curetaje I-TREATMENT y I-TREATMENT exodoncia I-TREATMENT de I-TREATMENT los I-TREATMENT tres I-TREATMENT dientes I-TREATMENT definitivos I-TREATMENT incluidos I-TREATMENT en I-TREATMENT la I-TREATMENT lesión. I-TREATMENT El I-TREATMENT defecto I-TREATMENT óseo I-TREATMENT no I-TREATMENT precisa I-TREATMENT reconstrucción, I-TREATMENT pero I-TREATMENT a I-TREATMENT fin I-TREATMENT de I-TREATMENT favorecer I-TREATMENT la I-TREATMENT remodelación I-TREATMENT ósea I-TREATMENT guiada I-TREATMENT del I-TREATMENT lecho I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT emplea I-TREATMENT una I-TREATMENT lámina I-TREATMENT de I-TREATMENT hueso I-TREATMENT desmineralizado I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT cortical I-TREATMENT externa I-TREATMENT mandibular. I-TREATMENT I-TREATMENT Al B-DERIVED_FROM/TO alta I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO ortodoncista I-DERIVED_FROM/TO para I-DERIVED_FROM/TO ferulización I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO arcada I-DERIVED_FROM/TO inferior, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO objetivo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO asegurar I-DERIVED_FROM/TO la I-DERIVED_FROM/TO estabilidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO misma, I-DERIVED_FROM/TO dada I-DERIVED_FROM/TO la I-DERIVED_FROM/TO importante I-DERIVED_FROM/TO pérdida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO soporte I-DERIVED_FROM/TO óseo I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nivel I-DERIVED_FROM/TO crestal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO sínfisis I-DERIVED_FROM/TO mandibular. I-DERIVED_FROM/TO Dicha B-EVOLUTION fijación I-EVOLUTION es I-EVOLUTION mantenida I-EVOLUTION durante I-EVOLUTION 6 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION definitivo I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION quiste I-EXPLORATION óseo I-EXPLORATION aneurismático I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION sólido. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION macroscópico I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION varios I-EXPLORATION fragmentos I-EXPLORATION irregulares I-EXPLORATION de I-EXPLORATION color I-EXPLORATION pardo-negruzco I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION firme; I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION microscópico, I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION pequeños I-EXPLORATION espacios I-EXPLORATION vasculares I-EXPLORATION revestidos I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION fibroso, I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION y I-EXPLORATION macrófagos, I-EXPLORATION con I-EXPLORATION mitosis I-EXPLORATION ocasionales, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION atipias I-EXPLORATION y I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION hemosiderina. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION postoperatoria, I-EVOLUTION con I-EVOLUTION una I-EVOLUTION correcta I-EVOLUTION apariencia I-EVOLUTION estética I-EVOLUTION y I-EVOLUTION funcional. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION 6 I-EVOLUTION años I-EVOLUTION en I-EVOLUTION seguimiento, I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION signos I-EVOLUTION clínicos I-EVOLUTION ni I-EVOLUTION radiológicos I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION local I-EVOLUTION y B-TREATMENT ha I-TREATMENT iniciado I-TREATMENT tratamiento I-TREATMENT ortodóncico I-TREATMENT para I-TREATMENT corrección I-TREATMENT de I-TREATMENT la I-TREATMENT malposición I-TREATMENT dentaria. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS género I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Estomatología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Facultad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Odontología I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Bauru I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Universidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS São I-PRESENT_ILLNESS Paulo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS queja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS "diente I-PRESENT_ILLNESS dentro I-PRESENT_ILLNESS del I-PRESENT_ILLNESS hueso" I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS realizarse I-PRESENT_ILLNESS un I-PRESENT_ILLNESS examen I-PRESENT_ILLNESS radiográfico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rutina. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Clínicamente, B-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION el I-EXPLORATION diente I-EXPLORATION 83 I-EXPLORATION estaba I-EXPLORATION presente I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION arco I-EXPLORATION dentario I-EXPLORATION y I-EXPLORATION el I-EXPLORATION elemento I-EXPLORATION dentario I-EXPLORATION 43 I-EXPLORATION estaba I-EXPLORATION ausente. I-EXPLORATION Se I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION óseo I-EXPLORATION asintomático, I-EXPLORATION con I-EXPLORATION evolución I-EXPLORATION aproximada I-EXPLORATION de I-EXPLORATION cinco I-EXPLORATION años, I-EXPLORATION extendiéndose I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION del I-EXPLORATION diente I-EXPLORATION 32 I-EXPLORATION al I-EXPLORATION diente I-EXPLORATION 44. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION visualización I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION radiográfico I-EXPLORATION panorámico I-EXPLORATION fue I-EXPLORATION detectada I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION radiolúcida I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION bien I-EXPLORATION definidos I-EXPLORATION con I-EXPLORATION material I-EXPLORATION amorfo I-EXPLORATION radiopaco I-EXPLORATION en I-EXPLORATION el I-EXPLORATION centro, I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION lobular, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION reabsorción I-EXPLORATION radicular I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dientes I-EXPLORATION adyacentes I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION del I-EXPLORATION elemento I-EXPLORATION dentario I-EXPLORATION 43 I-EXPLORATION no I-EXPLORATION erupcionado. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION presuntivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION odontoma I-EXPLORATION complejo. I-EXPLORATION I-EXPLORATION Bajo B-TREATMENT anestesia I-TREATMENT local, I-TREATMENT se I-TREATMENT realizó I-TREATMENT el I-TREATMENT acceso I-TREATMENT por I-TREATMENT medio I-TREATMENT de I-TREATMENT una I-TREATMENT incisión I-TREATMENT intra-sulcular I-TREATMENT extendiéndose I-TREATMENT de I-TREATMENT la I-TREATMENT región I-TREATMENT de I-TREATMENT los I-TREATMENT dientes I-TREATMENT 34 I-TREATMENT al I-TREATMENT 45 I-TREATMENT con I-TREATMENT consecuente I-TREATMENT exposición I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT ventana I-TREATMENT ósea I-TREATMENT creada I-TREATMENT con I-TREATMENT fresa I-TREATMENT quirúrgica I-TREATMENT bajo I-TREATMENT irrigación I-TREATMENT constante. I-TREATMENT La I-TREATMENT lesión I-TREATMENT fue I-TREATMENT removida I-TREATMENT por I-TREATMENT enucleación I-TREATMENT con I-TREATMENT un I-TREATMENT curetaje I-TREATMENT agresivo I-TREATMENT juntamente I-TREATMENT con I-TREATMENT el I-TREATMENT diente I-TREATMENT 43 I-TREATMENT no I-TREATMENT erupcionado. I-TREATMENT Los B-EXPLORATION cortes I-EXPLORATION microscópicos I-EXPLORATION revelaron I-EXPLORATION la I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION epiteliales I-EXPLORATION odontogénicas I-EXPLORATION en I-EXPLORATION íntimo I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION inúmeros I-EXPLORATION focos I-EXPLORATION redondeados I-EXPLORATION concéntricos I-EXPLORATION de I-EXPLORATION mineralización I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION anillos I-EXPLORATION de I-EXPLORATION Liesegang, I-EXPLORATION a I-EXPLORATION veces I-EXPLORATION resultando I-EXPLORATION en I-EXPLORATION densas I-EXPLORATION masas I-EXPLORATION sean I-EXPLORATION eosinofílicas I-EXPLORATION o I-EXPLORATION basofílicas. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION presentaban I-EXPLORATION puentes I-EXPLORATION intercelulares I-EXPLORATION bien I-EXPLORATION evidentes, I-EXPLORATION además I-EXPLORATION del I-EXPLORATION pleomorfismo, I-EXPLORATION hipercromatismo I-EXPLORATION y I-EXPLORATION variación I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION al I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION los I-EXPLORATION núcleos. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION conjuntivo I-EXPLORATION fibroso, I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION cordones I-EXPLORATION o I-EXPLORATION islas I-EXPLORATION de I-EXPLORATION epitelio I-EXPLORATION odontogénico. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION histopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION TEOC. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION radiográfico I-EXPLORATION de I-EXPLORATION proservación I-EXPLORATION de I-EXPLORATION cinco I-EXPLORATION años I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION señales I-EXPLORATION de I-EXPLORATION recurrencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION I-EXPLORATION Paciente, B-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS derivado B-DERIVED_FROM/TO el I-DERIVED_FROM/TO año I-DERIVED_FROM/TO 2004 I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO endocrinología I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO maxilofacial I-DERIVED_FROM/TO con I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tumor I-DERIVED_FROM/TO maxilar I-DERIVED_FROM/TO en I-DERIVED_FROM/TO estudio. I-DERIVED_FROM/TO Sus B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY incluyen I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 18 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY veces I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY semana. I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 27 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY detecta, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ecotomografía I-PAST_MEDICAL_HISTORY doppler, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nódulos I-PAST_MEDICAL_HISTORY bilaterales I-PAST_MEDICAL_HISTORY compatibles I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY adenoma I-PAST_MEDICAL_HISTORY paratiroideo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY niveles I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY PTH I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2.448 I-PAST_MEDICAL_HISTORY pg/ml I-PAST_MEDICAL_HISTORY (150-500 I-PAST_MEDICAL_HISTORY pg/ml). I-PAST_MEDICAL_HISTORY Con I-PAST_MEDICAL_HISTORY estos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY diagnosticó I-PAST_MEDICAL_HISTORY hiperparatiroidismo I-PAST_MEDICAL_HISTORY secundario. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY realiza I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paratiroidectomía I-PAST_MEDICAL_HISTORY parcial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY indica I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico I-PAST_MEDICAL_HISTORY protocolario, I-PAST_MEDICAL_HISTORY obteniéndose I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY normalización I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY niveles I-PAST_MEDICAL_HISTORY séricos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY calcio, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY manteniéndose I-PAST_MEDICAL_HISTORY altos I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY niveles I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY paratohormona. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY nota I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY volumen I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY maxilar I-PAST_MEDICAL_HISTORY izquierda, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY crecimiento I-PAST_MEDICAL_HISTORY lento I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY progresivo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2002. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION momento I-EXPLORATION de I-EXPLORATION consultar I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION servicio, I-EXPLORATION clínicamente I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION que I-EXPLORATION compromete I-EXPLORATION el I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION cara I-EXPLORATION anterior, I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION paladar I-EXPLORATION duro, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION indoloro, I-EXPLORATION cubierto I-EXPLORATION por I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal, I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION sensitiva, I-EXPLORATION que I-EXPLORATION produce I-EXPLORATION asimetría I-EXPLORATION y I-EXPLORATION deformación I-EXPLORATION facial I-EXPLORATION evidente. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION radiográficos I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION osteolíticas I-EXPLORATION que I-EXPLORATION afectan I-EXPLORATION el I-EXPLORATION cráneo, I-EXPLORATION la I-EXPLORATION mandíbula I-EXPLORATION y I-EXPLORATION el I-EXPLORATION maxilar I-EXPLORATION izquierdo. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION muestra I-EXPLORATION tumoración I-EXPLORATION exofítica I-EXPLORATION que I-EXPLORATION compromete I-EXPLORATION maxilar I-EXPLORATION izquierdo, I-EXPLORATION seno I-EXPLORATION maxilar, I-EXPLORATION fosas I-EXPLORATION nasales I-EXPLORATION y I-EXPLORATION piso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION describe I-EXPLORATION múltiples I-EXPLORATION trabéculas I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION óseo I-EXPLORATION inmaduro I-EXPLORATION y I-EXPLORATION una I-EXPLORATION matriz I-EXPLORATION fibrosa I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION multinucleadas. I-EXPLORATION Los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION muestran I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION calcio I-EXPLORATION sérico I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 6 I-EXPLORATION mg/dl I-EXPLORATION (8,1-10,3), I-EXPLORATION fosfatasa I-EXPLORATION alcalina: I-EXPLORATION 218 I-EXPLORATION UI/L I-EXPLORATION (73-189 I-EXPLORATION UI/L), I-EXPLORATION fósforo I-EXPLORATION inorgánico: I-EXPLORATION 56, I-EXPLORATION 7 I-EXPLORATION mg/dl I-EXPLORATION (2, I-EXPLORATION 5-5 I-EXPLORATION mg/dl) I-EXPLORATION y I-EXPLORATION PTH I-EXPLORATION intacta: I-EXPLORATION 2, I-EXPLORATION 448 I-EXPLORATION pg/ml I-EXPLORATION (150-500 I-EXPLORATION pg/ml). I-EXPLORATION Con I-EXPLORATION todos I-EXPLORATION estos I-EXPLORATION antecedentes I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION tumor I-EXPLORATION pardo I-EXPLORATION del I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION izquierdo. I-EXPLORATION Se B-TREATMENT decide I-TREATMENT realizar I-TREATMENT la I-TREATMENT paratiroidectomía I-TREATMENT total I-TREATMENT y I-TREATMENT mantener I-TREATMENT conducta I-TREATMENT expectante I-TREATMENT respecto I-TREATMENT al I-TREATMENT tumor I-TREATMENT pardo, I-TREATMENT esperando I-TREATMENT una I-TREATMENT eventual I-TREATMENT remisión I-TREATMENT espontánea I-TREATMENT con I-TREATMENT la I-TREATMENT normalización I-TREATMENT de I-TREATMENT los I-TREATMENT valores I-TREATMENT de I-TREATMENT PTH, I-TREATMENT calcio, I-TREATMENT fósforo I-TREATMENT y I-TREATMENT fosfatasa I-TREATMENT alcalina. I-TREATMENT El I-TREATMENT plan I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT incluye I-TREATMENT también I-TREATMENT controles I-TREATMENT periódicos I-TREATMENT clínicos, I-TREATMENT radiográficos I-TREATMENT y I-TREATMENT de I-TREATMENT laboratorio I-TREATMENT para I-TREATMENT evaluar I-TREATMENT el I-TREATMENT comportamiento I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT craneomaxilofaciales. I-TREATMENT I-TREATMENT Tras B-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION efectuada I-EVOLUTION la I-EVOLUTION paratiroidectomía I-EVOLUTION total I-EVOLUTION y I-EVOLUTION alcanzados I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION normales I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION de I-EVOLUTION PTH, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION evidencia I-EVOLUTION remisión I-EVOLUTION tumoral I-EVOLUTION maxilar. I-EVOLUTION Considerando B-TREATMENT el I-TREATMENT compromiso I-TREATMENT de I-TREATMENT las I-TREATMENT estructuras I-TREATMENT anatómicas I-TREATMENT vecinas I-TREATMENT y I-TREATMENT las I-TREATMENT posibles I-TREATMENT complicaciones I-TREATMENT se I-TREATMENT decide I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT I-TREATMENT Bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT e I-TREATMENT intubación I-TREATMENT nasotraqueal I-TREATMENT se I-TREATMENT realiza I-TREATMENT incisión I-TREATMENT en I-TREATMENT la I-TREATMENT cara I-TREATMENT interna I-TREATMENT del I-TREATMENT labio I-TREATMENT superior I-TREATMENT desde I-TREATMENT la I-TREATMENT línea I-TREATMENT media I-TREATMENT hasta I-TREATMENT la I-TREATMENT tuberosidad. I-TREATMENT Se I-TREATMENT levanta I-TREATMENT colgajo I-TREATMENT mucoperióstico I-TREATMENT hasta I-TREATMENT el I-TREATMENT penacho I-TREATMENT suborbitario, I-TREATMENT exponiéndose I-TREATMENT ampliamente I-TREATMENT el I-TREATMENT tumor. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT exéresis I-TREATMENT de I-TREATMENT gran I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT osteotomía I-TREATMENT con I-TREATMENT sierra I-TREATMENT reciprocante I-TREATMENT en I-TREATMENT zona I-TREATMENT pediculada I-TREATMENT que I-TREATMENT se I-TREATMENT encuentra I-TREATMENT adosa I-TREATMENT a I-TREATMENT la I-TREATMENT pared I-TREATMENT anterior I-TREATMENT y I-TREATMENT lateral I-TREATMENT del I-TREATMENT seno I-TREATMENT maxilar, I-TREATMENT a I-TREATMENT continuación I-TREATMENT se I-TREATMENT realiza I-TREATMENT la I-TREATMENT remodelación I-TREATMENT ósea I-TREATMENT con I-TREATMENT fresas I-TREATMENT tipo I-TREATMENT pimpollo, I-TREATMENT conservando I-TREATMENT la I-TREATMENT pared I-TREATMENT de I-TREATMENT seno I-TREATMENT maxilar I-TREATMENT y I-TREATMENT penacho I-TREATMENT suborbitario, I-TREATMENT sin I-TREATMENT necesidad I-TREATMENT de I-TREATMENT injerto I-TREATMENT óseo. I-TREATMENT Se I-TREATMENT logra I-TREATMENT cierre I-TREATMENT por I-TREATMENT primera I-TREATMENT intención. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION es I-EVOLUTION satisfactoria, I-EVOLUTION siendo I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION h. I-EVOLUTION I-EVOLUTION Se I-EVOLUTION realizan I-EVOLUTION controles I-EVOLUTION postoperatorios I-EVOLUTION clínicos I-EVOLUTION y I-EVOLUTION radiográficos, I-EVOLUTION se I-EVOLUTION evidencia I-EVOLUTION clínicamente I-EVOLUTION simetría I-EVOLUTION facial, I-EVOLUTION sin I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION sensibilidad I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION recurrencia I-EVOLUTION durante I-EVOLUTION los I-EVOLUTION 7 I-EVOLUTION años I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION resección I-EVOLUTION del I-EVOLUTION tumor. 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 73 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY sistémica I-PAST_MEDICAL_HISTORY actualmente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY médico, I-PAST_MEDICAL_HISTORY quien B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS valoración I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS ventral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS borde I-PRESENT_ILLNESS lateral I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lengua, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS exofítico, B-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION granulomatoso, I-EXPLORATION fácilmente I-EXPLORATION sangrante, I-EXPLORATION que I-EXPLORATION dificulta I-EXPLORATION considerablemente I-EXPLORATION la I-EXPLORATION deglución I-EXPLORATION y I-EXPLORATION el I-EXPLORATION habla, I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION aparentemente I-EXPLORATION rápido, I-EXPLORATION con I-EXPLORATION medidas I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION × I-EXPLORATION 3 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION violácea, I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION eritematosas, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION rojo I-EXPLORATION intenso I-EXPLORATION brillante, I-EXPLORATION adherido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION lingual I-EXPLORATION por I-EXPLORATION un I-EXPLORATION pedículo I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm, I-EXPLORATION refiriendo I-EXPLORATION sangrados I-EXPLORATION espontáneos I-EXPLORATION y I-EXPLORATION controlables I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION simple, I-EXPLORATION sin I-EXPLORATION linfadenopatía I-EXPLORATION regional I-EXPLORATION palpable I-EXPLORATION y I-EXPLORATION con I-EXPLORATION edentulismo I-EXPLORATION total I-EXPLORATION adquirido. I-EXPLORATION Se I-EXPLORATION obtienen I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION rutina, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION descartan I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION metástasis I-EXPLORATION a I-EXPLORATION distancia. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION bajo I-EXPLORATION anestesia I-EXPLORATION local I-EXPLORATION cuyo I-EXPLORATION estudio I-EXPLORATION reporta I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION leiomiosarcoma. I-EXPLORATION En B-TREATMENT un I-TREATMENT segundo I-TREATMENT tiempo I-TREATMENT quirúrgico, I-TREATMENT se I-TREATMENT realiza I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT con I-TREATMENT márgenes I-TREATMENT de I-TREATMENT seguridad I-TREATMENT amplios I-TREATMENT y I-TREATMENT se I-TREATMENT realiza I-TREATMENT plastia I-TREATMENT lingual I-TREATMENT y I-TREATMENT cierre I-TREATMENT primario I-TREATMENT del I-TREATMENT defecto. I-TREATMENT La B-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION es I-EXPLORATION enviada I-EXPLORATION para I-EXPLORATION valoración I-EXPLORATION histológica I-EXPLORATION e I-EXPLORATION inmunohistoquímica I-EXPLORATION siendo I-EXPLORATION confirmado I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION leiomiosarcoma I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION con I-EXPLORATION márgenes I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION neoplasia. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION alta I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION células I-EXPLORATION espinosas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION músculo I-EXPLORATION liso, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION inmunorreactividad I-EXPLORATION para I-EXPLORATION vicentina I-EXPLORATION y I-EXPLORATION actina I-EXPLORATION alfa I-EXPLORATION músculo I-EXPLORATION liso, I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION panqueratina, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION para I-EXPLORATION desmina I-EXPLORATION y I-EXPLORATION CD34. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION cursó I-EVOLUTION un I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION favorable I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION al I-EVOLUTION 5.° I-EVOLUTION día I-EVOLUTION de I-EVOLUTION internamiento I-EVOLUTION para I-EVOLUTION continuar I-EVOLUTION con I-EVOLUTION manejo I-EVOLUTION ambulatorio. I-EVOLUTION A I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION postoperada I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION con I-EVOLUTION una I-EVOLUTION adecuada I-EVOLUTION evolución, I-EVOLUTION alimentándose I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION adecuada, I-EVOLUTION sin I-EVOLUTION problemas I-EVOLUTION de I-EVOLUTION fonación I-EVOLUTION después I-EVOLUTION de I-EVOLUTION una I-EVOLUTION intensiva I-EVOLUTION terapia I-EVOLUTION de I-EVOLUTION lenguaje; I-EVOLUTION no I-EVOLUTION hay I-EVOLUTION datos I-EVOLUTION de I-EVOLUTION metástasis I-EVOLUTION corroborados I-EVOLUTION con I-EVOLUTION TAC I-EVOLUTION de I-EVOLUTION control. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS femenina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cirugía I-PRESENT_ILLNESS Oral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS odontológica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Corporación I-PRESENT_ILLNESS Universitaria I-PRESENT_ILLNESS Rafael I-PRESENT_ILLNESS Núñez I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS agrandamiento I-PRESENT_ILLNESS gingival I-PRESENT_ILLNESS generalizado. I-PRESENT_ILLNESS Como B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares, I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY y I-FAMILY_HISTORY un I-FAMILY_HISTORY hermano I-FAMILY_HISTORY describieron I-FAMILY_HISTORY presentar I-FAMILY_HISTORY aumento I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY volumen I-FAMILY_HISTORY del I-FAMILY_HISTORY tejido I-FAMILY_HISTORY gingival I-FAMILY_HISTORY de I-FAMILY_HISTORY forma I-FAMILY_HISTORY generalizada. I-FAMILY_HISTORY En B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY manifestó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY practicó I-PAST_MEDICAL_HISTORY gingivectomía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tamaño I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY encía I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY resultados I-PAST_MEDICAL_HISTORY satisfactorios, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY epilépticos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anticonvulsivante I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY fenitoína, I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY periodo I-PAST_MEDICAL_HISTORY aproximado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY días; I-PAST_MEDICAL_HISTORY en B-EXPLORATION la I-EXPLORATION revisión I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION y I-EXPLORATION sistemas I-EXPLORATION no I-EXPLORATION presentó I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION intraoral I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION agrandamiento I-EXPLORATION gingival I-EXPLORATION generalizado I-EXPLORATION comprometiendo I-EXPLORATION maxilar I-EXPLORATION y I-EXPLORATION mandíbula, I-EXPLORATION cubriendo I-EXPLORATION más I-EXPLORATION del I-EXPLORATION 85% I-EXPLORATION de I-EXPLORATION la I-EXPLORATION corona I-EXPLORATION dentaria I-EXPLORATION en I-EXPLORATION los I-EXPLORATION dientes I-EXPLORATION posteriores I-EXPLORATION y I-EXPLORATION 90% I-EXPLORATION en I-EXPLORATION los I-EXPLORATION anteriores, I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION un I-EXPLORATION año I-EXPLORATION de I-EXPLORATION evolución, I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION sangrado, I-EXPLORATION sin I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION placa I-EXPLORATION bacteriana, I-EXPLORATION asintomático, I-EXPLORATION originando I-EXPLORATION discapacidad I-EXPLORATION funcional, I-EXPLORATION estética I-EXPLORATION y I-EXPLORATION problemas I-EXPLORATION psicosociales. I-EXPLORATION Examen I-EXPLORATION radiográfico: I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ortopantomografía I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION dientes I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION del I-EXPLORATION diente I-EXPLORATION número I-EXPLORATION 73. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION ser I-EXPLORATION un I-EXPLORATION crecimiento I-EXPLORATION gingival I-EXPLORATION fibroso, I-EXPLORATION espontáneo, I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño, I-EXPLORATION sin I-EXPLORATION asociación I-EXPLORATION a I-EXPLORATION síndromes I-EXPLORATION y I-EXPLORATION por I-EXPLORATION la I-EXPLORATION historia I-EXPLORATION familiar I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION la I-EXPLORATION madre I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hermano I-EXPLORATION presentaron I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION patología, I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION fibromatosis I-EXPLORATION gingival I-EXPLORATION hereditaria. I-EXPLORATION I-EXPLORATION Procedimiento B-TREATMENT I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT consistió I-TREATMENT en I-TREATMENT una I-TREATMENT gingivectomía I-TREATMENT y I-TREATMENT gingivoplastía I-TREATMENT en I-TREATMENT 2 I-TREATMENT fases I-TREATMENT quirúrgicas I-TREATMENT inicialmente I-TREATMENT en I-TREATMENT la I-TREATMENT mandíbula I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT en I-TREATMENT el I-TREATMENT maxilar I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT local. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT incisión I-TREATMENT primaria I-TREATMENT a I-TREATMENT bisel I-TREATMENT interno I-TREATMENT a I-TREATMENT un I-TREATMENT ángulo I-TREATMENT de I-TREATMENT 45o I-TREATMENT hacia I-TREATMENT el I-TREATMENT ápice I-TREATMENT de I-TREATMENT los I-TREATMENT dientes, I-TREATMENT previa I-TREATMENT localización I-TREATMENT de I-TREATMENT los I-TREATMENT mismos I-TREATMENT con I-TREATMENT la I-TREATMENT sonda I-TREATMENT periodontal I-TREATMENT de I-TREATMENT Williams, I-TREATMENT aproximadamente I-TREATMENT a I-TREATMENT 5 I-TREATMENT mm I-TREATMENT del I-TREATMENT surco I-TREATMENT gingival, I-TREATMENT con I-TREATMENT hoja I-TREATMENT de I-TREATMENT bisturí I-TREATMENT del I-TREATMENT número I-TREATMENT 11 I-TREATMENT y I-TREATMENT 12 I-TREATMENT y I-TREATMENT mango I-TREATMENT bard I-TREATMENT parker I-TREATMENT número I-TREATMENT 3; I-TREATMENT luego I-TREATMENT se I-TREATMENT efectuó I-TREATMENT incisión I-TREATMENT intrasurcular I-TREATMENT creando I-TREATMENT un I-TREATMENT collar I-TREATMENT de I-TREATMENT tejido I-TREATMENT gingival, I-TREATMENT el I-TREATMENT cual I-TREATMENT fue I-TREATMENT removido I-TREATMENT posteriormente I-TREATMENT por I-TREATMENT curetas I-TREATMENT gracey I-TREATMENT específicas I-TREATMENT de I-TREATMENT cada I-TREATMENT diente, I-TREATMENT después I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT reafinado I-TREATMENT del I-TREATMENT bisel I-TREATMENT con I-TREATMENT el I-TREATMENT bisturí I-TREATMENT de I-TREATMENT Kirklan I-TREATMENT y I-TREATMENT Orban I-TREATMENT para I-TREATMENT las I-TREATMENT áreas I-TREATMENT interproximales I-TREATMENT y I-TREATMENT exodoncia I-TREATMENT del I-TREATMENT diente I-TREATMENT 73; I-TREATMENT finalmente I-TREATMENT se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT hemostasia I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT tutor I-TREATMENT en I-TREATMENT acetato I-TREATMENT diseñado I-TREATMENT prequirúrgicamente I-TREATMENT en I-TREATMENT modelos I-TREATMENT de I-TREATMENT estudios I-TREATMENT con I-TREATMENT cemento I-TREATMENT quirúrgico I-TREATMENT periodontal, I-TREATMENT para I-TREATMENT proteger I-TREATMENT en I-TREATMENT forma I-TREATMENT física I-TREATMENT la I-TREATMENT superficie I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT del I-TREATMENT trauma I-TREATMENT mecánico I-TREATMENT durante I-TREATMENT la I-TREATMENT cicatrización, I-TREATMENT evitar I-TREATMENT la I-TREATMENT formación I-TREATMENT de I-TREATMENT tejido I-TREATMENT excesivo I-TREATMENT de I-TREATMENT granulación I-TREATMENT y I-TREATMENT empaquetamiento I-TREATMENT de I-TREATMENT alimentos, I-TREATMENT se I-TREATMENT ordenó I-TREATMENT farmacoterapia I-TREATMENT con I-TREATMENT antibiótico, I-TREATMENT analgésico I-TREATMENT y I-TREATMENT antiinflamatorio, I-TREATMENT las I-TREATMENT indicaciones I-TREATMENT postoperatorias I-TREATMENT incluyeron I-TREATMENT adecuada I-TREATMENT higiene I-TREATMENT oral I-TREATMENT con I-TREATMENT uso I-TREATMENT del I-TREATMENT cepillo, I-TREATMENT seda I-TREATMENT dental I-TREATMENT y I-TREATMENT enjuagues I-TREATMENT con I-TREATMENT colutorios I-TREATMENT sin I-TREATMENT alcohol. I-TREATMENT El I-TREATMENT mismo I-TREATMENT procedimiento I-TREATMENT fue I-TREATMENT realizado I-TREATMENT en I-TREATMENT el I-TREATMENT maxilar I-TREATMENT 20 I-TREATMENT días I-TREATMENT después. I-TREATMENT I-TREATMENT El B-EXPLORATION examen I-EXPLORATION histopatológico I-EXPLORATION describe I-EXPLORATION microscópicamente I-EXPLORATION fragmentos I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION oral I-EXPLORATION revestidos I-EXPLORATION por I-EXPLORATION epitelio I-EXPLORATION paraqueratósico, I-EXPLORATION hiperplásico, I-EXPLORATION sobre I-EXPLORATION estroma I-EXPLORATION con I-EXPLORATION abundante I-EXPLORATION haces I-EXPLORATION gruesos I-EXPLORATION de I-EXPLORATION colágeno I-EXPLORATION dispuestos I-EXPLORATION al I-EXPLORATION azar, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION fibromatosis I-EXPLORATION gingival. I-EXPLORATION I-EXPLORATION En B-EVOLUTION el I-EVOLUTION control I-EVOLUTION posquirúrgico I-EVOLUTION que I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION a I-EVOLUTION los I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION cada I-EVOLUTION procedimiento I-EVOLUTION (maxilar I-EVOLUTION y I-EVOLUTION mandíbula), I-EVOLUTION se I-EVOLUTION evidenció I-EVOLUTION disminución I-EVOLUTION en I-EVOLUTION el I-EVOLUTION volumen I-EVOLUTION del I-EVOLUTION tejido I-EVOLUTION gingival, I-EVOLUTION buen I-EVOLUTION proceso I-EVOLUTION de I-EVOLUTION cicatrización, I-EVOLUTION las I-EVOLUTION coronas I-EVOLUTION dentarias I-EVOLUTION no I-EVOLUTION se I-EVOLUTION encontraron I-EVOLUTION cubiertas I-EVOLUTION por I-EVOLUTION tejido, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION manifestó I-EVOLUTION mejoras I-EVOLUTION en I-EVOLUTION el I-EVOLUTION proceso I-EVOLUTION de I-EVOLUTION masticación, I-EVOLUTION que I-EVOLUTION sonríe I-EVOLUTION frecuentemente I-EVOLUTION y I-EVOLUTION tiene I-EVOLUTION mayor I-EVOLUTION relación I-EVOLUTION social I-EVOLUTION con I-EVOLUTION los I-EVOLUTION compañeros I-EVOLUTION en I-EVOLUTION la I-EVOLUTION escuela. I-EVOLUTION También I-EVOLUTION presentó I-EVOLUTION alteraciones I-EVOLUTION en I-EVOLUTION la I-EVOLUTION oclusión I-EVOLUTION dental, I-EVOLUTION como I-EVOLUTION diastemas, I-EVOLUTION mordida I-EVOLUTION profunda, I-EVOLUTION mala I-EVOLUTION posición I-EVOLUTION dentaria, I-EVOLUTION entre I-EVOLUTION otros, I-EVOLUTION razón I-EVOLUTION por I-EVOLUTION la I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION remitió I-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION ortodoncia I-EVOLUTION para I-EVOLUTION su I-EVOLUTION terapéutica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 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 intervenido I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 22 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY meningioma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY frontal. I-PAST_MEDICAL_HISTORY En B-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Neurocirugía I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO entonces I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO signos I-DERIVED_FROM/TO de I-DERIVED_FROM/TO recidiva I-DERIVED_FROM/TO locorregional, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO remite I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Maxilofacial I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO reconstrucción I-DERIVED_FROM/TO de I-DERIVED_FROM/TO partes I-DERIVED_FROM/TO blandas I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nivel I-DERIVED_FROM/TO frontal I-DERIVED_FROM/TO como I-DERIVED_FROM/TO secuela I-DERIVED_FROM/TO de I-DERIVED_FROM/TO craniotomía I-DERIVED_FROM/TO complicada I-DERIVED_FROM/TO hace I-DERIVED_FROM/TO años. I-DERIVED_FROM/TO Ha B-EVOLUTION presentado I-EVOLUTION numerosas I-EVOLUTION infecciones I-EVOLUTION de I-EVOLUTION repetición I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION local I-EVOLUTION con I-EVOLUTION rechazo I-EVOLUTION de I-EVOLUTION plastia I-EVOLUTION craneal I-EVOLUTION en I-EVOLUTION 3 I-EVOLUTION ocasiones I-EVOLUTION e I-EVOLUTION intentos I-EVOLUTION fallidos I-EVOLUTION de I-EVOLUTION reconstrucción I-EVOLUTION con I-EVOLUTION injertos I-EVOLUTION cutáneos I-EVOLUTION y I-EVOLUTION colgajos I-EVOLUTION locales. I-EVOLUTION La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION defecto I-EXPLORATION estético I-EXPLORATION importante I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION frontal I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION ulceradas I-EXPLORATION y I-EXPLORATION supuración. I-EXPLORATION La I-EXPLORATION visión I-EXPLORATION tanto I-EXPLORATION de I-EXPLORATION frente I-EXPLORATION como I-EXPLORATION de I-EXPLORATION perfil I-EXPLORATION revelan I-EXPLORATION una I-EXPLORATION pérdida I-EXPLORATION severa I-EXPLORATION de I-EXPLORATION altura I-EXPLORATION facial I-EXPLORATION a I-EXPLORATION expensas I-EXPLORATION de I-EXPLORATION su I-EXPLORATION tercio I-EXPLORATION superior, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION considerable I-EXPLORATION de I-EXPLORATION la I-EXPLORATION curvatura I-EXPLORATION y I-EXPLORATION proyección I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bóveda I-EXPLORATION craneal. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION mediante I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION (RMN) I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION informaba I-EXPLORATION de I-EXPLORATION una I-EXPLORATION deformidad I-EXPLORATION anatómica I-EXPLORATION en I-EXPLORATION región I-EXPLORATION frontal I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas, I-EXPLORATION con I-EXPLORATION captación I-EXPLORATION heterogénea I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION hiperintensas I-EXPLORATION en I-EXPLORATION secuencias I-EXPLORATION potenciadas I-EXPLORATION en I-EXPLORATION T2, I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION nivel I-EXPLORATION hidroaéreo I-EXPLORATION realzadas I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION gadolinio, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION posible I-EXPLORATION proceso I-EXPLORATION infeccioso. I-EXPLORATION Asimismo, I-EXPLORATION se I-EXPLORATION indicaba I-EXPLORATION un I-EXPLORATION realce I-EXPLORATION meníngeo I-EXPLORATION en I-EXPLORATION localización I-EXPLORATION supero-anterior I-EXPLORATION sin I-EXPLORATION objetivarse I-EXPLORATION colecciones I-EXPLORATION extradurales, I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION cerebritis I-EXPLORATION o I-EXPLORATION abscesos I-EXPLORATION intraparenquimatosos I-EXPLORATION en I-EXPLORATION probable I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION posquirúrgicos I-EXPLORATION secundarios I-EXPLORATION a I-EXPLORATION plastia. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT estos I-TREATMENT datos I-TREATMENT se I-TREATMENT decidió I-TREATMENT reconstruir I-TREATMENT el I-TREATMENT defecto I-TREATMENT a I-TREATMENT nivel I-TREATMENT frontal I-TREATMENT mediante I-TREATMENT el I-TREATMENT empleo I-TREATMENT de I-TREATMENT un I-TREATMENT colgajo I-TREATMENT libre I-TREATMENT microvascularizado I-TREATMENT anterolateral I-TREATMENT de I-TREATMENT muslo I-TREATMENT (ALT) I-TREATMENT derecho I-TREATMENT en I-TREATMENT un I-TREATMENT intento I-TREATMENT de I-TREATMENT resolver I-TREATMENT ambos I-TREATMENT problemas, I-TREATMENT estético I-TREATMENT e I-TREATMENT infeccioso. I-TREATMENT Para I-TREATMENT ello I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT exposición I-TREATMENT del I-TREATMENT defecto I-TREATMENT frontal I-TREATMENT mediante I-TREATMENT un I-TREATMENT abordaje I-TREATMENT coronal I-TREATMENT empleando I-TREATMENT una I-TREATMENT cicatriz I-TREATMENT previa. I-TREATMENT Tras I-TREATMENT acceso I-TREATMENT al I-TREATMENT seno I-TREATMENT frontal I-TREATMENT remanente, I-TREATMENT resultado I-TREATMENT de I-TREATMENT cirugías I-TREATMENT previas, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT limpieza I-TREATMENT del I-TREATMENT mismo I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT reparación I-TREATMENT de I-TREATMENT una I-TREATMENT fístula I-TREATMENT de I-TREATMENT pequeño I-TREATMENT tamaño I-TREATMENT de I-TREATMENT duramadre I-TREATMENT con I-TREATMENT un I-TREATMENT injerto I-TREATMENT de I-TREATMENT fascia I-TREATMENT de I-TREATMENT músculo I-TREATMENT temporal. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT disección I-TREATMENT del I-TREATMENT colgajo I-TREATMENT fasciocutáneo I-TREATMENT ALT I-TREATMENT con I-TREATMENT un I-TREATMENT tamaño I-TREATMENT de I-TREATMENT 10 I-TREATMENT x I-TREATMENT 15 I-TREATMENT cm, I-TREATMENT siendo I-TREATMENT desepitelizada I-TREATMENT un I-TREATMENT área I-TREATMENT de I-TREATMENT 7 I-TREATMENT x I-TREATMENT 5 I-TREATMENT cm. I-TREATMENT En I-TREATMENT el I-TREATMENT área I-TREATMENT desepitelizada I-TREATMENT se I-TREATMENT conservó I-TREATMENT tejido I-TREATMENT celular I-TREATMENT subcutáneo I-TREATMENT para I-TREATMENT recubrimiento I-TREATMENT y I-TREATMENT sellado I-TREATMENT de I-TREATMENT la I-TREATMENT duramadre I-TREATMENT y I-TREATMENT seno I-TREATMENT frontal. I-TREATMENT La I-TREATMENT anastomosis I-TREATMENT vascular I-TREATMENT se I-TREATMENT realizó I-TREATMENT tras I-TREATMENT un I-TREATMENT abordaje I-TREATMENT preauricular I-TREATMENT empleando I-TREATMENT los I-TREATMENT vasos I-TREATMENT temporales I-TREATMENT superficiales. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION post-intervención I-EVOLUTION el I-EVOLUTION colgajo I-EVOLUTION presentaba I-EVOLUTION un I-EVOLUTION aspecto I-EVOLUTION óptimo, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION excelente I-EVOLUTION resultado I-EVOLUTION estético I-EVOLUTION y I-EVOLUTION funcional. I-EVOLUTION No I-EVOLUTION se I-EVOLUTION apreciaron I-EVOLUTION signos I-EVOLUTION infección, I-EVOLUTION reabsorción I-EVOLUTION ni I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION frontal, I-EVOLUTION habiéndose I-EVOLUTION preservado I-EVOLUTION su I-EVOLUTION tamaño I-EVOLUTION y I-EVOLUTION forma I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION Actualmente, I-EVOLUTION el I-EVOLUTION paciente, I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION su I-EVOLUTION identidad I-EVOLUTION y I-EVOLUTION la I-EVOLUTION solución I-EVOLUTION efectiva I-EVOLUTION del I-EVOLUTION problema I-EVOLUTION fistuloso, I-EVOLUTION ha I-EVOLUTION rehusado I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION intervención I-EVOLUTION para I-EVOLUTION la I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION una I-EVOLUTION cranioplastia I-EVOLUTION por I-EVOLUTION parte I-EVOLUTION del I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Neurocirugía. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 84 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que B-DERIVED_FROM/TO nos I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO oral I-DERIVED_FROM/TO y I-DERIVED_FROM/TO maxilofacial I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO dentista I-DERIVED_FROM/TO al I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO exposición I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hueso I-DERIVED_FROM/TO crestal I-DERIVED_FROM/TO mandibular I-DERIVED_FROM/TO y I-DERIVED_FROM/TO supuración I-DERIVED_FROM/TO periimplantar I-DERIVED_FROM/TO 3 I-DERIVED_FROM/TO semanas I-DERIVED_FROM/TO después I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO colocación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 6 I-DERIVED_FROM/TO implantes I-DERIVED_FROM/TO dentales I-DERIVED_FROM/TO con I-DERIVED_FROM/TO carga I-DERIVED_FROM/TO inmediata. I-DERIVED_FROM/TO Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY solo I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY osteoporosis. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY tomó I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY medicamento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY regularidad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY nunca I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY bifosfonatos. I-PAST_MEDICAL_HISTORY Cinco I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colocación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY implantes, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY comenzó I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antirresortivo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY denosumab I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY subcutánea I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY tratar I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY osteoporosis. I-PAST_MEDICAL_HISTORY Solo I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY administró I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY sola I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY denosumab. I-PAST_MEDICAL_HISTORY El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION mostró I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION alveolar I-EXPLORATION mandibular I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION las I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION exposición I-EXPLORATION ósea I-EXPLORATION que I-EXPLORATION correspondían I-EXPLORATION con I-EXPLORATION las I-EXPLORATION extracciones I-EXPLORATION dentales I-EXPLORATION previas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dientes I-EXPLORATION 48 I-EXPLORATION y I-EXPLORATION 47. I-EXPLORATION Una I-EXPLORATION ortopantomografía I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION varias I-EXPLORATION zonas I-EXPLORATION osteolíticas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION mandibular I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION los I-EXPLORATION implantes. I-EXPLORATION En I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION mandibular I-EXPLORATION para I-EXPLORATION determinar I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION destrucción I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION vestibular I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION mandibular I-EXPLORATION derecho, I-EXPLORATION espacios I-EXPLORATION trabeculares I-EXPLORATION dilatados I-EXPLORATION e I-EXPLORATION irregulares I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION hipodensas I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION osteonecrosis I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION los I-EXPLORATION implantes I-EXPLORATION y I-EXPLORATION de I-EXPLORATION los I-EXPLORATION alveolos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dientes I-EXPLORATION extraídos. I-EXPLORATION Una I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION infección I-EXPLORATION severa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION mandibular. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT conservador I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT según I-TREATMENT protocolo I-TREATMENT de I-TREATMENT nuestro I-TREATMENT servicio I-TREATMENT (amoxicilina-clavulánico I-TREATMENT vía I-TREATMENT oral I-TREATMENT 875/125 I-TREATMENT mg, I-TREATMENT 3 I-TREATMENT veces/día I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días I-TREATMENT asociados I-TREATMENT con I-TREATMENT enjuagues I-TREATMENT de I-TREATMENT clorhexidina I-TREATMENT al I-TREATMENT 0, I-TREATMENT 12%, I-TREATMENT 2-3 I-TREATMENT veces/día) I-TREATMENT y I-TREATMENT se I-TREATMENT interrumpió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT denosumab. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION iniciar I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION dolor, I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION supuración I-EVOLUTION y I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION periimplantitis. I-EVOLUTION Se B-TREATMENT inició I-TREATMENT entonces I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT dosis I-TREATMENT bajas I-TREATMENT con I-TREATMENT teriparatida I-TREATMENT 20 I-TREATMENT μg I-TREATMENT subcutánea I-TREATMENT en I-TREATMENT inyección I-TREATMENT diaria I-TREATMENT durante I-TREATMENT 6 I-TREATMENT meses. I-TREATMENT Pasado I-TREATMENT este I-TREATMENT tiempo, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT en I-TREATMENT ese I-TREATMENT momento I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT teriparatida, I-TREATMENT ya I-TREATMENT que I-TREATMENT los I-TREATMENT focos I-TREATMENT de I-TREATMENT exposición I-TREATMENT ósea I-TREATMENT fueron I-TREATMENT cubiertos I-TREATMENT por I-TREATMENT mucosa I-TREATMENT oral I-TREATMENT sana, I-TREATMENT observándose B-EXPLORATION en I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION control I-EXPLORATION una I-EXPLORATION recuperación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION densidad I-EXPLORATION ósea I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION las I-EXPLORATION zonas I-EXPLORATION osteolíticas I-EXPLORATION con I-EXPLORATION cierto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION esclerosis. I-EXPLORATION En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION finalización I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION teriparida, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática, I-EVOLUTION habiéndose I-EVOLUTION realizado I-EVOLUTION la I-EVOLUTION rehabilitación I-EVOLUTION protésica I-EVOLUTION sobre I-EVOLUTION los I-EVOLUTION implantes I-EVOLUTION viables I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION remisión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS parotídea I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asintomática, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS más I-PRESENT_ILLNESS rápido I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS meses. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY relevante, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY dermatofibrosarcoma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY escapular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION mide I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION está I-EXPLORATION mal I-EXPLORATION delimitada I-EXPLORATION y I-EXPLORATION se I-EXPLORATION localiza I-EXPLORATION en I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION parotídea I-EXPLORATION derecha. I-EXPLORATION No I-EXPLORATION presenta I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION facial I-EXPLORATION ni I-EXPLORATION adenopatías I-EXPLORATION palpables I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION cervical. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION realizada I-EXPLORATION mediante I-EXPLORATION punción I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF), I-EXPLORATION obtiene I-EXPLORATION material I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION benigna, I-EXPLORATION con I-EXPLORATION ligera I-EXPLORATION linfocitosis I-EXPLORATION sin I-EXPLORATION componente I-EXPLORATION epitelial. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION cervicofacial I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION irregulares, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION superficial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION parótida I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION extensión I-EXPLORATION focal I-EXPLORATION al I-EXPLORATION lóbulo I-EXPLORATION profundo. I-EXPLORATION Se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipodensa I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION × I-EXPLORATION 24 I-EXPLORATION × I-EXPLORATION 34 I-EXPLORATION mm, I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION fina I-EXPLORATION y I-EXPLORATION que I-EXPLORATION realza I-EXPLORATION mínimamente I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION Así, I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION es I-EXPLORATION de I-EXPLORATION tumoración I-EXPLORATION parotídea I-EXPLORATION quística I-EXPLORATION benigna, I-EXPLORATION sin I-EXPLORATION poder I-EXPLORATION descartar I-EXPLORATION otras I-EXPLORATION posibilidades. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT se I-TREATMENT interviene I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT mediante I-TREATMENT incisión I-TREATMENT de I-TREATMENT ritidectomía I-TREATMENT y I-TREATMENT colgajo I-TREATMENT de I-TREATMENT SMAS. I-TREATMENT Se I-TREATMENT procede I-TREATMENT a I-TREATMENT la I-TREATMENT identificación I-TREATMENT rutinaria I-TREATMENT del I-TREATMENT tronco I-TREATMENT del I-TREATMENT nervio I-TREATMENT facial, I-TREATMENT con I-TREATMENT gran I-TREATMENT dificultad I-TREATMENT para I-TREATMENT su I-TREATMENT localización, I-TREATMENT lo I-TREATMENT que I-TREATMENT pone I-TREATMENT de I-TREATMENT manifiesto I-TREATMENT su I-TREATMENT íntima I-TREATMENT relación I-TREATMENT con I-TREATMENT el I-TREATMENT tumor. I-TREATMENT Tras I-TREATMENT la I-TREATMENT disección I-TREATMENT retrógrada I-TREATMENT de I-TREATMENT las I-TREATMENT principales I-TREATMENT ramas I-TREATMENT del I-TREATMENT VII I-TREATMENT par I-TREATMENT (marginal, I-TREATMENT bucal, I-TREATMENT palpebral I-TREATMENT y I-TREATMENT frontal) I-TREATMENT utilizando I-TREATMENT microscopio I-TREATMENT óptico, I-TREATMENT no I-TREATMENT es I-TREATMENT posible I-TREATMENT separar I-TREATMENT el I-TREATMENT tumor I-TREATMENT del I-TREATMENT tronco I-TREATMENT nervioso I-TREATMENT y I-TREATMENT del I-TREATMENT resto I-TREATMENT de I-TREATMENT ramas. I-TREATMENT La I-TREATMENT lesión I-TREATMENT está I-TREATMENT integrada I-TREATMENT por I-TREATMENT fascículos I-TREATMENT fusiformes I-TREATMENT imbricados I-TREATMENT entre I-TREATMENT ramos I-TREATMENT nerviosos I-TREATMENT y I-TREATMENT áreas I-TREATMENT quísticas, I-TREATMENT conformando I-TREATMENT una I-TREATMENT lesión I-TREATMENT lobulada I-TREATMENT bien I-TREATMENT delimitada I-TREATMENT respeto I-TREATMENT al I-TREATMENT tejido I-TREATMENT parotídeo. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT drenaje I-TREATMENT del I-TREATMENT contenido I-TREATMENT quístico, I-TREATMENT con I-TREATMENT gran I-TREATMENT reducción I-TREATMENT del I-TREATMENT tamaño I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT y I-TREATMENT se I-TREATMENT mandan I-TREATMENT 2 I-TREATMENT biopsias I-TREATMENT intraoperatorias. I-TREATMENT La B-EXPLORATION primera I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION inflamatorio I-EXPLORATION y I-EXPLORATION la I-EXPLORATION segunda, I-EXPLORATION como I-EXPLORATION tumor I-EXPLORATION fusiforme I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION schwannoma. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT explicar I-TREATMENT a I-TREATMENT la I-TREATMENT familia I-TREATMENT durante I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT las I-TREATMENT diferentes I-TREATMENT opciones I-TREATMENT terapéuticas, I-TREATMENT se I-TREATMENT decide I-TREATMENT no I-TREATMENT extirpar I-TREATMENT la I-TREATMENT tumoración I-TREATMENT en I-TREATMENT su I-TREATMENT totalidad I-TREATMENT y I-TREATMENT esperar I-TREATMENT el I-TREATMENT resultado I-TREATMENT histopatológico I-TREATMENT definitivo. I-TREATMENT Se I-TREATMENT dispone I-TREATMENT un I-TREATMENT tubo I-TREATMENT de I-TREATMENT silicona I-TREATMENT en I-TREATMENT torno I-TREATMENT a I-TREATMENT 3 I-TREATMENT de I-TREATMENT las I-TREATMENT ramas I-TREATMENT distales I-TREATMENT del I-TREATMENT nervio I-TREATMENT facial I-TREATMENT disecadas, I-TREATMENT para I-TREATMENT facilitar I-TREATMENT su I-TREATMENT ulterior I-TREATMENT identificación I-TREATMENT si I-TREATMENT fuera I-TREATMENT necesaria I-TREATMENT una I-TREATMENT segunda I-TREATMENT intervención. I-TREATMENT Se I-TREATMENT procede I-TREATMENT al I-TREATMENT tensado I-TREATMENT de I-TREATMENT SMAS I-TREATMENT y I-TREATMENT cierre I-TREATMENT por I-TREATMENT planos, I-TREATMENT colocación I-TREATMENT de I-TREATMENT drenaje I-TREATMENT con I-TREATMENT vacío I-TREATMENT y I-TREATMENT vendaje, I-TREATMENT según I-TREATMENT el I-TREATMENT protocolo I-TREATMENT habitual. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION parálisis I-EVOLUTION facial I-EVOLUTION completa I-EVOLUTION (grado I-EVOLUTION VI I-EVOLUTION en I-EVOLUTION escala I-EVOLUTION House-Brackman) I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION recuperación I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION (grado I-EVOLUTION I, I-EVOLUTION House-Brackman). I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION también I-EVOLUTION manifiesta I-EVOLUTION síntomas I-EVOLUTION de I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Frey, I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía, I-EVOLUTION tratándose B-TREATMENT con I-TREATMENT toxina I-TREATMENT botulínica I-TREATMENT de I-TREATMENT forma I-TREATMENT exitosa. I-TREATMENT I-TREATMENT El I-TREATMENT diagnóstico I-TREATMENT anatomopatológico I-TREATMENT definitivo I-TREATMENT fue I-TREATMENT de I-TREATMENT schwannoma I-TREATMENT de I-TREATMENT nervio I-TREATMENT periférico. I-TREATMENT Se I-TREATMENT discute I-TREATMENT con I-TREATMENT la I-TREATMENT paciente I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT extirpación I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración, I-TREATMENT con I-TREATMENT sacrificio I-TREATMENT del I-TREATMENT nervio I-TREATMENT facial I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT inmediata I-TREATMENT con I-TREATMENT injerto I-TREATMENT nervioso, I-TREATMENT pero I-TREATMENT hasta I-TREATMENT el I-TREATMENT momento I-TREATMENT la I-TREATMENT paciente I-TREATMENT rechaza I-TREATMENT esta I-TREATMENT opción. I-TREATMENT I-TREATMENT El B-EXPLORATION primer I-EXPLORATION control I-EXPLORATION posquirúrgico I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION con I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 5 I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cirugía, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION aparece I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION hipercaptante I-EXPLORATION en I-EXPLORATION celda I-EXPLORATION parotídea, I-EXPLORATION englobada I-EXPLORATION en I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION fibrosis. I-EXPLORATION La I-EXPLORATION imagen I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION fibrosis I-EXPLORATION inmadura I-EXPLORATION sin I-EXPLORATION descartar I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION schwannoma. I-EXPLORATION Clínicamente, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION tumoración I-EVOLUTION palpable I-EVOLUTION en I-EVOLUTION la I-EVOLUTION región I-EVOLUTION intervenida I-EVOLUTION ni I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION motilidad I-EVOLUTION facial I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION 3 I-EVOLUTION años. I-EVOLUTION Los I-EVOLUTION controles I-EVOLUTION mediante I-EVOLUTION RM I-EVOLUTION anuales I-EVOLUTION no I-EVOLUTION muestran I-EVOLUTION cambios I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION los I-EVOLUTION controles I-EVOLUTION previos. I-EVOLUTION I-EVOLUTION Una B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS femenina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS queja I-PRESENT_ILLNESS por I-PRESENT_ILLNESS mostrar I-PRESENT_ILLNESS excesivamente I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS gingival I-PRESENT_ILLNESS al I-PRESENT_ILLNESS sonreír, I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS objetivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mejorar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS estética I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS sonrisa I-PRESENT_ILLNESS gingival. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS informa I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS encuentra I-PRESENT_ILLNESS su I-PRESENT_ILLNESS sonrisa I-PRESENT_ILLNESS armoniosa, I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS está I-PRESENT_ILLNESS dispuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS un I-PRESENT_ILLNESS procedimiento I-PRESENT_ILLNESS invasivo I-PRESENT_ILLNESS para I-PRESENT_ILLNESS corregir I-PRESENT_ILLNESS su I-PRESENT_ILLNESS situación I-PRESENT_ILLNESS bucal. I-PRESENT_ILLNESS Al B-EXPLORATION momento I-EXPLORATION de I-EXPLORATION ser I-EXPLORATION realizada I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION clínica, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION 4 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION exposición I-EXPLORATION gingival. I-EXPLORATION I-EXPLORATION Fue I-EXPLORATION evaluada I-EXPLORATION la I-EXPLORATION etiología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sonrisa I-EXPLORATION gingival, I-EXPLORATION llegando I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION que I-EXPLORATION su I-EXPLORATION sonrisa I-EXPLORATION gingival I-EXPLORATION era I-EXPLORATION debida I-EXPLORATION a I-EXPLORATION la I-EXPLORATION hiperactividad I-EXPLORATION del I-EXPLORATION músculo I-EXPLORATION elevador I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION superior. I-EXPLORATION Entre B-TREATMENT las I-TREATMENT opciones I-TREATMENT para I-TREATMENT resolver I-TREATMENT el I-TREATMENT caso I-TREATMENT que I-TREATMENT fueron I-TREATMENT presentadas I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT (incluyendo I-TREATMENT ventajas I-TREATMENT y I-TREATMENT limitaciones I-TREATMENT de I-TREATMENT cada I-TREATMENT una), I-TREATMENT fue I-TREATMENT escogido I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT BTX-A, I-TREATMENT con I-TREATMENT el I-TREATMENT fin I-TREATMENT de I-TREATMENT reducir I-TREATMENT la I-TREATMENT fuerza I-TREATMENT de I-TREATMENT contracción I-TREATMENT del I-TREATMENT labio I-TREATMENT superior. I-TREATMENT I-TREATMENT Para I-TREATMENT la I-TREATMENT ubicación I-TREATMENT del I-TREATMENT punto I-TREATMENT de I-TREATMENT aplicación, I-TREATMENT fue I-TREATMENT utilizada I-TREATMENT la I-TREATMENT técnica I-TREATMENT "Yonsei I-TREATMENT Point"2, I-TREATMENT descrita I-TREATMENT en I-TREATMENT la I-TREATMENT figura I-TREATMENT 2. I-TREATMENT I-TREATMENT Se I-TREATMENT utilizó I-TREATMENT la I-TREATMENT BTX-A I-TREATMENT (botox I-TREATMENT de I-TREATMENT la I-TREATMENT casa I-TREATMENT comercial I-TREATMENT Allergan) I-TREATMENT de I-TREATMENT 100 I-TREATMENT unidades I-TREATMENT (U) I-TREATMENT como I-TREATMENT medicación I-TREATMENT de I-TREATMENT elección. I-TREATMENT La I-TREATMENT dilución I-TREATMENT del I-TREATMENT medicamento I-TREATMENT se I-TREATMENT realizó I-TREATMENT como I-TREATMENT se I-TREATMENT describe I-TREATMENT en I-TREATMENT las I-TREATMENT instrucciones I-TREATMENT de I-TREATMENT uso I-TREATMENT del I-TREATMENT mismo. I-TREATMENT La I-TREATMENT BTX-A I-TREATMENT se I-TREATMENT diluyó I-TREATMENT con I-TREATMENT 2 I-TREATMENT ml I-TREATMENT de I-TREATMENT solución I-TREATMENT salina I-TREATMENT 0, I-TREATMENT 9% I-TREATMENT sin I-TREATMENT conservantes I-TREATMENT y I-TREATMENT estéril I-TREATMENT para I-TREATMENT producir I-TREATMENT 5 I-TREATMENT U I-TREATMENT por I-TREATMENT 0, I-TREATMENT 1 I-TREATMENT ml. I-TREATMENT Se I-TREATMENT inyectaron I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT U I-TREATMENT en I-TREATMENT el I-TREATMENT músculo I-TREATMENT elevador I-TREATMENT del I-TREATMENT labio I-TREATMENT superior, I-TREATMENT de I-TREATMENT forma I-TREATMENT bilateral. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION evaluó I-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION aplicación. I-EVOLUTION I-EVOLUTION La I-EVOLUTION exposición I-EVOLUTION gingival I-EVOLUTION se I-EVOLUTION redujo I-EVOLUTION notablemente I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION evaluación I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refirió I-EVOLUTION estar I-EVOLUTION satisfecha I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION resultado I-EVOLUTION que I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION sin I-EVOLUTION la I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION nuevas I-EVOLUTION aplicaciones I-EVOLUTION de I-EVOLUTION la I-EVOLUTION medicación I-EVOLUTION por I-EVOLUTION 6 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS linfedema I-PRESENT_ILLNESS facial I-PRESENT_ILLNESS inexorable. I-PRESENT_ILLNESS Dos B-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY epidermoide I-PAST_MEDICAL_HISTORY supraglótico. I-PAST_MEDICAL_HISTORY Se B-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT laringectomía I-TREATMENT supraglótica I-TREATMENT con I-TREATMENT vaciamiento I-TREATMENT cervical I-TREATMENT bilateral I-TREATMENT y I-TREATMENT RT. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT empleado I-TREATMENT fue I-TREATMENT amlodipino, I-TREATMENT manitol, I-TREATMENT acetazolamida, I-TREATMENT furosemida I-TREATMENT y I-TREATMENT dexametasona. I-TREATMENT Le B-EVOLUTION provocó I-EVOLUTION tensiones I-EVOLUTION arteriales I-EVOLUTION inestables I-EVOLUTION y I-EVOLUTION fluctuantes, I-EVOLUTION hiperglucemia I-EVOLUTION e I-EVOLUTION hiponatremia I-EVOLUTION afectando I-EVOLUTION al I-EVOLUTION estado I-EVOLUTION hemodinámico I-EVOLUTION del I-EVOLUTION paciente. I-EVOLUTION Se B-TREATMENT utilizó I-TREATMENT también I-TREATMENT tratamiento I-TREATMENT rehabilitador, I-TREATMENT punciones I-TREATMENT transcutáneas I-TREATMENT y I-TREATMENT cámara I-TREATMENT hiperbárica, I-TREATMENT pero I-TREATMENT sin I-TREATMENT éxito. I-TREATMENT I-TREATMENT En B-DERIVED_FROM/TO el I-DERIVED_FROM/TO momento I-DERIVED_FROM/TO en I-DERIVED_FROM/TO que I-DERIVED_FROM/TO nos I-DERIVED_FROM/TO remiten I-DERIVED_FROM/TO al I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO presenta I-DERIVED_FROM/TO un I-DERIVED_FROM/TO edema I-DERIVED_FROM/TO facial I-DERIVED_FROM/TO masivo, I-DERIVED_FROM/TO una I-DERIVED_FROM/TO gran I-DERIVED_FROM/TO fibrosis I-DERIVED_FROM/TO cervical, I-DERIVED_FROM/TO traqueotomía, I-DERIVED_FROM/TO gastrostomía, I-DERIVED_FROM/TO disnea I-DERIVED_FROM/TO con I-DERIVED_FROM/TO saturaciones I-DERIVED_FROM/TO de I-DERIVED_FROM/TO oxígeno I-DERIVED_FROM/TO del I-DERIVED_FROM/TO 85%, I-DERIVED_FROM/TO edema I-DERIVED_FROM/TO bipalpebral I-DERIVED_FROM/TO bilateral I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO apertura I-DERIVED_FROM/TO voluntaria I-DERIVED_FROM/TO de I-DERIVED_FROM/TO los I-DERIVED_FROM/TO párpados, I-DERIVED_FROM/TO hipoacusia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO transmisión, I-DERIVED_FROM/TO incompetencia I-DERIVED_FROM/TO labial I-DERIVED_FROM/TO e I-DERIVED_FROM/TO imposibilidad I-DERIVED_FROM/TO para I-DERIVED_FROM/TO la I-DERIVED_FROM/TO deglución. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-TREATMENT decidió I-TREATMENT realizar I-TREATMENT un I-TREATMENT colgajo I-TREATMENT miocutáneo I-TREATMENT deltopectoral I-TREATMENT diferido I-TREATMENT con I-TREATMENT el I-TREATMENT objetivo I-TREATMENT de I-TREATMENT introducir I-TREATMENT nuevos I-TREATMENT vasos I-TREATMENT linfáticos I-TREATMENT en I-TREATMENT la I-TREATMENT mejilla I-TREATMENT y I-TREATMENT mejorar I-TREATMENT su I-TREATMENT situación. I-TREATMENT I-TREATMENT Un I-TREATMENT colgajo I-TREATMENT deltopectoral I-TREATMENT derecho I-TREATMENT fue I-TREATMENT tallado, I-TREATMENT un I-TREATMENT área I-TREATMENT distal I-TREATMENT de I-TREATMENT 6 I-TREATMENT × I-TREATMENT 5 I-TREATMENT cm I-TREATMENT se I-TREATMENT desepiteliza I-TREATMENT y I-TREATMENT se I-TREATMENT introduce I-TREATMENT en I-TREATMENT un I-TREATMENT bolsillo I-TREATMENT subdérmico I-TREATMENT en I-TREATMENT la I-TREATMENT mejilla. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT cierre I-TREATMENT directo I-TREATMENT del I-TREATMENT defecto I-TREATMENT salvo I-TREATMENT el I-TREATMENT extremo I-TREATMENT distal I-TREATMENT que I-TREATMENT se I-TREATMENT cubre I-TREATMENT con I-TREATMENT el I-TREATMENT tejido I-TREATMENT desepitelizado I-TREATMENT como I-TREATMENT injerto I-TREATMENT cutáneo I-TREATMENT libre. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION h I-EVOLUTION comenzó I-EVOLUTION a I-EVOLUTION oír, I-EVOLUTION a I-EVOLUTION ver, I-EVOLUTION mejoró I-EVOLUTION la I-EVOLUTION competencia I-EVOLUTION labial I-EVOLUTION y I-EVOLUTION el I-EVOLUTION volumen I-EVOLUTION facial I-EVOLUTION había I-EVOLUTION disminuido. I-EVOLUTION Una I-EVOLUTION semana I-EVOLUTION después I-EVOLUTION presenta I-EVOLUTION dificultad I-EVOLUTION respiratoria I-EVOLUTION provocada I-EVOLUTION por I-EVOLUTION una I-EVOLUTION atelectasia I-EVOLUTION basal I-EVOLUTION derecha I-EVOLUTION que I-EVOLUTION empeora I-EVOLUTION progresivamente. I-EVOLUTION Se I-EVOLUTION acompaña I-EVOLUTION de I-EVOLUTION fibrilación I-EVOLUTION auricular, I-EVOLUTION hiponatremia I-EVOLUTION e I-EVOLUTION hiperglucemia. I-EVOLUTION Finalmente, I-EVOLUTION fallece I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 31 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION por I-EVOLUTION fallo I-EVOLUTION multiorgánico. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY indoeuropeo I-PAST_MEDICAL_HISTORY que B-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO odontólogo I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hallazgo I-DERIVED_FROM/TO incidental, I-DERIVED_FROM/TO al I-DERIVED_FROM/TO realizar I-DERIVED_FROM/TO una I-DERIVED_FROM/TO ortopantomografía, I-DERIVED_FROM/TO de I-DERIVED_FROM/TO imágenes I-DERIVED_FROM/TO intrasinusales I-DERIVED_FROM/TO de I-DERIVED_FROM/TO radioopacidad I-DERIVED_FROM/TO metálica. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY solo I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY herida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY arma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fuego I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY consulta, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY temporal I-PAST_MEDICAL_HISTORY izquierda. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocupación I-PRESENT_ILLNESS pansinusal I-PRESENT_ILLNESS más I-PRESENT_ILLNESS marcada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS seno I-PRESENT_ILLNESS maxilar I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rinorrea I-PRESENT_ILLNESS ocasional I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION volvió I-EXPLORATION a I-EXPLORATION resultar I-EXPLORATION anodina, I-EXPLORATION sin I-EXPLORATION abombamiento I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION vestibular I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION cuadrante, I-EXPLORATION ni I-EXPLORATION hallazgo I-EXPLORATION de I-EXPLORATION fístulas I-EXPLORATION orosinusales I-EXPLORATION visibles. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION realizadas I-EXPLORATION (ortopantomografía, I-EXPLORATION DentaScan I-EXPLORATION y I-EXPLORATION TC I-EXPLORATION facial) I-EXPLORATION mostraron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION material I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION intrasinusal I-EXPLORATION de I-EXPLORATION radiopacidad I-EXPLORATION metálica I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION un I-EXPLORATION único I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION circular I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION superolateral I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION izquierdo, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION reacción I-EXPLORATION inflamatoria I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION sinusal. I-EXPLORATION I-EXPLORATION Dados B-TREATMENT los I-TREATMENT antecedentes I-TREATMENT de I-TREATMENT herida I-TREATMENT por I-TREATMENT arma I-TREATMENT de I-TREATMENT fuego I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT pensó I-TREATMENT que I-TREATMENT pudiera I-TREATMENT tratarse I-TREATMENT de I-TREATMENT cuerpos I-TREATMENT extraños I-TREATMENT intrasinusales I-TREATMENT derivados I-TREATMENT del I-TREATMENT mismo, I-TREATMENT así I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT Cadwell-Luc I-TREATMENT y I-TREATMENT antrostomía I-TREATMENT por I-TREATMENT vía I-TREATMENT intraoral I-TREATMENT para I-TREATMENT la I-TREATMENT extirpación I-TREATMENT del I-TREATMENT cuerpo I-TREATMENT extraño I-TREATMENT y I-TREATMENT de I-TREATMENT la I-TREATMENT mucosa I-TREATMENT sinusal I-TREATMENT afecta, I-TREATMENT sin I-TREATMENT identificarse I-TREATMENT fragmentos I-TREATMENT metálicos I-TREATMENT o I-TREATMENT restos I-TREATMENT óseos. I-TREATMENT Se B-EXPLORATION obtuvo I-EXPLORATION un I-EXPLORATION material I-EXPLORATION blanquecino I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION fibroelástica I-EXPLORATION similar I-EXPLORATION al I-EXPLORATION obtenido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION caso I-EXPLORATION presentado I-EXPLORATION anterior. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION como I-EXPLORATION mucosa I-EXPLORATION sinusal I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION inflamación I-EXPLORATION crónica, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION material I-EXPLORATION blanquecino I-EXPLORATION formado I-EXPLORATION por I-EXPLORATION hifas I-EXPLORATION ramificadas I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION bola I-EXPLORATION fúngica I-EXPLORATION intrasinusal I-EXPLORATION causada I-EXPLORATION por I-EXPLORATION Aspergillus. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION microbiológicos I-EXPLORATION volvieron I-EXPLORATION a I-EXPLORATION resultar I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION En B-EVOLUTION este I-EVOLUTION caso I-EVOLUTION la I-EVOLUTION mucosa I-EVOLUTION no I-EVOLUTION se I-EVOLUTION hallaba I-EVOLUTION infiltrada I-EVOLUTION a I-EVOLUTION ningún I-EVOLUTION nivel, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION ni I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION antifúngico I-EVOLUTION intravenoso. I-EVOLUTION I-EVOLUTION En I-EVOLUTION las I-EVOLUTION revisiones I-EVOLUTION posteriores I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION complicaciones I-EVOLUTION en I-EVOLUTION un I-EVOLUTION periodo I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION 8 I-EVOLUTION años. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS femenina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS mandibular I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS rápido, I-PRESENT_ILLNESS ligero I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión. I-PRESENT_ILLNESS Intraoralmente B-EXPLORATION expansión I-EXPLORATION de I-EXPLORATION corticales I-EXPLORATION óseas I-EXPLORATION mandibulares I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION molares. I-EXPLORATION Una I-EXPLORATION tomografía I-EXPLORATION tridimensional I-EXPLORATION confirma I-EXPLORATION extensa I-EXPLORATION destrucción I-EXPLORATION ósea. I-EXPLORATION Resultado I-EXPLORATION histopatológico, I-EXPLORATION osteoblastoma I-EXPLORATION benigno I-EXPLORATION mandibular. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT amplia I-TREATMENT destrucción, I-TREATMENT y I-TREATMENT el I-TREATMENT comportamiento I-TREATMENT local I-TREATMENT agresivo I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT se I-TREATMENT realiza I-TREATMENT hemimandibulectomía I-TREATMENT derecha, I-TREATMENT y I-TREATMENT se I-TREATMENT coloca I-TREATMENT prótesis I-TREATMENT de I-TREATMENT reconstrucción I-TREATMENT mandibular I-TREATMENT con I-TREATMENT cóndilo I-TREATMENT en I-TREATMENT el I-TREATMENT lecho I-TREATMENT quirúrgico. I-TREATMENT Control B-EVOLUTION postoperatorio I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION apertura I-EVOLUTION bucal, I-EVOLUTION sin I-EVOLUTION daño I-EVOLUTION a I-EVOLUTION estructuras I-EVOLUTION nerviosas I-EVOLUTION de I-EVOLUTION importancia, I-EVOLUTION conservando I-EVOLUTION continuidad I-EVOLUTION de I-EVOLUTION nervios I-EVOLUTION sensitivos I-EVOLUTION (dentario I-EVOLUTION inferior), I-EVOLUTION y I-EVOLUTION motores. I-EVOLUTION A B-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT a I-TREATMENT los I-TREATMENT 6 I-TREATMENT meses I-TREATMENT posteriores I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía I-TREATMENT inicial, I-TREATMENT colocación I-TREATMENT de I-TREATMENT matriz I-TREATMENT ósea I-TREATMENT mezclada I-TREATMENT con I-TREATMENT aspirado I-TREATMENT medular I-TREATMENT en I-TREATMENT el I-TREATMENT lecho I-TREATMENT quirúrgico, I-TREATMENT observando B-EVOLUTION al I-EVOLUTION año I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION posterior I-EVOLUTION ligera I-EVOLUTION formación I-EVOLUTION ósea I-EVOLUTION conservando I-EVOLUTION a I-EVOLUTION la I-EVOLUTION fecha I-EVOLUTION excelente I-EVOLUTION oclusión I-EVOLUTION dental I-EVOLUTION y I-EVOLUTION apertura I-EVOLUTION bucal I-EVOLUTION adecuadas I-EVOLUTION así I-EVOLUTION como I-EVOLUTION estética I-EVOLUTION facial I-EVOLUTION satisfactorias, I-EVOLUTION adecuada I-EVOLUTION sensibilidad I-EVOLUTION y I-EVOLUTION motricidad, I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION control I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trece I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cefalea I-PAST_MEDICAL_HISTORY progresiva I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY intensidad I-PAST_MEDICAL_HISTORY y, I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nuestra I-PAST_MEDICAL_HISTORY institución, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY obstrucción I-PAST_MEDICAL_HISTORY nasal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anosmia I-PAST_MEDICAL_HISTORY derechas. I-PAST_MEDICAL_HISTORY Durante B-PRESENT_ILLNESS todo I-PRESENT_ILLNESS su I-PRESENT_ILLNESS padecimiento I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS proptosis I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diplopia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mirada I-PRESENT_ILLNESS extrema. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION reveló I-EXPLORATION proptosis I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION asimetría I-EXPLORATION facial I-EXPLORATION por I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION mejilla I-EXPLORATION ipsilateral. I-EXPLORATION La I-EXPLORATION rinoscopía I-EXPLORATION mostró I-EXPLORATION abombamiento I-EXPLORATION septal I-EXPLORATION con I-EXPLORATION convexidad I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION coanal I-EXPLORATION derecha. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hipodensa, I-EXPLORATION ovoidea, I-EXPLORATION ocupando I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION infratemporal, I-EXPLORATION seno I-EXPLORATION esfenoidal, I-EXPLORATION espacio I-EXPLORATION parafaríngeo I-EXPLORATION y I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION derechos, I-EXPLORATION provocando I-EXPLORATION compresión I-EXPLORATION y I-EXPLORATION desplazamientos I-EXPLORATION rostral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION caudal I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar, I-EXPLORATION caudal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION apófisis I-EXPLORATION pterigoides I-EXPLORATION y I-EXPLORATION dorsal I-EXPLORATION del I-EXPLORATION piso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita, I-EXPLORATION contactando I-EXPLORATION incluso I-EXPLORATION con I-EXPLORATION el I-EXPLORATION clivus; I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION material I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION mostró I-EXPLORATION escasa I-EXPLORATION captación. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (IRM) I-EXPLORATION se I-EXPLORATION mostró I-EXPLORATION hipointensa I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION e I-EXPLORATION hiperintensa I-EXPLORATION en I-EXPLORATION T2, I-EXPLORATION realzándose I-EXPLORATION intensamente I-EXPLORATION con I-EXPLORATION gadolinio. I-EXPLORATION Sus I-EXPLORATION bordes I-EXPLORATION aparecían I-EXPLORATION bien I-EXPLORATION definidos I-EXPLORATION y, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION los I-EXPLORATION desplazamientos I-EXPLORATION ya I-EXPLORATION escritos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION TC, I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION moldeamiento I-EXPLORATION del I-EXPLORATION paladar I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION duro I-EXPLORATION y I-EXPLORATION del I-EXPLORATION septum I-EXPLORATION nasal. I-EXPLORATION También I-EXPLORATION observamos I-EXPLORATION adelgazamiento I-EXPLORATION y I-EXPLORATION deformidad I-EXPLORATION del I-EXPLORATION piso I-EXPLORATION medio, I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION hacía I-EXPLORATION difícil I-EXPLORATION determinar I-EXPLORATION si I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION originaba I-EXPLORATION en I-EXPLORATION dicha I-EXPLORATION área, I-EXPLORATION o I-EXPLORATION era I-EXPLORATION una I-EXPLORATION extensión I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION infratemporal. I-EXPLORATION Por I-EXPLORATION lo I-EXPLORATION tanto, I-EXPLORATION los I-EXPLORATION diagnósticos I-EXPLORATION probables I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION neurinoma I-EXPLORATION y I-EXPLORATION papiloma I-EXPLORATION invertido I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION esfenoidal. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT fue I-TREATMENT sometida I-TREATMENT a I-TREATMENT cirugía I-TREATMENT mediante I-TREATMENT incisión I-TREATMENT sublabial I-TREATMENT con I-TREATMENT abordaje I-TREATMENT intercartilaginoso I-TREATMENT centrofacial I-TREATMENT transmaxilar, I-TREATMENT replegamiento I-TREATMENT del I-TREATMENT colgajo I-TREATMENT miocutáneo I-TREATMENT y I-TREATMENT abordaje I-TREATMENT transmaxilar. I-TREATMENT Se I-TREATMENT halló I-TREATMENT una I-TREATMENT tumoración I-TREATMENT de I-TREATMENT bastante I-TREATMENT consistencia I-TREATMENT encapsulada I-TREATMENT (como I-TREATMENT tela I-TREATMENT de I-TREATMENT hule) I-TREATMENT de I-TREATMENT coloración I-TREATMENT grisácea, I-TREATMENT escasamente I-TREATMENT vascularizada I-TREATMENT que I-TREATMENT desplazaba I-TREATMENT estructuras I-TREATMENT vecinas. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT intracapsular I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION reveló I-EXPLORATION schwannoma. I-EXPLORATION I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION cursó I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION notable I-EVOLUTION de I-EVOLUTION la I-EVOLUTION proptosis. I-EVOLUTION La B-EXPLORATION TC I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION exéresis I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION I-EXPLORATION Recien B-PRESENT_ILLNESS nacido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gestación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS parto I-PRESENT_ILLNESS asistido I-PRESENT_ILLNESS con I-PRESENT_ILLNESS forceps. I-PRESENT_ILLNESS Es B-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO por I-DERIVED_FROM/TO cefalohematoma I-DERIVED_FROM/TO parietal I-DERIVED_FROM/TO izquierdo I-DERIVED_FROM/TO con I-DERIVED_FROM/TO fractura I-DERIVED_FROM/TO deprimida I-DERIVED_FROM/TO parietal I-DERIVED_FROM/TO y I-DERIVED_FROM/TO hematoma I-DERIVED_FROM/TO epidural I-DERIVED_FROM/TO subyacente. I-DERIVED_FROM/TO La B-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Fue B-TREATMENT intervenido I-TREATMENT evacuándose I-TREATMENT el I-TREATMENT hematoma I-TREATMENT y I-TREATMENT elevándose I-TREATMENT la I-TREATMENT fractura I-TREATMENT deprimida, I-TREATMENT dejando I-TREATMENT un I-TREATMENT drenaje I-TREATMENT epidural I-TREATMENT 24 I-TREATMENT horas. I-TREATMENT Fue B-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION está I-EVOLUTION asintomático. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS recién I-PRESENT_ILLNESS nacida I-PRESENT_ILLNESS con I-PRESENT_ILLNESS forceps I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS deprimida I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS mostrada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS TAC. I-PRESENT_ILLNESS Fue B-TREATMENT intervenida I-TREATMENT de I-TREATMENT urgencia I-TREATMENT elevando I-TREATMENT la I-TREATMENT depresión. I-TREATMENT Se B-EVOLUTION remitió I-EVOLUTION a I-EVOLUTION su I-EVOLUTION domicilio I-EVOLUTION tras I-EVOLUTION 5 I-EVOLUTION días I-EVOLUTION postoperatorio; I-EVOLUTION tras I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION es I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION definitivamente I-EVOLUTION con I-EVOLUTION TAC I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS politraumatismo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS competición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bicicleta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS montaña. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS el I-PRESENT_ILLNESS evento I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS es I-PRESENT_ILLNESS portador I-PRESENT_ILLNESS de I-PRESENT_ILLNESS casco I-PRESENT_ILLNESS integral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS armilla I-PRESENT_ILLNESS protectora I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS impacto I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS cráneo-encefálico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conocimiento I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hiperextensión I-PRESENT_ILLNESS cervical. I-PRESENT_ILLNESS A I-PRESENT_ILLNESS su I-PRESENT_ILLNESS llegada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encuentra I-PRESENT_ILLNESS en I-PRESENT_ILLNESS GCS I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paresia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS VI I-PRESENT_ILLNESS par I-PRESENT_ILLNESS craneal I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION TC I-EXPLORATION craneal I-EXPLORATION y I-EXPLORATION cervical I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION lesión I-EXPLORATION hemorrágica I-EXPLORATION subdural I-EXPLORATION retroclival I-EXPLORATION y I-EXPLORATION espinal. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION fracturas I-EXPLORATION de I-EXPLORATION base I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION ni I-EXPLORATION cervicales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION TC I-EXPLORATION toraco-abdominal I-EXPLORATION que I-EXPLORATION descarta I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION con I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION normales. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION estable I-EVOLUTION neurológicamente I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT manejo I-TREATMENT conservador I-TREATMENT con I-TREATMENT colocación I-TREATMENT de I-TREATMENT collarín I-TREATMENT rígido. I-TREATMENT Se B-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION con I-EXPLORATION resonancia I-EXPLORATION cráneo-cervical I-EXPLORATION que I-EXPLORATION descarta I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION ligamentosas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION unión I-EXPLORATION cráneo-cervical. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION con I-EVOLUTION 15 I-EVOLUTION puntos I-EVOLUTION en I-EVOLUTION la I-EVOLUTION escala I-EVOLUTION de I-EVOLUTION Glasgow I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION y I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paresia I-EVOLUTION del I-EVOLUTION VI I-EVOLUTION par I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION días. I-EVOLUTION Tras I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION evolución I-EVOLUTION se I-EVOLUTION comprueba I-EVOLUTION mediante I-EVOLUTION TC I-EVOLUTION cráneo-cervical I-EVOLUTION reducción I-EVOLUTION del I-EVOLUTION hematoma I-EVOLUTION subdural I-EVOLUTION y I-EVOLUTION mediante I-EVOLUTION radiografías I-EVOLUTION funcionales I-EVOLUTION cervicales I-EVOLUTION la I-EVOLUTION estabilidad I-EVOLUTION atlo-axoidea. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION resolución I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION hematoma I-EVOLUTION subdural I-EVOLUTION con I-EVOLUTION íntegra I-EVOLUTION recuperación I-EVOLUTION neurológica. I-EVOLUTION I-EVOLUTION A B-PRESENT_ILLNESS continuación I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad. I-PRESENT_ILLNESS Vive B-PAST_MEDICAL_HISTORY solo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Barcelona I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY pareja. I-PAST_MEDICAL_HISTORY Trabaja I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ámbito I-PAST_MEDICAL_HISTORY militar, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY implica I-PAST_MEDICAL_HISTORY disponibilidad I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY viajar I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY países I-PAST_MEDICAL_HISTORY frecuentemente. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY acudir I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY plantea I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cambio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ubicación I-PAST_MEDICAL_HISTORY estable I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY puesto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trabajo. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY reside I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY ciudad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY está I-PAST_MEDICAL_HISTORY estrechamente I-PAST_MEDICAL_HISTORY relacionada I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ámbito I-PAST_MEDICAL_HISTORY militar. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY entorno I-PAST_MEDICAL_HISTORY social I-PAST_MEDICAL_HISTORY está I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY vinculado I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ocio, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY entorno I-PAST_MEDICAL_HISTORY laboral. I-PAST_MEDICAL_HISTORY Presenta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY bajo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY satisfacción I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY laboral. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS demanda I-PRESENT_ILLNESS principal I-PRESENT_ILLNESS se I-PRESENT_ILLNESS centra I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS problema I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alcoholismo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS bulimia, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS en I-PRESENT_ILLNESS conductas I-PRESENT_ILLNESS englobadas I-PRESENT_ILLNESS como I-PRESENT_ILLNESS desorden I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS general. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cliente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY puede I-PAST_MEDICAL_HISTORY estar I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY seguidos I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY beber I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY establece I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY línea I-PAST_MEDICAL_HISTORY base I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY consumiciones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bebidas I-PAST_MEDICAL_HISTORY alcohólicas I-PAST_MEDICAL_HISTORY diarias, I-PAST_MEDICAL_HISTORY reflejado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY embriaguez I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY acude I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY primeras I-PAST_MEDICAL_HISTORY sesiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evaluación. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY aumentó I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY coincidiendo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY disminución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conductas I-PAST_MEDICAL_HISTORY bulímicas. I-PAST_MEDICAL_HISTORY Cuando I-PAST_MEDICAL_HISTORY acude I-PAST_MEDICAL_HISTORY solo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY bar I-PAST_MEDICAL_HISTORY procura I-PAST_MEDICAL_HISTORY ir I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY lugares I-PAST_MEDICAL_HISTORY diferentes I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY vean I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY amigos. I-PAST_MEDICAL_HISTORY Si I-PAST_MEDICAL_HISTORY bebe I-PAST_MEDICAL_HISTORY acompañado, I-PAST_MEDICAL_HISTORY normalmente I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY compañeros I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trabajo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY amiga I-PAST_MEDICAL_HISTORY suya, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY situaciones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ocio. I-PAST_MEDICAL_HISTORY El B-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION consumo I-EXPLORATION encajaría I-EXPLORATION con I-EXPLORATION el I-EXPLORATION trastorno I-EXPLORATION por I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION definido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION DSM-5 I-EXPLORATION (APA, I-EXPLORATION 2014) I-EXPLORATION como I-EXPLORATION “un I-EXPLORATION patrón I-EXPLORATION problemático I-EXPLORATION de I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION que I-EXPLORATION provoca I-EXPLORATION un I-EXPLORATION deterioro I-EXPLORATION o I-EXPLORATION malestar I-EXPLORATION clínicamente I-EXPLORATION significativo”. I-EXPLORATION Incluye I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION criterios I-EXPLORATION para I-EXPLORATION diagnosticar, I-EXPLORATION teniendo I-EXPLORATION que I-EXPLORATION cumplirse I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION dos I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION durante I-EXPLORATION un I-EXPLORATION mínimo I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION meses. I-EXPLORATION El I-EXPLORATION cliente I-EXPLORATION cumple I-EXPLORATION la I-EXPLORATION mayoría I-EXPLORATION de I-EXPLORATION los I-EXPLORATION criterios, I-EXPLORATION incluido I-EXPLORATION el I-EXPLORATION criterio I-EXPLORATION temporal. I-EXPLORATION I-EXPLORATION Por B-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY lado, I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY conductas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bulimia I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY inician I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY 19 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY reducen I-PAST_MEDICAL_HISTORY considerablemente I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY vuelto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY purgarse I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY darse I-PAST_MEDICAL_HISTORY atracones I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY frecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY veces I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY semana, I-PAST_MEDICAL_HISTORY todo I-PAST_MEDICAL_HISTORY ello I-PAST_MEDICAL_HISTORY elicitado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY verbalizaciones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fracaso I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY “me I-PAST_MEDICAL_HISTORY he I-PAST_MEDICAL_HISTORY pasado”, I-PAST_MEDICAL_HISTORY “me I-PAST_MEDICAL_HISTORY he I-PAST_MEDICAL_HISTORY descontrolado”. I-PAST_MEDICAL_HISTORY El B-EXPLORATION trastorno I-EXPLORATION de I-EXPLORATION bulimia I-EXPLORATION nerviosa I-EXPLORATION se I-EXPLORATION caracteriza I-EXPLORATION por I-EXPLORATION episodios I-EXPLORATION recurrentes I-EXPLORATION de I-EXPLORATION atracones I-EXPLORATION acompañado I-EXPLORATION de I-EXPLORATION conductas I-EXPLORATION compensatorias I-EXPLORATION inadecuadas, I-EXPLORATION como I-EXPLORATION vómito I-EXPLORATION autoprovocado I-EXPLORATION o I-EXPLORATION uso I-EXPLORATION de I-EXPLORATION laxantes I-EXPLORATION (DSM-5; I-EXPLORATION APA, I-EXPLORATION 2014). I-EXPLORATION La I-EXPLORATION gravedad I-EXPLORATION del I-EXPLORATION trastorno I-EXPLORATION se I-EXPLORATION diagnostica I-EXPLORATION con I-EXPLORATION base I-EXPLORATION en I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION de I-EXPLORATION esas I-EXPLORATION conductas I-EXPLORATION compensatorias, I-EXPLORATION pudiendo I-EXPLORATION ser I-EXPLORATION de I-EXPLORATION grado I-EXPLORATION leve, I-EXPLORATION medio I-EXPLORATION o I-EXPLORATION grave. I-EXPLORATION En I-EXPLORATION este I-EXPLORATION caso, I-EXPLORATION el I-EXPLORATION cliente I-EXPLORATION cumpliría I-EXPLORATION criterios I-EXPLORATION para I-EXPLORATION ser I-EXPLORATION diagnosticado I-EXPLORATION con I-EXPLORATION un I-EXPLORATION grado I-EXPLORATION leve I-EXPLORATION de I-EXPLORATION bulimia I-EXPLORATION nerviosa. I-EXPLORATION I-EXPLORATION Evaluación I-EXPLORATION I-EXPLORATION Para I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION empleado I-EXPLORATION la I-EXPLORATION entrevista I-EXPLORATION no I-EXPLORATION estructurada, I-EXPLORATION complementada I-EXPLORATION con I-EXPLORATION autorregistros. I-EXPLORATION Esta I-EXPLORATION fase I-EXPLORATION se I-EXPLORATION extiende, I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION formal, I-EXPLORATION durante I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION primeras I-EXPLORATION sesiones. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION realizada I-EXPLORATION la I-EXPLORATION evaluación, I-EXPLORATION se I-EXPLORATION establece I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION de I-EXPLORATION trabajo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION objetivo I-EXPLORATION central, I-EXPLORATION que I-EXPLORATION será I-EXPLORATION fundamental I-EXPLORATION para I-EXPLORATION el I-EXPLORATION cumplimiento I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION objetivos: I-EXPLORATION incrementar I-EXPLORATION autocontrol. I-EXPLORATION La B-TREATMENT periodicidad I-TREATMENT de I-TREATMENT las I-TREATMENT sesiones I-TREATMENT comienza I-TREATMENT siendo I-TREATMENT semanal, I-TREATMENT pero I-TREATMENT según I-TREATMENT avanza I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT espacia I-TREATMENT a I-TREATMENT quincenal I-TREATMENT hasta I-TREATMENT finalizar I-TREATMENT con I-TREATMENT un I-TREATMENT seguimiento I-TREATMENT mensual I-TREATMENT a I-TREATMENT partir I-TREATMENT de I-TREATMENT la I-TREATMENT octava I-TREATMENT sesión. I-TREATMENT Este I-TREATMENT espaciamiento I-TREATMENT es I-TREATMENT importante I-TREATMENT de I-TREATMENT cara I-TREATMENT al I-TREATMENT análisis I-TREATMENT de I-TREATMENT los I-TREATMENT resultados I-TREATMENT conseguidos I-TREATMENT durante I-TREATMENT la I-TREATMENT intervención. I-TREATMENT I-TREATMENT Como I-TREATMENT el I-TREATMENT cliente I-TREATMENT no I-TREATMENT presenta I-TREATMENT problemas I-TREATMENT de I-TREATMENT salud, I-TREATMENT el I-TREATMENT objetivo I-TREATMENT en I-TREATMENT relación I-TREATMENT al I-TREATMENT patrón I-TREATMENT de I-TREATMENT bebida I-TREATMENT es I-TREATMENT modificar I-TREATMENT las I-TREATMENT situaciones I-TREATMENT de I-TREATMENT consumo I-TREATMENT en I-TREATMENT lugar I-TREATMENT de I-TREATMENT plantear I-TREATMENT una I-TREATMENT reducción I-TREATMENT del I-TREATMENT mismo, I-TREATMENT aunque I-TREATMENT sí I-TREATMENT se I-TREATMENT consigue I-TREATMENT esa I-TREATMENT reducción I-TREATMENT como I-TREATMENT consecuencia I-TREATMENT del I-TREATMENT trabajo I-TREATMENT realizado. I-TREATMENT Dado I-TREATMENT que I-TREATMENT es I-TREATMENT una I-TREATMENT conducta I-TREATMENT reforzada I-TREATMENT en I-TREATMENT su I-TREATMENT ambiente, I-TREATMENT sería I-TREATMENT inadecuado I-TREATMENT dirigir I-TREATMENT el I-TREATMENT objetivo I-TREATMENT a I-TREATMENT la I-TREATMENT abstinencia, I-TREATMENT ya I-TREATMENT que I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT pretende I-TREATMENT es I-TREATMENT eliminar I-TREATMENT el I-TREATMENT patrón I-TREATMENT de I-TREATMENT consumo I-TREATMENT problemático, I-TREATMENT sustituyéndolo I-TREATMENT por I-TREATMENT uno I-TREATMENT más I-TREATMENT controlado I-TREATMENT que I-TREATMENT no I-TREATMENT genere I-TREATMENT malestar. I-TREATMENT De I-TREATMENT este I-TREATMENT modo I-TREATMENT el I-TREATMENT cliente I-TREATMENT puede I-TREATMENT conseguir I-TREATMENT un I-TREATMENT consumo I-TREATMENT fuera I-TREATMENT de I-TREATMENT los I-TREATMENT parámetros I-TREATMENT problemáticos I-TREATMENT así I-TREATMENT como I-TREATMENT mantener I-TREATMENT el I-TREATMENT acceso I-TREATMENT a I-TREATMENT sus I-TREATMENT reforzadores I-TREATMENT sociales I-TREATMENT relacionados I-TREATMENT con I-TREATMENT el I-TREATMENT consumo I-TREATMENT de I-TREATMENT alcohol. I-TREATMENT Es I-TREATMENT por I-TREATMENT ello I-TREATMENT que I-TREATMENT la I-TREATMENT terapia I-TREATMENT se I-TREATMENT orienta I-TREATMENT a I-TREATMENT facilitar I-TREATMENT la I-TREATMENT discriminación I-TREATMENT de I-TREATMENT cuándo I-TREATMENT es I-TREATMENT adecuado I-TREATMENT beber I-TREATMENT y I-TREATMENT cuándo I-TREATMENT no. I-TREATMENT I-TREATMENT Análisis B-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY continuación I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY expone I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY análisis I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY caso I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY base I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY modelo I-PAST_MEDICAL_HISTORY propuesto I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Segura, I-PAST_MEDICAL_HISTORY Sánchez I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Barbado I-PAST_MEDICAL_HISTORY (1991). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Variables I-PAST_MEDICAL_HISTORY disposicionales I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Dentro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aprendizaje I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY elevado I-PAST_MEDICAL_HISTORY cumplimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY normas, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY reforzado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ámbito I-PAST_MEDICAL_HISTORY familiar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY laboral, I-PAST_MEDICAL_HISTORY dadas I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY exigencias I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY demandan I-PAST_MEDICAL_HISTORY ambos I-PAST_MEDICAL_HISTORY contextos I-PAST_MEDICAL_HISTORY relacionados I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY militar. I-PAST_MEDICAL_HISTORY Esto I-PAST_MEDICAL_HISTORY significa I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY conducta, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY medida, I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY gobernada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY discriminativos I-PAST_MEDICAL_HISTORY externos. I-PAST_MEDICAL_HISTORY Todo I-PAST_MEDICAL_HISTORY ello, I-PAST_MEDICAL_HISTORY sumado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ausencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY discriminativos I-PAST_MEDICAL_HISTORY internos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY prácticamente I-PAST_MEDICAL_HISTORY inexistente I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY elementos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY (como I-PAST_MEDICAL_HISTORY vivir I-PAST_MEDICAL_HISTORY solo, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tener I-PAST_MEDICAL_HISTORY pareja, I-PAST_MEDICAL_HISTORY viajar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY frecuencia) I-PAST_MEDICAL_HISTORY fuera I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ámbito I-PAST_MEDICAL_HISTORY laboral, I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY precipitado I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ausencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aprendizaje I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conductas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY autocontrol. I-PAST_MEDICAL_HISTORY Cierto I-PAST_MEDICAL_HISTORY condicionamiento I-PAST_MEDICAL_HISTORY aversivo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY falta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fracaso I-PAST_MEDICAL_HISTORY precipita I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ingesta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY atracones. I-PAST_MEDICAL_HISTORY Por I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY parte, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ausencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consecuencias I-PAST_MEDICAL_HISTORY aversivas I-PAST_MEDICAL_HISTORY ante I-PAST_MEDICAL_HISTORY conductas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY descontrol I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ámbito I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY contribuye I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY continua I-PAST_MEDICAL_HISTORY emisión I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY patrón I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY respuesta. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY baja I-PAST_MEDICAL_HISTORY tasa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY reforzadores I-PAST_MEDICAL_HISTORY precipita I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cliente I-PAST_MEDICAL_HISTORY presente I-PAST_MEDICAL_HISTORY bajo I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ánimo I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY incrementa I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY valor I-PAST_MEDICAL_HISTORY reforzante I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY conducta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY beber, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY pocos I-PAST_MEDICAL_HISTORY reforzadores I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY fácil I-PAST_MEDICAL_HISTORY acceso, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY afecta I-PAST_MEDICAL_HISTORY directamente I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY mantenimiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY problema. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Un I-PAST_MEDICAL_HISTORY entorno I-PAST_MEDICAL_HISTORY laboral I-PAST_MEDICAL_HISTORY percibido I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY poco I-PAST_MEDICAL_HISTORY demandante I-PAST_MEDICAL_HISTORY facilita I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol, I-PAST_MEDICAL_HISTORY dado I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY existen I-PAST_MEDICAL_HISTORY consecuencias I-PAST_MEDICAL_HISTORY aversivas I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY entorpezcan I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY labor I-PAST_MEDICAL_HISTORY profesional. I-PAST_MEDICAL_HISTORY Otro I-PAST_MEDICAL_HISTORY factor I-PAST_MEDICAL_HISTORY añadido I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY sociales I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY producen I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY trabajo I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY desarrollan I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY mayoría I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY torno I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY bebida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY comida. I-PAST_MEDICAL_HISTORY Todo I-PAST_MEDICAL_HISTORY ello I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY facilitado I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY asocie I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ocio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY libre I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol, I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY precipita I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY beba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY solitario I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY libre. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Variables B-EXPLORATION funcionales: I-EXPLORATION atracones I-EXPLORATION y I-EXPLORATION vómitos I-EXPLORATION I-EXPLORATION Hipótesis I-EXPLORATION de I-EXPLORATION adquisición: I-EXPLORATION se I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION una I-EXPLORATION asociación I-EXPLORATION pavloviana I-EXPLORATION previa I-EXPLORATION entre I-EXPLORATION ingesta I-EXPLORATION de I-EXPLORATION comida I-EXPLORATION calórica I-EXPLORATION y I-EXPLORATION respuestas I-EXPLORATION de I-EXPLORATION malestar. I-EXPLORATION El I-EXPLORATION ingerir I-EXPLORATION comida I-EXPLORATION calórica, I-EXPLORATION por I-EXPLORATION poca I-EXPLORATION que I-EXPLORATION sea, I-EXPLORATION elicita I-EXPLORATION verbalizaciones I-EXPLORATION de I-EXPLORATION fracaso I-EXPLORATION y I-EXPLORATION culpa I-EXPLORATION (“me I-EXPLORATION he I-EXPLORATION pasado”). I-EXPLORATION Se I-EXPLORATION hipotetiza I-EXPLORATION que I-EXPLORATION esta I-EXPLORATION asociación I-EXPLORATION aversiva I-EXPLORATION lleva I-EXPLORATION a I-EXPLORATION que I-EXPLORATION el I-EXPLORATION cliente I-EXPLORATION se I-EXPLORATION mantenga I-EXPLORATION en I-EXPLORATION un I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION privación I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION esos I-EXPLORATION alimentos: I-EXPLORATION evita I-EXPLORATION ingerirlos. I-EXPLORATION Esa I-EXPLORATION asociación I-EXPLORATION también I-EXPLORATION lleva I-EXPLORATION a I-EXPLORATION sentimientos I-EXPLORATION de I-EXPLORATION culpa I-EXPLORATION cuando I-EXPLORATION ingiere I-EXPLORATION esos I-EXPLORATION alimentos, I-EXPLORATION discriminada I-EXPLORATION tal I-EXPLORATION conducta I-EXPLORATION por I-EXPLORATION aburrimiento. I-EXPLORATION I-EXPLORATION Hipótesis I-EXPLORATION de I-EXPLORATION mantenimiento: I-EXPLORATION el I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION privación I-EXPLORATION del I-EXPLORATION cliente I-EXPLORATION aumenta I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION reforzante I-EXPLORATION de I-EXPLORATION la I-EXPLORATION comida I-EXPLORATION calórica. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION que I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION producido I-EXPLORATION la I-EXPLORATION ingesta, I-EXPLORATION la I-EXPLORATION culpa I-EXPLORATION y I-EXPLORATION el I-EXPLORATION malestar I-EXPLORATION finalmente I-EXPLORATION elicitan I-EXPLORATION verbalizaciones I-EXPLORATION de I-EXPLORATION permiso I-EXPLORATION y I-EXPLORATION de I-EXPLORATION anticipación I-EXPLORATION del I-EXPLORATION vómito, I-EXPLORATION que I-EXPLORATION discriminan I-EXPLORATION la I-EXPLORATION conducta I-EXPLORATION de I-EXPLORATION atracón, I-EXPLORATION manteniéndose I-EXPLORATION por I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION reforzante I-EXPLORATION de I-EXPLORATION la I-EXPLORATION comida, I-EXPLORATION aumentado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION privación. I-EXPLORATION Esto I-EXPLORATION lleva I-EXPLORATION a I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION sensaciones I-EXPLORATION desagradables, I-EXPLORATION condicionadas I-EXPLORATION e I-EXPLORATION incondicionadas, I-EXPLORATION que I-EXPLORATION discriminan I-EXPLORATION el I-EXPLORATION vómito I-EXPLORATION para I-EXPLORATION reducir I-EXPLORATION el I-EXPLORATION malestar I-EXPLORATION generado I-EXPLORATION por I-EXPLORATION las I-EXPLORATION mismas. I-EXPLORATION I-EXPLORATION Variables I-EXPLORATION funcionales: I-EXPLORATION ingesta I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION I-EXPLORATION Hipótesis I-EXPLORATION de I-EXPLORATION adquisición: I-EXPLORATION el I-EXPLORATION cliente I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION relacionado I-EXPLORATION con I-EXPLORATION situaciones I-EXPLORATION sociales I-EXPLORATION de I-EXPLORATION ocio. I-EXPLORATION El I-EXPLORATION mantenimiento I-EXPLORATION de I-EXPLORATION este I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION ocio I-EXPLORATION puede I-EXPLORATION llevar I-EXPLORATION a I-EXPLORATION percibir I-EXPLORATION el I-EXPLORATION alcohol I-EXPLORATION como I-EXPLORATION una I-EXPLORATION vía I-EXPLORATION para I-EXPLORATION la I-EXPLORATION obtención I-EXPLORATION de I-EXPLORATION refuerzo I-EXPLORATION social, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION los I-EXPLORATION reforzadores I-EXPLORATION propios I-EXPLORATION del I-EXPLORATION alcohol I-EXPLORATION (sabor, I-EXPLORATION efectos). I-EXPLORATION El I-EXPLORATION consumo I-EXPLORATION empezó I-EXPLORATION a I-EXPLORATION aumentar I-EXPLORATION en I-EXPLORATION una I-EXPLORATION etapa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION desaparecieron I-EXPLORATION los I-EXPLORATION atracones. I-EXPLORATION El I-EXPLORATION beber I-EXPLORATION se I-EXPLORATION convirtió I-EXPLORATION en I-EXPLORATION un I-EXPLORATION sustituto I-EXPLORATION del I-EXPLORATION comer, I-EXPLORATION con I-EXPLORATION los I-EXPLORATION consecuentes I-EXPLORATION refuerzos I-EXPLORATION negativos I-EXPLORATION de I-EXPLORATION sentirse I-EXPLORATION lleno I-EXPLORATION sin I-EXPLORATION comer. I-EXPLORATION El I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION consumo I-EXPLORATION comenzó I-EXPLORATION primero I-EXPLORATION en I-EXPLORATION casa, I-EXPLORATION pasando I-EXPLORATION posteriormente I-EXPLORATION a I-EXPLORATION beber I-EXPLORATION en I-EXPLORATION solitario I-EXPLORATION en I-EXPLORATION bares I-EXPLORATION por I-EXPLORATION la I-EXPLORATION obtención I-EXPLORATION del I-EXPLORATION refuerzo I-EXPLORATION social I-EXPLORATION y I-EXPLORATION por I-EXPLORATION pasar I-EXPLORATION menos I-EXPLORATION tiempo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION vivienda. I-EXPLORATION Cabe I-EXPLORATION mencionar I-EXPLORATION la I-EXPLORATION influencia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION algunas I-EXPLORATION variables I-EXPLORATION disposicionales. I-EXPLORATION Por I-EXPLORATION ejemplo, I-EXPLORATION cierto I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION reforzadores I-EXPLORATION podría I-EXPLORATION precipitar I-EXPLORATION un I-EXPLORATION mayor I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION porque I-EXPLORATION llevaría I-EXPLORATION a I-EXPLORATION la I-EXPLORATION obtención I-EXPLORATION de I-EXPLORATION los I-EXPLORATION mismos I-EXPLORATION con I-EXPLORATION un I-EXPLORATION menor I-EXPLORATION coste. I-EXPLORATION I-EXPLORATION Hipótesis I-EXPLORATION de I-EXPLORATION mantenimiento: I-EXPLORATION las I-EXPLORATION variables I-EXPLORATION disposicionales I-EXPLORATION anteriormente I-EXPLORATION citadas I-EXPLORATION también I-EXPLORATION estarían I-EXPLORATION ejerciendo I-EXPLORATION cierta I-EXPLORATION influencia I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION mantenimiento I-EXPLORATION del I-EXPLORATION problema. I-EXPLORATION Cuando I-EXPLORATION bebe I-EXPLORATION acompañado I-EXPLORATION suele I-EXPLORATION ser I-EXPLORATION en I-EXPLORATION situaciones I-EXPLORATION de I-EXPLORATION ocio I-EXPLORATION y I-EXPLORATION tiempo I-EXPLORATION libre I-EXPLORATION asociadas I-EXPLORATION al I-EXPLORATION consumo. I-EXPLORATION En I-EXPLORATION cambio, I-EXPLORATION cuando I-EXPLORATION bebe I-EXPLORATION en I-EXPLORATION solitario I-EXPLORATION lo I-EXPLORATION hace I-EXPLORATION por I-EXPLORATION escapar I-EXPLORATION de I-EXPLORATION una I-EXPLORATION situación I-EXPLORATION de I-EXPLORATION aburrimiento. I-EXPLORATION El I-EXPLORATION consumo I-EXPLORATION también I-EXPLORATION está I-EXPLORATION discriminado I-EXPLORATION por I-EXPLORATION determinadas I-EXPLORATION situaciones I-EXPLORATION que I-EXPLORATION se I-EXPLORATION han I-EXPLORATION establecido I-EXPLORATION como I-EXPLORATION rutinarias. I-EXPLORATION Hay I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION estímulos I-EXPLORATION que I-EXPLORATION discriminan I-EXPLORATION conductas I-EXPLORATION de I-EXPLORATION control I-EXPLORATION del I-EXPLORATION consumo I-EXPLORATION de I-EXPLORATION alcohol: I-EXPLORATION comer I-EXPLORATION sano I-EXPLORATION en I-EXPLORATION el I-EXPLORATION trabajo, I-EXPLORATION ir I-EXPLORATION al I-EXPLORATION gimnasio, I-EXPLORATION tener I-EXPLORATION pareja, I-EXPLORATION realizar I-EXPLORATION tareas I-EXPLORATION del I-EXPLORATION hogar I-EXPLORATION nada I-EXPLORATION más I-EXPLORATION llegar. I-EXPLORATION Serán I-EXPLORATION muy I-EXPLORATION importantes I-EXPLORATION de I-EXPLORATION cara I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención. I-EXPLORATION I-EXPLORATION Tratamiento B-TREATMENT I-TREATMENT Con I-TREATMENT base I-TREATMENT en I-TREATMENT el I-TREATMENT análisis I-TREATMENT funcional I-TREATMENT plasmado I-TREATMENT anteriormente, I-TREATMENT se I-TREATMENT plantean I-TREATMENT una I-TREATMENT serie I-TREATMENT de I-TREATMENT objetivos I-TREATMENT de I-TREATMENT tratamiento: I-TREATMENT I-TREATMENT Fomentar I-TREATMENT un I-TREATMENT estilo I-TREATMENT de I-TREATMENT vida I-TREATMENT más I-TREATMENT organizado. I-TREATMENT Se I-TREATMENT centra I-TREATMENT en I-TREATMENT lograr I-TREATMENT que I-TREATMENT el I-TREATMENT cliente I-TREATMENT sea I-TREATMENT capaz I-TREATMENT de I-TREATMENT seguir I-TREATMENT unos I-TREATMENT horarios I-TREATMENT estables I-TREATMENT entre I-TREATMENT semana, I-TREATMENT llegando I-TREATMENT puntual I-TREATMENT al I-TREATMENT trabajo I-TREATMENT y I-TREATMENT acudiendo I-TREATMENT al I-TREATMENT gimnasio, I-TREATMENT entre I-TREATMENT otras I-TREATMENT actividades I-TREATMENT o I-TREATMENT tareas. I-TREATMENT También I-TREATMENT se I-TREATMENT busca I-TREATMENT que I-TREATMENT el I-TREATMENT cliente I-TREATMENT tenga I-TREATMENT un I-TREATMENT patrón I-TREATMENT de I-TREATMENT comidas I-TREATMENT más I-TREATMENT ordenado I-TREATMENT y I-TREATMENT planificado, I-TREATMENT así I-TREATMENT como I-TREATMENT más I-TREATMENT saludable. I-TREATMENT Este I-TREATMENT objetivo I-TREATMENT tiene I-TREATMENT gran I-TREATMENT relevancia I-TREATMENT en I-TREATMENT el I-TREATMENT caso, I-TREATMENT ya I-TREATMENT que I-TREATMENT se I-TREATMENT parte I-TREATMENT de I-TREATMENT que I-TREATMENT el I-TREATMENT descontrol I-TREATMENT y I-TREATMENT la I-TREATMENT desorganización I-TREATMENT general I-TREATMENT han I-TREATMENT precipitado I-TREATMENT otras I-TREATMENT conductas I-TREATMENT problemáticas. I-TREATMENT I-TREATMENT Disminuir I-TREATMENT el I-TREATMENT consumo I-TREATMENT de I-TREATMENT alcohol I-TREATMENT y I-TREATMENT aumentar I-TREATMENT la I-TREATMENT capacidad I-TREATMENT de I-TREATMENT control I-TREATMENT sobre I-TREATMENT el I-TREATMENT mismo. I-TREATMENT La I-TREATMENT disminución I-TREATMENT del I-TREATMENT consumo I-TREATMENT se I-TREATMENT orienta I-TREATMENT a I-TREATMENT la I-TREATMENT frecuencia I-TREATMENT y I-TREATMENT las I-TREATMENT situaciones I-TREATMENT en I-TREATMENT las I-TREATMENT que I-TREATMENT se I-TREATMENT produce. I-TREATMENT De I-TREATMENT esta I-TREATMENT manera, I-TREATMENT se I-TREATMENT cambia I-TREATMENT de I-TREATMENT un I-TREATMENT patrón I-TREATMENT de I-TREATMENT consumo I-TREATMENT desajustado I-TREATMENT a I-TREATMENT uno I-TREATMENT más I-TREATMENT normalizado, I-TREATMENT pudiendo I-TREATMENT beber I-TREATMENT en I-TREATMENT situaciones I-TREATMENT sociales I-TREATMENT o I-TREATMENT de I-TREATMENT ocio I-TREATMENT en I-TREATMENT las I-TREATMENT que I-TREATMENT sea I-TREATMENT oportuno. I-TREATMENT La I-TREATMENT parte I-TREATMENT más I-TREATMENT importante I-TREATMENT es I-TREATMENT el I-TREATMENT control I-TREATMENT sobre I-TREATMENT el I-TREATMENT consumo, I-TREATMENT entendiendo I-TREATMENT como I-TREATMENT tal I-TREATMENT que I-TREATMENT el I-TREATMENT cliente I-TREATMENT pueda I-TREATMENT decidir I-TREATMENT beber I-TREATMENT o I-TREATMENT no I-TREATMENT y I-TREATMENT ser I-TREATMENT congruente I-TREATMENT con I-TREATMENT esa I-TREATMENT decisión. I-TREATMENT I-TREATMENT Eliminar I-TREATMENT atracones I-TREATMENT y I-TREATMENT vómitos. I-TREATMENT Se I-TREATMENT centra I-TREATMENT en I-TREATMENT la I-TREATMENT eliminación I-TREATMENT de I-TREATMENT las I-TREATMENT conductas I-TREATMENT de I-TREATMENT atracones I-TREATMENT así I-TREATMENT como I-TREATMENT de I-TREATMENT las I-TREATMENT purgas I-TREATMENT subsiguientes. I-TREATMENT También I-TREATMENT incluye I-TREATMENT la I-TREATMENT introducción I-TREATMENT de I-TREATMENT una I-TREATMENT mayor I-TREATMENT variedad I-TREATMENT de I-TREATMENT alimentos I-TREATMENT en I-TREATMENT la I-TREATMENT dieta. I-TREATMENT I-TREATMENT Aumentar I-TREATMENT las I-TREATMENT fuentes I-TREATMENT de I-TREATMENT reforzadores. I-TREATMENT Este I-TREATMENT objetivo I-TREATMENT resulta I-TREATMENT central I-TREATMENT en I-TREATMENT el I-TREATMENT caso, I-TREATMENT ya I-TREATMENT que I-TREATMENT el I-TREATMENT déficit I-TREATMENT en I-TREATMENT esta I-TREATMENT área I-TREATMENT ha I-TREATMENT podido I-TREATMENT influir I-TREATMENT en I-TREATMENT el I-TREATMENT aumento I-TREATMENT del I-TREATMENT consumo. I-TREATMENT Se I-TREATMENT divide I-TREATMENT en I-TREATMENT tres I-TREATMENT subobjetivos: I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT actividades I-TREATMENT gratificantes I-TREATMENT en I-TREATMENT solitario, I-TREATMENT realizar I-TREATMENT actividades I-TREATMENT sociales I-TREATMENT y I-TREATMENT de I-TREATMENT ocio I-TREATMENT no I-TREATMENT relacionadas I-TREATMENT con I-TREATMENT el I-TREATMENT alcohol I-TREATMENT y, I-TREATMENT por I-TREATMENT último, I-TREATMENT buscar I-TREATMENT pareja. I-TREATMENT I-TREATMENT Para I-TREATMENT lograr I-TREATMENT estos I-TREATMENT objetivos, I-TREATMENT se I-TREATMENT desarrollan I-TREATMENT y I-TREATMENT se I-TREATMENT ponen I-TREATMENT en I-TREATMENT marcha I-TREATMENT una I-TREATMENT serie I-TREATMENT de I-TREATMENT técnicas I-TREATMENT de I-TREATMENT intervención, I-TREATMENT tanto I-TREATMENT dentro I-TREATMENT de I-TREATMENT sesión I-TREATMENT como I-TREATMENT fuera, I-TREATMENT en I-TREATMENT este I-TREATMENT último I-TREATMENT caso I-TREATMENT pautándolas I-TREATMENT como I-TREATMENT tareas I-TREATMENT para I-TREATMENT la I-TREATMENT semana: I-TREATMENT I-TREATMENT El I-TREATMENT objetivo I-TREATMENT 1 I-TREATMENT se I-TREATMENT trabaja I-TREATMENT mediante I-TREATMENT el I-TREATMENT establecimiento I-TREATMENT de I-TREATMENT un I-TREATMENT calendario I-TREATMENT de I-TREATMENT organización I-TREATMENT conductual I-TREATMENT o I-TREATMENT planning. I-TREATMENT A I-TREATMENT través I-TREATMENT del I-TREATMENT cumplimiento I-TREATMENT de I-TREATMENT este I-TREATMENT calendario, I-TREATMENT y I-TREATMENT por I-TREATMENT tanto I-TREATMENT de I-TREATMENT la I-TREATMENT consecución I-TREATMENT del I-TREATMENT primer I-TREATMENT objetivo, I-TREATMENT se I-TREATMENT facilita I-TREATMENT el I-TREATMENT cambio I-TREATMENT en I-TREATMENT las I-TREATMENT demás I-TREATMENT áreas I-TREATMENT problemáticas. I-TREATMENT I-TREATMENT El I-TREATMENT objetivo I-TREATMENT 2 I-TREATMENT se I-TREATMENT consigue I-TREATMENT con I-TREATMENT la I-TREATMENT implementación I-TREATMENT de I-TREATMENT diferentes I-TREATMENT estrategias. I-TREATMENT En I-TREATMENT primer I-TREATMENT lugar, I-TREATMENT se I-TREATMENT realiza I-TREATMENT un I-TREATMENT moldeamiento I-TREATMENT de I-TREATMENT la I-TREATMENT conducta I-TREATMENT de I-TREATMENT beber I-TREATMENT con I-TREATMENT control. I-TREATMENT En I-TREATMENT segundo I-TREATMENT lugar, I-TREATMENT se I-TREATMENT desarrolla I-TREATMENT dentro I-TREATMENT y I-TREATMENT fuera I-TREATMENT de I-TREATMENT sesión I-TREATMENT un I-TREATMENT entrenamiento I-TREATMENT en I-TREATMENT detección I-TREATMENT de I-TREATMENT los I-TREATMENT estímulos I-TREATMENT discriminativos I-TREATMENT de I-TREATMENT la I-TREATMENT conducta I-TREATMENT de I-TREATMENT beber, I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT interacción I-TREATMENT terapéutica I-TREATMENT y I-TREATMENT de I-TREATMENT autorregistros. I-TREATMENT En I-TREATMENT tercer I-TREATMENT lugar, I-TREATMENT se I-TREATMENT entrena I-TREATMENT al I-TREATMENT cliente I-TREATMENT en I-TREATMENT autocontrol, I-TREATMENT buscando I-TREATMENT que I-TREATMENT sus I-TREATMENT propias I-TREATMENT verbalizaciones I-TREATMENT adquieran I-TREATMENT valor I-TREATMENT discriminativo I-TREATMENT para I-TREATMENT guiar I-TREATMENT su I-TREATMENT conducta. I-TREATMENT I-TREATMENT El I-TREATMENT objetivo I-TREATMENT 3 I-TREATMENT se I-TREATMENT lleva I-TREATMENT a I-TREATMENT cabo I-TREATMENT mediante I-TREATMENT la I-TREATMENT técnica I-TREATMENT de I-TREATMENT exposición I-TREATMENT con I-TREATMENT prevención I-TREATMENT de I-TREATMENT respuesta, I-TREATMENT centrada I-TREATMENT en I-TREATMENT el I-TREATMENT aumento I-TREATMENT de I-TREATMENT la I-TREATMENT cantidad I-TREATMENT y I-TREATMENT frecuencia I-TREATMENT de I-TREATMENT ingestas I-TREATMENT calóricas I-TREATMENT con I-TREATMENT ausencia I-TREATMENT de I-TREATMENT conductas I-TREATMENT compensatorias. I-TREATMENT I-TREATMENT Los I-TREATMENT subobjetivos I-TREATMENT incluidos I-TREATMENT en I-TREATMENT el I-TREATMENT objetivo I-TREATMENT 4 I-TREATMENT se I-TREATMENT consiguen I-TREATMENT con I-TREATMENT pautas I-TREATMENT concretas I-TREATMENT relacionadas I-TREATMENT con I-TREATMENT cada I-TREATMENT uno I-TREATMENT de I-TREATMENT ellos: I-TREATMENT meter I-TREATMENT en I-TREATMENT el I-TREATMENT calendario I-TREATMENT momentos I-TREATMENT determinados I-TREATMENT para I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT actividades I-TREATMENT en I-TREATMENT solitario, I-TREATMENT pautar I-TREATMENT actividades I-TREATMENT en I-TREATMENT grupo, I-TREATMENT utilizar I-TREATMENT páginas I-TREATMENT de I-TREATMENT contacto I-TREATMENT social I-TREATMENT y I-TREATMENT páginas I-TREATMENT para I-TREATMENT buscar I-TREATMENT pareja. I-TREATMENT Durante B-EVOLUTION la I-EVOLUTION consecución I-EVOLUTION de I-EVOLUTION este I-EVOLUTION objetivo, I-EVOLUTION surgen I-EVOLUTION nuevas I-EVOLUTION conductas I-EVOLUTION problemáticas I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION la I-EVOLUTION búsqueda I-EVOLUTION y I-EVOLUTION mantenimiento I-EVOLUTION de I-EVOLUTION relaciones I-EVOLUTION de I-EVOLUTION pareja. I-EVOLUTION Por I-EVOLUTION este I-EVOLUTION motivo, I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION de I-EVOLUTION la I-EVOLUTION novena I-EVOLUTION sesión I-EVOLUTION se I-EVOLUTION evalúan I-EVOLUTION y I-EVOLUTION tratan I-EVOLUTION estas I-EVOLUTION conductas I-EVOLUTION como I-EVOLUTION nueva I-EVOLUTION demanda, I-EVOLUTION siendo I-EVOLUTION de I-EVOLUTION gran I-EVOLUTION relevancia I-EVOLUTION para I-EVOLUTION el I-EVOLUTION mantenimiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION demás I-EVOLUTION objetivos. I-EVOLUTION I-EVOLUTION Un B-TREATMENT objetivo I-TREATMENT que I-TREATMENT se I-TREATMENT trabaja I-TREATMENT de I-TREATMENT forma I-TREATMENT paralela I-TREATMENT a I-TREATMENT los I-TREATMENT anteriores, I-TREATMENT y I-TREATMENT transversalmente I-TREATMENT durante I-TREATMENT la I-TREATMENT terapia, I-TREATMENT teniendo I-TREATMENT más I-TREATMENT peso I-TREATMENT en I-TREATMENT las I-TREATMENT últimas I-TREATMENT sesiones, I-TREATMENT es I-TREATMENT la I-TREATMENT detección I-TREATMENT y I-TREATMENT afrontamiento I-TREATMENT de I-TREATMENT situaciones I-TREATMENT de I-TREATMENT riesgo, I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT conoce I-TREATMENT en I-TREATMENT la I-TREATMENT literatura I-TREATMENT como I-TREATMENT prevención I-TREATMENT de I-TREATMENT recaídas I-TREATMENT (Larimer, I-TREATMENT Palmer I-TREATMENT y I-TREATMENT Marlatt, I-TREATMENT 1999). I-TREATMENT Siguiendo B-EXPLORATION el I-EXPLORATION modelo I-EXPLORATION de I-EXPLORATION recaídas I-EXPLORATION presentado I-EXPLORATION por I-EXPLORATION Marlatt I-EXPLORATION y I-EXPLORATION George I-EXPLORATION (1984, I-EXPLORATION citado I-EXPLORATION en I-EXPLORATION Echeburúa-Odriozola, I-EXPLORATION 1994), I-EXPLORATION una I-EXPLORATION vez I-EXPLORATION que I-EXPLORATION la I-EXPLORATION persona I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION en I-EXPLORATION una I-EXPLORATION situación I-EXPLORATION de I-EXPLORATION riesgo I-EXPLORATION puede I-EXPLORATION llevar I-EXPLORATION a I-EXPLORATION cabo I-EXPLORATION o I-EXPLORATION no I-EXPLORATION respuestas I-EXPLORATION de I-EXPLORATION afrontamiento. I-EXPLORATION Si I-EXPLORATION lo I-EXPLORATION hace, I-EXPLORATION su I-EXPLORATION percepción I-EXPLORATION de I-EXPLORATION autoeficacia I-EXPLORATION aumentará I-EXPLORATION y I-EXPLORATION disminuirá I-EXPLORATION la I-EXPLORATION probabilidad I-EXPLORATION de I-EXPLORATION que I-EXPLORATION se I-EXPLORATION produzca I-EXPLORATION una I-EXPLORATION recaída. I-EXPLORATION En I-EXPLORATION cambio, I-EXPLORATION si I-EXPLORATION no I-EXPLORATION aparecen I-EXPLORATION las I-EXPLORATION respuestas I-EXPLORATION adecuadas I-EXPLORATION se I-EXPLORATION producirá I-EXPLORATION el I-EXPLORATION efecto I-EXPLORATION contrario. I-EXPLORATION Se I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION planteamiento I-EXPLORATION de I-EXPLORATION Bandura I-EXPLORATION (2005) I-EXPLORATION de I-EXPLORATION que I-EXPLORATION la I-EXPLORATION eficacia I-EXPLORATION percibida I-EXPLORATION o I-EXPLORATION autoeficacia I-EXPLORATION no I-EXPLORATION es I-EXPLORATION un I-EXPLORATION rasgo I-EXPLORATION global I-EXPLORATION o I-EXPLORATION estable I-EXPLORATION de I-EXPLORATION la I-EXPLORATION persona, I-EXPLORATION sino I-EXPLORATION un I-EXPLORATION conjunto I-EXPLORATION de I-EXPLORATION autocreencias I-EXPLORATION ligadas I-EXPLORATION a I-EXPLORATION ámbitos I-EXPLORATION de I-EXPLORATION funcionamiento I-EXPLORATION diferenciado I-EXPLORATION dependientes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION situación. I-EXPLORATION Se B-TREATMENT trabaja I-TREATMENT en I-TREATMENT esta I-TREATMENT línea I-TREATMENT a I-TREATMENT partir I-TREATMENT de I-TREATMENT la I-TREATMENT octava I-TREATMENT sesión, I-TREATMENT en I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT explica I-TREATMENT la I-TREATMENT diferencia I-TREATMENT entre I-TREATMENT una I-TREATMENT recaída I-TREATMENT y I-TREATMENT una I-TREATMENT caída, I-TREATMENT reestructurando I-TREATMENT verbalizaciones I-TREATMENT de I-TREATMENT fracaso I-TREATMENT o I-TREATMENT retroceso, I-TREATMENT quitando I-TREATMENT valor I-TREATMENT negativo I-TREATMENT a I-TREATMENT las I-TREATMENT mismas I-TREATMENT y I-TREATMENT destacando I-TREATMENT el I-TREATMENT manejo I-TREATMENT adecuado I-TREATMENT durante I-TREATMENT la I-TREATMENT semana. I-TREATMENT De I-TREATMENT esta I-TREATMENT manera I-TREATMENT mejoraría I-TREATMENT la I-TREATMENT autoeficacia I-TREATMENT y I-TREATMENT sensación I-TREATMENT de I-TREATMENT control I-TREATMENT percibidas I-TREATMENT por I-TREATMENT el I-TREATMENT cliente. I-TREATMENT En I-TREATMENT sesiones I-TREATMENT anteriores, I-TREATMENT también I-TREATMENT se I-TREATMENT trabaja I-TREATMENT prevención I-TREATMENT de I-TREATMENT recaídas, I-TREATMENT pautando I-TREATMENT tareas I-TREATMENT y I-TREATMENT emitiendo I-TREATMENT discriminativos I-TREATMENT en I-TREATMENT sesión, I-TREATMENT encaminadas I-TREATMENT ambas I-TREATMENT estrategias I-TREATMENT a I-TREATMENT que I-TREATMENT el I-TREATMENT cliente I-TREATMENT detecte I-TREATMENT situaciones I-TREATMENT de I-TREATMENT riesgo I-TREATMENT y I-TREATMENT emita I-TREATMENT respuestas I-TREATMENT de I-TREATMENT control I-TREATMENT y I-TREATMENT afrontamiento I-TREATMENT en I-TREATMENT las I-TREATMENT mismas. I-TREATMENT Esta I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT terapia I-TREATMENT es I-TREATMENT especialmente I-TREATMENT importante I-TREATMENT en I-TREATMENT este I-TREATMENT tipo I-TREATMENT de I-TREATMENT problemática, I-TREATMENT ya I-TREATMENT que I-TREATMENT si I-TREATMENT ante I-TREATMENT una I-TREATMENT situación I-TREATMENT de I-TREATMENT riesgo I-TREATMENT el I-TREATMENT sujeto I-TREATMENT logra I-TREATMENT emitir I-TREATMENT una I-TREATMENT respuesta I-TREATMENT adecuada I-TREATMENT con I-TREATMENT la I-TREATMENT que I-TREATMENT evita I-TREATMENT el I-TREATMENT consumo, I-TREATMENT la I-TREATMENT sensación I-TREATMENT de I-TREATMENT autocontrol I-TREATMENT y I-TREATMENT autoeficacia I-TREATMENT incrementa I-TREATMENT y I-TREATMENT la I-TREATMENT probabilidad I-TREATMENT de I-TREATMENT recaída I-TREATMENT disminuirá I-TREATMENT significativamente I-TREATMENT (Becoña-Iglesias I-TREATMENT y I-TREATMENT Cortés-Tomás, I-TREATMENT 2008). I-TREATMENT I-TREATMENT Resultados B-EVOLUTION I-EVOLUTION Para I-EVOLUTION el I-EVOLUTION análisis I-EVOLUTION de I-EVOLUTION los I-EVOLUTION resultados I-EVOLUTION nos I-EVOLUTION centramos I-EVOLUTION en I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION primeros I-EVOLUTION objetivos: I-EVOLUTION conseguir I-EVOLUTION un I-EVOLUTION estilo I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION más I-EVOLUTION organizado, I-EVOLUTION disminuir I-EVOLUTION el I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION alcohol I-EVOLUTION aprendiendo I-EVOLUTION a I-EVOLUTION controlarlo I-EVOLUTION y I-EVOLUTION eliminar I-EVOLUTION vómitos I-EVOLUTION y I-EVOLUTION atracones. I-EVOLUTION El I-EVOLUTION cuarto I-EVOLUTION objetivo, I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION fuentes I-EVOLUTION de I-EVOLUTION refuerzo, I-EVOLUTION quedaría I-EVOLUTION reflejado I-EVOLUTION dentro I-EVOLUTION del I-EVOLUTION establecimiento I-EVOLUTION de I-EVOLUTION un I-EVOLUTION estilo I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION más I-EVOLUTION organizado, I-EVOLUTION trabajado I-EVOLUTION con I-EVOLUTION el I-EVOLUTION calendario I-EVOLUTION de I-EVOLUTION organización I-EVOLUTION conductual. I-EVOLUTION I-EVOLUTION A I-EVOLUTION lo I-EVOLUTION largo I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION cómo I-EVOLUTION han I-EVOLUTION evolucionado I-EVOLUTION las I-EVOLUTION conductas I-EVOLUTION problemáticas, I-EVOLUTION reduciéndose I-EVOLUTION su I-EVOLUTION emisión I-EVOLUTION a I-EVOLUTION medida I-EVOLUTION que I-EVOLUTION el I-EVOLUTION terapeuta I-EVOLUTION pauta I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION consumo I-EVOLUTION para I-EVOLUTION las I-EVOLUTION semanas. I-EVOLUTION Se I-EVOLUTION produce I-EVOLUTION una I-EVOLUTION disminución I-EVOLUTION y I-EVOLUTION retirada I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION de I-EVOLUTION bebidas I-EVOLUTION alcohólicas, I-EVOLUTION obteniendo I-EVOLUTION unos I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION consumo I-EVOLUTION más I-EVOLUTION normalizados. I-EVOLUTION La I-EVOLUTION ingesta I-EVOLUTION de I-EVOLUTION alcohol I-EVOLUTION estando I-EVOLUTION solo I-EVOLUTION en I-EVOLUTION casa I-EVOLUTION se I-EVOLUTION elimina I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 7 I-EVOLUTION y I-EVOLUTION se I-EVOLUTION comienza I-EVOLUTION a I-EVOLUTION controlar I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION de I-EVOLUTION alcohol I-EVOLUTION estando I-EVOLUTION fuera I-EVOLUTION de I-EVOLUTION casa I-EVOLUTION en I-EVOLUTION solitario I-EVOLUTION entre I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 7 I-EVOLUTION y I-EVOLUTION 8, I-EVOLUTION habiendo I-EVOLUTION reducido I-EVOLUTION anteriormente I-EVOLUTION la I-EVOLUTION frecuencia. I-EVOLUTION I-EVOLUTION El I-EVOLUTION segundo I-EVOLUTION objetivo, I-EVOLUTION disminuir I-EVOLUTION y I-EVOLUTION controlar I-EVOLUTION el I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION alcohol, I-EVOLUTION se I-EVOLUTION refleja I-EVOLUTION y I-EVOLUTION analiza I-EVOLUTION en I-EVOLUTION la I-EVOLUTION figura I-EVOLUTION 4. I-EVOLUTION Esta I-EVOLUTION ingesta I-EVOLUTION de I-EVOLUTION bebidas I-EVOLUTION alcohólicas I-EVOLUTION disminuye I-EVOLUTION a I-EVOLUTION medida I-EVOLUTION que I-EVOLUTION se I-EVOLUTION pautan I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION consumo. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION figura I-EVOLUTION 4 I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION que I-EVOLUTION durante I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION sesiones I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION (de I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION 1 I-EVOLUTION a I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION 3, I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION 4, I-EVOLUTION 5 I-EVOLUTION y I-EVOLUTION 6) I-EVOLUTION se I-EVOLUTION presentan I-EVOLUTION mayores I-EVOLUTION unidades I-EVOLUTION de I-EVOLUTION alcohol I-EVOLUTION ingerido I-EVOLUTION y I-EVOLUTION con I-EVOLUTION menor I-EVOLUTION variedad, I-EVOLUTION siendo I-EVOLUTION el I-EVOLUTION vino I-EVOLUTION la I-EVOLUTION bebida I-EVOLUTION que I-EVOLUTION predomina, I-EVOLUTION cuya I-EVOLUTION frecuencia I-EVOLUTION y I-EVOLUTION cantidad I-EVOLUTION de I-EVOLUTION ingesta I-EVOLUTION es I-EVOLUTION mayor I-EVOLUTION en I-EVOLUTION comparación I-EVOLUTION con I-EVOLUTION las I-EVOLUTION últimas I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION Los I-EVOLUTION datos I-EVOLUTION correspondientes I-EVOLUTION a I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION 7 I-EVOLUTION y I-EVOLUTION 8 I-EVOLUTION (semanas I-EVOLUTION 5, I-EVOLUTION 6, I-EVOLUTION 7 I-EVOLUTION y I-EVOLUTION 8) I-EVOLUTION reflejan I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION frecuencia I-EVOLUTION de I-EVOLUTION consumo I-EVOLUTION por I-EVOLUTION días, I-EVOLUTION disminuyendo I-EVOLUTION considerablemente I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION y I-EVOLUTION el I-EVOLUTION fin I-EVOLUTION de I-EVOLUTION semana. I-EVOLUTION Por I-EVOLUTION último, I-EVOLUTION los I-EVOLUTION datos I-EVOLUTION correspondientes I-EVOLUTION a I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 9 I-EVOLUTION (de I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION 9 I-EVOLUTION a I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION 15 I-EVOLUTION del I-EVOLUTION tratamiento) I-EVOLUTION indican I-EVOLUTION que I-EVOLUTION el I-EVOLUTION cliente I-EVOLUTION no I-EVOLUTION solo I-EVOLUTION reduce I-EVOLUTION el I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION bebidas I-EVOLUTION alcohólicas, I-EVOLUTION sino I-EVOLUTION que I-EVOLUTION también I-EVOLUTION incorpora I-EVOLUTION mayor I-EVOLUTION variedad I-EVOLUTION en I-EVOLUTION su I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION bebidas I-EVOLUTION no I-EVOLUTION alcohólicas I-EVOLUTION y I-EVOLUTION alcohólicas I-EVOLUTION con I-EVOLUTION menor I-EVOLUTION graduación I-EVOLUTION en I-EVOLUTION situaciones I-EVOLUTION de I-EVOLUTION ocio, I-EVOLUTION como I-EVOLUTION agua I-EVOLUTION con I-EVOLUTION gas I-EVOLUTION o I-EVOLUTION claras I-EVOLUTION de I-EVOLUTION cerveza. I-EVOLUTION I-EVOLUTION El I-EVOLUTION exceso I-EVOLUTION percibido I-EVOLUTION de I-EVOLUTION consumo I-EVOLUTION queda I-EVOLUTION reflejado I-EVOLUTION en I-EVOLUTION la I-EVOLUTION figura I-EVOLUTION 5, I-EVOLUTION que I-EVOLUTION representa I-EVOLUTION las I-EVOLUTION verbalizaciones I-EVOLUTION que I-EVOLUTION el I-EVOLUTION cliente I-EVOLUTION emite I-EVOLUTION en I-EVOLUTION sesión I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION su I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION haberse I-EVOLUTION excedido I-EVOLUTION en I-EVOLUTION el I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION alcohol I-EVOLUTION y I-EVOLUTION los I-EVOLUTION registros I-EVOLUTION relacionados I-EVOLUTION con I-EVOLUTION tareas I-EVOLUTION concretas I-EVOLUTION que I-EVOLUTION indicaba I-EVOLUTION el I-EVOLUTION terapeuta. I-EVOLUTION Se I-EVOLUTION puede I-EVOLUTION observar I-EVOLUTION que I-EVOLUTION en I-EVOLUTION las I-EVOLUTION marcas I-EVOLUTION correspondientes I-EVOLUTION a I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 8 I-EVOLUTION y I-EVOLUTION 9 I-EVOLUTION (del I-EVOLUTION día I-EVOLUTION 40 I-EVOLUTION al I-EVOLUTION 80) I-EVOLUTION continúa I-EVOLUTION apareciendo I-EVOLUTION esa I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION exceso, I-EVOLUTION pero I-EVOLUTION esta I-EVOLUTION vez I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION un I-EVOLUTION consumo I-EVOLUTION menor I-EVOLUTION y I-EVOLUTION más I-EVOLUTION controlado. I-EVOLUTION Esto I-EVOLUTION supone I-EVOLUTION un I-EVOLUTION cambio I-EVOLUTION en I-EVOLUTION la I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ingesta I-EVOLUTION de I-EVOLUTION bebidas I-EVOLUTION alcohólicas I-EVOLUTION y I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION cuándo I-EVOLUTION dejar I-EVOLUTION de I-EVOLUTION beber. I-EVOLUTION I-EVOLUTION En I-EVOLUTION la I-EVOLUTION figura I-EVOLUTION 3 I-EVOLUTION podemos I-EVOLUTION observar I-EVOLUTION el I-EVOLUTION cumplimiento I-EVOLUTION de I-EVOLUTION actividades I-EVOLUTION de I-EVOLUTION un I-EVOLUTION calendario I-EVOLUTION de I-EVOLUTION organización I-EVOLUTION conductual, I-EVOLUTION relacionado I-EVOLUTION con I-EVOLUTION el I-EVOLUTION objetivo I-EVOLUTION de I-EVOLUTION fomentar I-EVOLUTION un I-EVOLUTION estilo I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION más I-EVOLUTION saludable, I-EVOLUTION incluyendo I-EVOLUTION reforzadores. I-EVOLUTION El I-EVOLUTION número I-EVOLUTION máximo I-EVOLUTION de I-EVOLUTION actividades I-EVOLUTION diarias I-EVOLUTION viene I-EVOLUTION indicado I-EVOLUTION por I-EVOLUTION una I-EVOLUTION puntuación I-EVOLUTION máxima I-EVOLUTION de I-EVOLUTION 10 I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION el I-EVOLUTION número I-EVOLUTION de I-EVOLUTION ítems I-EVOLUTION que I-EVOLUTION debía I-EVOLUTION cumplir. I-EVOLUTION Lo I-EVOLUTION relevante I-EVOLUTION en I-EVOLUTION este I-EVOLUTION caso I-EVOLUTION es I-EVOLUTION la I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION días I-EVOLUTION que I-EVOLUTION pueden I-EVOLUTION indicar I-EVOLUTION descontrol I-EVOLUTION no I-EVOLUTION cumpliendo I-EVOLUTION ningún I-EVOLUTION ítem. I-EVOLUTION En I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION del I-EVOLUTION 1 I-EVOLUTION al I-EVOLUTION 20, I-EVOLUTION correspondientes I-EVOLUTION a I-EVOLUTION los I-EVOLUTION días I-EVOLUTION comprendidos I-EVOLUTION entre I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION 4, I-EVOLUTION 5 I-EVOLUTION y I-EVOLUTION 6, I-EVOLUTION se I-EVOLUTION observan I-EVOLUTION días I-EVOLUTION de I-EVOLUTION no I-EVOLUTION cumplimiento I-EVOLUTION de I-EVOLUTION tareas I-EVOLUTION con I-EVOLUTION una I-EVOLUTION frecuencia I-EVOLUTION semanal I-EVOLUTION y I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION consecutiva. I-EVOLUTION En I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION correspondientes I-EVOLUTION a I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION 7 I-EVOLUTION y I-EVOLUTION 8 I-EVOLUTION (del I-EVOLUTION día I-EVOLUTION 20 I-EVOLUTION al I-EVOLUTION 50) I-EVOLUTION se I-EVOLUTION produce I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION considerable I-EVOLUTION de I-EVOLUTION días I-EVOLUTION en I-EVOLUTION los I-EVOLUTION que I-EVOLUTION no I-EVOLUTION se I-EVOLUTION cumple I-EVOLUTION ningún I-EVOLUTION ítem, I-EVOLUTION coincidiendo I-EVOLUTION estos I-EVOLUTION días I-EVOLUTION con I-EVOLUTION eventos I-EVOLUTION familiares I-EVOLUTION y I-EVOLUTION laborales I-EVOLUTION que I-EVOLUTION dificultan I-EVOLUTION el I-EVOLUTION cumplimiento, I-EVOLUTION siendo I-EVOLUTION más I-EVOLUTION elevadas I-EVOLUTION las I-EVOLUTION puntuaciones, I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION significa I-EVOLUTION que I-EVOLUTION el I-EVOLUTION cliente I-EVOLUTION cumple I-EVOLUTION la I-EVOLUTION mayor I-EVOLUTION parte I-EVOLUTION de I-EVOLUTION los I-EVOLUTION ítems I-EVOLUTION diarios I-EVOLUTION en I-EVOLUTION estas I-EVOLUTION semanas. I-EVOLUTION Por I-EVOLUTION último, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION período I-EVOLUTION comprendido I-EVOLUTION entre I-EVOLUTION el I-EVOLUTION día I-EVOLUTION 50 I-EVOLUTION y I-EVOLUTION el I-EVOLUTION día I-EVOLUTION 80, I-EVOLUTION correspondiente I-EVOLUTION a I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 9, I-EVOLUTION se I-EVOLUTION puede I-EVOLUTION observar I-EVOLUTION un I-EVOLUTION cumplimiento I-EVOLUTION más I-EVOLUTION estable, I-EVOLUTION aunque I-EVOLUTION con I-EVOLUTION excepciones I-EVOLUTION de I-EVOLUTION no I-EVOLUTION cumplimiento I-EVOLUTION que I-EVOLUTION coinciden I-EVOLUTION con I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION eventos I-EVOLUTION sociales I-EVOLUTION o I-EVOLUTION viajes I-EVOLUTION de I-EVOLUTION trabajo I-EVOLUTION que I-EVOLUTION dificultan I-EVOLUTION la I-EVOLUTION realización I-EVOLUTION de I-EVOLUTION las I-EVOLUTION tareas. I-EVOLUTION I-EVOLUTION El I-EVOLUTION cambio I-EVOLUTION de I-EVOLUTION patrón I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION los I-EVOLUTION atracones I-EVOLUTION y I-EVOLUTION vómitos I-EVOLUTION es I-EVOLUTION también I-EVOLUTION evidente I-EVOLUTION y I-EVOLUTION muy I-EVOLUTION temprano I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tiempo. I-EVOLUTION Sólo I-EVOLUTION se I-EVOLUTION dan I-EVOLUTION en I-EVOLUTION dos I-EVOLUTION ocasiones, I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION las I-EVOLUTION semanas I-EVOLUTION 5 I-EVOLUTION y I-EVOLUTION 6. I-EVOLUTION La I-EVOLUTION eliminación I-EVOLUTION de I-EVOLUTION atracones I-EVOLUTION se I-EVOLUTION trabaja I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sexta I-EVOLUTION sesión, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION logro I-EVOLUTION total I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION aplicación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION técnica I-EVOLUTION de I-EVOLUTION exposición I-EVOLUTION con I-EVOLUTION prevención I-EVOLUTION de I-EVOLUTION respuesta, I-EVOLUTION introduciendo I-EVOLUTION cada I-EVOLUTION vez I-EVOLUTION más I-EVOLUTION alimentos I-EVOLUTION calóricos I-EVOLUTION hasta I-EVOLUTION llegar I-EVOLUTION a I-EVOLUTION una I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION control I-EVOLUTION total I-EVOLUTION sobre I-EVOLUTION esta I-EVOLUTION conducta I-EVOLUTION en I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 9 I-EVOLUTION y I-EVOLUTION 10. I-EVOLUTION Los I-EVOLUTION vómitos I-EVOLUTION se I-EVOLUTION eliminan I-EVOLUTION a I-EVOLUTION partir I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sesión I-EVOLUTION 3. I-EVOLUTION I-EVOLUTION Estos I-EVOLUTION resultados I-EVOLUTION indican, I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION tentativa, I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION un I-EVOLUTION elevado I-EVOLUTION cumplimiento I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pautas, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION un I-EVOLUTION elevado I-EVOLUTION compromiso I-EVOLUTION con I-EVOLUTION la I-EVOLUTION terapia. I-EVOLUTION Los I-EVOLUTION resultados I-EVOLUTION indican I-EVOLUTION una I-EVOLUTION notable I-EVOLUTION mejoría I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION a I-EVOLUTION la I-EVOLUTION adquisición I-EVOLUTION de I-EVOLUTION un I-EVOLUTION estilo I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION más I-EVOLUTION organizado I-EVOLUTION y I-EVOLUTION mayor I-EVOLUTION autocontrol I-EVOLUTION en I-EVOLUTION relación I-EVOLUTION al I-EVOLUTION consumo I-EVOLUTION de I-EVOLUTION alcohol I-EVOLUTION y I-EVOLUTION cumplimiento I-EVOLUTION de I-EVOLUTION actividades. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY epidermoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pulmón I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY microcítico I-PAST_MEDICAL_HISTORY estadio I-PAST_MEDICAL_HISTORY IIIb. I-PAST_MEDICAL_HISTORY Inició I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY quimioterápico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cisplatino I-PAST_MEDICAL_HISTORY 75 I-PAST_MEDICAL_HISTORY mg/m2 I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY vinorelbina I-PAST_MEDICAL_HISTORY oral I-PAST_MEDICAL_HISTORY 60 I-PAST_MEDICAL_HISTORY mg/m2 I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 8, I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY semanas, I-PAST_MEDICAL_HISTORY combinado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY radioterapia. I-PAST_MEDICAL_HISTORY Coincidiendo B-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS infusión I-PRESENT_ILLNESS del I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS ciclo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cisplatino, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS brusca I-PRESENT_ILLNESS con I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS saturación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS oxígeno I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 70%, I-PRESENT_ILLNESS que B-TREATMENT recuperó I-TREATMENT parcialmente I-TREATMENT con I-TREATMENT corticoterapia I-TREATMENT y I-TREATMENT oxígeno I-TREATMENT a I-TREATMENT alto I-TREATMENT flujo. I-TREATMENT La B-EXPLORATION gravedad I-EXPLORATION de I-EXPLORATION dicha I-EXPLORATION reacción I-EXPLORATION fue I-EXPLORATION clasificada I-EXPLORATION según I-EXPLORATION la I-EXPLORATION Common I-EXPLORATION Toxicity I-EXPLORATION Criteria I-EXPLORATION (versión I-EXPLORATION 4.0) I-EXPLORATION 9 I-EXPLORATION en I-EXPLORATION RHS I-EXPLORATION grado I-EXPLORATION 3, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION recomienda I-EXPLORATION cambiar I-EXPLORATION el I-EXPLORATION tratamiento, I-EXPLORATION opción I-EXPLORATION a I-EXPLORATION veces I-EXPLORATION limitada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION quimiosensibilidad I-EXPLORATION del I-EXPLORATION tumor, I-EXPLORATION o I-EXPLORATION bien I-EXPLORATION aplicar I-EXPLORATION protocolos I-EXPLORATION de I-EXPLORATION desensibilización I-EXPLORATION en I-EXPLORATION aquellos I-EXPLORATION pacientes I-EXPLORATION en I-EXPLORATION los I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION desee I-EXPLORATION discontinuar I-EXPLORATION la I-EXPLORATION terapia. I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION cutáneas I-EXPLORATION con I-EXPLORATION cisplatino, I-EXPLORATION para I-EXPLORATION confirmar I-EXPLORATION la I-EXPLORATION posible I-EXPLORATION asociación I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION anafiláctica I-EXPLORATION y I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION dicho I-EXPLORATION citostático. I-EXPLORATION Además, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION reactividad I-EXPLORATION cruzada I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION sales I-EXPLORATION de I-EXPLORATION platino I-EXPLORATION cuya I-EXPLORATION incidencia I-EXPLORATION aún I-EXPLORATION no I-EXPLORATION ha I-EXPLORATION sido I-EXPLORATION establecida8, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION dichas I-EXPLORATION pruebas I-EXPLORATION con I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION análogos I-EXPLORATION de I-EXPLORATION platino. I-EXPLORATION Las I-EXPLORATION soluciones I-EXPLORATION madre I-EXPLORATION utilizadas I-EXPLORATION fueron: I-EXPLORATION cisplatino I-EXPLORATION 1 I-EXPLORATION mg/ml, I-EXPLORATION carboplatino I-EXPLORATION 10 I-EXPLORATION mg/ml I-EXPLORATION y I-EXPLORATION oxaliplatino I-EXPLORATION 5 I-EXPLORATION mg/ml. I-EXPLORATION A I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION éstas, I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION diluciones I-EXPLORATION 1/10000, I-EXPLORATION 1/1000, I-EXPLORATION 1/100 I-EXPLORATION y I-EXPLORATION 1/10 I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION platinos I-EXPLORATION para I-EXPLORATION administración I-EXPLORATION intradérmica. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION cutáneas I-EXPLORATION realizadas I-EXPLORATION con I-EXPLORATION cisplatino I-EXPLORATION fueron I-EXPLORATION positivas I-EXPLORATION para I-EXPLORATION la I-EXPLORATION solución I-EXPLORATION madre I-EXPLORATION y I-EXPLORATION negativas I-EXPLORATION para I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION diluciones. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION demás I-EXPLORATION análogos I-EXPLORATION de I-EXPLORATION platino, I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION resultaron I-EXPLORATION todas I-EXPLORATION negativas, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que, I-TREATMENT se I-TREATMENT decidió I-TREATMENT protocolizar I-TREATMENT una I-TREATMENT pauta I-TREATMENT de I-TREATMENT desensibilización I-TREATMENT para I-TREATMENT la I-TREATMENT administración I-TREATMENT del I-TREATMENT siguiente I-TREATMENT ciclo I-TREATMENT de I-TREATMENT cisplatino. I-TREATMENT I-TREATMENT El I-TREATMENT PD I-TREATMENT consistió I-TREATMENT en I-TREATMENT 12 I-TREATMENT etapas I-TREATMENT para I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT la I-TREATMENT dosis I-TREATMENT total I-TREATMENT del I-TREATMENT fármaco I-TREATMENT (140 I-TREATMENT mg). I-TREATMENT El I-TREATMENT protocolo I-TREATMENT consistió I-TREATMENT en I-TREATMENT ir I-TREATMENT aumentando I-TREATMENT de I-TREATMENT forma I-TREATMENT progresiva I-TREATMENT la I-TREATMENT velocidad I-TREATMENT de I-TREATMENT infusión I-TREATMENT y I-TREATMENT la I-TREATMENT concentración I-TREATMENT del I-TREATMENT fármaco. I-TREATMENT Se I-TREATMENT prepararon I-TREATMENT tres I-TREATMENT soluciones I-TREATMENT de I-TREATMENT las I-TREATMENT siguientes I-TREATMENT diluciones: I-TREATMENT 1/100; I-TREATMENT 1/10 I-TREATMENT y I-TREATMENT 1/1, I-TREATMENT con I-TREATMENT un I-TREATMENT volumen I-TREATMENT total I-TREATMENT de I-TREATMENT 250 I-TREATMENT ml. I-TREATMENT La I-TREATMENT primera I-TREATMENT solución I-TREATMENT se I-TREATMENT utilizó I-TREATMENT en I-TREATMENT los I-TREATMENT cuatro I-TREATMENT primeros I-TREATMENT pasos, I-TREATMENT la I-TREATMENT segunda I-TREATMENT en I-TREATMENT los I-TREATMENT cuatro I-TREATMENT siguientes, I-TREATMENT y I-TREATMENT la I-TREATMENT tercera I-TREATMENT solución I-TREATMENT en I-TREATMENT los I-TREATMENT últimos I-TREATMENT cuatro I-TREATMENT pasos. I-TREATMENT La I-TREATMENT velocidad I-TREATMENT de I-TREATMENT infusión I-TREATMENT se I-TREATMENT incrementó I-TREATMENT cada I-TREATMENT quince I-TREATMENT minutos, I-TREATMENT de I-TREATMENT forma I-TREATMENT que I-TREATMENT con I-TREATMENT cada I-TREATMENT paso I-TREATMENT se I-TREATMENT administraba I-TREATMENT el I-TREATMENT doble I-TREATMENT que I-TREATMENT en I-TREATMENT el I-TREATMENT paso I-TREATMENT anterior. I-TREATMENT En I-TREATMENT el I-TREATMENT último I-TREATMENT paso I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT la I-TREATMENT velocidad I-TREATMENT constante I-TREATMENT hasta I-TREATMENT acabar I-TREATMENT de I-TREATMENT administrar I-TREATMENT la I-TREATMENT dosis I-TREATMENT total. I-TREATMENT En I-TREATMENT la I-TREATMENT tabla I-TREATMENT 1 I-TREATMENT se I-TREATMENT resumen I-TREATMENT las I-TREATMENT soluciones I-TREATMENT y I-TREATMENT el I-TREATMENT esquema I-TREATMENT de I-TREATMENT administración I-TREATMENT del I-TREATMENT protocolo I-TREATMENT de I-TREATMENT desensibilización. I-TREATMENT I-TREATMENT La I-TREATMENT administración I-TREATMENT se I-TREATMENT realizó I-TREATMENT en I-TREATMENT hospital I-TREATMENT de I-TREATMENT día I-TREATMENT bajo I-TREATMENT estrecha I-TREATMENT monitorización I-TREATMENT y I-TREATMENT supervisión I-TREATMENT médica, I-TREATMENT con I-TREATMENT una I-TREATMENT duración I-TREATMENT total I-TREATMENT de I-TREATMENT 5 I-TREATMENT horas I-TREATMENT y I-TREATMENT 37 I-TREATMENT minutos. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION ninguna I-EVOLUTION RHS I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION infusión I-EVOLUTION del I-EVOLUTION citostático I-EVOLUTION mediante I-EVOLUTION el I-EVOLUTION PD I-EVOLUTION ni I-EVOLUTION posteriormente. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY DM I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II, I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY urotelial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vejiga I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY RTU, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY adyuvante I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mitomicina I-PAST_MEDICAL_HISTORY intravesical I-PAST_MEDICAL_HISTORY semanal, I-PAST_MEDICAL_HISTORY seguido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mantenimiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY instilaciones I-PAST_MEDICAL_HISTORY vesicales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mitomicina I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY mensuales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tras B-PRESENT_ILLNESS la I-PRESENT_ILLNESS quinta I-PRESENT_ILLNESS instilación I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mantenimiento, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS una I-PRESENT_ILLNESS dilatación I-PRESENT_ILLNESS uretral, I-PRESENT_ILLNESS asociada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS intensa I-PRESENT_ILLNESS reacción I-PRESENT_ILLNESS cutánea I-PRESENT_ILLNESS genital I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS toxicodermia I-PRESENT_ILLNESS sistémica, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS posible I-PRESENT_ILLNESS reacción I-PRESENT_ILLNESS alérgica I-PRESENT_ILLNESS a I-PRESENT_ILLNESS mitomicina. I-PRESENT_ILLNESS Se B-TREATMENT le I-TREATMENT pautó I-TREATMENT tratamiento I-TREATMENT sintomático I-TREATMENT con I-TREATMENT corticoides, I-TREATMENT siendo B-DERIVED_FROM/TO referido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO dermatología I-DERIVED_FROM/TO del I-DERIVED_FROM/TO hospital, I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realizó I-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO evolución. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Dos B-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION periodo I-EVOLUTION en I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION la I-EVOLUTION erupción I-EVOLUTION había I-EVOLUTION mostrado I-EVOLUTION un I-EVOLUTION progreso I-EVOLUTION favorable, I-EVOLUTION aunque I-EVOLUTION sin I-EVOLUTION llegar I-EVOLUTION a I-EVOLUTION resolverse I-EVOLUTION por I-EVOLUTION completo, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION acudió I-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones, I-EVOLUTION siendo I-EVOLUTION diagnosticado I-EVOLUTION de I-EVOLUTION una I-EVOLUTION sobreinfección I-EVOLUTION de I-EVOLUTION las I-EVOLUTION mismas. I-EVOLUTION Se B-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT sistémico I-TREATMENT de I-TREATMENT forma I-TREATMENT empírica I-TREATMENT (ciprofloxacino I-TREATMENT 500mg I-TREATMENT v.o. I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas), I-TREATMENT asociado I-TREATMENT a I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT corticoides I-TREATMENT tópicos. I-TREATMENT Pese B-EVOLUTION al I-EVOLUTION tratamiento, I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION después I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION acudir I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION eritema I-EVOLUTION con I-EVOLUTION enrojecimiento I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION genital, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION incremento I-EVOLUTION del I-EVOLUTION perímetro I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION miembros I-EVOLUTION inferiores. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION úlcera I-EXPLORATION extensa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION pene I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION escroto, I-EXPLORATION con I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION temperatura I-EXPLORATION local I-EXPLORATION así I-EXPLORATION como I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION necrótica I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pene; I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION edema I-EXPLORATION (con I-EXPLORATION fóvea) I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rodilla. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT valoración I-TREATMENT del I-TREATMENT servicio I-TREATMENT de I-TREATMENT Cirugía I-TREATMENT Plástica, I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT una I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT para I-TREATMENT desbridar I-TREATMENT el I-TREATMENT tejido I-TREATMENT necrotizado. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION se I-EVOLUTION registraron I-EVOLUTION varios I-EVOLUTION picos I-EVOLUTION febriles, I-EVOLUTION siendo B-TREATMENT reintervenido I-TREATMENT en I-TREATMENT varias I-TREATMENT ocasiones I-TREATMENT para I-TREATMENT desbridar I-TREATMENT más I-TREATMENT tejido I-TREATMENT fibrótico-granulomatoso, I-TREATMENT hasta I-TREATMENT albugínea I-TREATMENT testicular I-TREATMENT y I-TREATMENT cuerpos I-TREATMENT cavernosos, I-TREATMENT recibiendo I-TREATMENT curas I-TREATMENT periódicas I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT durante I-TREATMENT un I-TREATMENT mes. I-TREATMENT El B-EXPLORATION cultivo I-EXPLORATION microbiológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION reveló I-EXPLORATION que I-EXPLORATION la I-EXPLORATION sobreinfección I-EXPLORATION se I-EXPLORATION debía I-EXPLORATION a I-EXPLORATION Enterococcus I-EXPLORATION tecalis, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT fosfomicina I-TREATMENT oral I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1.000 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 6 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 24 I-TREATMENT días. I-TREATMENT I-TREATMENT Tras I-TREATMENT la I-TREATMENT resolución I-TREATMENT de I-TREATMENT la I-TREATMENT sobreinfección, I-TREATMENT se I-TREATMENT programó I-TREATMENT una I-TREATMENT cirugía I-TREATMENT plástica I-TREATMENT de I-TREATMENT reconstrucción, I-TREATMENT utilizando I-TREATMENT piel I-TREATMENT sana I-TREATMENT del I-TREATMENT escroto I-TREATMENT para I-TREATMENT cubrir I-TREATMENT las I-TREATMENT zonas I-TREATMENT desprovistas I-TREATMENT en I-TREATMENT pene I-TREATMENT y I-TREATMENT testículos; I-TREATMENT así I-TREATMENT mismo, I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT uretroplastia I-TREATMENT para I-TREATMENT reconstruir I-TREATMENT la I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT uretra I-TREATMENT que I-TREATMENT había I-TREATMENT sido I-TREATMENT dañada. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS HIV+, B-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY (único I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antirretroviral), I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY acude B-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION tos I-EXPLORATION seca, I-EXPLORATION crepitantes I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION bases I-EXPLORATION y I-EXPLORATION febrícula. I-EXPLORATION La B-FAMILY_HISTORY paciente I-FAMILY_HISTORY no I-FAMILY_HISTORY presentó I-FAMILY_HISTORY otros I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY enfermedades I-FAMILY_HISTORY respiratorias I-FAMILY_HISTORY en I-FAMILY_HISTORY familiares I-FAMILY_HISTORY cercanos, I-FAMILY_HISTORY ni I-FAMILY_HISTORY viajes I-FAMILY_HISTORY recientes. I-FAMILY_HISTORY No B-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION adenomegalias, I-EXPLORATION insuficiencia I-EXPLORATION cardiaca I-EXPLORATION o I-EXPLORATION troboembolismo I-EXPLORATION venoso I-EXPLORATION profundo. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION último I-EXPLORATION control, I-EXPLORATION 6 I-EXPLORATION meses I-EXPLORATION previos I-EXPLORATION al I-EXPLORATION ingreso, I-EXPLORATION presentó I-EXPLORATION 49 I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 106/L I-EXPLORATION CD4 I-EXPLORATION (33%) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION de I-EXPLORATION 51.000 I-EXPLORATION copias. I-EXPLORATION Al I-EXPLORATION ingreso, I-EXPLORATION estas I-EXPLORATION cifras I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 129 I-EXPLORATION x I-EXPLORATION 106/L I-EXPLORATION CD4 I-EXPLORATION (16%) I-EXPLORATION y I-EXPLORATION 330.000 I-EXPLORATION copias. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION inicial I-EVOLUTION fue I-EVOLUTION tórpida, I-EVOLUTION con I-EVOLUTION dificultad I-EVOLUTION respiratoria I-EVOLUTION progresiva. I-EVOLUTION La B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION con I-EXPLORATION un I-EXPLORATION patrón I-EXPLORATION reticular-intersticial, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION gammagrafía I-EXPLORATION pulmonar I-EXPLORATION descartó I-EXPLORATION un I-EXPLORATION tromboembolismo I-EXPLORATION pulmonar. I-EXPLORATION Se I-EXPLORATION recogieron I-EXPLORATION muestras I-EXPLORATION de I-EXPLORATION esputo I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION fibrobroncoscopia I-EXPLORATION con I-EXPLORATION lavado I-EXPLORATION broncoalveolar I-EXPLORATION (BAL). I-EXPLORATION Se B-TREATMENT inició I-TREATMENT cotrimoxazol I-TREATMENT + I-TREATMENT levofloxacino I-TREATMENT por I-TREATMENT vía I-TREATMENT intravenosa, I-TREATMENT pero I-TREATMENT ante I-TREATMENT el I-TREATMENT hallazgo I-TREATMENT posterior I-TREATMENT de I-TREATMENT P. I-TREATMENT jirovecii I-TREATMENT en I-TREATMENT el I-TREATMENT BAL, I-TREATMENT se I-TREATMENT retiró I-TREATMENT la I-TREATMENT quinolona. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION antibiótico I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION mejoró I-EVOLUTION notablemente, I-EVOLUTION disminuyó I-EVOLUTION la I-EVOLUTION demanda I-EVOLUTION de I-EVOLUTION O2 I-EVOLUTION y B-TREATMENT en I-TREATMENT el I-TREATMENT sexto I-TREATMENT día I-TREATMENT se I-TREATMENT pasó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT vía I-TREATMENT oral. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 11 I-EVOLUTION días, I-EVOLUTION apareció I-EVOLUTION una I-EVOLUTION erupción I-EVOLUTION cutánea I-EVOLUTION eritematosa I-EVOLUTION en I-EVOLUTION espalda I-EVOLUTION y I-EVOLUTION cuello, I-EVOLUTION no I-EVOLUTION pruriginosa, I-EVOLUTION junto I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION de I-EVOLUTION 39o I-EVOLUTION C. I-EVOLUTION Ante B-TREATMENT el I-TREATMENT cuadro I-TREATMENT sugestivo I-TREATMENT de I-TREATMENT reacción I-TREATMENT alérgica I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT cotrimoxazol I-TREATMENT y I-TREATMENT se I-TREATMENT pasó I-TREATMENT a I-TREATMENT pentamidina I-TREATMENT IV. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT ante I-TREATMENT la I-TREATMENT buena I-TREATMENT evolución I-TREATMENT de I-TREATMENT la I-TREATMENT neumonía I-TREATMENT y I-TREATMENT la I-TREATMENT desaparición I-TREATMENT del I-TREATMENT rash I-TREATMENT y I-TREATMENT la I-TREATMENT fiebre I-TREATMENT a I-TREATMENT las I-TREATMENT 48 I-TREATMENT h, I-TREATMENT se I-TREATMENT valoró I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT administrar I-TREATMENT trimetroprim I-TREATMENT y I-TREATMENT dapsona I-TREATMENT oral, I-TREATMENT como I-TREATMENT alternativa I-TREATMENT a I-TREATMENT cotrimoxazol, I-TREATMENT con I-TREATMENT el I-TREATMENT objetivo I-TREATMENT de I-TREATMENT plantear I-TREATMENT la I-TREATMENT continuación I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT forma I-TREATMENT ambulatoria. I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION la I-EVOLUTION administración I-EVOLUTION de I-EVOLUTION dapsona, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION el I-EVOLUTION rash I-EVOLUTION morbiliforme I-EVOLUTION y B-TREATMENT fiebre, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT retiró I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT oral I-TREATMENT y I-TREATMENT finalizó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT pentamidina I-TREATMENT IV I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 21 I-TREATMENT días. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY ingresado B-PRESENT_ILLNESS a I-PRESENT_ILLNESS raíz I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS hipoglucemia I-PRESENT_ILLNESS severa I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS antidiabéticos I-PRESENT_ILLNESS orales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION presentaba I-EXPLORATION traumatismo I-EXPLORATION con I-EXPLORATION herida I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION tuvo I-EXPLORATION como I-EXPLORATION consecuencia I-EXPLORATION una I-EXPLORATION úlcera I-EXPLORATION por I-EXPLORATION presión I-EXPLORATION talar I-EXPLORATION izquierda I-EXPLORATION diagnosticada I-EXPLORATION como I-EXPLORATION pie I-EXPLORATION diabético. I-EXPLORATION Mediante I-EXPLORATION cultivo I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION era I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION PAMR I-EXPLORATION y I-EXPLORATION SARM. I-EXPLORATION I-EXPLORATION Posteriormente I-EXPLORATION mediante I-EXPLORATION antibiograma I-EXPLORATION se I-EXPLORATION valoró I-EXPLORATION que I-EXPLORATION el I-EXPLORATION PAMR I-EXPLORATION era I-EXPLORATION sensible I-EXPLORATION únicamente I-EXPLORATION a I-EXPLORATION colistina I-EXPLORATION (CMI I-EXPLORATION < I-EXPLORATION 2) I-EXPLORATION e I-EXPLORATION intermedio I-EXPLORATION a I-EXPLORATION amikacina I-EXPLORATION (CMI I-EXPLORATION = I-EXPLORATION 16) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION SARM I-EXPLORATION era I-EXPLORATION sensible I-EXPLORATION entre I-EXPLORATION otros I-EXPLORATION a I-EXPLORATION cotrimoxazol I-EXPLORATION (CMI I-EXPLORATION ≤ I-EXPLORATION 1/19). I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT crema I-TREATMENT de I-TREATMENT colistina I-TREATMENT 0, I-TREATMENT 1% I-TREATMENT con I-TREATMENT una I-TREATMENT aplicación I-TREATMENT diaria I-TREATMENT en I-TREATMENT la I-TREATMENT cura I-TREATMENT y I-TREATMENT además I-TREATMENT se I-TREATMENT administró I-TREATMENT cotrimoxazol I-TREATMENT 800/160mg I-TREATMENT oral I-TREATMENT cada I-TREATMENT doce I-TREATMENT horas I-TREATMENT para I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT del I-TREATMENT SARM. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION úlcera I-EVOLUTION fue I-EVOLUTION favorable. I-EVOLUTION Según B-TREATMENT criterio I-TREATMENT médico, I-TREATMENT se I-TREATMENT finalizó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT tópico I-TREATMENT con I-TREATMENT colistina I-TREATMENT tras I-TREATMENT 23 I-TREATMENT días, I-TREATMENT realizando B-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION úlcera I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 4 I-EXPLORATION días I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION a I-EXPLORATION PAMR, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento. I-TREATMENT La B-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION la I-EVOLUTION úlcera I-EVOLUTION al I-EVOLUTION finalizar I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION tópico I-EVOLUTION con I-EVOLUTION colistina I-EVOLUTION fue I-EVOLUTION notable. I-EVOLUTION Se B-TREATMENT continuó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT al I-TREATMENT persistir I-TREATMENT el I-TREATMENT SARM. I-TREATMENT I-TREATMENT No I-TREATMENT se I-TREATMENT administró I-TREATMENT en I-TREATMENT ninguno I-TREATMENT de I-TREATMENT los I-TREATMENT casos I-TREATMENT tratamiento I-TREATMENT sistémico I-TREATMENT con I-TREATMENT colistina I-TREATMENT intravenosa. I-TREATMENT I-TREATMENT En I-TREATMENT conclusión, I-TREATMENT los I-TREATMENT resultados I-TREATMENT sugieren I-TREATMENT que I-TREATMENT el I-TREATMENT preparado I-TREATMENT de I-TREATMENT colistina I-TREATMENT 0, I-TREATMENT 1% I-TREATMENT elaborado I-TREATMENT por I-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT farmacia I-TREATMENT podría I-TREATMENT ser I-TREATMENT útil I-TREATMENT para I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT úlceras I-TREATMENT infectadas I-TREATMENT por I-TREATMENT PAMR I-TREATMENT negativizando I-TREATMENT el I-TREATMENT cultivo I-TREATMENT del I-TREATMENT exudado I-TREATMENT en I-TREATMENT uno I-TREATMENT de I-TREATMENT los I-TREATMENT casos. I-TREATMENT I-TREATMENT No B-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION disponer I-EVOLUTION de I-EVOLUTION un I-EVOLUTION cultivo I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION en I-EVOLUTION uno I-EVOLUTION de I-EVOLUTION los I-EVOLUTION pacientes, I-EVOLUTION aunque I-EVOLUTION a I-EVOLUTION criterio I-EVOLUTION médico I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION crecimiento I-EVOLUTION de I-EVOLUTION bordes I-EVOLUTION y I-EVOLUTION tejido I-EVOLUTION de I-EVOLUTION granulación, I-EVOLUTION indicativos I-EVOLUTION de I-EVOLUTION mejoría I-EVOLUTION clínica. I-EVOLUTION I-EVOLUTION El I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION casos I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION infección I-EVOLUTION y I-EVOLUTION la I-EVOLUTION falta I-EVOLUTION de I-EVOLUTION información I-EVOLUTION en I-EVOLUTION cuanto I-EVOLUTION a I-EVOLUTION eficacia I-EVOLUTION y I-EVOLUTION resultados I-EVOLUTION plantea I-EVOLUTION la I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION seguir I-EVOLUTION investigando I-EVOLUTION en I-EVOLUTION el I-EVOLUTION campo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION colistina I-EVOLUTION tópica I-EVOLUTION para I-EVOLUTION llegar I-EVOLUTION a I-EVOLUTION conclusiones I-EVOLUTION más I-EVOLUTION sólidas I-EVOLUTION sobre I-EVOLUTION las I-EVOLUTION posibilidades I-EVOLUTION de I-EVOLUTION la I-EVOLUTION utilización I-EVOLUTION de I-EVOLUTION este I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION P. I-EVOLUTION March I-EVOLUTION López1, I-EVOLUTION S. I-EVOLUTION Redondo I-EVOLUTION Capafons2, I-EVOLUTION D. I-EVOLUTION Cruz I-EVOLUTION Guerrero3 I-EVOLUTION y I-EVOLUTION R. I-EVOLUTION Garriga I-EVOLUTION Biosca2 I-EVOLUTION 1Farmacéutico I-EVOLUTION Residente. I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Farmacia. I-EVOLUTION Hospital I-EVOLUTION Universitari I-EVOLUTION Mútua I-EVOLUTION Terrassa I-EVOLUTION (Barcelona). I-EVOLUTION España. I-EVOLUTION 2Farmacéutica I-EVOLUTION Adjunta. I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Farmacia. I-EVOLUTION Hospital I-EVOLUTION Universitari I-EVOLUTION Mútua I-EVOLUTION Terrassa I-EVOLUTION (Barcelona). I-EVOLUTION España. I-EVOLUTION 3Médico I-EVOLUTION Adjunto. I-EVOLUTION Centre I-EVOLUTION Soci-Sanitari I-EVOLUTION Residencia I-EVOLUTION L´Ametlla I-EVOLUTION del I-EVOLUTION Vallés. I-EVOLUTION Fundació I-EVOLUTION Vallparadis. I-EVOLUTION Grup I-EVOLUTION Mútua I-EVOLUTION Terrassa. I-EVOLUTION Terrassa I-EVOLUTION (Barcelona). I-EVOLUTION España. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS segunda I-PRESENT_ILLNESS instilación I-PRESENT_ILLNESS con I-PRESENT_ILLNESS gemcitabina I-PRESENT_ILLNESS intravesical I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS local I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS quemazón I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tenesmo I-PRESENT_ILLNESS vesical I-PRESENT_ILLNESS (grado I-PRESENT_ILLNESS 2) I-PRESENT_ILLNESS 5, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS obligó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS interrupción I-PRESENT_ILLNESS inmediata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS administración, I-PRESENT_ILLNESS persistiendo I-PRESENT_ILLNESS disuria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS suprapúbico I-PRESENT_ILLNESS que B-TREATMENT mejoró I-TREATMENT durante I-TREATMENT las I-TREATMENT 24 I-TREATMENT horas I-TREATMENT siguientes I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT antiinflamatorio I-TREATMENT vía I-TREATMENT oral. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT suspendió I-TREATMENT a I-TREATMENT petición I-TREATMENT del I-TREATMENT paciente. I-TREATMENT Dos I-TREATMENT semanas I-TREATMENT después I-TREATMENT el I-TREATMENT paciente I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT intravesical I-TREATMENT con I-TREATMENT MMC, I-TREATMENT con I-TREATMENT buena I-TREATMENT tolerancia I-TREATMENT tras I-TREATMENT cuatro I-TREATMENT instilaciones. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Neurocirugía I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hematoma I-PRESENT_ILLNESS cerebral I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS rotura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aneurisma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS arteria I-PRESENT_ILLNESS cerebral I-PRESENT_ILLNESS media I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Se B-TREATMENT realiza I-TREATMENT un I-TREATMENT clipaje I-TREATMENT de I-TREATMENT aneurisma I-TREATMENT de I-TREATMENT urgencia I-TREATMENT para I-TREATMENT la I-TREATMENT evacuación I-TREATMENT del I-TREATMENT hematoma I-TREATMENT y I-TREATMENT una I-TREATMENT craniectomía I-TREATMENT frontotemporal I-TREATMENT izquierda I-TREATMENT descompresiva, I-TREATMENT dejándose I-TREATMENT un I-TREATMENT drenaje I-TREATMENT ventricular I-TREATMENT externo. I-TREATMENT Desde B-EVOLUTION el I-EVOLUTION día I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION presenta I-EVOLUTION fiebre I-EVOLUTION persistente, I-EVOLUTION siendo I-EVOLUTION diagnosticada I-EVOLUTION de I-EVOLUTION un I-EVOLUTION posible I-EVOLUTION Síndrome I-EVOLUTION de I-EVOLUTION Respuesta I-EVOLUTION Inflamatoria I-EVOLUTION Sistémica I-EVOLUTION con I-EVOLUTION sospecha I-EVOLUTION de I-EVOLUTION un I-EVOLUTION foco I-EVOLUTION pulmonar, I-EVOLUTION posiblemente I-EVOLUTION por I-EVOLUTION neumonía I-EVOLUTION aspirativa. I-EVOLUTION Recibe B-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT 1.000 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT durante I-TREATMENT 7 I-TREATMENT días I-TREATMENT y I-TREATMENT meropenem I-TREATMENT 1.000 I-TREATMENT mg/8 I-TREATMENT h I-TREATMENT durante I-TREATMENT 14 I-TREATMENT días. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION es I-EVOLUTION diagnosticada I-EVOLUTION de I-EVOLUTION una I-EVOLUTION infección I-EVOLUTION por I-EVOLUTION Enterococcus I-EVOLUTION faecalis I-EVOLUTION de I-EVOLUTION la I-EVOLUTION herida I-EVOLUTION de I-EVOLUTION la I-EVOLUTION craniectomía I-EVOLUTION y B-EXPLORATION 7 I-EXPLORATION días I-EXPLORATION después I-EXPLORATION se I-EXPLORATION le I-EXPLORATION practica I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION nuclear I-EXPLORATION cerebral I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION meningoencefalitis, I-EXPLORATION pese I-EXPLORATION a I-EXPLORATION que I-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION (LCR) I-EXPLORATION son I-EXPLORATION negativos. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT es I-TREATMENT tratada I-TREATMENT con I-TREATMENT vancomicina I-TREATMENT 1.000 I-TREATMENT mg/8 I-TREATMENT h I-TREATMENT y I-TREATMENT cefepima I-TREATMENT 2.000 I-TREATMENT mg/8 I-TREATMENT h I-TREATMENT durante I-TREATMENT 23 I-TREATMENT días. I-TREATMENT A B-EXPLORATION los I-EXPLORATION 45 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION se I-EXPLORATION diagnostica, I-EXPLORATION tras I-EXPLORATION extraer I-EXPLORATION nuevos I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION LCR, I-EXPLORATION una I-EXPLORATION ventriculitis I-EXPLORATION por I-EXPLORATION E. I-EXPLORATION faecalis I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION la I-EXPLORATION derivación I-EXPLORATION externa I-EXPLORATION y I-EXPLORATION es I-EXPLORATION tratada I-EXPLORATION con I-EXPLORATION meropenem I-EXPLORATION 1.000 I-EXPLORATION mg/8 I-EXPLORATION h I-EXPLORATION durante I-EXPLORATION 13 I-EXPLORATION días I-EXPLORATION y I-EXPLORATION ampicilina I-EXPLORATION 2.000 I-EXPLORATION mg/24 I-EXPLORATION h I-EXPLORATION durante I-EXPLORATION 24 I-EXPLORATION días. I-EXPLORATION Tras I-EXPLORATION 59 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION aísla I-EXPLORATION Candida I-EXPLORATION albicans I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION con I-EXPLORATION candidemia I-EXPLORATION asociada I-EXPLORATION y B-TREATMENT se I-TREATMENT añade I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT fluconazol I-TREATMENT 400 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT durante I-TREATMENT 17 I-TREATMENT días. I-TREATMENT I-TREATMENT Los B-EXPLORATION cultivos I-EXPLORATION posteriores I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION y I-EXPLORATION sangre I-EXPLORATION para I-EXPLORATION los I-EXPLORATION patógenos I-EXPLORATION mencionados I-EXPLORATION resultan I-EXPLORATION negativos, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION infiere I-EXPLORATION la I-EXPLORATION resolución I-EXPLORATION de I-EXPLORATION las I-EXPLORATION infecciones I-EXPLORATION previas; I-EXPLORATION sin B-EVOLUTION embargo I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION fiebre I-EVOLUTION elevada I-EVOLUTION y B-EXPLORATION el I-EXPLORATION día I-EXPLORATION +70 I-EXPLORATION se I-EXPLORATION aísla, I-EXPLORATION en I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION las I-EXPLORATION secreciones I-EXPLORATION respiratorias, I-EXPLORATION P. I-EXPLORATION aeruginosa I-EXPLORATION multirresistente, I-EXPLORATION sensible I-EXPLORATION únicamente I-EXPLORATION a I-EXPLORATION ceftazidima I-EXPLORATION (CMI I-EXPLORATION ≤ I-EXPLORATION 4 I-EXPLORATION mg/L) I-EXPLORATION y I-EXPLORATION a I-EXPLORATION colistina I-EXPLORATION (CMI I-EXPLORATION ≤ I-EXPLORATION 2 I-EXPLORATION mg/L) I-EXPLORATION (EUCAST-2012, I-EXPLORATION www.eucast.org). I-EXPLORATION Asimismo, I-EXPLORATION el I-EXPLORATION día I-EXPLORATION +73 I-EXPLORATION se I-EXPLORATION aísla I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION Stenotrophomonas I-EXPLORATION maltophilia, I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION betalactámicos, I-EXPLORATION aminoglucósidos I-EXPLORATION y I-EXPLORATION fluoroquinolonas, I-EXPLORATION sensible I-EXPLORATION solo I-EXPLORATION a I-EXPLORATION cotrimoxazol I-EXPLORATION (CMI I-EXPLORATION ≤ I-EXPLORATION 2/38 I-EXPLORATION mg/L) I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION CMI I-EXPLORATION de I-EXPLORATION colistina I-EXPLORATION ≤ I-EXPLORATION 2 I-EXPLORATION mg/L. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION falta I-EXPLORATION de I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION para I-EXPLORATION este I-EXPLORATION último I-EXPLORATION antimicrobiano I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION S. I-EXPLORATION maltophilia I-EXPLORATION se I-EXPLORATION utilizó I-EXPLORATION el I-EXPLORATION definido I-EXPLORATION por I-EXPLORATION EUCAST I-EXPLORATION para I-EXPLORATION Acinetobacter I-EXPLORATION spp I-EXPLORATION (sensibilidad, I-EXPLORATION ≤ I-EXPLORATION 2 I-EXPLORATION mg/L). I-EXPLORATION Tras B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cotrimoxazol I-TREATMENT iv I-TREATMENT 800/160 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT y I-TREATMENT con I-TREATMENT ceftazidima I-TREATMENT iv I-TREATMENT 2.000 I-TREATMENT mg/8 I-TREATMENT h, I-TREATMENT el I-TREATMENT día I-TREATMENT +75 I-TREATMENT la I-TREATMENT paciente I-TREATMENT continúa I-TREATMENT con I-TREATMENT fiebre, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT plantea I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT rescate I-TREATMENT con I-TREATMENT colistina I-TREATMENT iv I-TREATMENT 2 I-TREATMENT MUI/8 I-TREATMENT h, I-TREATMENT colistina I-TREATMENT intraventricular I-TREATMENT 60.000 I-TREATMENT UI/12 I-TREATMENT h I-TREATMENT y I-TREATMENT cotrimoxazol I-TREATMENT iv I-TREATMENT 1.600/320 I-TREATMENT mg/12 I-TREATMENT h. I-TREATMENT Transcurridos B-EXPLORATION 7 I-EXPLORATION días I-EXPLORATION con I-EXPLORATION dicho I-EXPLORATION tratamiento, I-EXPLORATION el I-EXPLORATION día I-EXPLORATION +82 I-EXPLORATION crece, I-EXPLORATION en I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION LCR, I-EXPLORATION S. I-EXPLORATION maltophilia I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION minociclina I-EXPLORATION (CMI I-EXPLORATION ≤ I-EXPLORATION 4 I-EXPLORATION mg/L, I-EXPLORATION CLSI-2012) I-EXPLORATION y I-EXPLORATION resistente I-EXPLORATION a I-EXPLORATION colistina I-EXPLORATION (CMI I-EXPLORATION > I-EXPLORATION 4 I-EXPLORATION mg/L) I-EXPLORATION 2. I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION confirmación I-EXPLORATION de I-EXPLORATION este I-EXPLORATION valor I-EXPLORATION mediante I-EXPLORATION una I-EXPLORATION tira I-EXPLORATION de I-EXPLORATION gradiente I-EXPLORATION preformado I-EXPLORATION de I-EXPLORATION CMI, I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION que I-EXPLORATION se I-EXPLORATION debe I-EXPLORATION al I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION una I-EXPLORATION subpoblación I-EXPLORATION diferente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mayoritaria. I-EXPLORATION Ante B-TREATMENT esta I-TREATMENT situación I-TREATMENT se I-TREATMENT suspende I-TREATMENT colistina I-TREATMENT y I-TREATMENT se I-TREATMENT administra I-TREATMENT minociclina I-TREATMENT 200 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT por I-TREATMENT sonda I-TREATMENT nasogástrica, I-TREATMENT además I-TREATMENT de I-TREATMENT cotrimoxazol I-TREATMENT iv I-TREATMENT 1.600/320 I-TREATMENT mg/12 I-TREATMENT h. I-TREATMENT Posteriormente, I-TREATMENT ante I-TREATMENT la I-TREATMENT necesidad I-TREATMENT de I-TREATMENT dieta I-TREATMENT absoluta I-TREATMENT como I-TREATMENT consecuencia I-TREATMENT de I-TREATMENT una I-TREATMENT hemorragia I-TREATMENT digestiva, I-TREATMENT el I-TREATMENT día I-TREATMENT +94 I-TREATMENT se I-TREATMENT suspende I-TREATMENT minociclina I-TREATMENT y I-TREATMENT se I-TREATMENT pauta I-TREATMENT tigeciclina I-TREATMENT iv I-TREATMENT 50 I-TREATMENT mg/12 I-TREATMENT h. I-TREATMENT Finalmente B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fallece I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 95 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION por I-EVOLUTION infecciones I-EVOLUTION intercurrentes. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dos/tres I-PAST_MEDICAL_HISTORY cigarrillos/día I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY veinte I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Menarquia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Primer I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Cinco I-PAST_MEDICAL_HISTORY gestaciones I-PAST_MEDICAL_HISTORY (tres I-PAST_MEDICAL_HISTORY cesáreas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY abortos). I-PAST_MEDICAL_HISTORY Uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY anticonceptivos I-PAST_MEDICAL_HISTORY orales I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS diciembre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2013 I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS oncología I-PRESENT_ILLNESS y B-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presenta I-EXPLORATION edema I-EXPLORATION cutáneo I-EXPLORATION que I-EXPLORATION engloba I-EXPLORATION a I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION mama I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION piel I-EXPLORATION tensa, I-EXPLORATION vesiculosa, I-EXPLORATION areola I-EXPLORATION y I-EXPLORATION pezón I-EXPLORATION retraídos, I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION axilares I-EXPLORATION derecha I-EXPLORATION e I-EXPLORATION izquierda I-EXPLORATION dolorosas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION Presenta I-EXPLORATION molestia I-EXPLORATION en I-EXPLORATION mama I-EXPLORATION derecha, I-EXPLORATION zona I-EXPLORATION costal I-EXPLORATION y I-EXPLORATION submamaria. I-EXPLORATION ECOG I-EXPLORATION 2 I-EXPLORATION como I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizaron I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION necesarias I-EXPLORATION para I-EXPLORATION determinar I-EXPLORATION el I-EXPLORATION estadio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neoplasia. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION presentó I-EXPLORATION Fe: I-EXPLORATION 26 I-EXPLORATION μg/dL I-EXPLORATION (RN: I-EXPLORATION 50-170 I-EXPLORATION μg/dL), I-EXPLORATION IST: I-EXPLORATION 9% I-EXPLORATION (RN: I-EXPLORATION 25-50 I-EXPLORATION %). I-EXPLORATION Ca I-EXPLORATION 15 I-EXPLORATION 3: I-EXPLORATION 92, I-EXPLORATION 2 I-EXPLORATION UI/mL I-EXPLORATION (RN: I-EXPLORATION < I-EXPLORATION 32, I-EXPLORATION 4 I-EXPLORATION UI/mL) I-EXPLORATION con I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION hemograma I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION BAG I-EXPLORATION (biopsia I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION gruesa), I-EXPLORATION Punch I-EXPLORATION cutáneo I-EXPLORATION y I-EXPLORATION Hercep I-EXPLORATION Test®: I-EXPLORATION positivo I-EXPLORATION (HER I-EXPLORATION 2 I-EXPLORATION +). I-EXPLORATION El I-EXPLORATION PET-TAC I-EXPLORATION describió I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION tumoral I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mama I-EXPLORATION derecha, I-EXPLORATION en I-EXPLORATION adenopatías I-EXPLORATION axilares I-EXPLORATION derechas I-EXPLORATION e I-EXPLORATION izquierda, I-EXPLORATION adenopatía I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION mamaria I-EXPLORATION interna I-EXPLORATION derecha, I-EXPLORATION en I-EXPLORATION vértebras I-EXPLORATION óseas I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION inferior I-EXPLORATION (VI) I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION derecho I-EXPLORATION hepático. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION lo I-EXPLORATION tanto I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION fue I-EXPLORATION diagnosticada I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION ductal I-EXPLORATION infiltrante I-EXPLORATION G2 I-EXPLORATION cT4d I-EXPLORATION cN1 I-EXPLORATION M1 I-EXPLORATION (óseas, I-EXPLORATION ganglionares I-EXPLORATION y I-EXPLORATION hepáticas) I-EXPLORATION estadio I-EXPLORATION IV, I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION mamario I-EXPLORATION y I-EXPLORATION ferropenia, I-EXPLORATION secundarios I-EXPLORATION a I-EXPLORATION su I-EXPLORATION enfermedad I-EXPLORATION principal. I-EXPLORATION Como B-TREATMENT terapia I-TREATMENT de I-TREATMENT elección I-TREATMENT se I-TREATMENT propuso I-TREATMENT pertuzumab I-TREATMENT para I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT del I-TREATMENT CM I-TREATMENT HER2 I-TREATMENT + I-TREATMENT metastásico I-TREATMENT o I-TREATMENT localmente I-TREATMENT recurrente I-TREATMENT no I-TREATMENT resecable, I-TREATMENT en I-TREATMENT combinación I-TREATMENT con I-TREATMENT trastuzumab I-TREATMENT y I-TREATMENT docetaxel4. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION para I-EXPLORATION la I-EXPLORATION monitorización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION función I-EXPLORATION cardíaca I-EXPLORATION con I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION FEVI I-EXPLORATION 63, I-EXPLORATION 9% I-EXPLORATION normal, I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION podía I-EXPLORATION verse I-EXPLORATION afectada I-EXPLORATION por I-EXPLORATION trastuzumab I-EXPLORATION y I-EXPLORATION pertuzumab, I-EXPLORATION y I-EXPLORATION RMN I-EXPLORATION (resonancia I-EXPLORATION magnética I-EXPLORATION nuclear) I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION metástasis I-EXPLORATION cerebrales I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION se I-EXPLORATION considera I-EXPLORATION un I-EXPLORATION criterio I-EXPLORATION para I-EXPLORATION excluir I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION del I-EXPLORATION beneficio I-EXPLORATION de I-EXPLORATION pertuzumab. I-EXPLORATION I-EXPLORATION El B-TREATMENT esquema I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT planteado I-TREATMENT fue: I-TREATMENT pertuzumab I-TREATMENT 840mg I-TREATMENT (inicio) I-TREATMENT /420 I-TREATMENT mg I-TREATMENT (mantenimiento), I-TREATMENT trastuzumab I-TREATMENT 8mg/kg I-TREATMENT (inicio) I-TREATMENT /6mg/kg I-TREATMENT (mantenimiento), I-TREATMENT docetaxel I-TREATMENT 75mg/m2, I-TREATMENT cada I-TREATMENT 21 I-TREATMENT días5. I-TREATMENT Las I-TREATMENT dosis I-TREATMENT de I-TREATMENT antineoplásicos I-TREATMENT fueron I-TREATMENT calculadas I-TREATMENT según I-TREATMENT peso I-TREATMENT (88kg) I-TREATMENT y I-TREATMENT superficie I-TREATMENT corporal I-TREATMENT (1, I-TREATMENT 95 I-TREATMENT m2). I-TREATMENT El I-TREATMENT inicio I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT fue I-TREATMENT interrumpido I-TREATMENT por I-TREATMENT una I-TREATMENT reacción I-TREATMENT inmediata I-TREATMENT sistémica I-TREATMENT a I-TREATMENT la I-TREATMENT infusión I-TREATMENT de I-TREATMENT docetaxel I-TREATMENT con I-TREATMENT presencia I-TREATMENT de I-TREATMENT disnea I-TREATMENT y I-TREATMENT mareos I-TREATMENT que I-TREATMENT precisó I-TREATMENT paracetamol, I-TREATMENT hidrocortisona, I-TREATMENT lorazepam I-TREATMENT y I-TREATMENT posterior I-TREATMENT valoración I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Alergia I-TREATMENT que I-TREATMENT pautó I-TREATMENT un I-TREATMENT protocolo I-TREATMENT de I-TREATMENT desensibilización I-TREATMENT para I-TREATMENT administrar I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT docetaxel. I-TREATMENT La I-TREATMENT paciente I-TREATMENT ingresó I-TREATMENT en I-TREATMENT UCI I-TREATMENT de I-TREATMENT forma I-TREATMENT programada I-TREATMENT al I-TREATMENT día I-TREATMENT siguiente I-TREATMENT para I-TREATMENT su I-TREATMENT administración I-TREATMENT y I-TREATMENT completar I-TREATMENT así I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT QT. I-TREATMENT I-TREATMENT Para I-TREATMENT la I-TREATMENT pauta I-TREATMENT de I-TREATMENT desensibilización I-TREATMENT se I-TREATMENT utilizaron I-TREATMENT tres I-TREATMENT soluciones I-TREATMENT del I-TREATMENT medicamento I-TREATMENT (cada I-TREATMENT una I-TREATMENT de I-TREATMENT 250 I-TREATMENT mL I-TREATMENT ClNa I-TREATMENT 0, I-TREATMENT 9%): I-TREATMENT A, I-TREATMENT B I-TREATMENT y I-TREATMENT C I-TREATMENT que I-TREATMENT se I-TREATMENT administraron I-TREATMENT en I-TREATMENT doce I-TREATMENT pasos I-TREATMENT consecutivos I-TREATMENT con I-TREATMENT aumento I-TREATMENT de I-TREATMENT la I-TREATMENT velocidad I-TREATMENT de I-TREATMENT infusión. I-TREATMENT La I-TREATMENT solución I-TREATMENT A I-TREATMENT contenía I-TREATMENT una I-TREATMENT dilución I-TREATMENT 1/100 I-TREATMENT de I-TREATMENT la I-TREATMENT concentración I-TREATMENT objetivo I-TREATMENT final I-TREATMENT (pasos I-TREATMENT 1-4) I-TREATMENT y I-TREATMENT la I-TREATMENT solución I-TREATMENT B I-TREATMENT una I-TREATMENT dilución I-TREATMENT 1/10 I-TREATMENT de I-TREATMENT la I-TREATMENT concentración I-TREATMENT objetivo I-TREATMENT final I-TREATMENT (pasos I-TREATMENT 5-8). I-TREATMENT De I-TREATMENT la I-TREATMENT solución I-TREATMENT C I-TREATMENT (150 I-TREATMENT mg/250 I-TREATMENT mL) I-TREATMENT se I-TREATMENT administró I-TREATMENT la I-TREATMENT dosis I-TREATMENT restante, I-TREATMENT que I-TREATMENT fue I-TREATMENT calculada I-TREATMENT restando I-TREATMENT la I-TREATMENT dosis I-TREATMENT acumulada I-TREATMENT a I-TREATMENT la I-TREATMENT dosis I-TREATMENT total I-TREATMENT que I-TREATMENT había I-TREATMENT que I-TREATMENT administrar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente. I-TREATMENT Cada I-TREATMENT uno I-TREATMENT de I-TREATMENT los I-TREATMENT pasos I-TREATMENT 1 I-TREATMENT a I-TREATMENT 11 I-TREATMENT se I-TREATMENT administró I-TREATMENT en I-TREATMENT 15 I-TREATMENT minutos I-TREATMENT (la I-TREATMENT dosis I-TREATMENT se I-TREATMENT incrementó I-TREATMENT en I-TREATMENT un I-TREATMENT 2 I-TREATMENT - I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT veces I-TREATMENT con I-TREATMENT cada I-TREATMENT paso) I-TREATMENT y I-TREATMENT el I-TREATMENT paso I-TREATMENT 12 I-TREATMENT se I-TREATMENT prolongó I-TREATMENT para I-TREATMENT completar I-TREATMENT la I-TREATMENT dosis I-TREATMENT objetivo I-TREATMENT de I-TREATMENT 150 I-TREATMENT mg. I-TREATMENT El I-TREATMENT tiempo I-TREATMENT total I-TREATMENT de I-TREATMENT desensibilización I-TREATMENT fue I-TREATMENT de I-TREATMENT 5, I-TREATMENT 8 I-TREATMENT horas. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION respuesta I-EVOLUTION parcial I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION ciclo I-EVOLUTION con I-EVOLUTION evidente I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION mama I-EVOLUTION afectada I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION su I-EVOLUTION volumen I-EVOLUTION sin I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION del I-EVOLUTION aspecto I-EVOLUTION necrótico I-EVOLUTION previo. I-EVOLUTION Tras B-EXPLORATION el I-EXPLORATION sexto I-EXPLORATION ciclo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION PET-TAC I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION actividad I-EXPLORATION metabólica I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mama I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION axilares, I-EXPLORATION como I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION óseo I-EXPLORATION y I-EXPLORATION hepático, I-EXPLORATION con I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION muy I-EXPLORATION buena I-EXPLORATION respuesta I-EXPLORATION metabólica I-EXPLORATION y I-EXPLORATION funcional I-EXPLORATION al I-EXPLORATION tratamiento. I-EXPLORATION Actualmente B-EVOLUTION tras I-EVOLUTION el I-EVOLUTION octavo I-EVOLUTION ciclo I-EVOLUTION no I-EVOLUTION presenta I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS Kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS ADPV, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hepatopatía I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS por I-PRESENT_ILLNESS VHC I-PRESENT_ILLNESS (genotipo I-PRESENT_ILLNESS 1a, I-PRESENT_ILLNESS polimorfismo I-PRESENT_ILLNESS IL-B28 I-PRESENT_ILLNESS CC), I-PRESENT_ILLNESS fibrosis I-PRESENT_ILLNESS grado I-PRESENT_ILLNESS F4 I-PRESENT_ILLNESS (Fibroscan I-PRESENT_ILLNESS 36, I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS KPa), I-PRESENT_ILLNESS carga I-PRESENT_ILLNESS viral I-PRESENT_ILLNESS (CV) I-PRESENT_ILLNESS 14.440 I-PRESENT_ILLNESS UI I-PRESENT_ILLNESS RNA/ml, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS datos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipertensión I-PRESENT_ILLNESS portal, I-PRESENT_ILLNESS probable I-PRESENT_ILLNESS esteatohepatitis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS mixto, I-PRESENT_ILLNESS Child I-PRESENT_ILLNESS A5 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS elevación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alfafetoproteína. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacan I-PAST_MEDICAL_HISTORY hemocromatosis I-PAST_MEDICAL_HISTORY (mutación I-PAST_MEDICAL_HISTORY H63D I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY heterocigosis) I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sobrecarga I-PAST_MEDICAL_HISTORY férrica I-PAST_MEDICAL_HISTORY controlada I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY realización I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sangrías, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY insulina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY metformina, I-PAST_MEDICAL_HISTORY esofagitis I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pequeño I-PAST_MEDICAL_HISTORY cordón I-PAST_MEDICAL_HISTORY varicoso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ansiedad. I-PAST_MEDICAL_HISTORY En B-EXPLORATION los I-EXPLORATION datos I-EXPLORATION analíticos I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION valores: I-EXPLORATION Hemoglobina I-EXPLORATION 13, I-EXPLORATION 2 I-EXPLORATION g/dl, I-EXPLORATION Hematocrito I-EXPLORATION 39, I-EXPLORATION 3%, I-EXPLORATION Leucocitos I-EXPLORATION 6070, I-EXPLORATION Plaquetas I-EXPLORATION 90000, I-EXPLORATION INR I-EXPLORATION 1, I-EXPLORATION 04, I-EXPLORATION Creatinina I-EXPLORATION 0, I-EXPLORATION 9 I-EXPLORATION mg/dl, I-EXPLORATION Bilirrubina I-EXPLORATION total I-EXPLORATION 1, I-EXPLORATION 4 I-EXPLORATION mg/dl, I-EXPLORATION Albúmina I-EXPLORATION 3, I-EXPLORATION 1 I-EXPLORATION g/dl, I-EXPLORATION ASAT I-EXPLORATION 106 I-EXPLORATION UI/L, I-EXPLORATION ALAT I-EXPLORATION 108 I-EXPLORATION UI/L, I-EXPLORATION Fosfatasa I-EXPLORATION alcalina I-EXPLORATION 144 I-EXPLORATION UI/L, I-EXPLORATION Gamma-GT I-EXPLORATION 553 I-EXPLORATION UI/L I-EXPLORATION y I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION MELD I-EXPLORATION (Model I-EXPLORATION for I-EXPLORATION End I-EXPLORATION Stage I-EXPLORATION Liver I-EXPLORATION Disease) I-EXPLORATION de I-EXPLORATION 8. I-EXPLORATION I-EXPLORATION Respondedor B-TREATMENT nulo I-TREATMENT a I-TREATMENT IFN I-TREATMENT en I-TREATMENT monoterapia I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT a I-TREATMENT P-INF I-TREATMENT asociado I-TREATMENT a I-TREATMENT RBV I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT es I-TREATMENT candidato I-TREATMENT a I-TREATMENT triple I-TREATMENT terapia I-TREATMENT con I-TREATMENT boceprevir. I-TREATMENT Inicia I-TREATMENT lead I-TREATMENT in I-TREATMENT con I-TREATMENT RBV I-TREATMENT oral I-TREATMENT 1000 I-TREATMENT mg/día I-TREATMENT y I-TREATMENT P-INF I-TREATMENT α2b I-TREATMENT subcutáneo I-TREATMENT 120 I-TREATMENT mcg/semana. I-TREATMENT No I-TREATMENT superó I-TREATMENT la I-TREATMENT fase I-TREATMENT de I-TREATMENT lead I-TREATMENT in I-TREATMENT (CV=33.680 I-TREATMENT UI I-TREATMENT RNA/ml), I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT la I-TREATMENT 5a I-TREATMENT semana, I-TREATMENT sin I-TREATMENT haber I-TREATMENT iniciado I-TREATMENT boceprevir. I-TREATMENT I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION última I-EVOLUTION inyección I-EVOLUTION de I-EVOLUTION P-INF I-EVOLUTION α2b I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION objetivando I-EVOLUTION hematoma I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION local I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION anterior I-EVOLUTION del I-EVOLUTION muslo I-EVOLUTION derecho I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION y I-EVOLUTION temperatura I-EVOLUTION local, I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION al I-EVOLUTION mover I-EVOLUTION la I-EVOLUTION cadera I-EVOLUTION derecha, I-EVOLUTION administrándose I-EVOLUTION analgésicos I-EVOLUTION y I-EVOLUTION antibióticos I-EVOLUTION (amoxicilina-clavulánico I-EVOLUTION 1g/62, I-EVOLUTION 5mg/8 I-EVOLUTION horas I-EVOLUTION oral). I-EVOLUTION Dos I-EVOLUTION días I-EVOLUTION después I-EVOLUTION regresó I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION presentando I-EVOLUTION impotencia I-EVOLUTION funcional I-EVOLUTION y I-EVOLUTION sensación I-EVOLUTION distérmica. I-EVOLUTION Mediante B-EXPLORATION ecografía I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION hipoecogénica I-EXPLORATION ovoidea I-EXPLORATION de I-EXPLORATION 21x19x9 I-EXPLORATION mm. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION infección I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION absceso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION musculo I-EXPLORATION abductor I-EXPLORATION largo I-EXPLORATION del I-EXPLORATION muslo I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION inferiormente I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION compartimento I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION medio I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT antibióticos I-TREATMENT (piperacilina/tazobactam I-TREATMENT 4g/0, I-TREATMENT 5g/8 I-TREATMENT horas I-TREATMENT y I-TREATMENT daptomicina I-TREATMENT 500mg/24 I-TREATMENT horas I-TREATMENT intravenosos, I-TREATMENT durante I-TREATMENT 3 I-TREATMENT días) I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT desbridamiento I-TREATMENT quirúrgico. I-TREATMENT Tras B-EVOLUTION una I-EVOLUTION cirugía I-EVOLUTION con I-EVOLUTION complicaciones, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION ingresó I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidados I-EVOLUTION intensivos I-EVOLUTION (UCI). I-EVOLUTION I-EVOLUTION En I-EVOLUTION UCI I-EVOLUTION presentó I-EVOLUTION shock I-EVOLUTION séptico I-EVOLUTION complicado I-EVOLUTION con I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION disfunción I-EVOLUTION multiorgánica. I-EVOLUTION En B-EXPLORATION los I-EXPLORATION cultivos I-EXPLORATION del I-EXPLORATION absceso I-EXPLORATION muscular I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION Staphylococcus I-EXPLORATION aureus I-EXPLORATION meticilin-sensible, I-EXPLORATION que B-TREATMENT se I-TREATMENT trató I-TREATMENT con I-TREATMENT linezolid I-TREATMENT (600mg/12 I-TREATMENT horas I-TREATMENT intravenoso) I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT con I-TREATMENT cloxacilina I-TREATMENT (1g/6 I-TREATMENT horas I-TREATMENT intravenoso) I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días. I-TREATMENT I-TREATMENT Posteriormente B-EVOLUTION desarrolló I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION distress I-EVOLUTION respiratorio I-EVOLUTION agudo I-EVOLUTION que B-TREATMENT precisó I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasiva; I-TREATMENT neumonía B-EVOLUTION por I-EVOLUTION Escherichia I-EVOLUTION Coli I-EVOLUTION asociada I-EVOLUTION a I-EVOLUTION ventilación I-EVOLUTION mecánica I-EVOLUTION que I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION con B-TREATMENT meropenem I-TREATMENT (1000mg/8 I-TREATMENT horas I-TREATMENT intravenoso) I-TREATMENT y I-TREATMENT levofloxacino I-TREATMENT (500 I-TREATMENT mg/24 I-TREATMENT horas I-TREATMENT intravenoso) I-TREATMENT durante I-TREATMENT 10 I-TREATMENT días; I-TREATMENT insuficiencia B-EVOLUTION renal I-EVOLUTION (IR) I-EVOLUTION con I-EVOLUTION oliguria I-EVOLUTION que B-TREATMENT requirió I-TREATMENT hemofiltración I-TREATMENT venosa I-TREATMENT continua; I-TREATMENT anemia B-EVOLUTION y I-EVOLUTION trombopenia I-EVOLUTION graves I-EVOLUTION que B-TREATMENT requirieron I-TREATMENT transfusiones I-TREATMENT de I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes I-TREATMENT y I-TREATMENT plaquetas; I-TREATMENT hiperfosfatemia; B-EVOLUTION hiperglucemia I-EVOLUTION que B-TREATMENT requirió I-TREATMENT perfusión I-TREATMENT de I-TREATMENT insulina; I-TREATMENT colonización B-EVOLUTION por I-EVOLUTION Candida I-EVOLUTION Albicans I-EVOLUTION en I-EVOLUTION orina, I-EVOLUTION secreciones I-EVOLUTION y I-EVOLUTION heces; I-EVOLUTION hemorragia I-EVOLUTION digestiva I-EVOLUTION alta I-EVOLUTION (HDA) I-EVOLUTION y I-EVOLUTION melenas; I-EVOLUTION varices I-EVOLUTION esofágicas I-EVOLUTION grado I-EVOLUTION III I-EVOLUTION que I-EVOLUTION no I-EVOLUTION mostraban I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION sangrado I-EVOLUTION activo I-EVOLUTION pero B-TREATMENT que I-TREATMENT requirieron I-TREATMENT ligadura I-TREATMENT con I-TREATMENT bandas I-TREATMENT elásticas I-TREATMENT y I-TREATMENT aumento I-TREATMENT transitorio I-TREATMENT de I-TREATMENT enzimas I-TREATMENT hepáticas I-TREATMENT y I-TREATMENT bilirrubina I-TREATMENT (17, I-TREATMENT 2 I-TREATMENT mg/dL). I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION continuó I-EVOLUTION con I-EVOLUTION deterioro I-EVOLUTION gasométrico I-EVOLUTION y I-EVOLUTION radiológico, I-EVOLUTION con I-EVOLUTION infiltrados I-EVOLUTION alveolo-intersticiales I-EVOLUTION basales I-EVOLUTION y I-EVOLUTION bilaterales I-EVOLUTION en I-EVOLUTION los I-EVOLUTION que I-EVOLUTION se I-EVOLUTION aisló I-EVOLUTION Klebsiella I-EVOLUTION Pneumoniae I-EVOLUTION productora I-EVOLUTION de I-EVOLUTION betalactamasas I-EVOLUTION de I-EVOLUTION amplio I-EVOLUTION espectro I-EVOLUTION sensible I-EVOLUTION a I-EVOLUTION colistina. I-EVOLUTION A I-EVOLUTION pesar I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION dirigido I-EVOLUTION (colistina I-EVOLUTION intravenosa I-EVOLUTION e I-EVOLUTION inhalada I-EVOLUTION ajustada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal) I-EVOLUTION durante I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION más, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION insuficiencia I-EVOLUTION respiratoria I-EVOLUTION aguda I-EVOLUTION grave, I-EVOLUTION disfunción I-EVOLUTION multiorgánica I-EVOLUTION con I-EVOLUTION acidosis I-EVOLUTION láctica I-EVOLUTION grave I-EVOLUTION y I-EVOLUTION shock I-EVOLUTION séptico I-EVOLUTION refractario I-EVOLUTION siendo I-EVOLUTION finalmente I-EVOLUTION exitus. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumadora, B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas I-PAST_MEDICAL_HISTORY conocidas, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon I-PAST_MEDICAL_HISTORY irritable, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY depresivo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY migrañas, I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuello I-PAST_MEDICAL_HISTORY uterino I-PAST_MEDICAL_HISTORY aparentemente I-PAST_MEDICAL_HISTORY localizado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY julio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2012. I-PAST_MEDICAL_HISTORY Se B-TREATMENT realizó I-TREATMENT histerectomía, I-TREATMENT doble I-TREATMENT annexectomía I-TREATMENT y I-TREATMENT estadificación I-TREATMENT ganglionar I-TREATMENT quirúrgica I-TREATMENT retroperitoneal. I-TREATMENT La B-EXPLORATION estadificación I-EXPLORATION final I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION pT3N1 I-EXPLORATION (ganglios I-EXPLORATION pélvicos). I-EXPLORATION A B-TREATMENT continuación I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT cisplatino I-TREATMENT (40 I-TREATMENT mg/m2 I-TREATMENT semanales) I-TREATMENT concomitante I-TREATMENT a I-TREATMENT radioterapia. I-TREATMENT Por I-TREATMENT alta I-TREATMENT probabilidad I-TREATMENT de I-TREATMENT recaída I-TREATMENT recibió I-TREATMENT posteriormente I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT el I-TREATMENT esquema I-TREATMENT carboplatino I-TREATMENT (5 I-TREATMENT mg/AUC) I-TREATMENT y I-TREATMENT paclitaxel I-TREATMENT (175 I-TREATMENT mg/m2), I-TREATMENT recibiendo I-TREATMENT cinco I-TREATMENT ciclos I-TREATMENT en I-TREATMENT total I-TREATMENT con I-TREATMENT varias I-TREATMENT reducciones I-TREATMENT de I-TREATMENT dosis I-TREATMENT por I-TREATMENT diferentes I-TREATMENT toxicidades I-TREATMENT (plaquetopenia I-TREATMENT grado I-TREATMENT IV, I-TREATMENT oclusión I-TREATMENT intestinal I-TREATMENT y I-TREATMENT neurotoxicidad I-TREATMENT grado I-TREATMENT II). I-TREATMENT Permaneció B-EVOLUTION libre I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION hasta I-EVOLUTION octubre I-EVOLUTION de I-EVOLUTION 2014, I-EVOLUTION fecha I-EVOLUTION en I-EVOLUTION la I-EVOLUTION que I-EVOLUTION se I-EVOLUTION detecta I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION de I-EVOLUTION implantes I-EVOLUTION peritoneales I-EVOLUTION e I-EVOLUTION implantes I-EVOLUTION metastásicos I-EVOLUTION esplénicos. I-EVOLUTION Inicia B-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT con I-TREATMENT el I-TREATMENT esquema I-TREATMENT bevacizumab I-TREATMENT (15 I-TREATMENT mg/kg), I-TREATMENT cisplatino I-TREATMENT (50 I-TREATMENT mg/m2) I-TREATMENT y I-TREATMENT paclitaxel I-TREATMENT (175 I-TREATMENT mg/m2), I-TREATMENT cada I-TREATMENT 21 I-TREATMENT días. I-TREATMENT El B-EVOLUTION día I-EVOLUTION posterior I-EVOLUTION a I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION administración I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION con I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION agudo I-EVOLUTION y I-EVOLUTION náuseas I-EVOLUTION sin I-EVOLUTION vómitos, I-EVOLUTION no I-EVOLUTION presentado I-EVOLUTION fiebre. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION detecta I-EXPLORATION abdomen I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION diseminado I-EXPLORATION tanto I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION superficial I-EXPLORATION como I-EXPLORATION profundo, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION peritonismo. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION perforación I-EXPLORATION de I-EXPLORATION implante I-EXPLORATION peritoneal I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION sigma, I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION burbujas I-EXPLORATION aéreas I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION superior I-EXPLORATION e I-EXPLORATION inferior, I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION fecaloidea. I-EXPLORATION Se B-TREATMENT procede I-TREATMENT a I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT urgente I-TREATMENT (sigmoidectomía I-TREATMENT y I-TREATMENT colostomía I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT ciego). I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS LLC I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS B I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS evidencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS progresión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS años I-PRESENT_ILLNESS después I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS y I-PRESENT_ILLNESS progresión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS inguinales, I-PRESENT_ILLNESS axiales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cervicales. I-PRESENT_ILLNESS Recibe B-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT con I-TREATMENT el I-TREATMENT esquema I-TREATMENT rituximab I-TREATMENT (375 I-TREATMENT mg/m2 I-TREATMENT IV I-TREATMENT de I-TREATMENT inicio, I-TREATMENT 500 I-TREATMENT mg/m2 I-TREATMENT IV I-TREATMENT dosis I-TREATMENT sucesivas), I-TREATMENT fludarabina I-TREATMENT (25 I-TREATMENT mg/m2 I-TREATMENT IV) I-TREATMENT y I-TREATMENT ciclofosfamida I-TREATMENT (250 I-TREATMENT mg/m2 I-TREATMENT i.v.), I-TREATMENT alcanzando I-TREATMENT remisión I-TREATMENT parcial I-TREATMENT con I-TREATMENT persistencia I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad, I-TREATMENT presencia I-TREATMENT de I-TREATMENT cariotipo I-TREATMENT complejo I-TREATMENT y I-TREATMENT aparición I-TREATMENT de I-TREATMENT deleción I-TREATMENT del I-TREATMENT gen I-TREATMENT p53. I-TREATMENT Por I-TREATMENT estas I-TREATMENT características I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT idelalisib I-TREATMENT (150 I-TREATMENT mg/12 I-TREATMENT horas I-TREATMENT v.o.) I-TREATMENT combinado I-TREATMENT con I-TREATMENT rituximab I-TREATMENT (dosis I-TREATMENT inicial I-TREATMENT de I-TREATMENT 375 I-TREATMENT mg/m2 I-TREATMENT IV, I-TREATMENT dosis I-TREATMENT posteriores I-TREATMENT de I-TREATMENT 500 I-TREATMENT mg/m2 I-TREATMENT IV). I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION ingresa I-EVOLUTION por I-EVOLUTION diarrea I-EVOLUTION líquida I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION evolución, I-EVOLUTION con I-EVOLUTION 7-8 I-EVOLUTION deposiciones I-EVOLUTION al I-EVOLUTION día, I-EVOLUTION sin I-EVOLUTION productos I-EVOLUTION patológicos, I-EVOLUTION acompañada I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION mesogástrico I-EVOLUTION continuo I-EVOLUTION que I-EVOLUTION cede I-EVOLUTION parcialmente I-EVOLUTION con I-EVOLUTION la I-EVOLUTION deposición, I-EVOLUTION con I-EVOLUTION febrícula I-EVOLUTION pero I-EVOLUTION sin I-EVOLUTION náuseas I-EVOLUTION ni I-EVOLUTION vómitos. I-EVOLUTION Los B-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION coprocultivos I-EXPLORATION y I-EXPLORATION hemocultivos I-EXPLORATION realizados I-EXPLORATION son I-EXPLORATION negativos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION ascendente I-EXPLORATION de I-EXPLORATION calibre I-EXPLORATION aumentado, I-EXPLORATION engrosamiento I-EXPLORATION mural I-EXPLORATION y I-EXPLORATION realce I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION colitis I-EXPLORATION inflamatoria. I-EXPLORATION Se I-EXPLORATION suspende I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION idelalisib I-EXPLORATION y I-EXPLORATION se I-EXPLORATION inicia I-EXPLORATION sueroterapia I-EXPLORATION y I-EXPLORATION analgesia. I-EXPLORATION Evoluciona B-TREATMENT con I-TREATMENT pico I-TREATMENT febril I-TREATMENT y I-TREATMENT deterioro I-TREATMENT general, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT añade I-TREATMENT ciprofloxacino I-TREATMENT (400 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT IV), I-TREATMENT sustituyéndose I-TREATMENT posteriormente I-TREATMENT por I-TREATMENT piperacilina/tazobactam I-TREATMENT (4 I-TREATMENT g/6 I-TREATMENT h I-TREATMENT IV). I-TREATMENT I-TREATMENT Como B-EVOLUTION complicaciones I-EVOLUTION derivadas I-EVOLUTION del I-EVOLUTION ingreso, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION desarrolla I-EVOLUTION un I-EVOLUTION neumotórax I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION canalización I-EVOLUTION de I-EVOLUTION una I-EVOLUTION vía I-EVOLUTION central I-EVOLUTION y, I-EVOLUTION durante I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION en I-EVOLUTION UCI, I-EVOLUTION presenta I-EVOLUTION diarrea I-EVOLUTION cuantiosa I-EVOLUTION con I-EVOLUTION alteraciones I-EVOLUTION hidroelectrolíticas I-EVOLUTION que I-EVOLUTION requieren I-EVOLUTION reposición I-EVOLUTION volémica I-EVOLUTION y I-EVOLUTION electrolítica I-EVOLUTION y I-EVOLUTION aporte I-EVOLUTION de I-EVOLUTION nutrición I-EVOLUTION parenteral. I-EVOLUTION I-EVOLUTION A B-TREATMENT la I-TREATMENT semana I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT se I-TREATMENT origina I-TREATMENT alteración I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT renal I-TREATMENT y, I-TREATMENT debido I-TREATMENT al I-TREATMENT deterioro I-TREATMENT clínico I-TREATMENT a I-TREATMENT nivel I-TREATMENT digestivo, I-TREATMENT recibe I-TREATMENT corticoides I-TREATMENT (budesónida I-TREATMENT 9 I-TREATMENT mg/24 I-TREATMENT h I-TREATMENT VO I-TREATMENT que I-TREATMENT es I-TREATMENT sustituida I-TREATMENT por I-TREATMENT metilprednisolona I-TREATMENT 60 I-TREATMENT mg/24 I-TREATMENT h I-TREATMENT IV I-TREATMENT por I-TREATMENT persistencia I-TREATMENT de I-TREATMENT la I-TREATMENT diarrea) I-TREATMENT y I-TREATMENT rifaximina I-TREATMENT (200 I-TREATMENT mg/6 I-TREATMENT h I-TREATMENT VO). I-TREATMENT Tras B-EVOLUTION siete I-EVOLUTION días I-EVOLUTION con I-EVOLUTION corticoides I-EVOLUTION sistémicos I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION (llegando I-EVOLUTION a I-EVOLUTION desaparecer), I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION número I-EVOLUTION y I-EVOLUTION la I-EVOLUTION cantidad I-EVOLUTION de I-EVOLUTION deposiciones I-EVOLUTION y I-EVOLUTION recuperación I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general. I-EVOLUTION En B-TREATMENT el I-TREATMENT momento I-TREATMENT del I-TREATMENT alta I-TREATMENT hospitalaria I-TREATMENT se I-TREATMENT mantiene I-TREATMENT prednisona I-TREATMENT (50 I-TREATMENT mg/24 I-TREATMENT h I-TREATMENT VO) I-TREATMENT hasta I-TREATMENT resolución I-TREATMENT completa I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas. I-TREATMENT I-TREATMENT A I-TREATMENT los I-TREATMENT dos I-TREATMENT meses I-TREATMENT del I-TREATMENT alta I-TREATMENT hospitalaria I-TREATMENT reanuda I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT idelalisib I-TREATMENT (100 I-TREATMENT mg/12 I-TREATMENT h I-TREATMENT VO) I-TREATMENT y I-TREATMENT dos I-TREATMENT meses I-TREATMENT después I-TREATMENT el I-TREATMENT paciente I-TREATMENT reingresa I-TREATMENT por I-TREATMENT un I-TREATMENT nuevo I-TREATMENT episodio I-TREATMENT de I-TREATMENT colitis, I-TREATMENT aunque I-TREATMENT más I-TREATMENT leve I-TREATMENT que I-TREATMENT el I-TREATMENT primero. I-TREATMENT Se I-TREATMENT suspende I-TREATMENT idelalisib I-TREATMENT definitivamente I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT sueroterapia I-TREATMENT de I-TREATMENT soporte. I-TREATMENT A I-TREATMENT las I-TREATMENT 24 I-TREATMENT h I-TREATMENT continúa I-TREATMENT con I-TREATMENT diarrea I-TREATMENT profusa I-TREATMENT (10 I-TREATMENT deposiciones I-TREATMENT líquidas I-TREATMENT diarias) I-TREATMENT y I-TREATMENT pico I-TREATMENT febril, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inicia I-TREATMENT antibioterapia I-TREATMENT con I-TREATMENT levofloxacino I-TREATMENT (500 I-TREATMENT mg/24 I-TREATMENT h I-TREATMENT IV), I-TREATMENT que I-TREATMENT es I-TREATMENT sustituido I-TREATMENT por I-TREATMENT meropenem I-TREATMENT (1 I-TREATMENT g/8h I-TREATMENT IV). I-TREATMENT Los B-EXPLORATION coprocultivos I-EXPLORATION y I-EXPLORATION hemocultivos I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Después B-TREATMENT de I-TREATMENT una I-TREATMENT semana I-TREATMENT con I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT se I-TREATMENT inicia I-TREATMENT terapia I-TREATMENT con I-TREATMENT corticoides I-TREATMENT sistémicos I-TREATMENT a I-TREATMENT 1 I-TREATMENT mg/kg/día, I-TREATMENT presentando I-TREATMENT mejoría I-TREATMENT del I-TREATMENT estado I-TREATMENT general, I-TREATMENT con I-TREATMENT disminución I-TREATMENT del I-TREATMENT número I-TREATMENT de I-TREATMENT deposiciones I-TREATMENT al I-TREATMENT cabo I-TREATMENT de I-TREATMENT una I-TREATMENT semana I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT es I-TREATMENT dado I-TREATMENT de I-TREATMENT alta I-TREATMENT hospitalaria I-TREATMENT con I-TREATMENT prednisona I-TREATMENT oral I-TREATMENT hasta I-TREATMENT resolución I-TREATMENT completa I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS bebedor B-PAST_MEDICAL_HISTORY moderado, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY hipertensiva, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY moderada, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardiaca I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY fallo I-PAST_MEDICAL_HISTORY sistólico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ventrículo I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY transitorio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY paroxística I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY amiodarona I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2013. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY habitual I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY torasemida I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY QD, I-PAST_MEDICAL_HISTORY acenocumarol I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY QD, I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY QD, I-PAST_MEDICAL_HISTORY bisoprolol I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY QD I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY omeprazol I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY QD. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION abril I-EXPLORATION de I-EXPLORATION 2015 I-EXPLORATION presentó I-EXPLORATION en I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION control I-EXPLORATION hipertiroidismo I-EXPLORATION primario: I-EXPLORATION T4 I-EXPLORATION libre I-EXPLORATION 25, I-EXPLORATION 5 I-EXPLORATION pg/ml I-EXPLORATION y I-EXPLORATION hormona I-EXPLORATION estimulante I-EXPLORATION de I-EXPLORATION tiroides I-EXPLORATION (TSH) I-EXPLORATION 0, I-EXPLORATION 002 I-EXPLORATION Ul/ml. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION gammagrafía I-EXPLORATION tiroidea I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION bocio I-EXPLORATION difuso I-EXPLORATION hipercaptador. I-EXPLORATION Respecto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION autoinmunidad I-EXPLORATION tiroidea I-EXPLORATION presentó I-EXPLORATION anticuerpos I-EXPLORATION antitiroglobulina, I-EXPLORATION anticuerpos I-EXPLORATION antiperoxidasa I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION receptor I-EXPLORATION TSH I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT orientó I-TREATMENT como I-TREATMENT un I-TREATMENT hipertiroidismo I-TREATMENT inducido I-TREATMENT por I-TREATMENT amiodarona I-TREATMENT tipo I-TREATMENT l5, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT este I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tiamazol, I-TREATMENT 5 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas. I-TREATMENT Se I-TREATMENT incrementó I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT bisoprolol I-TREATMENT de I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT mg I-TREATMENT a I-TREATMENT 5 I-TREATMENT mg I-TREATMENT QD I-TREATMENT para I-TREATMENT el I-TREATMENT control I-TREATMENT de I-TREATMENT la I-TREATMENT fibrilación I-TREATMENT auricular. I-TREATMENT I-TREATMENT Tras I-TREATMENT dos I-TREATMENT meses I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tiamazol, I-TREATMENT en B-EXPLORATION consultas I-EXPLORATION de I-EXPLORATION Endocrinología, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION enzimas I-EXPLORATION hepáticas: I-EXPLORATION glutamato-oxalacetato I-EXPLORATION transaminasa I-EXPLORATION (GOT) I-EXPLORATION 100 I-EXPLORATION Ul/L, I-EXPLORATION glutamato-piruvato I-EXPLORATION transaminasa I-EXPLORATION (GPT) I-EXPLORATION 109 I-EXPLORATION Ul/L, I-EXPLORATION GGT I-EXPLORATION 1177 I-EXPLORATION Ul/L, I-EXPLORATION lactato I-EXPLORATION deshidrogenasa I-EXPLORATION (LDH) I-EXPLORATION 742 I-EXPLORATION Ul/L, I-EXPLORATION FA I-EXPLORATION 247 I-EXPLORATION Ul/L; I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION permanecieron I-EXPLORATION normales I-EXPLORATION los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION bilirrubina I-EXPLORATION directa, I-EXPLORATION 0, I-EXPLORATION 3 I-EXPLORATION mg/dL, I-EXPLORATION y I-EXPLORATION bilirrubina I-EXPLORATION total, I-EXPLORATION 0, I-EXPLORATION 7 I-EXPLORATION mg/dL. I-EXPLORATION Se B-DERIVED_FROM/TO ingresó I-DERIVED_FROM/TO al I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO en I-DERIVED_FROM/TO Medicina I-DERIVED_FROM/TO Interna I-DERIVED_FROM/TO para I-DERIVED_FROM/TO estudiar I-DERIVED_FROM/TO la I-DERIVED_FROM/TO posible I-DERIVED_FROM/TO colestasis I-DERIVED_FROM/TO disociada I-DERIVED_FROM/TO y I-DERIVED_FROM/TO citolisis. I-DERIVED_FROM/TO Se B-EXPLORATION descartaron I-EXPLORATION causas I-EXPLORATION autoinmunes I-EXPLORATION e I-EXPLORATION infecciosas. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION hepatotropos I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION Ante B-TREATMENT estos I-TREATMENT resultados I-TREATMENT se I-TREATMENT asoció I-TREATMENT la I-TREATMENT colestasis I-TREATMENT disociada I-TREATMENT al I-TREATMENT uso I-TREATMENT de I-TREATMENT tiamazol, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT retiró I-TREATMENT y I-TREATMENT se I-TREATMENT observó I-TREATMENT una I-TREATMENT mejoría I-TREATMENT progresiva I-TREATMENT de I-TREATMENT los I-TREATMENT niveles I-TREATMENT enzimáticos I-TREATMENT hasta I-TREATMENT su I-TREATMENT completa I-TREATMENT normalización I-TREATMENT dos I-TREATMENT meses I-TREATMENT después. I-TREATMENT I-TREATMENT Los B-EVOLUTION valores I-EVOLUTION de I-EVOLUTION hormonas I-EVOLUTION tiroideas I-EVOLUTION se I-EVOLUTION normalizaron, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION recomendó I-EVOLUTION control I-EVOLUTION cada I-EVOLUTION 6-12 I-EVOLUTION meses I-EVOLUTION sin I-EVOLUTION que I-EVOLUTION precisase I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS niño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocho I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS del B-PAST_MEDICAL_HISTORY ámbito I-PAST_MEDICAL_HISTORY rural, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION inicial I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION fue I-EXPLORATION negativa, I-EXPLORATION a I-EXPLORATION excepción I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION erosiones I-EXPLORATION en I-EXPLORATION antebrazo, I-EXPLORATION brazo I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION piernas, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION pústula I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION externa I-EXPLORATION de I-EXPLORATION brazo I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION adenopatía I-EXPLORATION axilar I-EXPLORATION izquierda. I-EXPLORATION Los I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION iniciales I-EXPLORATION incluyeron, I-EXPLORATION leucocitosis I-EXPLORATION 12.400 I-EXPLORATION con I-EXPLORATION 69% I-EXPLORATION de I-EXPLORATION granulocitos, I-EXPLORATION 8% I-EXPLORATION de I-EXPLORATION monocitos, I-EXPLORATION 23% I-EXPLORATION de I-EXPLORATION linfocitos, I-EXPLORATION VSG I-EXPLORATION 63 I-EXPLORATION mm/h, I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION heces I-EXPLORATION negativos, I-EXPLORATION tuberculina I-EXPLORATION 2UI I-EXPLORATION PPD I-EXPLORATION negativa, I-EXPLORATION orina I-EXPLORATION normal, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION senos I-EXPLORATION normal, I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION normales. I-EXPLORATION Mantienen I-EXPLORATION los I-EXPLORATION picos I-EXPLORATION febriles I-EXPLORATION con I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION diaria. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT fiebre I-TREATMENT botonosa, I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT doxiciclina I-TREATMENT a I-TREATMENT dosis I-TREATMENT habitual, I-TREATMENT que I-TREATMENT se I-TREATMENT suspende I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT días I-TREATMENT ante I-TREATMENT la I-TREATMENT negatividad I-TREATMENT de I-TREATMENT la I-TREATMENT serología I-TREATMENT de I-TREATMENT Rickettsia I-TREATMENT conorii. I-TREATMENT I-TREATMENT El B-EXPLORATION paciente I-EXPLORATION continúa I-EXPLORATION presentando I-EXPLORATION picos I-EXPLORATION febriles, I-EXPLORATION programándose I-EXPLORATION nuevos I-EXPLORATION estudios I-EXPLORATION complementarios, I-EXPLORATION que I-EXPLORATION revelaron I-EXPLORATION un I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION leucocitos I-EXPLORATION normal, I-EXPLORATION VSG I-EXPLORATION 92 I-EXPLORATION mm/h, I-EXPLORATION citomorfología I-EXPLORATION normal, I-EXPLORATION PCR I-EXPLORATION 3 I-EXPLORATION mg/dl, I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION normales, I-EXPLORATION aglutinaciones I-EXPLORATION a I-EXPLORATION Salmonella I-EXPLORATION y I-EXPLORATION Brucella I-EXPLORATION negativas, I-EXPLORATION serología I-EXPLORATION de I-EXPLORATION Epstein I-EXPLORATION Barr, I-EXPLORATION Citomegalovirus, I-EXPLORATION Hepatitis, I-EXPLORATION HIV, I-EXPLORATION Borrelia I-EXPLORATION burgdorferi I-EXPLORATION negativas. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION revela I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION hipoecoicas, I-EXPLORATION la I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION bazo I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hígado I-EXPLORATION imagen I-EXPLORATION similar I-EXPLORATION única I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION La I-EXPLORATION TAC I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION corrobora I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION ecográficos I-EXPLORATION y I-EXPLORATION sugiere I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION microabscesos I-EXPLORATION o I-EXPLORATION Enfermedad I-EXPLORATION por I-EXPLORATION Arañazo I-EXPLORATION de I-EXPLORATION Gato; I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION serología I-EXPLORATION a I-EXPLORATION Bartonella I-EXPLORATION Henselae, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION positiva, I-EXPLORATION iniciándose B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT eritromicina. I-TREATMENT I-TREATMENT Ante I-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT picos I-TREATMENT febriles I-TREATMENT y I-TREATMENT dolor I-TREATMENT abdominal, I-TREATMENT se I-TREATMENT sustituye I-TREATMENT la I-TREATMENT eritromicina I-TREATMENT por I-TREATMENT rifampicina I-TREATMENT más I-TREATMENT gentamicina, I-TREATMENT constatándose B-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION dicho I-EVOLUTION tratamiento I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fiebre, I-EVOLUTION cuya I-EVOLUTION duración I-EVOLUTION total I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION 28 I-EVOLUTION días. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38º I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS escasa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS blanquecina. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION sólo I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION hipertrofia I-EXPLORATION en I-EXPLORATION amígdala I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION adenopatías I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION yugular I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño I-EXPLORATION (3x3 I-EXPLORATION cm). I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT faringoamigdalitis I-TREATMENT bacteriana I-TREATMENT se I-TREATMENT pautó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amoxicilina I-TREATMENT e I-TREATMENT ibuprofeno. I-TREATMENT No B-EXPLORATION obstante, I-EXPLORATION ante I-EXPLORATION el I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION las I-EXPLORATION adenopatías I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION solicitar I-EXPLORATION test I-EXPLORATION de I-EXPLORATION mononucleosis I-EXPLORATION infecciosa I-EXPLORATION (MI) I-EXPLORATION y I-EXPLORATION analítica I-EXPLORATION general. I-EXPLORATION I-EXPLORATION Acude B-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION por I-EVOLUTION fiebre I-EVOLUTION alta, I-EVOLUTION malestar I-EVOLUTION general, I-EVOLUTION cansancio I-EVOLUTION intenso I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION región I-EVOLUTION laterocervical I-EVOLUTION izquierda. I-EVOLUTION En B-EXPLORATION este I-EXPLORATION momento I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION gran I-EXPLORATION adenopatía I-EXPLORATION submaxilar I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION dolorosa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION y I-EXPLORATION otra I-EXPLORATION supraclavicular I-EXPLORATION izquierda. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION adenopatías I-EXPLORATION en I-EXPLORATION otros I-EXPLORATION grupos I-EXPLORATION ganglionares, I-EXPLORATION hepatoesplenomegalia, I-EXPLORATION lesiones I-EXPLORATION cutáneas I-EXPLORATION o I-EXPLORATION afectación I-EXPLORATION articular. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION lesiones I-EXPLORATION locales, I-EXPLORATION la I-EXPLORATION otoscopia I-EXPLORATION es I-EXPLORATION normal, I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION faríngea I-EXPLORATION y I-EXPLORATION tiroidea I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destaca: I-EXPLORATION LDH I-EXPLORATION 1400 I-EXPLORATION UI/l, I-EXPLORATION Got I-EXPLORATION 56, I-EXPLORATION gpt I-EXPLORATION 47 I-EXPLORATION UI/l, I-EXPLORATION no I-EXPLORATION existe I-EXPLORATION leucocitosis, I-EXPLORATION sólo I-EXPLORATION una I-EXPLORATION leve I-EXPLORATION linfocitosis. I-EXPLORATION Test I-EXPLORATION de I-EXPLORATION MI: I-EXPLORATION negativo. I-EXPLORATION Se I-EXPLORATION solicita I-EXPLORATION test I-EXPLORATION para I-EXPLORATION el I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION (VIH), I-EXPLORATION análisis I-EXPLORATION anatomopatológico I-EXPLORATION mediante I-EXPLORATION punción I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION nuevo I-EXPLORATION test I-EXPLORATION de I-EXPLORATION MI. I-EXPLORATION Para I-EXPLORATION evitar I-EXPLORATION demoras I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION acude I-EXPLORATION a I-EXPLORATION un I-EXPLORATION centro I-EXPLORATION privado I-EXPLORATION para I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION PAAF I-EXPLORATION y I-EXPLORATION los I-EXPLORATION cirujanos I-EXPLORATION encargados I-EXPLORATION de I-EXPLORATION realizarla, I-EXPLORATION ante I-EXPLORATION el I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION las I-EXPLORATION adenopatías, I-EXPLORATION deciden I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION biopsia. I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION del I-EXPLORATION test I-EXPLORATION de I-EXPLORATION MI I-EXPLORATION es I-EXPLORATION nuevamente I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION persistiendo I-EVOLUTION febrícula I-EVOLUTION durante I-EVOLUTION 20 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION lenta I-EVOLUTION y I-EVOLUTION paulatina I-EVOLUTION del I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION las I-EVOLUTION adenopatías. I-EVOLUTION El B-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION se I-EXPLORATION informa I-EXPLORATION como: I-EXPLORATION linfadenitis I-EXPLORATION histiocitaria I-EXPLORATION necrotizante I-EXPLORATION o I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION Kikuchi. I-EXPLORATION Ante I-EXPLORATION este I-EXPLORATION resultado I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION analítica I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION posibles I-EXPLORATION procesos I-EXPLORATION asociados I-EXPLORATION a I-EXPLORATION esta I-EXPLORATION enfermedad. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION son I-EXPLORATION los I-EXPLORATION siguientes: I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION negativo, I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (ANAs) I-EXPLORATION negativos, I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY hipercolesterolemia, I-PAST_MEDICAL_HISTORY hiperuricemia, I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY 33 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY bebedor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 25-30 I-PAST_MEDICAL_HISTORY unidades I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY semana; I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY paroxística I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY última I-PAST_MEDICAL_HISTORY revisión I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY problema I-PAST_MEDICAL_HISTORY cardiológico, I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes, I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY todas I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY pruebas I-PAST_MEDICAL_HISTORY complementarias I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraban I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY rangos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY normalidad I-PAST_MEDICAL_HISTORY (incluidas I-PAST_MEDICAL_HISTORY hormonas I-PAST_MEDICAL_HISTORY tiroideas). I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY clortalidona I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY atorvastatina I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg/día, I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY acetilsalicílico I-PAST_MEDICAL_HISTORY 200 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY amiodarona I-PAST_MEDICAL_HISTORY 400 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY excepto I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY sábados I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY domingos. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS constitucional I-PRESENT_ILLNESS dominado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS apetito I-PRESENT_ILLNESS con I-PRESENT_ILLNESS adelgazamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS kilogramos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS (que I-PRESENT_ILLNESS suponen I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 10% I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS corporal). I-PRESENT_ILLNESS Además I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS importante I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS cinturas I-PRESENT_ILLNESS escapular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pélvica, I-PRESENT_ILLNESS más I-PRESENT_ILLNESS llamativa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS primera. I-PRESENT_ILLNESS Otro I-PRESENT_ILLNESS dato I-PRESENT_ILLNESS destacable I-PRESENT_ILLNESS es I-PRESENT_ILLNESS que I-PRESENT_ILLNESS aquejaba I-PRESENT_ILLNESS insomnio I-PRESENT_ILLNESS con I-PRESENT_ILLNESS nerviosismo. I-PRESENT_ILLNESS Una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS autolimitado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS consistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS líquidas I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS patológicos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION nos I-EXPLORATION encontramos I-EXPLORATION ante I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION y I-EXPLORATION buenas I-EXPLORATION constantes I-EXPLORATION (TA I-EXPLORATION 120/70 I-EXPLORATION mm I-EXPLORATION Hg, I-EXPLORATION Tª I-EXPLORATION 36, I-EXPLORATION 5 I-EXPLORATION ºC I-EXPLORATION y I-EXPLORATION 78 I-EXPLORATION lpm, I-EXPLORATION peso I-EXPLORATION 74 I-EXPLORATION kg), I-EXPLORATION eupneico, I-EXPLORATION bien I-EXPLORATION nutrido I-EXPLORATION y I-EXPLORATION coloreado, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION bocio. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION cardiopulmonar I-EXPLORATION no I-EXPLORATION había I-EXPLORATION alteraciones. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION el I-EXPLORATION hígado I-EXPLORATION a I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION reborde I-EXPLORATION costal, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION blanda I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos. I-EXPLORATION Presentaba I-EXPLORATION un I-EXPLORATION discreto I-EXPLORATION edema I-EXPLORATION pretibial I-EXPLORATION bilateral I-EXPLORATION que I-EXPLORATION dejaba I-EXPLORATION fovea I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION con I-EXPLORATION pulsos I-EXPLORATION periféricos I-EXPLORATION conservados I-EXPLORATION y I-EXPLORATION simétricos. I-EXPLORATION Ante I-EXPLORATION esta I-EXPLORATION situación I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION algunas I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION cuyos I-EXPLORATION resultados I-EXPLORATION fueron I-EXPLORATION los I-EXPLORATION siguientes: I-EXPLORATION Hemograma: I-EXPLORATION 4.640 I-EXPLORATION leucocitos/ I-EXPLORATION mm3 I-EXPLORATION con I-EXPLORATION fórmula I-EXPLORATION normal, I-EXPLORATION 4, I-EXPLORATION 17 I-EXPLORATION millones I-EXPLORATION de I-EXPLORATION hematíes/ I-EXPLORATION mm3, I-EXPLORATION Hb I-EXPLORATION 12, I-EXPLORATION 7g/dl, I-EXPLORATION Hto I-EXPLORATION 36, I-EXPLORATION 3%, I-EXPLORATION VCM I-EXPLORATION 87, I-EXPLORATION 1, I-EXPLORATION HCM I-EXPLORATION 30, I-EXPLORATION 5, I-EXPLORATION 231.000 I-EXPLORATION plaquetas/mm3. I-EXPLORATION VSG I-EXPLORATION 23 I-EXPLORATION mm/h. I-EXPLORATION Bioquímica: I-EXPLORATION glucosa I-EXPLORATION 83 I-EXPLORATION mg/dl, I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 7 I-EXPLORATION mg/dl, I-EXPLORATION urea I-EXPLORATION 54 I-EXPLORATION mg/dl, I-EXPLORATION ácido I-EXPLORATION úrico I-EXPLORATION 7, I-EXPLORATION 10 I-EXPLORATION mg/dl, I-EXPLORATION GGT I-EXPLORATION 91 I-EXPLORATION mg/dl, I-EXPLORATION GPT I-EXPLORATION 143 I-EXPLORATION mg/dl, I-EXPLORATION GOT I-EXPLORATION 95 I-EXPLORATION mg/dl, I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION 59 I-EXPLORATION mg/dl, I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION 0, I-EXPLORATION 50 I-EXPLORATION mg/dl, I-EXPLORATION colesterol I-EXPLORATION 140 I-EXPLORATION mg/dl, I-EXPLORATION triglicéridos I-EXPLORATION 221 I-EXPLORATION mg/dl, I-EXPLORATION HDL I-EXPLORATION colesterol I-EXPLORATION 24 I-EXPLORATION mg/dl, I-EXPLORATION colesterol I-EXPLORATION VLDL I-EXPLORATION 44 I-EXPLORATION mg/dl, I-EXPLORATION colesterol I-EXPLORATION LDL I-EXPLORATION 72 I-EXPLORATION mg/dl. I-EXPLORATION Ferritina I-EXPLORATION 1.172 I-EXPLORATION mg/ml, I-EXPLORATION hierro I-EXPLORATION 47 I-EXPLORATION µg/dl, I-EXPLORATION Transferrina I-EXPLORATION 148 I-EXPLORATION mg/dl I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION 25%. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION Serología I-EXPLORATION de I-EXPLORATION hepatitis: I-EXPLORATION Ac I-EXPLORATION HVC I-EXPLORATION (-), I-EXPLORATION Ac I-EXPLORATION HB I-EXPLORATION core I-EXPLORATION (-), I-EXPLORATION AcHBs I-EXPLORATION (- I-EXPLORATION ) I-EXPLORATION y I-EXPLORATION HAV I-EXPLORATION Ig I-EXPLORATION M I-EXPLORATION (-) I-EXPLORATION Serología I-EXPLORATION de I-EXPLORATION CMV I-EXPLORATION : I-EXPLORATION Ig I-EXPLORATION M I-EXPLORATION (-) I-EXPLORATION e I-EXPLORATION Ig I-EXPLORATION G I-EXPLORATION (+). I-EXPLORATION Marcadores I-EXPLORATION tumorales: I-EXPLORATION alfa-fetoproteína, I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario I-EXPLORATION y I-EXPLORATION antígeno I-EXPLORATION prostático I-EXPLORATION específico I-EXPLORATION total I-EXPLORATION negativos. I-EXPLORATION Ecografía I-EXPLORATION abdominal: I-EXPLORATION alteración I-EXPLORATION difusa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ecogenicidad I-EXPLORATION hepática I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION esteatosis I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION ocupantes I-EXPLORATION de I-EXPLORATION espacio I-EXPLORATION ni I-EXPLORATION otros I-EXPLORATION hallazgos. I-EXPLORATION Colonoscopia I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION cecal I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Hormonas I-EXPLORATION tiroideas: I-EXPLORATION TSH I-EXPLORATION 0, I-EXPLORATION 01 I-EXPLORATION mUI/l I-EXPLORATION (0,20-5,00), I-EXPLORATION T4 I-EXPLORATION libre I-EXPLORATION 9, I-EXPLORATION 86 I-EXPLORATION ng/dl I-EXPLORATION (0,85-2,1). I-EXPLORATION I-EXPLORATION DISCUSIÓN I-EXPLORATION Nos I-EXPLORATION encontramos I-EXPLORATION ante I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION un I-EXPLORATION síndrome I-EXPLORATION constitucional I-EXPLORATION y I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática. I-EXPLORATION Debemos I-EXPLORATION tener I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION que I-EXPLORATION un I-EXPLORATION incremento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION transaminasas I-EXPLORATION es I-EXPLORATION un I-EXPLORATION fenómeno I-EXPLORATION inespecífico1 I-EXPLORATION que I-EXPLORATION puede I-EXPLORATION ocurrir I-EXPLORATION en I-EXPLORATION gran I-EXPLORATION número I-EXPLORATION de I-EXPLORATION situaciones I-EXPLORATION patológicas I-EXPLORATION y I-EXPLORATION que I-EXPLORATION no I-EXPLORATION siempre I-EXPLORATION traduce I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION hepática. I-EXPLORATION La I-EXPLORATION valoración I-EXPLORATION e I-EXPLORATION interpretación I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hipertransaminasemia I-EXPLORATION han I-EXPLORATION de I-EXPLORATION hacerse I-EXPLORATION siempre I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION contexto I-EXPLORATION clínico I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION y I-EXPLORATION han I-EXPLORATION de I-EXPLORATION tenerse I-EXPLORATION siempre I-EXPLORATION presentes I-EXPLORATION tanto I-EXPLORATION la I-EXPLORATION importancia I-EXPLORATION cuantitativa I-EXPLORATION de I-EXPLORATION su I-EXPLORATION elevación I-EXPLORATION como I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION que I-EXPLORATION persiste I-EXPLORATION la I-EXPLORATION anomalía. I-EXPLORATION La I-EXPLORATION alta I-EXPLORATION prevalencia I-EXPLORATION de I-EXPLORATION enolismo I-EXPLORATION y I-EXPLORATION hepatitis I-EXPLORATION víricas I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION entorno I-EXPLORATION hacen I-EXPLORATION que I-EXPLORATION estas I-EXPLORATION etiologías I-EXPLORATION deban I-EXPLORATION descartarse I-EXPLORATION de I-EXPLORATION entrada2. I-EXPLORATION Iniciamos I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION la I-EXPLORATION confirmación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION alteraciones I-EXPLORATION bioquímicas I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION paso I-EXPLORATION siempre I-EXPLORATION debe I-EXPLORATION ser I-EXPLORATION repetir I-EXPLORATION la I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio3 I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION cualquier I-EXPLORATION error. I-EXPLORATION A B-PAST_MEDICAL_HISTORY continuación I-PAST_MEDICAL_HISTORY realizamos I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY anamnesis I-PAST_MEDICAL_HISTORY exhaustiva I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY encontramos I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alcohol I-PAST_MEDICAL_HISTORY moderado I-PAST_MEDICAL_HISTORY (insuficiente I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY justificar I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hepatopatía I-PAST_MEDICAL_HISTORY alcohólica), I-PAST_MEDICAL_HISTORY uso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY atorvastatina I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY puede I-PAST_MEDICAL_HISTORY aumentar I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY transaminasas I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY alteración I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY general, I-PAST_MEDICAL_HISTORY así B-FAMILY_HISTORY como I-FAMILY_HISTORY la I-FAMILY_HISTORY ausencia I-FAMILY_HISTORY de I-FAMILY_HISTORY datos I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY prácticas B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo, I-PAST_MEDICAL_HISTORY transfusiones I-PAST_MEDICAL_HISTORY sanguíneas, I-PAST_MEDICAL_HISTORY etc. I-PAST_MEDICAL_HISTORY A B-EXPLORATION continuación I-EXPLORATION se I-EXPLORATION le I-EXPLORATION hizo I-EXPLORATION una I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION completa I-EXPLORATION sin I-EXPLORATION obtener I-EXPLORATION datos I-EXPLORATION reseñables I-EXPLORATION salvo I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION hepatomegalia. I-EXPLORATION Con I-EXPLORATION las I-EXPLORATION serologías I-EXPLORATION (primero I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION hepatitis I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION virus I-EXPLORATION hepatotropos I-EXPLORATION como I-EXPLORATION son I-EXPLORATION el I-EXPLORATION citomegalovirus I-EXPLORATION y I-EXPLORATION el I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein-Barr) I-EXPLORATION descartamos I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION hepatitis I-EXPLORATION vírica I-EXPLORATION y I-EXPLORATION otros I-EXPLORATION cuadros I-EXPLORATION infecciosos I-EXPLORATION parecían I-EXPLORATION poco I-EXPLORATION probables I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION del I-EXPLORATION paciente. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION ecogénica I-EXPLORATION del I-EXPLORATION hígado I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION esteatosis I-EXPLORATION hepática I-EXPLORATION (no I-EXPLORATION debemos I-EXPLORATION olvidar I-EXPLORATION que I-EXPLORATION nuestro I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION hipercolesterolemia I-EXPLORATION y I-EXPLORATION consume I-EXPLORATION alcohol) I-EXPLORATION que, I-EXPLORATION si I-EXPLORATION bien I-EXPLORATION podría I-EXPLORATION justificar I-EXPLORATION las I-EXPLORATION alteraciones I-EXPLORATION hepáticas, I-EXPLORATION no I-EXPLORATION parece I-EXPLORATION justificar I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION deterioro I-EXPLORATION general I-EXPLORATION y I-EXPLORATION diarrea. I-EXPLORATION I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION del I-EXPLORATION paciente, I-EXPLORATION la I-EXPLORATION alteración I-EXPLORATION del I-EXPLORATION hábito I-EXPLORATION intestinal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ferritina, I-EXPLORATION otra I-EXPLORATION opción I-EXPLORATION diagnóstica I-EXPLORATION que I-EXPLORATION se I-EXPLORATION nos I-EXPLORATION plantea I-EXPLORATION es I-EXPLORATION la I-EXPLORATION etiología I-EXPLORATION tumoral, I-EXPLORATION aunque I-EXPLORATION con I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION habíamos I-EXPLORATION descartado I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION ocupantes I-EXPLORATION de I-EXPLORATION espacio, I-EXPLORATION y I-EXPLORATION por I-EXPLORATION ello I-EXPLORATION decidimos I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION colonoscopia I-EXPLORATION que I-EXPLORATION descarta I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION neoformación. I-EXPLORATION Otra I-EXPLORATION posibilidad I-EXPLORATION sería I-EXPLORATION la I-EXPLORATION hemocromatosis I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION hay I-EXPLORATION otros I-EXPLORATION datos I-EXPLORATION sugestivos I-EXPLORATION (articulares, I-EXPLORATION miocárdicos, I-EXPLORATION gonadales, I-EXPLORATION cutáneos, I-EXPLORATION etc.) I-EXPLORATION ni I-EXPLORATION antecedentes I-EXPLORATION familiares I-EXPLORATION sugestivos I-EXPLORATION y I-EXPLORATION la I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION transferrina I-EXPLORATION tampoco I-EXPLORATION apoya I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION puesto I-EXPLORATION que I-EXPLORATION debería I-EXPLORATION estar I-EXPLORATION elevada. I-EXPLORATION Antes I-EXPLORATION de I-EXPLORATION recurrir I-EXPLORATION a I-EXPLORATION otros I-EXPLORATION estudios I-EXPLORATION más I-EXPLORATION complejos I-EXPLORATION y I-EXPLORATION costosos, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION repetir I-EXPLORATION la I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION hormonas I-EXPLORATION tiroideas, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION tener I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION rigurosamente I-EXPLORATION normal I-EXPLORATION cinco I-EXPLORATION meses I-EXPLORATION antes, I-EXPLORATION porque I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION continuaba I-EXPLORATION en I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION amiodarona. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION hipertiroidismo I-EXPLORATION en I-EXPLORATION paciente I-EXPLORATION tratado I-EXPLORATION con I-EXPLORATION amiodarona. I-EXPLORATION La B-TREATMENT actitud I-TREATMENT que I-TREATMENT seguimos I-TREATMENT fue I-TREATMENT retirar I-TREATMENT el I-TREATMENT fármaco I-TREATMENT e I-TREATMENT iniciar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT metimazol I-TREATMENT y I-TREATMENT betabloqueantes I-TREATMENT para I-TREATMENT controlar I-TREATMENT su I-TREATMENT arritmia. I-TREATMENT I-TREATMENT La I-TREATMENT amiodarona I-TREATMENT es I-TREATMENT un I-TREATMENT antiarrítmico I-TREATMENT de I-TREATMENT clase I-TREATMENT III I-TREATMENT cuya I-TREATMENT estructura I-TREATMENT molecular I-TREATMENT es I-TREATMENT muy I-TREATMENT similar I-TREATMENT a I-TREATMENT la I-TREATMENT triiodotironina. I-TREATMENT Contiene I-TREATMENT dos I-TREATMENT átomos I-TREATMENT de I-TREATMENT yodo, I-TREATMENT lo I-TREATMENT que I-TREATMENT le I-TREATMENT confiere I-TREATMENT un I-TREATMENT 37, I-TREATMENT 2% I-TREATMENT del I-TREATMENT peso I-TREATMENT en I-TREATMENT yodo. I-TREATMENT Esto I-TREATMENT supone I-TREATMENT que I-TREATMENT con I-TREATMENT una I-TREATMENT dosis I-TREATMENT de I-TREATMENT mantenimiento I-TREATMENT de I-TREATMENT 200 I-TREATMENT a I-TREATMENT 600 I-TREATMENT mg I-TREATMENT se I-TREATMENT aporten I-TREATMENT 75 I-TREATMENT a I-TREATMENT 225 I-TREATMENT mg/día I-TREATMENT de I-TREATMENT yodo4. I-TREATMENT Este I-TREATMENT exceso I-TREATMENT de I-TREATMENT yodo I-TREATMENT puede I-TREATMENT tener I-TREATMENT consecuencias I-TREATMENT sobre I-TREATMENT la I-TREATMENT fisiología I-TREATMENT tiroidea. I-TREATMENT Por I-TREATMENT otra I-TREATMENT parte I-TREATMENT debemos I-TREATMENT tener I-TREATMENT en I-TREATMENT cuenta I-TREATMENT que I-TREATMENT es I-TREATMENT una I-TREATMENT molécula I-TREATMENT muy I-TREATMENT lipofílica, I-TREATMENT lo I-TREATMENT que I-TREATMENT le I-TREATMENT confiere I-TREATMENT una I-TREATMENT vida I-TREATMENT media I-TREATMENT muy I-TREATMENT prolongada I-TREATMENT (22-55 I-TREATMENT días), I-TREATMENT pudiendo I-TREATMENT detectarse I-TREATMENT en I-TREATMENT plasma I-TREATMENT hasta I-TREATMENT 9 I-TREATMENT meses I-TREATMENT después I-TREATMENT de I-TREATMENT retirado I-TREATMENT el I-TREATMENT fármaco. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona I-TREATMENT provoca I-TREATMENT una I-TREATMENT serie I-TREATMENT de I-TREATMENT cambios I-TREATMENT en I-TREATMENT las I-TREATMENT hormonas I-TREATMENT tiroideas I-TREATMENT que I-TREATMENT consisten I-TREATMENT en I-TREATMENT un I-TREATMENT aumento I-TREATMENT de I-TREATMENT la I-TREATMENT T4 I-TREATMENT total I-TREATMENT y I-TREATMENT libre I-TREATMENT y I-TREATMENT de I-TREATMENT rT3, I-TREATMENT una I-TREATMENT disminución I-TREATMENT de I-TREATMENT la I-TREATMENT T3 I-TREATMENT total, I-TREATMENT junto I-TREATMENT con I-TREATMENT un I-TREATMENT aumento I-TREATMENT inicial I-TREATMENT y I-TREATMENT precoz I-TREATMENT de I-TREATMENT TSH I-TREATMENT que I-TREATMENT tiende I-TREATMENT a I-TREATMENT normalizarse, I-TREATMENT aunque I-TREATMENT en I-TREATMENT ocasiones I-TREATMENT persiste I-TREATMENT aumentado I-TREATMENT tras I-TREATMENT tratamientos I-TREATMENT crónicos. I-TREATMENT Estos I-TREATMENT cambios I-TREATMENT se I-TREATMENT producen I-TREATMENT en I-TREATMENT más I-TREATMENT del I-TREATMENT 50% I-TREATMENT de I-TREATMENT los I-TREATMENT pacientes I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona, I-TREATMENT sin I-TREATMENT ninguna I-TREATMENT relevancia I-TREATMENT clínica I-TREATMENT (estado I-TREATMENT eutiroideo). I-TREATMENT La I-TREATMENT incidencia I-TREATMENT de I-TREATMENT disfunción I-TREATMENT tiroidea I-TREATMENT oscila I-TREATMENT entre I-TREATMENT un I-TREATMENT 2 I-TREATMENT y I-TREATMENT un I-TREATMENT 24%5. I-TREATMENT En I-TREATMENT nuestro I-TREATMENT medio I-TREATMENT la I-TREATMENT incidencia I-TREATMENT de I-TREATMENT tirotoxicosis I-TREATMENT por I-TREATMENT amiodarona I-TREATMENT se I-TREATMENT encuentra I-TREATMENT en I-TREATMENT torno I-TREATMENT al I-TREATMENT 1, I-TREATMENT 5% I-TREATMENT y I-TREATMENT es I-TREATMENT más I-TREATMENT frecuente I-TREATMENT en I-TREATMENT zonas I-TREATMENT con I-TREATMENT déficit I-TREATMENT de I-TREATMENT yodo. I-TREATMENT Se B-EXPLORATION han I-EXPLORATION descrito I-EXPLORATION dos I-EXPLORATION mecanismos I-EXPLORATION fisiopatológicos I-EXPLORATION diferentes6: I-EXPLORATION Tipo I-EXPLORATION I: I-EXPLORATION se I-EXPLORATION produce I-EXPLORATION sobre I-EXPLORATION tiroides I-EXPLORATION con I-EXPLORATION patología I-EXPLORATION subyacente I-EXPLORATION con I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mecanismo I-EXPLORATION autorregulador I-EXPLORATION de I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION yodo I-EXPLORATION que I-EXPLORATION llevaría I-EXPLORATION a I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION con I-EXPLORATION el I-EXPLORATION consiguiente I-EXPLORATION aumento I-EXPLORATION en I-EXPLORATION la I-EXPLORATION síntesis I-EXPLORATION de I-EXPLORATION hormona I-EXPLORATION tiroidea. I-EXPLORATION Tipo I-EXPLORATION II: I-EXPLORATION se I-EXPLORATION produce I-EXPLORATION sobre I-EXPLORATION glándulas I-EXPLORATION aparentemente I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION bocio I-EXPLORATION y I-EXPLORATION con I-EXPLORATION anticuerpos I-EXPLORATION antiroideos I-EXPLORATION y I-EXPLORATION antirreceptor I-EXPLORATION de I-EXPLORATION TSH I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION mecanismo I-EXPLORATION sería I-EXPLORATION una I-EXPLORATION citotoxicidad I-EXPLORATION inducida I-EXPLORATION por I-EXPLORATION la I-EXPLORATION amiodarona I-EXPLORATION o I-EXPLORATION el I-EXPLORATION yodo. I-EXPLORATION La I-EXPLORATION manifestación I-EXPLORATION clínica I-EXPLORATION más I-EXPLORATION frecuente I-EXPLORATION en I-EXPLORATION estos I-EXPLORATION casos I-EXPLORATION suele I-EXPLORATION ser I-EXPLORATION un I-EXPLORATION empeoramiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION cardiaca I-EXPLORATION subyacente, I-EXPLORATION aunque I-EXPLORATION pueden I-EXPLORATION existir I-EXPLORATION los I-EXPLORATION síntomas I-EXPLORATION clásicos I-EXPLORATION de I-EXPLORATION hipertiroidismo. I-EXPLORATION En I-EXPLORATION ocasiones I-EXPLORATION el I-EXPLORATION curso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION es I-EXPLORATION autolimitado, I-EXPLORATION resolviéndose I-EXPLORATION la I-EXPLORATION situación I-EXPLORATION tras I-EXPLORATION la I-EXPLORATION retirada I-EXPLORATION de I-EXPLORATION la I-EXPLORATION amiodarona I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION tratamiento I-EXPLORATION adicional, I-EXPLORATION aunque I-EXPLORATION generalmente I-EXPLORATION tras I-EXPLORATION largos I-EXPLORATION periodos I-EXPLORATION de I-EXPLORATION tiempo. I-EXPLORATION La I-EXPLORATION resolución I-EXPLORATION del I-EXPLORATION cuadro I-EXPLORATION es I-EXPLORATION más I-EXPLORATION precoz I-EXPLORATION cuando I-EXPLORATION no I-EXPLORATION existe I-EXPLORATION patología I-EXPLORATION subyacente. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT incluye I-TREATMENT tionamidas I-TREATMENT que I-TREATMENT pueden I-TREATMENT asociarse I-TREATMENT con I-TREATMENT perclorato I-TREATMENT potásico I-TREATMENT para I-TREATMENT conseguir I-TREATMENT una I-TREATMENT rápida I-TREATMENT descarga I-TREATMENT del I-TREATMENT yodo I-TREATMENT intratiroideo I-TREATMENT aumentando I-TREATMENT su I-TREATMENT eficacia, I-TREATMENT corticoides, I-TREATMENT plasmaféresis I-TREATMENT en I-TREATMENT casos I-TREATMENT de I-TREATMENT crisis I-TREATMENT tireotóxicas I-TREATMENT que I-TREATMENT ponen I-TREATMENT en I-TREATMENT peligro I-TREATMENT la I-TREATMENT vida I-TREATMENT del I-TREATMENT paciente, I-TREATMENT litio I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT quirúrgico. I-TREATMENT Bartalena I-TREATMENT ha I-TREATMENT propuesto I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT específico I-TREATMENT según I-TREATMENT el I-TREATMENT tipo. I-TREATMENT En I-TREATMENT el I-TREATMENT tipo I-TREATMENT I, I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT existe I-TREATMENT una I-TREATMENT síntesis I-TREATMENT de I-TREATMENT hormona I-TREATMENT tiroidea I-TREATMENT aumentada, I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT elección I-TREATMENT serían I-TREATMENT los I-TREATMENT antitiroideos I-TREATMENT junto I-TREATMENT a I-TREATMENT perclorato I-TREATMENT potásico, I-TREATMENT mientras I-TREATMENT que I-TREATMENT los I-TREATMENT corticoides I-TREATMENT tendrían I-TREATMENT un I-TREATMENT papel I-TREATMENT limitado. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT en I-TREATMENT el I-TREATMENT tipo I-TREATMENT II, I-TREATMENT en I-TREATMENT el I-TREATMENT que I-TREATMENT el I-TREATMENT mecanismo I-TREATMENT fundamental I-TREATMENT es I-TREATMENT una I-TREATMENT destrucción I-TREATMENT tisular, I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT elección I-TREATMENT serían I-TREATMENT los I-TREATMENT corticoides I-TREATMENT en I-TREATMENT dosis I-TREATMENT altas, I-TREATMENT por I-TREATMENT su I-TREATMENT efecto I-TREATMENT antiinflamatorio I-TREATMENT y I-TREATMENT estabilizador I-TREATMENT de I-TREATMENT membranas. I-TREATMENT La I-TREATMENT cirugía I-TREATMENT está I-TREATMENT indicada I-TREATMENT en I-TREATMENT casos I-TREATMENT graves I-TREATMENT con I-TREATMENT arritmias I-TREATMENT potencialmente I-TREATMENT letales I-TREATMENT para I-TREATMENT el I-TREATMENT paciente I-TREATMENT en I-TREATMENT los I-TREATMENT que I-TREATMENT se I-TREATMENT requiera I-TREATMENT una I-TREATMENT solución I-TREATMENT rápida, I-TREATMENT cuando I-TREATMENT no I-TREATMENT se I-TREATMENT pueda I-TREATMENT retirar I-TREATMENT la I-TREATMENT amiodarona I-TREATMENT y I-TREATMENT cuando I-TREATMENT se I-TREATMENT haya I-TREATMENT demostrado I-TREATMENT una I-TREATMENT resistencia I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT médico. I-TREATMENT Debe I-TREATMENT practicarse I-TREATMENT una I-TREATMENT tiroidectomía I-TREATMENT total I-TREATMENT o I-TREATMENT casi I-TREATMENT total I-TREATMENT sobre I-TREATMENT todo I-TREATMENT en I-TREATMENT aquellos I-TREATMENT pacientes I-TREATMENT que I-TREATMENT vayan I-TREATMENT a I-TREATMENT seguir I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amiodarona. I-TREATMENT I-TREATMENT CORRESPONDENCIA: I-TREATMENT Carmen I-TREATMENT G. I-TREATMENT Suárez I-TREATMENT Álvarez I-TREATMENT Unidad I-TREATMENT Hospitalización I-TREATMENT a I-TREATMENT Domicilio I-TREATMENT Fundación I-TREATMENT Jiménez I-TREATMENT Díaz I-TREATMENT Avda. I-TREATMENT Reyes I-TREATMENT Católicos, I-TREATMENT 2 I-TREATMENT 28040 I-TREATMENT Madrid I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS persona I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS nacido B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY aldea I-PAST_MEDICAL_HISTORY asturiana I-PAST_MEDICAL_HISTORY cuya I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY vive I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY campo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ganadería. I-PAST_MEDICAL_HISTORY Sus B-FAMILY_HISTORY padres, I-FAMILY_HISTORY sin I-FAMILY_HISTORY estudios, I-FAMILY_HISTORY fallecen I-FAMILY_HISTORY él I-FAMILY_HISTORY por I-FAMILY_HISTORY patología I-FAMILY_HISTORY tumoral, I-FAMILY_HISTORY y I-FAMILY_HISTORY ella I-FAMILY_HISTORY por I-FAMILY_HISTORY cardiopatía I-FAMILY_HISTORY y I-FAMILY_HISTORY diabetes. I-FAMILY_HISTORY Es B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY hermanos. I-PAST_MEDICAL_HISTORY Escolarizado I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY comienza I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY trabajar I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY peón I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY minería. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY reconoce I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY persona I-PAST_MEDICAL_HISTORY alegre, I-PAST_MEDICAL_HISTORY amigo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fiestas, I-PAST_MEDICAL_HISTORY trabajador, I-PAST_MEDICAL_HISTORY activo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY colaborador. I-PAST_MEDICAL_HISTORY Dos B-FAMILY_HISTORY de I-FAMILY_HISTORY sus I-FAMILY_HISTORY hermanas I-FAMILY_HISTORY emigran I-FAMILY_HISTORY a I-FAMILY_HISTORY Europa I-FAMILY_HISTORY por I-FAMILY_HISTORY motivos I-FAMILY_HISTORY laborales. I-FAMILY_HISTORY Una I-FAMILY_HISTORY de I-FAMILY_HISTORY ellas, I-FAMILY_HISTORY la I-FAMILY_HISTORY mayor, I-FAMILY_HISTORY se I-FAMILY_HISTORY suicida I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 48 I-FAMILY_HISTORY años. I-FAMILY_HISTORY I-FAMILY_HISTORY Poco B-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esquizofrenia I-PAST_MEDICAL_HISTORY paranoide I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1982, I-PAST_MEDICAL_HISTORY contrajo I-PAST_MEDICAL_HISTORY matrimonio I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY mujer I-PAST_MEDICAL_HISTORY pidió I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY separación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY pocos I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY Recibe I-PAST_MEDICAL_HISTORY atención I-PAST_MEDICAL_HISTORY ambulatoria I-PAST_MEDICAL_HISTORY haciendo I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cumplimiento I-PAST_MEDICAL_HISTORY irregular I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico I-PAST_MEDICAL_HISTORY evitando I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY tomas I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY engaño, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1984 I-PAST_MEDICAL_HISTORY abandona I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tratamiento. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Cuatro I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY tarde I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY detenido I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY acusado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY intento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY homicidio I-PAST_MEDICAL_HISTORY contra I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY matrimonio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vecinos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY siempre I-PAST_MEDICAL_HISTORY mantuvo I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY excelente I-PAST_MEDICAL_HISTORY relación. I-PAST_MEDICAL_HISTORY Según I-PAST_MEDICAL_HISTORY él, I-PAST_MEDICAL_HISTORY esas I-PAST_MEDICAL_HISTORY personas I-PAST_MEDICAL_HISTORY "ponían I-PAST_MEDICAL_HISTORY cirios" I-PAST_MEDICAL_HISTORY (hacían I-PAST_MEDICAL_HISTORY ofrendas) I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY cosas I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY fueran I-PAST_MEDICAL_HISTORY mal. I-PAST_MEDICAL_HISTORY Es I-PAST_MEDICAL_HISTORY encarcelado, I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY UHP I-PAST_MEDICAL_HISTORY (unidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hospitalización I-PAST_MEDICAL_HISTORY psiquiátrica) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY trasladado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY hospital I-PAST_MEDICAL_HISTORY psiquiátrico I-PAST_MEDICAL_HISTORY penitenciario. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY 1996 I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY retornado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY Asturias, I-PAST_MEDICAL_HISTORY permaneciendo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY diferentes I-PAST_MEDICAL_HISTORY unidades I-PAST_MEDICAL_HISTORY cerradas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY Servicios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Salud I-PAST_MEDICAL_HISTORY Mental I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY mayo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2000 I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ingresa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY Casita. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY caracteriza I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tener I-PAST_MEDICAL_HISTORY conciencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY psiquiátrica I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY somática, I-PAST_MEDICAL_HISTORY ya I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY padece I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY insulino-dependiente, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY manifiesta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY claro I-PAST_MEDICAL_HISTORY rechazo I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY toma I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY condición I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY permanecer I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY hogar I-PAST_MEDICAL_HISTORY tutelado. I-PAST_MEDICAL_HISTORY Posee I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY alto I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conservación I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY las 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 (AVDs) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY goza I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY capacidad I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY comunicación I-PAST_MEDICAL_HISTORY verbal. I-PAST_MEDICAL_HISTORY Ha I-PAST_MEDICAL_HISTORY perdido I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY contacto I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY entorno I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY consecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY casi I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY lleva I-PAST_MEDICAL_HISTORY institucionalizado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY problemas I-PAST_MEDICAL_HISTORY económicos, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY soporte I-PAST_MEDICAL_HISTORY familiar I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY suficiente I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY permanecer I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY casa. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION su I-EXPLORATION ingreso, I-EXPLORATION se I-EXPLORATION hace I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION de I-EXPLORATION enfermería I-EXPLORATION usando I-EXPLORATION el I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION salud I-EXPLORATION mental4, I-EXPLORATION procediendo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION patrones I-EXPLORATION alterados I-EXPLORATION según I-EXPLORATION Gordon5, I-EXPLORATION y I-EXPLORATION utilizando I-EXPLORATION diagnósticos I-EXPLORATION NANDA I-EXPLORATION 2001-20026. I-EXPLORATION Se I-EXPLORATION aplican I-EXPLORATION también I-EXPLORATION dos I-EXPLORATION escalas I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cuestionario I-EXPLORATION cuyos I-EXPLORATION resultados I-EXPLORATION están I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION se I-EXPLORATION evalúa I-EXPLORATION por I-EXPLORATION objetivos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION a I-EXPLORATION los I-EXPLORATION patrones I-EXPLORATION de I-EXPLORATION salud, I-EXPLORATION hay I-EXPLORATION cuatro I-EXPLORATION claramente I-EXPLORATION disfuncionales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION 2 I-EXPLORATION se I-EXPLORATION comentan I-EXPLORATION dichos I-EXPLORATION patrones I-EXPLORATION y I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION los I-EXPLORATION diagnósticos I-EXPLORATION seleccionados I-EXPLORATION para I-EXPLORATION cada I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION ellos. I-EXPLORATION Una B-TREATMENT vez I-TREATMENT examinados I-TREATMENT los I-TREATMENT patrones I-TREATMENT y I-TREATMENT seleccionados I-TREATMENT los I-TREATMENT diagnósticos, I-TREATMENT se I-TREATMENT establecen I-TREATMENT diferentes I-TREATMENT grupos I-TREATMENT de I-TREATMENT objetivos I-TREATMENT a I-TREATMENT partir I-TREATMENT de I-TREATMENT los I-TREATMENT cuales I-TREATMENT se I-TREATMENT diseñaran I-TREATMENT actividades I-TREATMENT para I-TREATMENT la I-TREATMENT consecución I-TREATMENT de I-TREATMENT los I-TREATMENT mismos. I-TREATMENT I-TREATMENT Manejo I-TREATMENT inefectivo I-TREATMENT del I-TREATMENT régimen I-TREATMENT terapéutico. I-TREATMENT Respecto I-TREATMENT al I-TREATMENT primer I-TREATMENT diagnóstico, I-TREATMENT se I-TREATMENT establecen I-TREATMENT tres I-TREATMENT grupos I-TREATMENT de I-TREATMENT objetivos: I-TREATMENT objetivos I-TREATMENT iniciales; I-TREATMENT objetivos I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT meses I-TREATMENT y I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años. I-TREATMENT Los I-TREATMENT objetivos I-TREATMENT iniciales I-TREATMENT son I-TREATMENT aquellos I-TREATMENT que I-TREATMENT se I-TREATMENT deben I-TREATMENT cumplir I-TREATMENT desde I-TREATMENT un I-TREATMENT primer I-TREATMENT momento. I-TREATMENT Tienen I-TREATMENT que I-TREATMENT ver I-TREATMENT con I-TREATMENT cuestiones I-TREATMENT básicas I-TREATMENT del I-TREATMENT funcionamiento I-TREATMENT del I-TREATMENT dispositivo I-TREATMENT que I-TREATMENT el I-TREATMENT sujeto I-TREATMENT debe I-TREATMENT asumir I-TREATMENT para I-TREATMENT poder I-TREATMENT permanecer I-TREATMENT en I-TREATMENT el I-TREATMENT hogar I-TREATMENT tutelado. I-TREATMENT Son I-TREATMENT los I-TREATMENT siguientes: I-TREATMENT 1) I-TREATMENT que I-TREATMENT tome I-TREATMENT su I-TREATMENT medicación I-TREATMENT desde I-TREATMENT el I-TREATMENT primer I-TREATMENT día; I-TREATMENT 2) I-TREATMENT que I-TREATMENT acuda I-TREATMENT acompañado I-TREATMENT a I-TREATMENT las I-TREATMENT citas I-TREATMENT en I-TREATMENT el I-TREATMENT centro I-TREATMENT de I-TREATMENT atención I-TREATMENT primaria I-TREATMENT (CAP); I-TREATMENT 3) I-TREATMENT someterse I-TREATMENT a I-TREATMENT los I-TREATMENT controles I-TREATMENT analíticos I-TREATMENT pertinentes, I-TREATMENT y I-TREATMENT 4) I-TREATMENT aceptar I-TREATMENT la I-TREATMENT dieta I-TREATMENT antiglucemiante. I-TREATMENT I-TREATMENT El I-TREATMENT segundo I-TREATMENT grupo I-TREATMENT de I-TREATMENT objetivos, I-TREATMENT es I-TREATMENT decir, I-TREATMENT los I-TREATMENT que I-TREATMENT se I-TREATMENT deben I-TREATMENT alcanzar I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT meses, I-TREATMENT son: I-TREATMENT 1) I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT tenga I-TREATMENT una I-TREATMENT noción I-TREATMENT básica I-TREATMENT de I-TREATMENT lo I-TREATMENT que I-TREATMENT son I-TREATMENT los I-TREATMENT fármacos, I-TREATMENT pudiendo I-TREATMENT enumerar I-TREATMENT tres I-TREATMENT beneficios I-TREATMENT y I-TREATMENT tres I-TREATMENT efectos I-TREATMENT secundarios; I-TREATMENT 2) I-TREATMENT que I-TREATMENT pueda I-TREATMENT autoadministrase I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT bajo I-TREATMENT supervisión; I-TREATMENT 3) I-TREATMENT será I-TREATMENT capaz I-TREATMENT de I-TREATMENT acudir I-TREATMENT a I-TREATMENT la I-TREATMENT farmacia I-TREATMENT sin I-TREATMENT acompañamiento; I-TREATMENT 4) I-TREATMENT podrá I-TREATMENT reconocer I-TREATMENT y I-TREATMENT nombrar I-TREATMENT al I-TREATMENT menos I-TREATMENT doce I-TREATMENT alimentos I-TREATMENT habituales I-TREATMENT contraindicados I-TREATMENT y I-TREATMENT 5) I-TREATMENT conocerá I-TREATMENT los I-TREATMENT riesgos I-TREATMENT de I-TREATMENT ser I-TREATMENT gran I-TREATMENT fumador I-TREATMENT describiendo I-TREATMENT tres I-TREATMENT enfermedades I-TREATMENT graves I-TREATMENT y I-TREATMENT tres I-TREATMENT beneficios I-TREATMENT de I-TREATMENT no I-TREATMENT fumar. I-TREATMENT I-TREATMENT Los I-TREATMENT objetivos I-TREATMENT a I-TREATMENT conseguir I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años, I-TREATMENT son I-TREATMENT el I-TREATMENT tercer I-TREATMENT grupo I-TREATMENT de I-TREATMENT los I-TREATMENT que I-TREATMENT corresponden I-TREATMENT al I-TREATMENT primer I-TREATMENT diagnóstico I-TREATMENT y I-TREATMENT contemplan: I-TREATMENT 1) I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT autoadministre I-TREATMENT su I-TREATMENT medicación I-TREATMENT preparándola I-TREATMENT él I-TREATMENT mismo I-TREATMENT y I-TREATMENT sin I-TREATMENT triturar, I-TREATMENT incluso I-TREATMENT estando I-TREATMENT fuera; I-TREATMENT 2) I-TREATMENT irá I-TREATMENT solo I-TREATMENT al I-TREATMENT CAP I-TREATMENT y I-TREATMENT usará I-TREATMENT su I-TREATMENT tarjeta I-TREATMENT de I-TREATMENT crónicos I-TREATMENT para I-TREATMENT obtener I-TREATMENT las I-TREATMENT recetas; I-TREATMENT 3) I-TREATMENT sellará I-TREATMENT sus I-TREATMENT recetas I-TREATMENT en I-TREATMENT la I-TREATMENT inspección I-TREATMENT médica I-TREATMENT sin I-TREATMENT acompañamiento; I-TREATMENT 4) I-TREATMENT si I-TREATMENT come I-TREATMENT fuera I-TREATMENT podrá I-TREATMENT elegir I-TREATMENT platos I-TREATMENT adecuados I-TREATMENT sin I-TREATMENT apoyo; I-TREATMENT 5) I-TREATMENT habrá I-TREATMENT reducido I-TREATMENT la I-TREATMENT dosis/día I-TREATMENT de I-TREATMENT cigarrillos I-TREATMENT a I-TREATMENT 10 I-TREATMENT como I-TREATMENT máximo. I-TREATMENT I-TREATMENT Después I-TREATMENT se I-TREATMENT da I-TREATMENT paso I-TREATMENT a I-TREATMENT la I-TREATMENT programación I-TREATMENT de I-TREATMENT actividades I-TREATMENT dirigidas I-TREATMENT al I-TREATMENT logro I-TREATMENT de I-TREATMENT cada I-TREATMENT uno I-TREATMENT de I-TREATMENT los I-TREATMENT tres I-TREATMENT grupos I-TREATMENT de I-TREATMENT objetivos. I-TREATMENT Para I-TREATMENT los I-TREATMENT objetivos I-TREATMENT iniciales, I-TREATMENT se I-TREATMENT trabajó I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT entrevista I-TREATMENT paciente-tutor I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT del I-TREATMENT ingreso. I-TREATMENT Se I-TREATMENT informa I-TREATMENT al I-TREATMENT paciente I-TREATMENT de I-TREATMENT las I-TREATMENT normas I-TREATMENT a I-TREATMENT seguir, I-TREATMENT de I-TREATMENT la I-TREATMENT importancia I-TREATMENT de I-TREATMENT la I-TREATMENT medicación I-TREATMENT y I-TREATMENT controles I-TREATMENT que I-TREATMENT debe I-TREATMENT asumir, I-TREATMENT mostrándole I-TREATMENT las I-TREATMENT ventajas I-TREATMENT y I-TREATMENT los I-TREATMENT lugares I-TREATMENT en I-TREATMENT que I-TREATMENT se I-TREATMENT va I-TREATMENT a I-TREATMENT realizar. I-TREATMENT Se I-TREATMENT le I-TREATMENT acompaña I-TREATMENT al I-TREATMENT CAP I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT presenta I-TREATMENT a I-TREATMENT los I-TREATMENT profesionales I-TREATMENT que I-TREATMENT le I-TREATMENT van I-TREATMENT a I-TREATMENT atender. I-TREATMENT Se I-TREATMENT le I-TREATMENT pide I-TREATMENT el I-TREATMENT consentimiento I-TREATMENT expreso I-TREATMENT y I-TREATMENT la I-TREATMENT aceptación I-TREATMENT voluntaria I-TREATMENT de I-TREATMENT la I-TREATMENT normativa I-TREATMENT de I-TREATMENT funcionamiento I-TREATMENT de I-TREATMENT La I-TREATMENT Casita. I-TREATMENT I-TREATMENT De I-TREATMENT entre I-TREATMENT las I-TREATMENT actividades I-TREATMENT que I-TREATMENT se I-TREATMENT realizaron I-TREATMENT para I-TREATMENT la I-TREATMENT consecución I-TREATMENT de I-TREATMENT los I-TREATMENT objetivos I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT meses I-TREATMENT y I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años, I-TREATMENT se I-TREATMENT destaca I-TREATMENT la I-TREATMENT inclusión I-TREATMENT del I-TREATMENT paciente I-TREATMENT en I-TREATMENT un I-TREATMENT programa I-TREATMENT de I-TREATMENT automedicación I-TREATMENT que I-TREATMENT se I-TREATMENT desarrolla I-TREATMENT con I-TREATMENT formato I-TREATMENT de I-TREATMENT taller I-TREATMENT y I-TREATMENT que I-TREATMENT integra I-TREATMENT también I-TREATMENT actividades I-TREATMENT individuales I-TREATMENT como I-TREATMENT elaboración I-TREATMENT de I-TREATMENT fichas I-TREATMENT de I-TREATMENT los I-TREATMENT fármacos I-TREATMENT que I-TREATMENT está I-TREATMENT tomando, I-TREATMENT posters I-TREATMENT y I-TREATMENT puestas I-TREATMENT en I-TREATMENT común I-TREATMENT sobre I-TREATMENT el I-TREATMENT tema. I-TREATMENT Se I-TREATMENT refuerza I-TREATMENT continuamente I-TREATMENT su I-TREATMENT colaboración I-TREATMENT y I-TREATMENT aceptación I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT anima I-TREATMENT a I-TREATMENT que I-TREATMENT vaya I-TREATMENT preparando I-TREATMENT la I-TREATMENT medicación. I-TREATMENT En I-TREATMENT la I-TREATMENT entrevista I-TREATMENT semanal I-TREATMENT con I-TREATMENT el I-TREATMENT tutor I-TREATMENT se I-TREATMENT tratan I-TREATMENT los I-TREATMENT problemas I-TREATMENT surgidos I-TREATMENT al I-TREATMENT respecto. I-TREATMENT Se I-TREATMENT acompaña I-TREATMENT al I-TREATMENT paciente I-TREATMENT a I-TREATMENT la I-TREATMENT farmacia, I-TREATMENT a I-TREATMENT la I-TREATMENT inspección I-TREATMENT y I-TREATMENT al I-TREATMENT CAP I-TREATMENT para I-TREATMENT que I-TREATMENT aprenda I-TREATMENT el I-TREATMENT proceso. I-TREATMENT Se I-TREATMENT refuerza I-TREATMENT la I-TREATMENT abstinencia I-TREATMENT del I-TREATMENT tabaco, I-TREATMENT se I-TREATMENT restringe I-TREATMENT su I-TREATMENT uso I-TREATMENT a I-TREATMENT determinados I-TREATMENT espacios I-TREATMENT de I-TREATMENT la I-TREATMENT casa I-TREATMENT y I-TREATMENT se I-TREATMENT colocan I-TREATMENT señales I-TREATMENT de I-TREATMENT advertencia. I-TREATMENT Se I-TREATMENT hacen I-TREATMENT además I-TREATMENT sesiones I-TREATMENT para I-TREATMENT debatir I-TREATMENT sobre I-TREATMENT el I-TREATMENT hábito I-TREATMENT tabáquico. I-TREATMENT I-TREATMENT En B-EVOLUTION la I-EVOLUTION evaluación, I-EVOLUTION decir I-EVOLUTION que I-EVOLUTION tanto I-EVOLUTION los I-EVOLUTION objetivos I-EVOLUTION inmediatos I-EVOLUTION como I-EVOLUTION los I-EVOLUTION que I-EVOLUTION van I-EVOLUTION a I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION se I-EVOLUTION han I-EVOLUTION conseguido. I-EVOLUTION No I-EVOLUTION ocurre I-EVOLUTION los I-EVOLUTION mismo I-EVOLUTION con I-EVOLUTION los I-EVOLUTION programados I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años, I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION los I-EVOLUTION objetivos I-EVOLUTION 1, I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION 5 I-EVOLUTION referentes I-EVOLUTION a I-EVOLUTION la I-EVOLUTION autoadministración I-EVOLUTION farmacológica, I-EVOLUTION la I-EVOLUTION dieta I-EVOLUTION antiglucemiante I-EVOLUTION y I-EVOLUTION el I-EVOLUTION tabaco I-EVOLUTION no I-EVOLUTION se I-EVOLUTION lograron. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION sigue I-EVOLUTION fumando I-EVOLUTION >40 I-EVOLUTION cigarrillos/día, I-EVOLUTION y I-EVOLUTION si I-EVOLUTION no I-EVOLUTION está I-EVOLUTION bajo I-EVOLUTION supervisión I-EVOLUTION no I-EVOLUTION toma I-EVOLUTION su I-EVOLUTION medicación I-EVOLUTION ni I-EVOLUTION tampoco I-EVOLUTION respeta I-EVOLUTION la I-EVOLUTION dieta. I-EVOLUTION I-EVOLUTION Trastornos B-TREATMENT de I-TREATMENT los I-TREATMENT procesos I-TREATMENT del I-TREATMENT pensamiento I-TREATMENT y I-TREATMENT Trastorno I-TREATMENT de I-TREATMENT la I-TREATMENT percepción I-TREATMENT sensorial I-TREATMENT auditiva. I-TREATMENT Continuando I-TREATMENT con I-TREATMENT los I-TREATMENT dos I-TREATMENT siguientes I-TREATMENT diagnósticos, I-TREATMENT se I-TREATMENT presentaron I-TREATMENT dos I-TREATMENT grupos I-TREATMENT de I-TREATMENT objetivos: I-TREATMENT unos I-TREATMENT permanentes I-TREATMENT y I-TREATMENT otros I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años. I-TREATMENT I-TREATMENT Los I-TREATMENT permanentes I-TREATMENT fueron: I-TREATMENT 1) I-TREATMENT conocer I-TREATMENT los I-TREATMENT síntomas I-TREATMENT psicopatológicos I-TREATMENT que I-TREATMENT presenta I-TREATMENT el I-TREATMENT paciente I-TREATMENT en I-TREATMENT cuanto I-TREATMENT a I-TREATMENT alteraciones I-TREATMENT del I-TREATMENT pensamiento I-TREATMENT y I-TREATMENT en I-TREATMENT lo I-TREATMENT cognitivo-perceptivo, I-TREATMENT y I-TREATMENT 2) I-TREATMENT evitar I-TREATMENT episodios I-TREATMENT de I-TREATMENT héteroagresividad I-TREATMENT y I-TREATMENT aparición I-TREATMENT de I-TREATMENT crisis. I-TREATMENT El I-TREATMENT objetivo I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años, I-TREATMENT indica I-TREATMENT que I-TREATMENT el I-TREATMENT sujeto I-TREATMENT habrá I-TREATMENT eliminado I-TREATMENT las I-TREATMENT expresiones I-TREATMENT verbales I-TREATMENT agresivas I-TREATMENT y I-TREATMENT con I-TREATMENT contenido I-TREATMENT de I-TREATMENT muerte I-TREATMENT hacia I-TREATMENT otras I-TREATMENT personas. I-TREATMENT I-TREATMENT Siguiendo I-TREATMENT con I-TREATMENT el I-TREATMENT proceso, I-TREATMENT se I-TREATMENT realizan I-TREATMENT las I-TREATMENT actividades I-TREATMENT acordadas I-TREATMENT que I-TREATMENT incluyen I-TREATMENT en I-TREATMENT primer I-TREATMENT lugar I-TREATMENT el I-TREATMENT registro I-TREATMENT de I-TREATMENT los I-TREATMENT datos I-TREATMENT recogidos I-TREATMENT sobre I-TREATMENT la I-TREATMENT ideación I-TREATMENT delirante I-TREATMENT y I-TREATMENT conducta I-TREATMENT del I-TREATMENT paciente. I-TREATMENT Se I-TREATMENT procura I-TREATMENT generar I-TREATMENT y I-TREATMENT mantener I-TREATMENT un I-TREATMENT espacio I-TREATMENT común I-TREATMENT para I-TREATMENT la I-TREATMENT convivencia I-TREATMENT y I-TREATMENT la I-TREATMENT tolerancia, I-TREATMENT fomentando I-TREATMENT el I-TREATMENT respeto I-TREATMENT a I-TREATMENT las I-TREATMENT personas. I-TREATMENT En I-TREATMENT las I-TREATMENT entrevistas I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT mantiene I-TREATMENT con I-TREATMENT el I-TREATMENT tutor, I-TREATMENT se I-TREATMENT analizan I-TREATMENT las I-TREATMENT conductas I-TREATMENT inapropiadas, I-TREATMENT presentando I-TREATMENT alternativas I-TREATMENT que I-TREATMENT cuando I-TREATMENT se I-TREATMENT reproducen I-TREATMENT son I-TREATMENT reforzadas I-TREATMENT mediante I-TREATMENT elogios. I-TREATMENT También I-TREATMENT se I-TREATMENT solicita I-TREATMENT presencia I-TREATMENT del I-TREATMENT clínico, I-TREATMENT a I-TREATMENT parte I-TREATMENT de I-TREATMENT las I-TREATMENT consultas, I-TREATMENT para I-TREATMENT las I-TREATMENT entrevistas I-TREATMENT cuando I-TREATMENT el I-TREATMENT tutor I-TREATMENT lo I-TREATMENT valora. I-TREATMENT I-TREATMENT Los B-EVOLUTION tres I-EVOLUTION objetivos I-EVOLUTION que I-EVOLUTION acabamos I-EVOLUTION de I-EVOLUTION exponer, I-EVOLUTION dos I-EVOLUTION permanentes I-EVOLUTION y I-EVOLUTION uno I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años, I-EVOLUTION fueron I-EVOLUTION conseguidos I-EVOLUTION en I-EVOLUTION los I-EVOLUTION plazos I-EVOLUTION previstos. I-EVOLUTION I-EVOLUTION Deterioro B-TREATMENT de I-TREATMENT la I-TREATMENT interacción I-TREATMENT social. I-TREATMENT Para I-TREATMENT trabajar I-TREATMENT la I-TREATMENT problemática I-TREATMENT que I-TREATMENT presenta I-TREATMENT el I-TREATMENT cuarto I-TREATMENT diagnóstico I-TREATMENT se I-TREATMENT establecen I-TREATMENT cuatro I-TREATMENT objetivos I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT meses I-TREATMENT y I-TREATMENT dos I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años. I-TREATMENT Los I-TREATMENT cuatro I-TREATMENT primeros I-TREATMENT son: I-TREATMENT 1) I-TREATMENT visitar I-TREATMENT e I-TREATMENT informar I-TREATMENT a I-TREATMENT los I-TREATMENT vecinos I-TREATMENT de I-TREATMENT su I-TREATMENT pueblo; I-TREATMENT 2) I-TREATMENT entrevistarse I-TREATMENT con I-TREATMENT las I-TREATMENT personas I-TREATMENT agredidas; I-TREATMENT 3) I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT haga I-TREATMENT visitas I-TREATMENT programadas I-TREATMENT a I-TREATMENT su I-TREATMENT casa I-TREATMENT siendo I-TREATMENT acompañado I-TREATMENT por I-TREATMENT personal I-TREATMENT enfermero I-TREATMENT y I-TREATMENT 4) I-TREATMENT se I-TREATMENT informará I-TREATMENT a I-TREATMENT las I-TREATMENT fuerzas I-TREATMENT del I-TREATMENT orden I-TREATMENT público I-TREATMENT de I-TREATMENT dicha I-TREATMENT actividad. I-TREATMENT I-TREATMENT Los I-TREATMENT dos I-TREATMENT objetivos I-TREATMENT siguientes, I-TREATMENT a I-TREATMENT conseguir I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años, I-TREATMENT son: I-TREATMENT 1) I-TREATMENT el I-TREATMENT paciente I-TREATMENT desarrollará I-TREATMENT una I-TREATMENT actividad I-TREATMENT normal I-TREATMENT durante I-TREATMENT las I-TREATMENT visitas, I-TREATMENT relacionándose I-TREATMENT con I-TREATMENT parientes I-TREATMENT y I-TREATMENT vecinos I-TREATMENT en I-TREATMENT la I-TREATMENT mediada I-TREATMENT de I-TREATMENT lo I-TREATMENT posible I-TREATMENT y I-TREATMENT 2) I-TREATMENT su I-TREATMENT presencia I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT no I-TREATMENT será I-TREATMENT causa I-TREATMENT de I-TREATMENT temor I-TREATMENT o I-TREATMENT alarma I-TREATMENT social. I-TREATMENT I-TREATMENT Para I-TREATMENT lograr I-TREATMENT estos I-TREATMENT objetivos I-TREATMENT se I-TREATMENT fueron I-TREATMENT realizando I-TREATMENT a I-TREATMENT lo I-TREATMENT largo I-TREATMENT de I-TREATMENT los I-TREATMENT meses I-TREATMENT numerosas I-TREATMENT entrevistas I-TREATMENT con I-TREATMENT vecinos I-TREATMENT del I-TREATMENT pueblo I-TREATMENT y I-TREATMENT familiares, I-TREATMENT con I-TREATMENT la I-TREATMENT persona I-TREATMENT agredida I-TREATMENT (la I-TREATMENT otra I-TREATMENT falleció) I-TREATMENT y I-TREATMENT con I-TREATMENT el I-TREATMENT cura I-TREATMENT amenazado I-TREATMENT por I-TREATMENT nuestro I-TREATMENT paciente. I-TREATMENT En I-TREATMENT estos I-TREATMENT encuentros I-TREATMENT se I-TREATMENT informó I-TREATMENT de I-TREATMENT las I-TREATMENT características I-TREATMENT del I-TREATMENT programa I-TREATMENT de I-TREATMENT visitas I-TREATMENT y I-TREATMENT se I-TREATMENT procuró I-TREATMENT reforzar I-TREATMENT la I-TREATMENT idea I-TREATMENT de I-TREATMENT que I-TREATMENT dichas I-TREATMENT visitas I-TREATMENT no I-TREATMENT alterarían I-TREATMENT en I-TREATMENT absoluto I-TREATMENT el I-TREATMENT orden I-TREATMENT público I-TREATMENT ni I-TREATMENT supondrían I-TREATMENT riesgo I-TREATMENT para I-TREATMENT nadie. I-TREATMENT Además I-TREATMENT se I-TREATMENT dejó I-TREATMENT perfectamente I-TREATMENT claro I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT siempre I-TREATMENT estaría I-TREATMENT acompañado I-TREATMENT de I-TREATMENT personal I-TREATMENT sanitario. I-TREATMENT La I-TREATMENT Guardia I-TREATMENT Civil I-TREATMENT también I-TREATMENT fue I-TREATMENT puntualmente I-TREATMENT informada. I-TREATMENT I-TREATMENT Dichas B-EVOLUTION actividades I-EVOLUTION condujeron I-EVOLUTION a I-EVOLUTION la I-EVOLUTION consecución I-EVOLUTION satisfactoria I-EVOLUTION en I-EVOLUTION tiempo I-EVOLUTION y I-EVOLUTION forma I-EVOLUTION de I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION objetivos I-EVOLUTION propuestos. I-EVOLUTION I-EVOLUTION Afrontamiento B-TREATMENT familiar I-TREATMENT comprometido. I-TREATMENT El I-TREATMENT quinto I-TREATMENT y I-TREATMENT último I-TREATMENT de I-TREATMENT los I-TREATMENT diagnósticos I-TREATMENT exige I-TREATMENT de I-TREATMENT nuevo I-TREATMENT el I-TREATMENT planteamiento I-TREATMENT de I-TREATMENT tres I-TREATMENT grupos I-TREATMENT de I-TREATMENT objetivos. I-TREATMENT Un I-TREATMENT primer I-TREATMENT objetivo I-TREATMENT permanente, I-TREATMENT el I-TREATMENT segundo I-TREATMENT grupo I-TREATMENT compuesto I-TREATMENT por I-TREATMENT tres I-TREATMENT objetivos I-TREATMENT a I-TREATMENT cumplir I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT meses I-TREATMENT y I-TREATMENT dos I-TREATMENT más I-TREATMENT que I-TREATMENT deberían I-TREATMENT lograrse I-TREATMENT a I-TREATMENT los I-TREATMENT dos I-TREATMENT años. I-TREATMENT I-TREATMENT El I-TREATMENT objetivo I-TREATMENT permanente, I-TREATMENT es I-TREATMENT que I-TREATMENT su I-TREATMENT familia I-TREATMENT reciba I-TREATMENT información I-TREATMENT del I-TREATMENT proyecto I-TREATMENT rehabilitador I-TREATMENT y I-TREATMENT evolución I-TREATMENT del I-TREATMENT paciente I-TREATMENT de I-TREATMENT forma I-TREATMENT sostenida, I-TREATMENT a I-TREATMENT través I-TREATMENT del I-TREATMENT contacto I-TREATMENT y I-TREATMENT entrevistas I-TREATMENT con I-TREATMENT el I-TREATMENT tutor. I-TREATMENT En I-TREATMENT los I-TREATMENT objetivos I-TREATMENT a I-TREATMENT los I-TREATMENT seis I-TREATMENT meses, I-TREATMENT se I-TREATMENT incluyen: I-TREATMENT 1) I-TREATMENT un I-TREATMENT mayor I-TREATMENT protagonismo I-TREATMENT de I-TREATMENT esta I-TREATMENT familia I-TREATMENT en I-TREATMENT el I-TREATMENT proceso I-TREATMENT terapéutico; I-TREATMENT 2) I-TREATMENT visitas I-TREATMENT programadas I-TREATMENT semanales I-TREATMENT al I-TREATMENT paciente I-TREATMENT para I-TREATMENT llevarlo I-TREATMENT a I-TREATMENT comer I-TREATMENT fuera, I-TREATMENT y I-TREATMENT 3) I-TREATMENT hacerse I-TREATMENT cargo I-TREATMENT del I-TREATMENT lavado I-TREATMENT de I-TREATMENT su I-TREATMENT ropa I-TREATMENT a I-TREATMENT cambio I-TREATMENT de I-TREATMENT una I-TREATMENT contraprestación I-TREATMENT económica I-TREATMENT pactada. I-TREATMENT A I-TREATMENT los I-TREATMENT dos I-TREATMENT años I-TREATMENT se I-TREATMENT establecen I-TREATMENT como I-TREATMENT objetivos, I-TREATMENT por I-TREATMENT una I-TREATMENT parte: I-TREATMENT 1) I-TREATMENT que I-TREATMENT su I-TREATMENT hermano I-TREATMENT sea I-TREATMENT capaz I-TREATMENT de I-TREATMENT verbalizar I-TREATMENT elogios I-TREATMENT hacia I-TREATMENT el I-TREATMENT paciente I-TREATMENT por I-TREATMENT su I-TREATMENT progresos I-TREATMENT y I-TREATMENT en I-TREATMENT su I-TREATMENT presencia I-TREATMENT y I-TREATMENT por I-TREATMENT otro I-TREATMENT lado: I-TREATMENT 2) I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT respete I-TREATMENT la I-TREATMENT opinión I-TREATMENT de I-TREATMENT sus I-TREATMENT familiares I-TREATMENT omitiendo I-TREATMENT expresiones I-TREATMENT desautorizantes I-TREATMENT o I-TREATMENT insultantes. I-TREATMENT I-TREATMENT El I-TREATMENT diseño I-TREATMENT de I-TREATMENT actividades I-TREATMENT para I-TREATMENT estos I-TREATMENT objetivos I-TREATMENT incluyó I-TREATMENT en I-TREATMENT un I-TREATMENT primer I-TREATMENT momento I-TREATMENT una I-TREATMENT serie I-TREATMENT de I-TREATMENT entrevistas I-TREATMENT programadas I-TREATMENT entre I-TREATMENT familiares, I-TREATMENT paciente I-TREATMENT y I-TREATMENT tutor I-TREATMENT a I-TREATMENT fin I-TREATMENT de I-TREATMENT aclarar I-TREATMENT todos I-TREATMENT los I-TREATMENT aspectos I-TREATMENT concernientes I-TREATMENT al I-TREATMENT proyecto I-TREATMENT terapéutico I-TREATMENT del I-TREATMENT paciente, I-TREATMENT normas I-TREATMENT de I-TREATMENT funcionamiento, I-TREATMENT actividades I-TREATMENT dentro I-TREATMENT y I-TREATMENT fuera I-TREATMENT del I-TREATMENT dispositivo I-TREATMENT y I-TREATMENT colaboración I-TREATMENT necesaria I-TREATMENT de I-TREATMENT la I-TREATMENT familia. I-TREATMENT A I-TREATMENT lo I-TREATMENT largo I-TREATMENT del I-TREATMENT tiempo I-TREATMENT se I-TREATMENT les I-TREATMENT fue I-TREATMENT informando I-TREATMENT de I-TREATMENT la I-TREATMENT evolución I-TREATMENT del I-TREATMENT paciente, I-TREATMENT de I-TREATMENT la I-TREATMENT autonomía I-TREATMENT que I-TREATMENT conseguía I-TREATMENT y I-TREATMENT de I-TREATMENT todos I-TREATMENT los I-TREATMENT avances I-TREATMENT y I-TREATMENT obstáculos. I-TREATMENT Se I-TREATMENT anima I-TREATMENT en I-TREATMENT las I-TREATMENT entrevistas I-TREATMENT a I-TREATMENT verbalizar I-TREATMENT lo I-TREATMENT que I-TREATMENT piensan I-TREATMENT unos I-TREATMENT de I-TREATMENT otros I-TREATMENT con I-TREATMENT corrección I-TREATMENT y I-TREATMENT respeto, I-TREATMENT se I-TREATMENT enseña I-TREATMENT al I-TREATMENT paciente I-TREATMENT a I-TREATMENT que I-TREATMENT respete I-TREATMENT las I-TREATMENT opiniones I-TREATMENT y I-TREATMENT los I-TREATMENT turnos I-TREATMENT de I-TREATMENT intervención I-TREATMENT de I-TREATMENT los I-TREATMENT demás I-TREATMENT y I-TREATMENT se I-TREATMENT consensuan I-TREATMENT acuerdos I-TREATMENT para I-TREATMENT el I-TREATMENT funcionamiento I-TREATMENT diario, I-TREATMENT visitas I-TREATMENT de I-TREATMENT la I-TREATMENT familia, I-TREATMENT salidas I-TREATMENT a I-TREATMENT comer I-TREATMENT fuera, I-TREATMENT día I-TREATMENT de I-TREATMENT recogida I-TREATMENT de I-TREATMENT la I-TREATMENT ropa I-TREATMENT sucia, I-TREATMENT etc. I-TREATMENT I-TREATMENT La B-EVOLUTION evaluación I-EVOLUTION evidencia I-EVOLUTION que I-EVOLUTION tanto I-EVOLUTION el I-EVOLUTION objetivo I-EVOLUTION permanente I-EVOLUTION como I-EVOLUTION los I-EVOLUTION referidos I-EVOLUTION a I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION se I-EVOLUTION consiguieron I-EVOLUTION correctamente, I-EVOLUTION no I-EVOLUTION así I-EVOLUTION los I-EVOLUTION objetivos I-EVOLUTION propuestos I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años. I-EVOLUTION El I-EVOLUTION hermano I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION a I-EVOLUTION penas I-EVOLUTION si I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION capaz I-EVOLUTION de I-EVOLUTION elogiar I-EVOLUTION los I-EVOLUTION evidentes I-EVOLUTION avances I-EVOLUTION del I-EVOLUTION paciente, I-EVOLUTION ni I-EVOLUTION éste I-EVOLUTION último I-EVOLUTION ha I-EVOLUTION podido I-EVOLUTION eliminar I-EVOLUTION determinadas I-EVOLUTION expresiones I-EVOLUTION inapropiadas I-EVOLUTION hacia I-EVOLUTION su I-EVOLUTION familia, I-EVOLUTION en I-EVOLUTION especial I-EVOLUTION hacia I-EVOLUTION su I-EVOLUTION hermano, I-EVOLUTION aunque I-EVOLUTION si I-EVOLUTION disminuyeron I-EVOLUTION en I-EVOLUTION tono I-EVOLUTION y I-EVOLUTION frecuencia. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipercolesterolemia, I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY rigidez I-PAST_MEDICAL_HISTORY articular, I-PAST_MEDICAL_HISTORY microadenoma I-PAST_MEDICAL_HISTORY hipofisiario I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY migrañoso, I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY ejerce I-PAST_MEDICAL_HISTORY funciones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pinche I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Hospital I-PAST_MEDICAL_HISTORY Universitario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Ceuta I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY diez I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Inicia B-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS contracturas I-PRESENT_ILLNESS musculares I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lumbalgias I-PRESENT_ILLNESS severas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS mayoría I-PRESENT_ILLNESS ocasionadas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS su I-PRESENT_ILLNESS rol I-PRESENT_ILLNESS dentro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cocina, I-PRESENT_ILLNESS solicitando I-PRESENT_ILLNESS constantes I-PRESENT_ILLNESS bajas I-PRESENT_ILLNESS laborales, I-PRESENT_ILLNESS evoluciona I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS parestesias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS e I-PRESENT_ILLNESS incontinencia I-PRESENT_ILLNESS urinaria, I-PRESENT_ILLNESS es B-DERIVED_FROM/TO referida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO especializado I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO realizar I-DERIVED_FROM/TO una I-DERIVED_FROM/TO artrodesis I-DERIVED_FROM/TO de I-DERIVED_FROM/TO columna I-DERIVED_FROM/TO lumbo-sacra I-DERIVED_FROM/TO L4-L5-S1 I-DERIVED_FROM/TO precisando I-DERIVED_FROM/TO incapacidad I-DERIVED_FROM/TO temporal I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO un I-DERIVED_FROM/TO año, I-DERIVED_FROM/TO posteriormente B-EVOLUTION presenta I-EVOLUTION síntomas I-EVOLUTION sugestivos I-EVOLUTION de I-EVOLUTION compresión I-EVOLUTION radicular I-EVOLUTION y I-EVOLUTION estenosis I-EVOLUTION de I-EVOLUTION canal I-EVOLUTION medular, I-EVOLUTION por B-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO nuevamente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO referida I-DERIVED_FROM/TO para I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO quirúrgico, I-DERIVED_FROM/TO realizándose I-DERIVED_FROM/TO una I-DERIVED_FROM/TO resección I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hernias I-DERIVED_FROM/TO discales I-DERIVED_FROM/TO C5-C6 I-DERIVED_FROM/TO y I-DERIVED_FROM/TO C6-C7, I-DERIVED_FROM/TO necesitando I-DERIVED_FROM/TO nuevamente I-DERIVED_FROM/TO una I-DERIVED_FROM/TO incapacidad I-DERIVED_FROM/TO temporal I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO año I-DERIVED_FROM/TO más. I-DERIVED_FROM/TO Al B-EVOLUTION reincorporarse I-EVOLUTION a I-EVOLUTION su I-EVOLUTION puesto I-EVOLUTION de I-EVOLUTION trabajo, I-EVOLUTION se I-EVOLUTION realiza I-EVOLUTION una I-EVOLUTION valoración I-EVOLUTION médica I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Prevención I-EVOLUTION de I-EVOLUTION Riesgos I-EVOLUTION Laborales I-EVOLUTION del I-EVOLUTION Hospital, I-EVOLUTION donde I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION estudio I-EVOLUTION de I-EVOLUTION los I-EVOLUTION protocolos I-EVOLUTION de I-EVOLUTION manipulación I-EVOLUTION manual I-EVOLUTION de I-EVOLUTION cargas I-EVOLUTION y I-EVOLUTION movimientos I-EVOLUTION repetitivos, I-EVOLUTION se I-EVOLUTION valora I-EVOLUTION como I-EVOLUTION No I-EVOLUTION Apta I-EVOLUTION para I-EVOLUTION realizar I-EVOLUTION las I-EVOLUTION funciones I-EVOLUTION de I-EVOLUTION pinche I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cocina. I-EVOLUTION Se I-EVOLUTION propone I-EVOLUTION una I-EVOLUTION adaptación I-EVOLUTION del I-EVOLUTION puesto I-EVOLUTION de I-EVOLUTION trabajo, I-EVOLUTION de I-EVOLUTION imposible I-EVOLUTION cumplimiento I-EVOLUTION por I-EVOLUTION su I-EVOLUTION mando I-EVOLUTION intermedio. I-EVOLUTION I-EVOLUTION El I-EVOLUTION caso I-EVOLUTION es I-EVOLUTION estudiado I-EVOLUTION por I-EVOLUTION Gerencia I-EVOLUTION para I-EVOLUTION solicitar I-EVOLUTION su I-EVOLUTION reubicación I-EVOLUTION en I-EVOLUTION un I-EVOLUTION puesto I-EVOLUTION acorde I-EVOLUTION a I-EVOLUTION las I-EVOLUTION patologías I-EVOLUTION que I-EVOLUTION presenta, I-EVOLUTION donde I-EVOLUTION pudiera I-EVOLUTION desempeñar I-EVOLUTION funciones I-EVOLUTION que I-EVOLUTION no I-EVOLUTION perjudicaran I-EVOLUTION su I-EVOLUTION salud; I-EVOLUTION en I-EVOLUTION vista I-EVOLUTION de I-EVOLUTION no I-EVOLUTION tener I-EVOLUTION un I-EVOLUTION puesto I-EVOLUTION con I-EVOLUTION esas I-EVOLUTION características I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION empresa, I-EVOLUTION la I-EVOLUTION trabajadora I-EVOLUTION denuncia I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION inspectoría I-EVOLUTION del I-EVOLUTION trabajo I-EVOLUTION su I-EVOLUTION situación I-EVOLUTION y I-EVOLUTION solicita I-EVOLUTION una I-EVOLUTION minusvalía I-EVOLUTION al I-EVOLUTION Instituto I-EVOLUTION de I-EVOLUTION Mayores I-EVOLUTION y I-EVOLUTION Servicios I-EVOLUTION Sociales, I-EVOLUTION donde I-EVOLUTION el I-EVOLUTION equipo I-EVOLUTION de I-EVOLUTION valoración I-EVOLUTION y I-EVOLUTION orientación I-EVOLUTION otorga I-EVOLUTION un I-EVOLUTION grado I-EVOLUTION de I-EVOLUTION discapacidad I-EVOLUTION del I-EVOLUTION 65% I-EVOLUTION según I-EVOLUTION los I-EVOLUTION baremos I-EVOLUTION vigentes I-EVOLUTION a I-EVOLUTION la I-EVOLUTION fecha I-EVOLUTION y I-EVOLUTION además I-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION Inspección I-EVOLUTION de I-EVOLUTION Trabajo I-EVOLUTION requiere I-EVOLUTION a I-EVOLUTION la I-EVOLUTION empresa I-EVOLUTION realizar I-EVOLUTION una I-EVOLUTION adaptación I-EVOLUTION del I-EVOLUTION puesto I-EVOLUTION de I-EVOLUTION trabajo I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION se I-EVOLUTION debe I-EVOLUTION garantizar I-EVOLUTION la I-EVOLUTION reinserción I-EVOLUTION de I-EVOLUTION los I-EVOLUTION trabajadores I-EVOLUTION con I-EVOLUTION minusvalías I-EVOLUTION por I-EVOLUTION condiciones I-EVOLUTION médicas. I-EVOLUTION Se I-EVOLUTION replantea I-EVOLUTION la I-EVOLUTION adaptación I-EVOLUTION del I-EVOLUTION puesto I-EVOLUTION de I-EVOLUTION trabajo I-EVOLUTION con I-EVOLUTION una I-EVOLUTION nueva I-EVOLUTION valoración I-EVOLUTION de I-EVOLUTION los I-EVOLUTION riesgos I-EVOLUTION por I-EVOLUTION parte I-EVOLUTION del I-EVOLUTION Técnico I-EVOLUTION de I-EVOLUTION Prevención I-EVOLUTION en I-EVOLUTION conjunto I-EVOLUTION con I-EVOLUTION la I-EVOLUTION Gobernanta, I-EVOLUTION haciéndolo I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION minuciosa I-EVOLUTION y I-EVOLUTION específica, I-EVOLUTION se I-EVOLUTION logra I-EVOLUTION un I-EVOLUTION acuerdo I-EVOLUTION para I-EVOLUTION su I-EVOLUTION reintegro I-EVOLUTION a I-EVOLUTION dicha I-EVOLUTION área. I-EVOLUTION Sin I-EVOLUTION embargo I-EVOLUTION a I-EVOLUTION su I-EVOLUTION reincorporación, I-EVOLUTION la I-EVOLUTION trabajadora I-EVOLUTION sufre I-EVOLUTION múltiples I-EVOLUTION episodios I-EVOLUTION conflictivospor I-EVOLUTION parte I-EVOLUTION de I-EVOLUTION compañeros, I-EVOLUTION quienes I-EVOLUTION se I-EVOLUTION niegan I-EVOLUTION a I-EVOLUTION asumir I-EVOLUTION gran I-EVOLUTION parte I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION actividades I-EVOLUTION diarias I-EVOLUTION por I-EVOLUTION la I-EVOLUTION adaptación I-EVOLUTION que I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION realizado. I-EVOLUTION Pasado I-EVOLUTION un I-EVOLUTION tiempo, I-EVOLUTION su I-EVOLUTION jefe I-EVOLUTION inmediato I-EVOLUTION ha I-EVOLUTION logrado I-EVOLUTION establecer I-EVOLUTION un I-EVOLUTION plan I-EVOLUTION de I-EVOLUTION trabajo I-EVOLUTION adecuado I-EVOLUTION para I-EVOLUTION distribuir I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION homogénea I-EVOLUTION las I-EVOLUTION actividades I-EVOLUTION diarias I-EVOLUTION de I-EVOLUTION cocina I-EVOLUTION y I-EVOLUTION mejorar I-EVOLUTION las I-EVOLUTION relaciones I-EVOLUTION interpersonales. I-EVOLUTION Actualmente I-EVOLUTION desempeña I-EVOLUTION las I-EVOLUTION funciones I-EVOLUTION de I-EVOLUTION pinche I-EVOLUTION de I-EVOLUTION cocina, I-EVOLUTION con I-EVOLUTION las I-EVOLUTION restricciones I-EVOLUTION impuestas I-EVOLUTION por I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Prevención I-EVOLUTION de I-EVOLUTION Riesgos I-EVOLUTION Laborales, I-EVOLUTION además I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION reconocimientos I-EVOLUTION médicos I-EVOLUTION anuales I-EVOLUTION valorando I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION de I-EVOLUTION su I-EVOLUTION patología. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 53 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS reconocimiento I-PRESENT_ILLNESS medico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS abril I-PRESENT_ILLNESS 2015. I-PRESENT_ILLNESS I-PRESENT_ILLNESS - B-PAST_MEDICAL_HISTORY Antecedentes I-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY coloide I-PAST_MEDICAL_HISTORY (tiroidectomía I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2010), I-PAST_MEDICAL_HISTORY intervención I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY debida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tráfico I-PAST_MEDICAL_HISTORY (1995). I-PAST_MEDICAL_HISTORY Menopausia I-PAST_MEDICAL_HISTORY precoz, I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY hipocrómica, I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tráfico I-PAST_MEDICAL_HISTORY (2009), I-PAST_MEDICAL_HISTORY rinitis I-PAST_MEDICAL_HISTORY vasomotora I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY extrínseca I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY polen I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY asma, I-PAST_MEDICAL_HISTORY gonalgia, I-PAST_MEDICAL_HISTORY hipocalcemia, I-PAST_MEDICAL_HISTORY adenoma I-PAST_MEDICAL_HISTORY tubular I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon I-PAST_MEDICAL_HISTORY (2014), I-PAST_MEDICAL_HISTORY obesidad. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Hace I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY aparecen I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY pigmentada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY dorsal I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY diagnosticadas I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY notalgia I-PAST_MEDICAL_HISTORY parestésica. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY relaciona I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY aparición I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ninguna I-PAST_MEDICAL_HISTORY situación I-PAST_MEDICAL_HISTORY especial, I-PAST_MEDICAL_HISTORY no B-FAMILY_HISTORY refiere I-FAMILY_HISTORY otros I-FAMILY_HISTORY casos I-FAMILY_HISTORY en I-FAMILY_HISTORY familiares. I-FAMILY_HISTORY I-FAMILY_HISTORY - B-EXPLORATION Exploración I-EXPLORATION física: I-EXPLORATION mácula I-EXPLORATION hiperpigmentada I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION supraescapular; I-EXPLORATION contracturas I-EXPLORATION musculares I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION trapecios I-EXPLORATION y I-EXPLORATION zona I-EXPLORATION supraescapular I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Síntomas: I-EXPLORATION refiere I-EXPLORATION mucho I-EXPLORATION prurito I-EXPLORATION y I-EXPLORATION "pinchazos", I-EXPLORATION mejora I-EXPLORATION cuando I-EXPLORATION está I-EXPLORATION más I-EXPLORATION relajada I-EXPLORATION y I-EXPLORATION tras I-EXPLORATION tratamiento I-EXPLORATION rehabilitador I-EXPLORATION con I-EXPLORATION fisioterapia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION contracturas I-EXPLORATION musculares. I-EXPLORATION Los I-EXPLORATION síntomas I-EXPLORATION empeoran I-EXPLORATION con I-EXPLORATION el I-EXPLORATION rascado. I-EXPLORATION I-EXPLORATION - B-TREATMENT Tratamiento: I-TREATMENT no I-TREATMENT ha I-TREATMENT requerido I-TREATMENT tratamiento I-TREATMENT específico I-TREATMENT salvo I-TREATMENT hidratación I-TREATMENT y I-TREATMENT evitar I-TREATMENT irritación I-TREATMENT la I-TREATMENT zona. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS reconocimiento I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS abril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2015. I-PRESENT_ILLNESS I-PRESENT_ILLNESS - B-PAST_MEDICAL_HISTORY Antecedentes I-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY gramíneas, I-PAST_MEDICAL_HISTORY condromalacia I-PAST_MEDICAL_HISTORY bilateral, I-PAST_MEDICAL_HISTORY lumbalgia I-PAST_MEDICAL_HISTORY (RMN I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2015: I-PAST_MEDICAL_HISTORY prolapso I-PAST_MEDICAL_HISTORY discal), I-PAST_MEDICAL_HISTORY contracturas I-PAST_MEDICAL_HISTORY cervicodorsales, I-PAST_MEDICAL_HISTORY urticaria I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2011que I-PAST_MEDICAL_HISTORY duró I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY causa I-PAST_MEDICAL_HISTORY probada I-PAST_MEDICAL_HISTORY (tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Xazal I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY remisión). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Hace I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY apareció I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY lesión I-PAST_MEDICAL_HISTORY pigmentada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY dorsal, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY eccema I-PAST_MEDICAL_HISTORY inespecífico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY corticoides I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY (por I-PAST_MEDICAL_HISTORY dermatólogo) I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY notalgia I-PAST_MEDICAL_HISTORY parestestica. I-PAST_MEDICAL_HISTORY Habitualmente B-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS contracturas I-PRESENT_ILLNESS cervicodorsales I-PRESENT_ILLNESS tensionales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS al I-PRESENT_ILLNESS estrés. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS mejoró I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS relajantes I-PRESENT_ILLNESS muscularespor I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lumbalgia I-PRESENT_ILLNESS aguda. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS relaciona I-PRESENT_ILLNESS su I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ninguna I-PRESENT_ILLNESS situación I-PRESENT_ILLNESS especial, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS casos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS familiares. I-PRESENT_ILLNESS I-PRESENT_ILLNESS - I-PRESENT_ILLNESS Exploración B-EXPLORATION física: I-EXPLORATION mácula I-EXPLORATION hiperpigmentada I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION dorsal I-EXPLORATION media I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION derecha, I-EXPLORATION contracturas I-EXPLORATION musculares I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION trapecios I-EXPLORATION y I-EXPLORATION músculos I-EXPLORATION paravertebrales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION cervicodorsal. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Síntomas: I-EXPLORATION prurito. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Tratamiento: B-TREATMENT la I-TREATMENT paciente I-TREATMENT refiere I-TREATMENT que I-TREATMENT los I-TREATMENT dermatólogos I-TREATMENT que I-TREATMENT lo I-TREATMENT habían I-TREATMENT visto I-TREATMENT inicialmente I-TREATMENT lo I-TREATMENT diagnosticaban I-TREATMENT más I-TREATMENT como I-TREATMENT un I-TREATMENT eczema I-TREATMENT inespecífico I-TREATMENT y I-TREATMENT lo I-TREATMENT trataron I-TREATMENT con I-TREATMENT corticoides I-TREATMENT tópicos, I-TREATMENT que I-TREATMENT remitían I-TREATMENT parcialmente I-TREATMENT la I-TREATMENT sintomatología, I-TREATMENT con I-TREATMENT recaídas I-TREATMENT continuadas I-TREATMENT tras I-TREATMENT cese I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT Los I-TREATMENT síntomas I-TREATMENT mejoran I-TREATMENT con I-TREATMENT crema I-TREATMENT hidratante I-TREATMENT tipo I-TREATMENT urea; I-TREATMENT el I-TREATMENT rascado I-TREATMENT empeora I-TREATMENT los I-TREATMENT síntomas I-TREATMENT y I-TREATMENT provoca I-TREATMENT aumento I-TREATMENT de I-TREATMENT tamaño I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT I-TREATMENT Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO desde I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Urgencias I-DERIVED_FROM/TO por I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO en I-DERIVED_FROM/TO pelvis. I-DERIVED_FROM/TO Refería B-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY suprarrenal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sospecha I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipoaldosteronismo, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY (EPOC) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY broncodilatadores. I-PAST_MEDICAL_HISTORY Tras B-TREATMENT múltiples I-TREATMENT resecciones I-TREATMENT transuretrales I-TREATMENT por I-TREATMENT adenocarcinoma I-TREATMENT vesical, I-TREATMENT se I-TREATMENT le I-TREATMENT practicó I-TREATMENT una I-TREATMENT prostatocistectomía I-TREATMENT más I-TREATMENT nefrectomía I-TREATMENT izquierda I-TREATMENT con I-TREATMENT derivación I-TREATMENT tipo I-TREATMENT Bricker I-TREATMENT por I-TREATMENT adenocarcinoma I-TREATMENT de I-TREATMENT próstata, I-TREATMENT carcinoma I-TREATMENT vesical I-TREATMENT infiltrante I-TREATMENT y I-TREATMENT anulación I-TREATMENT pielonefrótica I-TREATMENT izquierda. I-TREATMENT Posteriormente B-EVOLUTION al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION semanas I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION drenaje I-EVOLUTION mediante I-EVOLUTION punción I-EVOLUTION percutánea I-EVOLUTION de I-EVOLUTION absceso I-EVOLUTION pelviano I-EVOLUTION post-quirúrgico. I-EVOLUTION I-EVOLUTION Aproximadamente I-EVOLUTION al I-EVOLUTION año I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención I-EVOLUTION quirúrgica, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION elevaciones I-EVOLUTION importantes I-EVOLUTION del I-EVOLUTION PSA I-EVOLUTION de I-EVOLUTION 858, I-EVOLUTION 59 I-EVOLUTION ng.ml-1, I-EVOLUTION se I-EVOLUTION instauró I-EVOLUTION bloqueo I-EVOLUTION hormonal I-EVOLUTION con I-EVOLUTION antiandrógenos, I-EVOLUTION que I-EVOLUTION no I-EVOLUTION fueron I-EVOLUTION efectivos. I-EVOLUTION Clínicamente B-EXPLORATION presentaba I-EXPLORATION astenia, I-EXPLORATION anorexia, I-EXPLORATION objetivándose I-EXPLORATION una I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION de I-EXPLORATION 1.404 I-EXPLORATION U. I-EXPLORATION L-1, I-EXPLORATION descenso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hematocrito I-EXPLORATION (28,1%) I-EXPLORATION y I-EXPLORATION hemoglobina I-EXPLORATION (9, I-EXPLORATION 3 I-EXPLORATION g.dl-1), I-EXPLORATION se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT eritropoyetina I-TREATMENT más I-TREATMENT hierro. I-TREATMENT En B-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computerizada I-EXPLORATION (TAC) I-EXPLORATION abdomino-pélvica, I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION afectación I-EXPLORATION linfoadenopática I-EXPLORATION retroperitoneal I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION metastásico, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION metástasis I-EXPLORATION óseas I-EXPLORATION osteoblásticas I-EXPLORATION que I-EXPLORATION afectaban I-EXPLORATION a I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION lumbosacra I-EXPLORATION y I-EXPLORATION estructuras I-EXPLORATION pélvicas. I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION nuevo I-EXPLORATION control I-EXPLORATION al I-EXPLORATION cabo I-EXPLORATION de I-EXPLORATION tres I-EXPLORATION meses I-EXPLORATION con I-EXPLORATION hallazgos I-EXPLORATION similares, I-EXPLORATION llamaba I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION la I-EXPLORATION importante I-EXPLORATION esclerosis I-EXPLORATION existente I-EXPLORATION en I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION dorsales I-EXPLORATION y I-EXPLORATION primeros I-EXPLORATION lumbares I-EXPLORATION así I-EXPLORATION como I-EXPLORATION en I-EXPLORATION todas I-EXPLORATION las I-EXPLORATION costillas, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION blásticas. I-EXPLORATION I-EXPLORATION El B-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Dolor I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS la I-PRESENT_ILLNESS existencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS pelvis, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS lumbar, I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS caderas, I-PRESENT_ILLNESS región I-PRESENT_ILLNESS inguinal I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS extremidad I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuerza. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS era I-PRESENT_ILLNESS continuo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS EVA I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8/10, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS conciliar I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sueño, I-PRESENT_ILLNESS aumentaba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS movilización I-PRESENT_ILLNESS y I-PRESENT_ILLNESS asociaba I-PRESENT_ILLNESS parestesias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS extremidades. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION paresia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION grado I-EXPLORATION leve I-EXPLORATION (4/5) I-EXPLORATION en I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION de I-EXPLORATION balance I-EXPLORATION muscular. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION hallándose I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION diseminación I-EXPLORATION metastásica I-EXPLORATION en I-EXPLORATION calota, I-EXPLORATION escápula I-EXPLORATION derecha, I-EXPLORATION ambos I-EXPLORATION hombros, I-EXPLORATION húmero, I-EXPLORATION parrilla I-EXPLORATION costal, I-EXPLORATION pelvis, I-EXPLORATION ambos I-EXPLORATION fémures I-EXPLORATION y I-EXPLORATION tibias. I-EXPLORATION B-TREATMENT Se I-TREATMENT inició I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amitriptilina I-TREATMENT 25 I-TREATMENT mg.24 I-TREATMENT h-1, I-TREATMENT sulfato I-TREATMENT de I-TREATMENT morfina I-TREATMENT de I-TREATMENT liberación I-TREATMENT controlada I-TREATMENT 15 I-TREATMENT mg.12 I-TREATMENT h-1, I-TREATMENT acetil I-TREATMENT salicilato I-TREATMENT de I-TREATMENT lisisna I-TREATMENT 1800 I-TREATMENT mg.8 I-TREATMENT h-1, I-TREATMENT omeprazol I-TREATMENT 20 I-TREATMENT mg.24 I-TREATMENT h-1, I-TREATMENT lactulosa I-TREATMENT 10 I-TREATMENT g.8 I-TREATMENT h-1 I-TREATMENT y I-TREATMENT metamizol I-TREATMENT de I-TREATMENT analgésico I-TREATMENT de I-TREATMENT rescate. I-TREATMENT En I-TREATMENT la I-TREATMENT visita I-TREATMENT sucesiva I-TREATMENT se I-TREATMENT apreció I-TREATMENT un I-TREATMENT mal I-TREATMENT control I-TREATMENT del I-TREATMENT dolor I-TREATMENT a I-TREATMENT pesar I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT analgésico. I-TREATMENT Se I-TREATMENT aumentó I-TREATMENT el I-TREATMENT sulfato I-TREATMENT de I-TREATMENT morfina I-TREATMENT 30 I-TREATMENT mg.8 I-TREATMENT h-1, I-TREATMENT iniciándose I-TREATMENT pauta I-TREATMENT con I-TREATMENT dexametasona I-TREATMENT y I-TREATMENT se I-TREATMENT remitió I-TREATMENT al I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Medicina I-TREATMENT Nuclear I-TREATMENT para I-TREATMENT valorar I-TREATMENT tratamiento I-TREATMENT paliativo I-TREATMENT con I-TREATMENT Sm-153 I-TREATMENT Lexidronam I-TREATMENT (Quadramet®). I-TREATMENT El B-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION anemia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION previa I-EXPLORATION al I-EXPLORATION tratamiento. I-EXPLORATION Se B-TREATMENT administró I-TREATMENT una I-TREATMENT dosis I-TREATMENT paliativa I-TREATMENT de I-TREATMENT 80 I-TREATMENT mCi I-TREATMENT de I-TREATMENT Sm-153. I-TREATMENT I-TREATMENT Al B-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION una I-EVOLUTION semana, I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION de I-EVOLUTION la I-EVOLUTION región I-EVOLUTION lumbar I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION pelvis I-EVOLUTION habían I-EVOLUTION desaparecido I-EVOLUTION en I-EVOLUTION 48 I-EVOLUTION horas, I-EVOLUTION persistiendo I-EVOLUTION en I-EVOLUTION el I-EVOLUTION fémur I-EVOLUTION derecho. I-EVOLUTION El I-EVOLUTION EVA I-EVOLUTION era I-EVOLUTION de I-EVOLUTION 5/10 I-EVOLUTION y I-EVOLUTION había I-EVOLUTION mejorado I-EVOLUTION la I-EVOLUTION deambulación. I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT mantener I-TREATMENT el I-TREATMENT mismo I-TREATMENT tratamiento I-TREATMENT analgésico I-TREATMENT excepto I-TREATMENT la I-TREATMENT dexametasona I-TREATMENT que I-TREATMENT se I-TREATMENT retiró. I-TREATMENT Transcurridas B-EVOLUTION 4 I-EVOLUTION semanas I-EVOLUTION del I-EVOLUTION Sm-153, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION asintomático I-EVOLUTION con I-EVOLUTION EVA I-EVOLUTION de I-EVOLUTION 1/10, I-EVOLUTION en I-EVOLUTION la I-EVOLUTION analítica I-EVOLUTION de I-EVOLUTION control I-EVOLUTION se I-EVOLUTION apreciaba I-EVOLUTION leucopenia I-EVOLUTION (3.000/mm3) I-EVOLUTION y I-EVOLUTION plaquetopenia I-EVOLUTION (121.000/mm3), I-EVOLUTION sin I-EVOLUTION repercusiones I-EVOLUTION clínicas. I-EVOLUTION Los I-EVOLUTION opiáceos I-EVOLUTION y I-EVOLUTION los I-EVOLUTION AINE I-EVOLUTION fueron I-EVOLUTION retirados I-EVOLUTION progresivamente, I-EVOLUTION permaneciendo I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION con I-EVOLUTION amitriptilina I-EVOLUTION 25 I-EVOLUTION mg.24 I-EVOLUTION h-1 I-EVOLUTION y I-EVOLUTION metamizol I-EVOLUTION a I-EVOLUTION demanda. I-EVOLUTION La I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION las I-EVOLUTION 8 I-EVOLUTION semanas I-EVOLUTION y I-EVOLUTION la I-EVOLUTION analítica I-EVOLUTION se I-EVOLUTION normalizó. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colecistectomía, I-PAST_MEDICAL_HISTORY hallux I-PAST_MEDICAL_HISTORY valgus, I-PAST_MEDICAL_HISTORY úlcera I-PAST_MEDICAL_HISTORY gástrica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY neuralgia I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY quinto I-PAST_MEDICAL_HISTORY par I-PAST_MEDICAL_HISTORY izquierdo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Presentaba B-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS territorio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS trigémino I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS hacía I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS mantenido I-PRESENT_ILLNESS controlado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS gabapentina. I-PRESENT_ILLNESS Desde I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS era I-PRESENT_ILLNESS de I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS severa, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS al I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS farmacológico. I-PRESENT_ILLNESS La B-DERIVED_FROM/TO falta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO control I-DERIVED_FROM/TO motivó I-DERIVED_FROM/TO ingreso I-DERIVED_FROM/TO con I-DERIVED_FROM/TO carácter I-DERIVED_FROM/TO urgente I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Neurología, I-DERIVED_FROM/TO desde I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO solicitaron I-DERIVED_FROM/TO colaboración I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Dolor. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS fronto-parietal I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS paladar, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS descargas I-PRESENT_ILLNESS eléctricas I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS frecuentes I-PRESENT_ILLNESS (en I-PRESENT_ILLNESS torno I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS diarias), I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS EVA I-PRESENT_ILLNESS 9-10. I-PRESENT_ILLNESS En B-TREATMENT ese I-TREATMENT momento I-TREATMENT estaba I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT metamizol I-TREATMENT (8 I-TREATMENT gr/24 I-TREATMENT horas) I-TREATMENT y I-TREATMENT tramadol I-TREATMENT (300 I-TREATMENT mgr/24 I-TREATMENT horas) I-TREATMENT intravenoso I-TREATMENT en I-TREATMENT perfusión I-TREATMENT continua, I-TREATMENT gabapentina I-TREATMENT (1.200 I-TREATMENT mgr/8 I-TREATMENT horas) I-TREATMENT y I-TREATMENT topiramato I-TREATMENT (25 I-TREATMENT mgr/12 I-TREATMENT horas I-TREATMENT por I-TREATMENT vía I-TREATMENT oral), I-TREATMENT buprenorfina I-TREATMENT transdérmica I-TREATMENT (35 I-TREATMENT µgr/hora) I-TREATMENT y I-TREATMENT petidina I-TREATMENT intravenosa I-TREATMENT de I-TREATMENT rescate I-TREATMENT (100 I-TREATMENT mgr/8 I-TREATMENT horas). I-TREATMENT I-TREATMENT Se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT bloqueo I-TREATMENT nervioso I-TREATMENT de I-TREATMENT 1ª I-TREATMENT y I-TREATMENT 2ª I-TREATMENT ramas I-TREATMENT izquierdas I-TREATMENT del I-TREATMENT quinto I-TREATMENT par I-TREATMENT con I-TREATMENT bupivacaína I-TREATMENT 0, I-TREATMENT 5%, I-TREATMENT con B-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION logró I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION analgesia I-EVOLUTION superficial I-EVOLUTION (EVA I-EVOLUTION 4), I-EVOLUTION aunque I-EVOLUTION persistía I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION el I-EVOLUTION paladar. I-EVOLUTION Se B-TREATMENT ajustó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT asociando I-TREATMENT oxcarbacepina I-TREATMENT 300 I-TREATMENT mgr/12 I-TREATMENT horas I-TREATMENT y I-TREATMENT se I-TREATMENT suspendió I-TREATMENT topiramato I-TREATMENT y I-TREATMENT de I-TREATMENT manera I-TREATMENT progresiva I-TREATMENT la I-TREATMENT buprenorfina. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION días, I-EVOLUTION dada I-EVOLUTION la I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente, I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION presentando I-EVOLUTION entonces I-EVOLUTION EVA I-EVOLUTION 0 I-EVOLUTION (incluso I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION paladar). I-EVOLUTION La I-EVOLUTION cifra I-EVOLUTION de I-EVOLUTION sodio I-EVOLUTION al I-EVOLUTION abandonar I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION estaba I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION los I-EVOLUTION límites I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad, I-EVOLUTION según I-EVOLUTION una I-EVOLUTION analítica I-EVOLUTION realizada I-EVOLUTION durante I-EVOLUTION su I-EVOLUTION ingreso. I-EVOLUTION I-EVOLUTION El I-EVOLUTION dolor I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION controlado I-EVOLUTION y I-EVOLUTION en I-EVOLUTION una I-EVOLUTION revisión I-EVOLUTION efectuada I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refirió I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION crisis I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION ese I-EVOLUTION tiempo. I-EVOLUTION En B-EXPLORATION esa I-EXPLORATION misma I-EXPLORATION visita I-EXPLORATION se I-EXPLORATION comprueba I-EXPLORATION que I-EXPLORATION en I-EXPLORATION un I-EXPLORATION análisis I-EXPLORATION realizado I-EXPLORATION unos I-EXPLORATION días I-EXPLORATION antes I-EXPLORATION aparece I-EXPLORATION una I-EXPLORATION cifra I-EXPLORATION de I-EXPLORATION sodio I-EXPLORATION de I-EXPLORATION 125 I-EXPLORATION mgr/dl. I-EXPLORATION Hacía B-TREATMENT más I-TREATMENT de I-TREATMENT un I-TREATMENT mes I-TREATMENT había I-TREATMENT comenzado I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT un I-TREATMENT antihipertensivo I-TREATMENT que I-TREATMENT combina I-TREATMENT un I-TREATMENT inhibidor I-TREATMENT de I-TREATMENT los I-TREATMENT receptores I-TREATMENT de I-TREATMENT angiotensina I-TREATMENT II I-TREATMENT y I-TREATMENT un I-TREATMENT diurético I-TREATMENT tiazídico I-TREATMENT (hidroclorotiazida). I-TREATMENT La I-TREATMENT paciente I-TREATMENT no I-TREATMENT presentaba I-TREATMENT síntomas I-TREATMENT atribuibles I-TREATMENT a I-TREATMENT dicha I-TREATMENT hiponatremia. I-TREATMENT I-TREATMENT Debido I-TREATMENT a I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT la I-TREATMENT contribución I-TREATMENT tanto I-TREATMENT de I-TREATMENT hidroclorotiazida I-TREATMENT como I-TREATMENT oxcarbacepina I-TREATMENT en I-TREATMENT la I-TREATMENT hiponatremia, I-TREATMENT se I-TREATMENT retiró, I-TREATMENT de I-TREATMENT acuerdo I-TREATMENT con I-TREATMENT su I-TREATMENT médico I-TREATMENT de I-TREATMENT cabecera, I-TREATMENT la I-TREATMENT hidroclorotiazida. I-TREATMENT En B-EXPLORATION un I-EXPLORATION ionograma I-EXPLORATION solicitado I-EXPLORATION 15 I-EXPLORATION días I-EXPLORATION después, I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION del I-EXPLORATION sodio I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 143 I-EXPLORATION mgr/dl, I-EXPLORATION con I-EXPLORATION normalidad I-EXPLORATION del I-EXPLORATION potasio I-EXPLORATION y I-EXPLORATION cloro. I-EXPLORATION I-EXPLORATION Dos B-EVOLUTION meses I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION ingresada I-EVOLUTION en I-EVOLUTION el I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION con I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION intensa I-EVOLUTION astenia I-EVOLUTION y I-EVOLUTION debilidad I-EVOLUTION muscular I-EVOLUTION y I-EVOLUTION una I-EVOLUTION cifra I-EVOLUTION de I-EVOLUTION sodio I-EVOLUTION de I-EVOLUTION 120 I-EVOLUTION mgr/dl. I-EVOLUTION Nuevamente B-TREATMENT había I-TREATMENT comenzado, I-TREATMENT hacía I-TREATMENT un I-TREATMENT mes, I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT hidroclorotiazida I-TREATMENT debido I-TREATMENT al I-TREATMENT mal I-TREATMENT control I-TREATMENT de I-TREATMENT su I-TREATMENT presión I-TREATMENT arterial. I-TREATMENT I-TREATMENT Ante B-EVOLUTION la I-EVOLUTION buena I-EVOLUTION evolución, I-EVOLUTION en I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION meses, I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION doloroso I-EVOLUTION se B-TREATMENT decidió I-TREATMENT retirar I-TREATMENT la I-TREATMENT oxcarbacepina I-TREATMENT y I-TREATMENT dejar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT únicamente I-TREATMENT con I-TREATMENT gabapentina I-TREATMENT para I-TREATMENT control I-TREATMENT de I-TREATMENT su I-TREATMENT dolor I-TREATMENT neuropático. I-TREATMENT En B-EVOLUTION esta I-EVOLUTION ocasión I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION la I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION hidroclorotiazida. I-EVOLUTION Los I-EVOLUTION síntomas I-EVOLUTION atribuibles I-EVOLUTION a I-EVOLUTION la I-EVOLUTION hiponatremia I-EVOLUTION mejoraron I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION inmediata I-EVOLUTION al I-EVOLUTION retirar I-EVOLUTION oxcarbacepina. I-EVOLUTION En B-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION analítica I-EXPLORATION solicitada I-EXPLORATION 8 I-EXPLORATION días I-EXPLORATION después I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION el I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION sodio I-EXPLORATION fue I-EXPLORATION 140 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas I-PAST_MEDICAL_HISTORY conocidas, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY embarazos I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cirugía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estapedectomía I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY oído I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY otoesclerosis. I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Traumatología I-PRESENT_ILLNESS derivada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS Centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Salud I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Mayo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS 2002 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS omalgia I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS atraumática I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Previamente I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS valorada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS los I-PRESENT_ILLNESS servicios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Neurología, I-PRESENT_ILLNESS Reumatología I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Rehabilitación I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS mejoría. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION dolor I-EXPLORATION inespecífico I-EXPLORATION en I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION del I-EXPLORATION brazo I-EXPLORATION izquierdo, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION ocasiones I-EXPLORATION se I-EXPLORATION exacerbaba I-EXPLORATION sin I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION esfuerzos I-EXPLORATION ni I-EXPLORATION cambios I-EXPLORATION posturales. I-EXPLORATION No I-EXPLORATION habia I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION atrapamiento I-EXPLORATION subacromial I-EXPLORATION ni I-EXPLORATION atrofias I-EXPLORATION musculares I-EXPLORATION clínicamente I-EXPLORATION evidentes. I-EXPLORATION La I-EXPLORATION movilidad I-EXPLORATION era I-EXPLORATION completa. I-EXPLORATION Los I-EXPLORATION reflejos I-EXPLORATION eran I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION simétricos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION RM I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION aportaba I-EXPLORATION (Abril I-EXPLORATION 2002) I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION hallazgos I-EXPLORATION patológicos I-EXPLORATION evidentes. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION hombro I-EXPLORATION (Mayo I-EXPLORATION 2002) I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION rotura I-EXPLORATION parcial I-EXPLORATION del I-EXPLORATION tendón I-EXPLORATION supraespinoso I-EXPLORATION y I-EXPLORATION bursitis I-EXPLORATION subacromial I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT fue I-TREATMENT tratada I-TREATMENT mediante I-TREATMENT infiltraciones I-TREATMENT locales I-TREATMENT con I-TREATMENT corticoides I-TREATMENT y I-TREATMENT rehabilitación I-TREATMENT sin I-TREATMENT mejoría. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION seguía I-EVOLUTION presentando I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION sintomatología I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION neurofisiológico I-EXPLORATION (Junio I-EXPLORATION 2003) I-EXPLORATION de I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION dependientes I-EXPLORATION de I-EXPLORATION C5-C6 I-EXPLORATION izquierdos, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION hombro I-EXPLORATION (Agosto I-EXPLORATION 2003) I-EXPLORATION que I-EXPLORATION evidencia I-EXPLORATION nuevamente I-EXPLORATION una I-EXPLORATION rotura I-EXPLORATION parcial I-EXPLORATION del I-EXPLORATION tendón I-EXPLORATION supraespinoso. I-EXPLORATION Ante I-EXPLORATION esta I-EXPLORATION situación I-EXPLORATION y I-EXPLORATION de I-EXPLORATION acuerdo I-EXPLORATION con I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION exploración I-EXPLORATION artroscópica I-EXPLORATION (Diciembre I-EXPLORATION 2003) I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION bursitis I-EXPLORATION subacromial I-EXPLORATION con I-EXPLORATION manguito I-EXPLORATION íntegro, I-EXPLORATION realizándose B-TREATMENT una I-TREATMENT acromioplastia I-TREATMENT artroscópica. I-TREATMENT Tras B-EXPLORATION dicha I-EXPLORATION intervención I-EXPLORATION y I-EXPLORATION nueva I-EXPLORATION rehabilitación I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION mejoría I-EXPLORATION clínica. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION que I-EXPLORATION consistieron I-EXPLORATION en I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION torácico I-EXPLORATION (Diciembre I-EXPLORATION 2004), I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION hombro I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION una I-EXPLORATION RM I-EXPLORATION del I-EXPLORATION plexo I-EXPLORATION braquial I-EXPLORATION (Enero I-EXPLORATION 2005) I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION schwannoma I-EXPLORATION del I-EXPLORATION plexo I-EXPLORATION braquial. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION RM I-EXPLORATION del I-EXPLORATION plexo I-EXPLORATION braquial I-EXPLORATION (Junio I-EXPLORATION 2005) I-EXPLORATION mostrando I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION lesión I-EXPLORATION y I-EXPLORATION nuevo I-EXPLORATION estudio I-EXPLORATION neurofisiológico I-EXPLORATION (Julio I-EXPLORATION 2005) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION evidenciaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION plexo I-EXPLORATION braquial. I-EXPLORATION En B-TREATMENT este I-TREATMENT momento I-TREATMENT se I-TREATMENT plantea I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT una I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT para I-TREATMENT su I-TREATMENT resección. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT en I-TREATMENT ese I-TREATMENT momento I-TREATMENT incluía I-TREATMENT pregabalina I-TREATMENT (300 I-TREATMENT mg/12 I-TREATMENT horas), I-TREATMENT fentanilo I-TREATMENT transdermico I-TREATMENT (50 I-TREATMENT μg/72 I-TREATMENT horas) I-TREATMENT y I-TREATMENT ketorolaco I-TREATMENT (10 I-TREATMENT mg/8 I-TREATMENT horas). I-TREATMENT I-TREATMENT La I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT se I-TREATMENT lleva I-TREATMENT a I-TREATMENT cabo I-TREATMENT en I-TREATMENT Agosto I-TREATMENT 2005 I-TREATMENT procediéndose I-TREATMENT a I-TREATMENT la I-TREATMENT extirpación I-TREATMENT del I-TREATMENT tumor I-TREATMENT mediante I-TREATMENT osteotomía I-TREATMENT de I-TREATMENT clavícula I-TREATMENT con I-TREATMENT posterior I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT placa. I-TREATMENT La B-EVOLUTION anestesia I-EVOLUTION y I-EVOLUTION cirugía I-EVOLUTION transcurren I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION lo I-EXPLORATION describe I-EXPLORATION como I-EXPLORATION schwannoma I-EXPLORATION (neurilenoma) I-EXPLORATION antiguo. I-EXPLORATION I-EXPLORATION En B-EVOLUTION posteriores I-EVOLUTION consultas I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION de I-EVOLUTION miembro I-EVOLUTION superior I-EVOLUTION izquierdo I-EVOLUTION se I-EVOLUTION había I-EVOLUTION resuelto. I-EVOLUTION Sólo I-EVOLUTION quedó I-EVOLUTION una I-EVOLUTION ligera I-EVOLUTION hipoestesia I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION del I-EVOLUTION territorio I-EVOLUTION del I-EVOLUTION nervio I-EVOLUTION circunflejo, I-EVOLUTION sin I-EVOLUTION evidenciarse I-EVOLUTION alteraciones I-EVOLUTION en I-EVOLUTION la I-EVOLUTION fuerza I-EVOLUTION o I-EVOLUTION los I-EVOLUTION reflejos, I-EVOLUTION que I-EVOLUTION en I-EVOLUTION la I-EVOLUTION última I-EVOLUTION revisión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION había I-EVOLUTION normalizado. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS caucásica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS (contusión I-PRESENT_ILLNESS pulmonar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS clavícula I-PRESENT_ILLNESS izquierda) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pélvico I-PRESENT_ILLNESS como I-PRESENT_ILLNESS consecuencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tráfico. I-PRESENT_ILLNESS Debido B-TREATMENT a I-TREATMENT que I-TREATMENT desarrolló I-TREATMENT insuficiencia I-TREATMENT respiratoria I-TREATMENT hipoxémica I-TREATMENT fue I-TREATMENT ingresada I-TREATMENT en I-TREATMENT Unidad I-TREATMENT de I-TREATMENT Reanimación I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT invasiva. I-TREATMENT A B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION que I-EVOLUTION se I-EVOLUTION complicó I-EVOLUTION con I-EVOLUTION síndrome I-EVOLUTION del I-EVOLUTION distrés I-EVOLUTION respiratorio I-EVOLUTION del I-EVOLUTION adulto, I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION final I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION respiratorio I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y B-TREATMENT fue I-TREATMENT posible I-TREATMENT extubar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT a I-TREATMENT las I-TREATMENT 72 I-TREATMENT h. I-TREATMENT La I-TREATMENT sedoanalgesia I-TREATMENT consistió I-TREATMENT en I-TREATMENT midazolam I-TREATMENT y I-TREATMENT fentanilo I-TREATMENT en I-TREATMENT perfusión I-TREATMENT continua I-TREATMENT endovenosa. I-TREATMENT I-TREATMENT A B-EVOLUTION la I-EVOLUTION extubación I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refería I-EVOLUTION dolor I-EVOLUTION intenso I-EVOLUTION y I-EVOLUTION lancinante I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION del I-EVOLUTION hombro I-EVOLUTION izquierdo I-EVOLUTION con I-EVOLUTION impotencia I-EVOLUTION funcional. I-EVOLUTION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT analgésico I-TREATMENT con I-TREATMENT paracetamol I-TREATMENT 1g/6 I-TREATMENT h I-TREATMENT e I-TREATMENT infusión I-TREATMENT continua I-TREATMENT endovenosa I-TREATMENT de I-TREATMENT remifentanilo, I-TREATMENT y B-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética, I-EXPLORATION hallándose I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION plexo I-EXPLORATION braquial I-EXPLORATION izquierdo I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION supra I-EXPLORATION e I-EXPLORATION infraclavicular. I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT prescrito I-TREATMENT fue I-TREATMENT ineficaz I-TREATMENT y I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT remifentanilo I-TREATMENT fue I-TREATMENT elevándose I-TREATMENT hasta I-TREATMENT llegar I-TREATMENT a I-TREATMENT un I-TREATMENT máximo I-TREATMENT de I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT mcg/kg/min; I-TREATMENT en I-TREATMENT esta I-TREATMENT situación I-TREATMENT este I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT mostró I-TREATMENT ineficaz I-TREATMENT porque I-TREATMENT la I-TREATMENT intensidad I-TREATMENT del I-TREATMENT dolor I-TREATMENT no I-TREATMENT mejoró I-TREATMENT (VAS I-TREATMENT 8) I-TREATMENT y I-TREATMENT la I-TREATMENT paciente I-TREATMENT presentaba I-TREATMENT excesiva I-TREATMENT sedación I-TREATMENT que I-TREATMENT se I-TREATMENT manifestaba I-TREATMENT con I-TREATMENT desaturaciones I-TREATMENT frecuentes I-TREATMENT en I-TREATMENT la I-TREATMENT monitorización I-TREATMENT con I-TREATMENT pulsioximetría I-TREATMENT continua. I-TREATMENT I-TREATMENT En I-TREATMENT vista I-TREATMENT de I-TREATMENT las I-TREATMENT imágenes I-TREATMENT radiológicas, I-TREATMENT la I-TREATMENT alternativa I-TREATMENT analgésica I-TREATMENT consistió I-TREATMENT en I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT catéter I-TREATMENT epidural I-TREATMENT cervical I-TREATMENT a I-TREATMENT nivel I-TREATMENT C5-C6 I-TREATMENT para I-TREATMENT analgesia I-TREATMENT controlada I-TREATMENT por I-TREATMENT el I-TREATMENT paciente I-TREATMENT (PCA) I-TREATMENT con I-TREATMENT una I-TREATMENT perfusión I-TREATMENT de I-TREATMENT 0, I-TREATMENT 375 I-TREATMENT % I-TREATMENT ropivacaína I-TREATMENT a I-TREATMENT 2 I-TREATMENT mL/h I-TREATMENT con I-TREATMENT bolos I-TREATMENT de I-TREATMENT 2 I-TREATMENT mL I-TREATMENT (tiempo I-TREATMENT de I-TREATMENT cierre I-TREATMENT 60 I-TREATMENT min), I-TREATMENT tras I-TREATMENT realización I-TREATMENT de I-TREATMENT dosis I-TREATMENT test I-TREATMENT y I-TREATMENT de I-TREATMENT carga I-TREATMENT con I-TREATMENT 5 I-TREATMENT mL I-TREATMENT de I-TREATMENT ropivacaína I-TREATMENT 0, I-TREATMENT 375 I-TREATMENT % I-TREATMENT se B-EVOLUTION logró I-EVOLUTION en I-EVOLUTION diez I-EVOLUTION minutos I-EVOLUTION un I-EVOLUTION adecuado I-EVOLUTION control I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION (VAS I-EVOLUTION 2) I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION respiratorias I-EVOLUTION ni I-EVOLUTION hemodinámicas I-EVOLUTION asociadas. I-EVOLUTION A B-TREATMENT la I-TREATMENT vez I-TREATMENT se I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT específico I-TREATMENT para I-TREATMENT el I-TREATMENT dolor I-TREATMENT neuropático. I-TREATMENT I-TREATMENT La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO referencia I-DERIVED_FROM/TO 12 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO después I-DERIVED_FROM/TO del I-DERIVED_FROM/TO ingreso I-DERIVED_FROM/TO hospitalario, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO adecuado I-DERIVED_FROM/TO control I-DERIVED_FROM/TO del I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO en I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO con I-DERIVED_FROM/TO gabapentina I-DERIVED_FROM/TO 600 I-DERIVED_FROM/TO mg/8 I-DERIVED_FROM/TO h I-DERIVED_FROM/TO vo, I-DERIVED_FROM/TO amitriptilina I-DERIVED_FROM/TO 25 I-DERIVED_FROM/TO mg/d I-DERIVED_FROM/TO vo, I-DERIVED_FROM/TO clonacepam I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO mg/d, I-DERIVED_FROM/TO y I-DERIVED_FROM/TO tramadol I-DERIVED_FROM/TO 75 I-DERIVED_FROM/TO mg/12 I-DERIVED_FROM/TO h I-DERIVED_FROM/TO vo. I-DERIVED_FROM/TO El B-TREATMENT catéter I-TREATMENT fue I-TREATMENT entonces I-TREATMENT retirado I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diestra, I-PRESENT_ILLNESS viuda, I-PRESENT_ILLNESS ocupación: I-PRESENT_ILLNESS hogar. I-PRESENT_ILLNESS Padecimiento I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS toque I-PRESENT_ILLNESS eléctrico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS descargas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS frontal, I-PRESENT_ILLNESS temporal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS periorbitaria I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS segundos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS minuto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS períodos I-PRESENT_ILLNESS libres I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS las I-PRESENT_ILLNESS descargas I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS sensitivas, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS producía I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hablar I-PRESENT_ILLNESS o I-PRESENT_ILLNESS comer. I-PRESENT_ILLNESS Cuatro B-TREATMENT años I-TREATMENT previos I-TREATMENT a I-TREATMENT su I-TREATMENT llegada I-TREATMENT a I-TREATMENT nuestra I-TREATMENT clínica I-TREATMENT del I-TREATMENT dolor I-TREATMENT se I-TREATMENT le I-TREATMENT había I-TREATMENT realizado I-TREATMENT una I-TREATMENT compresión I-TREATMENT con I-TREATMENT balón I-TREATMENT en I-TREATMENT ganglio I-TREATMENT de I-TREATMENT Gasser I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT había I-TREATMENT sido I-TREATMENT tratada I-TREATMENT con I-TREATMENT carbamacepina I-TREATMENT por I-TREATMENT otros I-TREATMENT médicos, I-TREATMENT con I-TREATMENT éxito I-TREATMENT durante I-TREATMENT un I-TREATMENT año, I-TREATMENT posterior I-TREATMENT al I-TREATMENT cual I-TREATMENT reinicio I-TREATMENT cuadro I-TREATMENT de I-TREATMENT mismas I-TREATMENT característica. I-TREATMENT La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY contaba I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY craneal, I-PAST_MEDICAL_HISTORY cambios I-PAST_MEDICAL_HISTORY visuales, I-PAST_MEDICAL_HISTORY tinnitus, I-PAST_MEDICAL_HISTORY vértigo I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY auditiva. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY perdido I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY kg I-PAST_MEDICAL_HISTORY debido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY disminución I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ingesta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alimentos I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY dolor. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedades I-PAST_MEDICAL_HISTORY crónico-degenerativas. I-PAST_MEDICAL_HISTORY La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION inicial I-EXPLORATION era I-EXPLORATION esencialmente I-EXPLORATION normal. I-EXPLORATION Contaba I-EXPLORATION con I-EXPLORATION exámenes I-EXPLORATION generales I-EXPLORATION normales, I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT bloqueo I-TREATMENT de I-TREATMENT ganglio I-TREATMENT de I-TREATMENT Gasser I-TREATMENT con I-TREATMENT fenol I-TREATMENT y I-TREATMENT se I-TREATMENT inicio I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT carbamacepina I-TREATMENT 200 I-TREATMENT mg I-TREATMENT c-12 I-TREATMENT hrs I-TREATMENT y I-TREATMENT gabapentina I-TREATMENT 300 I-TREATMENT mg I-TREATMENT c-12 I-TREATMENT hrs, I-TREATMENT presentó I-TREATMENT mejoría I-TREATMENT 24 I-TREATMENT hrs I-TREATMENT y I-TREATMENT reinició I-TREATMENT sintomatología. I-TREATMENT Evolucionó B-EVOLUTION sin I-EVOLUTION control I-EVOLUTION y I-EVOLUTION al I-EVOLUTION reexplorar I-EVOLUTION se I-EVOLUTION encontró I-EVOLUTION punto I-EVOLUTION doloroso I-EVOLUTION bajo I-EVOLUTION mastoides I-EVOLUTION del I-EVOLUTION lado I-EVOLUTION izquierdo I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION exacerbado I-EVOLUTION a I-EVOLUTION la I-EVOLUTION flexión I-EVOLUTION de I-EVOLUTION cuello. I-EVOLUTION Se B-TREATMENT realizó I-TREATMENT bloqueo I-TREATMENT de I-TREATMENT plexo I-TREATMENT cervical I-TREATMENT superficial I-TREATMENT con I-TREATMENT lidocaína I-TREATMENT al I-TREATMENT 2% I-TREATMENT simple I-TREATMENT y I-TREATMENT C2 I-TREATMENT izquierdo I-TREATMENT con I-TREATMENT lidocaína I-TREATMENT al I-TREATMENT 1% I-TREATMENT simple I-TREATMENT y I-TREATMENT alcohol I-TREATMENT puro I-TREATMENT con I-TREATMENT mejoría I-TREATMENT inmediata, I-TREATMENT desapareciendo I-TREATMENT el I-TREATMENT dolor. I-TREATMENT La B-EXPLORATION RMN I-EXPLORATION mostró I-EXPLORATION estenosis I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION cervical. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomática I-EVOLUTION 7 I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION al I-EVOLUTION procedimiento, I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION momento I-EVOLUTION de I-EVOLUTION éste I-EVOLUTION reporte I-EVOLUTION sin I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION realizar I-EVOLUTION nuevo I-EVOLUTION bloqueo. I-EVOLUTION La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO enviada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO columna I-DERIVED_FROM/TO para I-DERIVED_FROM/TO completar I-DERIVED_FROM/TO tratamiento. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Paciente B-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 31 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS diestra, B-PAST_MEDICAL_HISTORY soltera, I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY ortopedista. I-PAST_MEDICAL_HISTORY Padecimiento B-PRESENT_ILLNESS actual I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS punzante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS región I-PRESENT_ILLNESS temporal I-PRESENT_ILLNESS del I-PRESENT_ILLNESS mismo I-PRESENT_ILLNESS lado I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS periorbitario I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS intermitente, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS sensitivas. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS no I-PRESENT_ILLNESS limitaba I-PRESENT_ILLNESS sueño I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS había I-PRESENT_ILLNESS bajado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS a I-PRESENT_ILLNESS causa I-PRESENT_ILLNESS del I-PRESENT_ILLNESS mismo. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION apófisis I-EXPLORATION espinosas I-EXPLORATION de I-EXPLORATION C2, I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION punto I-EXPLORATION doloroso I-EXPLORATION occipital I-EXPLORATION izquierdo. I-EXPLORATION Las I-EXPLORATION radiografías I-EXPLORATION mostraban I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lordosis I-EXPLORATION cervical. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT bloqueo I-TREATMENT desinflamatorio I-TREATMENT de I-TREATMENT C2 I-TREATMENT y I-TREATMENT C3 I-TREATMENT izquierdos I-TREATMENT con I-TREATMENT lidocaína I-TREATMENT al I-TREATMENT 1% I-TREATMENT simple I-TREATMENT con I-TREATMENT mejoría I-TREATMENT del I-TREATMENT 80% I-TREATMENT en I-TREATMENT sintomatología, I-TREATMENT se I-TREATMENT inicia I-TREATMENT gabapentina I-TREATMENT 300 I-TREATMENT mg I-TREATMENT c-12 I-TREATMENT hrs. I-TREATMENT Se I-TREATMENT dio I-TREATMENT manejo I-TREATMENT para I-TREATMENT patología I-TREATMENT cervical I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT servicio I-TREATMENT de I-TREATMENT columna, I-TREATMENT no I-TREATMENT hubo I-TREATMENT necesidad I-TREATMENT de I-TREATMENT aplicar I-TREATMENT nuevos I-TREATMENT bloqueos I-TREATMENT cervicales. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION permanece I-EVOLUTION asintomática I-EVOLUTION 3 I-EVOLUTION años I-EVOLUTION después. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hernia I-PRESENT_ILLNESS discal, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Durogesic® I-PRESENT_ILLNESS 150 I-PRESENT_ILLNESS μg/h I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS buena I-PRESENT_ILLNESS eficacia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seguridad. I-PRESENT_ILLNESS Se B-TREATMENT cambia I-TREATMENT por I-TREATMENT un I-TREATMENT genérico, I-TREATMENT notándose B-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION doloroso I-EVOLUTION y I-EVOLUTION síntomas I-EVOLUTION neurológicos I-EVOLUTION de I-EVOLUTION inestabilidad. I-EVOLUTION Se B-TREATMENT vuelve I-TREATMENT a I-TREATMENT cambiar I-TREATMENT a I-TREATMENT Durogesic®, I-TREATMENT y B-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION se I-EVOLUTION estabiliza I-EVOLUTION la I-EVOLUTION analgesia I-EVOLUTION y I-EVOLUTION desaparece I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION neurológica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS neuralgia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS trigémino, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Durogesic® I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS μg/h I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS buena I-PRESENT_ILLNESS eficacia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seguridad. I-PRESENT_ILLNESS En B-TREATMENT neurología I-TREATMENT se I-TREATMENT cambia I-TREATMENT por I-TREATMENT fentanilo I-TREATMENT genérico, I-TREATMENT notándose B-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION doloroso. I-EVOLUTION Se B-TREATMENT vuelve I-TREATMENT a I-TREATMENT cambiar I-TREATMENT a I-TREATMENT Durogesic®, I-TREATMENT y I-TREATMENT de I-TREATMENT nuevo I-TREATMENT se I-TREATMENT estabiliza I-TREATMENT la I-TREATMENT analgesia. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS 62 B-TREATMENT kg, I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Durogesic® I-TREATMENT 100 I-TREATMENT μg/h. I-TREATMENT Se I-TREATMENT cambia I-TREATMENT la I-TREATMENT prescripción I-TREATMENT a I-TREATMENT fentanilo I-TREATMENT genérico I-TREATMENT 100 I-TREATMENT μg. I-TREATMENT Pérdida B-EVOLUTION de I-EVOLUTION eficacia I-EVOLUTION analgésica. I-EVOLUTION Se B-TREATMENT restaura I-TREATMENT Durogesic® I-TREATMENT 100 I-TREATMENT μg/h. I-TREATMENT Mejoría B-EVOLUTION clínica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS diagnosticada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estenosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS canal I-PRESENT_ILLNESS medular I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hernia I-PRESENT_ILLNESS discal, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Durogesic® I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS μg/h I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS buena I-PRESENT_ILLNESS eficacia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seguridad. I-PRESENT_ILLNESS Se B-TREATMENT cambia I-TREATMENT por I-TREATMENT fentanilo I-TREATMENT genérico, I-TREATMENT notándose I-TREATMENT un I-TREATMENT empeoramiento I-TREATMENT del I-TREATMENT cuadro I-TREATMENT doloroso. I-TREATMENT Se I-TREATMENT vuelve I-TREATMENT a I-TREATMENT cambiar I-TREATMENT a I-TREATMENT Durogesic®, I-TREATMENT y I-TREATMENT de I-TREATMENT nuevo I-TREATMENT se I-TREATMENT estabiliza I-TREATMENT la I-TREATMENT analgesia. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS diagnosticado B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY osteoartrosis I-PAST_MEDICAL_HISTORY primaria, I-PAST_MEDICAL_HISTORY muy I-PAST_MEDICAL_HISTORY invalidante, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY prótesis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cadera I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Durogesic® I-PAST_MEDICAL_HISTORY 25 I-PAST_MEDICAL_HISTORY μg/h. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY modo. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY actualidad I-PAST_MEDICAL_HISTORY continúa I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Durogesic® I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY μg/h. I-PAST_MEDICAL_HISTORY Hace I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY brote I-PAST_MEDICAL_HISTORY psicótico, I-PAST_MEDICAL_HISTORY motivo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY psiquiátricamente. I-PAST_MEDICAL_HISTORY Al B-TREATMENT alta I-TREATMENT del I-TREATMENT hospital I-TREATMENT se I-TREATMENT le I-TREATMENT prescribió I-TREATMENT fentanilo I-TREATMENT 50 I-TREATMENT μg/h I-TREATMENT (genérico). I-TREATMENT A B-EVOLUTION raíz I-EVOLUTION de I-EVOLUTION dicho I-EVOLUTION cambio I-EVOLUTION se I-EVOLUTION volvieran I-EVOLUTION a I-EVOLUTION agravar I-EVOLUTION sus I-EVOLUTION algias I-EVOLUTION y I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION abstinencia I-EVOLUTION que I-EVOLUTION se I-EVOLUTION caracterizaba I-EVOLUTION por I-EVOLUTION inquietud, I-EVOLUTION irritabilidad I-EVOLUTION y B-TREATMENT un I-TREATMENT cuadro I-TREATMENT confusional I-TREATMENT que I-TREATMENT desapareció I-TREATMENT al I-TREATMENT volver I-TREATMENT a I-TREATMENT prescribirse I-TREATMENT nuevamente I-TREATMENT Durogesic® I-TREATMENT 50 I-TREATMENT μg/h. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cáncer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vejiga I-PRESENT_ILLNESS con I-PRESENT_ILLNESS metástasis, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS Durogesic® I-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS μg/h I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS buena I-PRESENT_ILLNESS eficacia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seguridad. I-PRESENT_ILLNESS En B-TREATMENT oncología I-TREATMENT se I-TREATMENT cambia I-TREATMENT por I-TREATMENT fentanilo I-TREATMENT genérico, I-TREATMENT notándose I-TREATMENT un I-TREATMENT empeoramiento I-TREATMENT del I-TREATMENT cuadro I-TREATMENT doloroso. I-TREATMENT Se B-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION cambiar I-EVOLUTION a I-EVOLUTION Durogesic®, I-EVOLUTION y I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION se I-EVOLUTION estabiliza I-EVOLUTION la I-EVOLUTION analgesia. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS fantasma I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS muñón I-PRESENT_ILLNESS en I-PRESENT_ILLNESS extremidad I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS (EID) I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1/3 I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS refractario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS analgésico I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS oral, I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Dolor I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO colocación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO bomba I-DERIVED_FROM/TO intratecal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ziconotide. I-DERIVED_FROM/TO Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presenta: I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY ansioso-depresivo, I-PAST_MEDICAL_HISTORY neumonía I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY atípica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY abril I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2007 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ciprofloxacino, I-PAST_MEDICAL_HISTORY castaña, I-PAST_MEDICAL_HISTORY kiwi I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY látex. I-PAST_MEDICAL_HISTORY Respecto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY traumatológica, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY sufre I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY espiroidea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tercio I-PAST_MEDICAL_HISTORY distal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tibia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY maleolo I-PAST_MEDICAL_HISTORY peroneo I-PAST_MEDICAL_HISTORY derechos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY mayo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2000 I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY laboral, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY osteosíntesis I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tornillos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY placa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY neutralización. I-PAST_MEDICAL_HISTORY Tras I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY curso I-PAST_MEDICAL_HISTORY postoperatorio I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY dada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alta. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY comienza I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY espontáneo, I-PAST_MEDICAL_HISTORY punzante I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tobillo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cara I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pierna I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY aumenta I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY palpación I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY cargar I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY miembro I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY intenta I-PAST_MEDICAL_HISTORY caminar, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY añade I-PAST_MEDICAL_HISTORY edema I-PAST_MEDICAL_HISTORY severo I-PAST_MEDICAL_HISTORY infracondíleo, I-PAST_MEDICAL_HISTORY palidez, I-PAST_MEDICAL_HISTORY frialdad I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hiperhidrosis I-PAST_MEDICAL_HISTORY diagnosticándose I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Distrofia I-PAST_MEDICAL_HISTORY Simpático I-PAST_MEDICAL_HISTORY Refleja I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EID. I-PAST_MEDICAL_HISTORY Es I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY técnicas I-PAST_MEDICAL_HISTORY regionales I-PAST_MEDICAL_HISTORY asociadas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fracasaron, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY finalmente, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY sufrir I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY intervenciones I-PAST_MEDICAL_HISTORY (simpatectomía I-PAST_MEDICAL_HISTORY lumbar, I-PAST_MEDICAL_HISTORY absceso, I-PAST_MEDICAL_HISTORY celulitis) I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY decide I-PAST_MEDICAL_HISTORY amputación I-PAST_MEDICAL_HISTORY infracondílea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EID. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY posteriori, I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY desfavorable, I-PAST_MEDICAL_HISTORY realizándose I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY nueva I-PAST_MEDICAL_HISTORY amputación I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1/3 I-PAST_MEDICAL_HISTORY medio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY muslo I-PAST_MEDICAL_HISTORY EID I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY marzo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2004. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Seguidamente I-PAST_MEDICAL_HISTORY continúa I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY intenso I-PAST_MEDICAL_HISTORY continuo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tobillo, I-PAST_MEDICAL_HISTORY pie I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY rodilla I-PAST_MEDICAL_HISTORY amputados I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY decide I-PAST_MEDICAL_HISTORY implantación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY catéter I-PAST_MEDICAL_HISTORY epidural I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY ambulatorio I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY analgesia I-PAST_MEDICAL_HISTORY epidural I-PAST_MEDICAL_HISTORY controlada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY (PCEA) I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 13 I-PAST_MEDICAL_HISTORY abril I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2004, I-PAST_MEDICAL_HISTORY asociado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY bajada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dosis I-PAST_MEDICAL_HISTORY importante I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY venía I-PAST_MEDICAL_HISTORY tomando I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY anterioridad I-PAST_MEDICAL_HISTORY (antidepresivos I-PAST_MEDICAL_HISTORY tricíclicos, I-PAST_MEDICAL_HISTORY benzodiacepinas, I-PAST_MEDICAL_HISTORY mórficos, I-PAST_MEDICAL_HISTORY AINEs, I-PAST_MEDICAL_HISTORY etc.). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY favorable I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2005 I-PAST_MEDICAL_HISTORY sufre I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY accidente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tráfico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY arrancamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY catéter I-PAST_MEDICAL_HISTORY epidural, I-PAST_MEDICAL_HISTORY contractura I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY muscular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY vertiginoso I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY empeoramiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY depresivo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY doloroso. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY intentó I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY adaptación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY prótesis I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY poder I-PAST_MEDICAL_HISTORY caminar I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY sesiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rehabilitación, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY éxito I-PAST_MEDICAL_HISTORY debido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY secuela I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY consistente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY flexo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cadera I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY EID I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY impidió I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY adaptación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY prótesis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY consecuencia, I-PAST_MEDICAL_HISTORY caminar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY normalidad. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-TREATMENT enero I-TREATMENT de I-TREATMENT 2008 I-TREATMENT acude I-TREATMENT a I-TREATMENT nuestra I-TREATMENT Unidad I-TREATMENT del I-TREATMENT Dolor I-TREATMENT donde I-TREATMENT se I-TREATMENT le I-TREATMENT propone I-TREATMENT la I-TREATMENT implantación I-TREATMENT de I-TREATMENT bomba I-TREATMENT de I-TREATMENT infusión I-TREATMENT continua I-TREATMENT de I-TREATMENT Ziconotide I-TREATMENT a I-TREATMENT nivel I-TREATMENT intratecal, I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT acepta I-TREATMENT tras I-TREATMENT ser I-TREATMENT informada I-TREATMENT del I-TREATMENT procedimiento, I-TREATMENT posibles I-TREATMENT resultados, I-TREATMENT complicaciones I-TREATMENT y I-TREATMENT efectos I-TREATMENT adversos. I-TREATMENT Se I-TREATMENT entrega I-TREATMENT consentimiento I-TREATMENT informado I-TREATMENT y I-TREATMENT se I-TREATMENT cita I-TREATMENT para I-TREATMENT el I-TREATMENT 20/2/2008 I-TREATMENT para I-TREATMENT colocación I-TREATMENT de I-TREATMENT bomba. I-TREATMENT I-TREATMENT Colocación I-TREATMENT de I-TREATMENT bomba I-TREATMENT intratecal I-TREATMENT de I-TREATMENT ziconotide I-TREATMENT y I-TREATMENT evolución I-TREATMENT posterior I-TREATMENT I-TREATMENT Con I-TREATMENT la I-TREATMENT paciente I-TREATMENT en I-TREATMENT decúbito I-TREATMENT lateral I-TREATMENT se I-TREATMENT hace I-TREATMENT incisión I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT abdomen I-TREATMENT para I-TREATMENT colocación I-TREATMENT de I-TREATMENT la I-TREATMENT bomba I-TREATMENT de I-TREATMENT infusión I-TREATMENT subcutánea. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT localiza I-TREATMENT espacio I-TREATMENT intradural I-TREATMENT a I-TREATMENT nivel I-TREATMENT L4-L5 I-TREATMENT donde I-TREATMENT se I-TREATMENT introduce I-TREATMENT catéter I-TREATMENT de I-TREATMENT infusión I-TREATMENT continua. I-TREATMENT Dicho I-TREATMENT catéter I-TREATMENT se I-TREATMENT tuneliza I-TREATMENT vía I-TREATMENT subcutánea I-TREATMENT hasta I-TREATMENT la I-TREATMENT unión I-TREATMENT con I-TREATMENT la I-TREATMENT bomba I-TREATMENT de I-TREATMENT infusión. I-TREATMENT Cierre I-TREATMENT de I-TREATMENT incisiones I-TREATMENT con I-TREATMENT sutura. I-TREATMENT Programación I-TREATMENT de I-TREATMENT la I-TREATMENT bomba I-TREATMENT de I-TREATMENT ziconotide. I-TREATMENT La I-TREATMENT dosis I-TREATMENT inicial I-TREATMENT fue I-TREATMENT de I-TREATMENT 1, I-TREATMENT 2 I-TREATMENT microg/día I-TREATMENT de I-TREATMENT ziconotide I-TREATMENT que I-TREATMENT a I-TREATMENT lo I-TREATMENT largo I-TREATMENT de I-TREATMENT 13 I-TREATMENT meses I-TREATMENT se I-TREATMENT aumentó I-TREATMENT a I-TREATMENT 7, I-TREATMENT 8 I-TREATMENT microg/día. I-TREATMENT I-TREATMENT El B-EVOLUTION estado I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION cuando I-EVOLUTION acudió I-EVOLUTION por I-EVOLUTION primera I-EVOLUTION vez I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION era I-EVOLUTION muy I-EVOLUTION desfavorable: I-EVOLUTION EVA I-EVOLUTION 8/10, I-EVOLUTION imposibilidad I-EVOLUTION de I-EVOLUTION sueño I-EVOLUTION reparador I-EVOLUTION por I-EVOLUTION despertares I-EVOLUTION frecuentes I-EVOLUTION por I-EVOLUTION dolor, I-EVOLUTION estreñimiento I-EVOLUTION moderado I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION los I-EVOLUTION opiodes, I-EVOLUTION falta I-EVOLUTION de I-EVOLUTION apetito, I-EVOLUTION incapacidad I-EVOLUTION de I-EVOLUTION realizar I-EVOLUTION actividad I-EVOLUTION normal I-EVOLUTION por I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION estado I-EVOLUTION depresivo I-EVOLUTION grave. I-EVOLUTION Los I-EVOLUTION requerimientos I-EVOLUTION analgésicos I-EVOLUTION eran I-EVOLUTION altos I-EVOLUTION con I-EVOLUTION dosis I-EVOLUTION muy I-EVOLUTION elevada I-EVOLUTION de I-EVOLUTION opioides I-EVOLUTION y I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION rescates I-EVOLUTION frecuentes I-EVOLUTION (cada I-EVOLUTION 2 I-EVOLUTION horas). I-EVOLUTION Durante I-EVOLUTION la I-EVOLUTION subida I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION bomba I-EVOLUTION de I-EVOLUTION ziconotide I-EVOLUTION se I-EVOLUTION consiguió I-EVOLUTION disminuir I-EVOLUTION su I-EVOLUTION tratamiento I-EVOLUTION antiálgico I-EVOLUTION y I-EVOLUTION mejorar I-EVOLUTION notablemente I-EVOLUTION su I-EVOLUTION dolor I-EVOLUTION pasando I-EVOLUTION de I-EVOLUTION 8/10 I-EVOLUTION a I-EVOLUTION 4/10 I-EVOLUTION en I-EVOLUTION la I-EVOLUTION escala I-EVOLUTION EVA, I-EVOLUTION además I-EVOLUTION de I-EVOLUTION un I-EVOLUTION mayor I-EVOLUTION descanso I-EVOLUTION nocturno I-EVOLUTION (durmiendo I-EVOLUTION más I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION horas I-EVOLUTION sin I-EVOLUTION despertar I-EVOLUTION por I-EVOLUTION el I-EVOLUTION dolor), I-EVOLUTION recuperar I-EVOLUTION apetito, I-EVOLUTION eliminar I-EVOLUTION estreñimiento, I-EVOLUTION volver I-EVOLUTION a I-EVOLUTION su I-EVOLUTION vida I-EVOLUTION cotidiana I-EVOLUTION y I-EVOLUTION elevar I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION de I-EVOLUTION ánimo. I-EVOLUTION En I-EVOLUTION este I-EVOLUTION tiempo I-EVOLUTION de I-EVOLUTION adaptación I-EVOLUTION dosis/efecto, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION periodos I-EVOLUTION limitados I-EVOLUTION de I-EVOLUTION mareo, I-EVOLUTION sensación I-EVOLUTION de I-EVOLUTION embotamiento I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cabeza, I-EVOLUTION acúfenos I-EVOLUTION y I-EVOLUTION cefalea I-EVOLUTION que I-EVOLUTION remitieron I-EVOLUTION con I-EVOLUTION tratamiento I-EVOLUTION sintomático I-EVOLUTION y I-EVOLUTION con I-EVOLUTION el I-EVOLUTION paso I-EVOLUTION del I-EVOLUTION tiempo. I-EVOLUTION I-EVOLUTION Actualmente, I-EVOLUTION continúa I-EVOLUTION en I-EVOLUTION seguimiento I-EVOLUTION en I-EVOLUTION nuestra I-EVOLUTION unidad I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION recaída I-EVOLUTION del I-EVOLUTION dolor. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rabdomiosarcoma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY muslo I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY metástasis I-PAST_MEDICAL_HISTORY ganglionar I-PAST_MEDICAL_HISTORY inguinal I-PAST_MEDICAL_HISTORY ipsilateral, I-PAST_MEDICAL_HISTORY fue B-PRESENT_ILLNESS programada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS electiva I-PRESENT_ILLNESS para I-PRESENT_ILLNESS resección I-PRESENT_ILLNESS de I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS tumoral I-PRESENT_ILLNESS local I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tejidos I-PRESENT_ILLNESS blandos, I-PRESENT_ILLNESS vaciamiento I-PRESENT_ILLNESS ganglionar I-PRESENT_ILLNESS inguinal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS colocación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS catéteres I-PRESENT_ILLNESS para I-PRESENT_ILLNESS braquiterapia. I-PRESENT_ILLNESS La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY recibido I-PAST_MEDICAL_HISTORY quimioterapia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY previos, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY medicamentos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY intervención I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY anestésicas. I-PAST_MEDICAL_HISTORY Sus B-EXPLORATION exámenes I-EXPLORATION prequirúrgicos I-EXPLORATION mostraban I-EXPLORATION hemoglobina I-EXPLORATION 10, I-EXPLORATION 9 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION 31, I-EXPLORATION 7%, I-EXPLORATION conteo I-EXPLORATION plaquetario I-EXPLORATION 213.000/µl, I-EXPLORATION TPT I-EXPLORATION 24, I-EXPLORATION 5 I-EXPLORATION segundos, I-EXPLORATION TP I-EXPLORATION 11, I-EXPLORATION 3 I-EXPLORATION segundos I-EXPLORATION e I-EXPLORATION INR I-EXPLORATION 1, I-EXPLORATION 06. I-EXPLORATION Se I-EXPLORATION reservó I-EXPLORATION 1 I-EXPLORATION unidad I-EXPLORATION de I-EXPLORATION glóbulos I-EXPLORATION rojos I-EXPLORATION empaquetados I-EXPLORATION en I-EXPLORATION su I-EXPLORATION evaluación I-EXPLORATION preanestésica. I-EXPLORATION Se B-TREATMENT discutió I-TREATMENT con I-TREATMENT su I-TREATMENT madre I-TREATMENT en I-TREATMENT la I-TREATMENT evaluación I-TREATMENT preanestésica I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT ofrecer I-TREATMENT una I-TREATMENT técnica I-TREATMENT regional I-TREATMENT continua I-TREATMENT para I-TREATMENT el I-TREATMENT manejo I-TREATMENT del I-TREATMENT perioperatorio, I-TREATMENT destacando I-TREATMENT su I-TREATMENT papel I-TREATMENT en I-TREATMENT el I-TREATMENT control I-TREATMENT analgésico I-TREATMENT post-quirúrgico. I-TREATMENT El I-TREATMENT consentimiento I-TREATMENT informado I-TREATMENT fue I-TREATMENT diligenciado. I-TREATMENT La I-TREATMENT paciente I-TREATMENT tenía I-TREATMENT una I-TREATMENT vena I-TREATMENT periférica I-TREATMENT canalizada I-TREATMENT a I-TREATMENT su I-TREATMENT ingreso I-TREATMENT al I-TREATMENT quirófano I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT inducción I-TREATMENT anestésica I-TREATMENT convencional I-TREATMENT con I-TREATMENT fentanil I-TREATMENT 2 I-TREATMENT µg/kg, I-TREATMENT lidocaína I-TREATMENT 1 I-TREATMENT mg/kg, I-TREATMENT propofol I-TREATMENT 2 I-TREATMENT mg/kg, I-TREATMENT dexametasona I-TREATMENT 0, I-TREATMENT 15 I-TREATMENT mg/kg I-TREATMENT y I-TREATMENT cisatracurio I-TREATMENT 2 I-TREATMENT mg/kg, I-TREATMENT intubación I-TREATMENT orotraqueal I-TREATMENT con I-TREATMENT tubo I-TREATMENT 5.0 I-TREATMENT sin I-TREATMENT balón, I-TREATMENT mantenimiento I-TREATMENT anestésico I-TREATMENT balanceado I-TREATMENT con I-TREATMENT remifentanilo I-TREATMENT en I-TREATMENT infusión I-TREATMENT titulada I-TREATMENT y I-TREATMENT sevoflurano I-TREATMENT a I-TREATMENT 0, I-TREATMENT 8 I-TREATMENT MAC, I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT con I-TREATMENT volumen I-TREATMENT corriente I-TREATMENT de I-TREATMENT 7 I-TREATMENT ml/kg, I-TREATMENT frecuencia I-TREATMENT respiratoria I-TREATMENT 22 I-TREATMENT por I-TREATMENT minuto, I-TREATMENT PEEP I-TREATMENT 5 I-TREATMENT cmH2O I-TREATMENT y I-TREATMENT FiO2 I-TREATMENT 70%. I-TREATMENT Después I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT posicionó I-TREATMENT en I-TREATMENT decúbito I-TREATMENT lateral I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT flexión I-TREATMENT de I-TREATMENT las I-TREATMENT caderas. I-TREATMENT En I-TREATMENT esta I-TREATMENT posición I-TREATMENT realizamos I-TREATMENT un I-TREATMENT escaneo I-TREATMENT previo I-TREATMENT de I-TREATMENT la I-TREATMENT zona I-TREATMENT caudal I-TREATMENT utilizando I-TREATMENT un I-TREATMENT equipo I-TREATMENT SonoSite I-TREATMENT M-Turbo® I-TREATMENT con I-TREATMENT transductor I-TREATMENT lineal I-TREATMENT L25x I-TREATMENT de I-TREATMENT 13-6 I-TREATMENT MHz, I-TREATMENT donde I-TREATMENT se I-TREATMENT identificaron I-TREATMENT los I-TREATMENT distintas I-TREATMENT estructuras I-TREATMENT a I-TREATMENT ese I-TREATMENT nivel I-TREATMENT incluida I-TREATMENT la I-TREATMENT membrana I-TREATMENT sacro-coxígea I-TREATMENT y I-TREATMENT los I-TREATMENT cuernos I-TREATMENT sacros. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT realizó I-TREATMENT antisepsia I-TREATMENT con I-TREATMENT clorhexidina I-TREATMENT al I-TREATMENT 4% I-TREATMENT en I-TREATMENT zona I-TREATMENT lumbosacra I-TREATMENT y I-TREATMENT perineal I-TREATMENT y I-TREATMENT se I-TREATMENT cubrió I-TREATMENT con I-TREATMENT campos I-TREATMENT estériles. I-TREATMENT Con I-TREATMENT técnica I-TREATMENT aséptica I-TREATMENT nuevamente I-TREATMENT se I-TREATMENT escanearon I-TREATMENT las I-TREATMENT estructuras I-TREATMENT y I-TREATMENT con I-TREATMENT el I-TREATMENT transductor I-TREATMENT en I-TREATMENT el I-TREATMENT eje I-TREATMENT longitudinal I-TREATMENT al I-TREATMENT sacro I-TREATMENT y I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT abordar I-TREATMENT el I-TREATMENT espacio I-TREATMENT caudal I-TREATMENT en I-TREATMENT plano I-TREATMENT con I-TREATMENT una I-TREATMENT aguja I-TREATMENT 20G I-TREATMENT de I-TREATMENT 5 I-TREATMENT cm I-TREATMENT para I-TREATMENT técnica I-TREATMENT continua I-TREATMENT (Set I-TREATMENT StimuLong I-TREATMENT Sono I-TREATMENT catheter I-TREATMENT PAJUNK®). I-TREATMENT Una I-TREATMENT vez I-TREATMENT allí I-TREATMENT y I-TREATMENT bajo I-TREATMENT visión I-TREATMENT ultrasonográfica I-TREATMENT directa I-TREATMENT se I-TREATMENT pasó I-TREATMENT el I-TREATMENT catéter I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT aguja, I-TREATMENT avanzándolo I-TREATMENT hasta I-TREATMENT una I-TREATMENT distancia I-TREATMENT de I-TREATMENT 8 I-TREATMENT cm, I-TREATMENT quedando I-TREATMENT 3 I-TREATMENT cm I-TREATMENT en I-TREATMENT el I-TREATMENT espacio I-TREATMENT caudal, I-TREATMENT se I-TREATMENT retiró I-TREATMENT la I-TREATMENT aguja I-TREATMENT y I-TREATMENT se I-TREATMENT instaló I-TREATMENT el I-TREATMENT filtro I-TREATMENT del I-TREATMENT equipo. I-TREATMENT Visualizando I-TREATMENT la I-TREATMENT punta I-TREATMENT del I-TREATMENT catéter I-TREATMENT en I-TREATMENT el I-TREATMENT espacio I-TREATMENT caudal I-TREATMENT y I-TREATMENT con I-TREATMENT el I-TREATMENT modo I-TREATMENT Doppler I-TREATMENT color I-TREATMENT activado I-TREATMENT en I-TREATMENT el I-TREATMENT quipo I-TREATMENT se I-TREATMENT inyectó I-TREATMENT una I-TREATMENT dosis I-TREATMENT bolo I-TREATMENT de I-TREATMENT 16 I-TREATMENT ml I-TREATMENT de I-TREATMENT mezcla I-TREATMENT anestésica I-TREATMENT (bupivacaína I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT con I-TREATMENT epinefrina I-TREATMENT 1: I-TREATMENT 200.000, I-TREATMENT 8 I-TREATMENT ml I-TREATMENT + I-TREATMENT solución I-TREATMENT salina I-TREATMENT 0, I-TREATMENT 9% I-TREATMENT estéril I-TREATMENT 8 I-TREATMENT ml) I-TREATMENT visualizando I-TREATMENT la I-TREATMENT estela I-TREATMENT de I-TREATMENT color I-TREATMENT (efecto I-TREATMENT Doppler) I-TREATMENT confirmando I-TREATMENT flujo I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT espacio I-TREATMENT epidural. I-TREATMENT Finalmente I-TREATMENT la I-TREATMENT porción I-TREATMENT externa I-TREATMENT del I-TREATMENT catéter I-TREATMENT fue I-TREATMENT dirigida I-TREATMENT hacia I-TREATMENT cefálico I-TREATMENT y I-TREATMENT se I-TREATMENT cubrió I-TREATMENT con I-TREATMENT apósitos I-TREATMENT estériles I-TREATMENT 3M™ I-TREATMENT Tegaderm™. I-TREATMENT I-TREATMENT Después I-TREATMENT de I-TREATMENT la I-TREATMENT colocación I-TREATMENT del I-TREATMENT catéter, I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT reposicionó I-TREATMENT en I-TREATMENT decúbito I-TREATMENT supino I-TREATMENT y I-TREATMENT fue I-TREATMENT llevada I-TREATMENT a I-TREATMENT cabo I-TREATMENT la I-TREATMENT cirugía I-TREATMENT donde I-TREATMENT se I-TREATMENT encuentra I-TREATMENT conglomerado I-TREATMENT tumoral I-TREATMENT sobre I-TREATMENT vasos I-TREATMENT inguinales I-TREATMENT los I-TREATMENT cuales I-TREATMENT se I-TREATMENT liberaron, I-TREATMENT se I-TREATMENT envió I-TREATMENT un I-TREATMENT espécimen I-TREATMENT inicial I-TREATMENT reseccionado I-TREATMENT para I-TREATMENT biopsia I-TREATMENT por I-TREATMENT congelación, I-TREATMENT que I-TREATMENT resultó I-TREATMENT positiva I-TREATMENT en I-TREATMENT los I-TREATMENT márgenes I-TREATMENT y I-TREATMENT se I-TREATMENT decidió I-TREATMENT ampliar I-TREATMENT dicha I-TREATMENT resección I-TREATMENT con I-TREATMENT nuevo I-TREATMENT resultado I-TREATMENT negativo. I-TREATMENT Se I-TREATMENT resecó I-TREATMENT vasto I-TREATMENT medial I-TREATMENT y I-TREATMENT crural I-TREATMENT completamente I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT afectada. I-TREATMENT Se I-TREATMENT dejaron I-TREATMENT 8 I-TREATMENT catéteres I-TREATMENT para I-TREATMENT braquiterapia. I-TREATMENT La I-TREATMENT pérdida I-TREATMENT sanguínea I-TREATMENT fue I-TREATMENT aproximadamente I-TREATMENT de I-TREATMENT 50 I-TREATMENT ml I-TREATMENT y I-TREATMENT no I-TREATMENT fue I-TREATMENT transfundida. I-TREATMENT La I-TREATMENT duración I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía I-TREATMENT fue I-TREATMENT de I-TREATMENT 4 I-TREATMENT horas I-TREATMENT y I-TREATMENT 15 I-TREATMENT minutos I-TREATMENT y I-TREATMENT los I-TREATMENT requerimientos I-TREATMENT anestésicos I-TREATMENT durante I-TREATMENT su I-TREATMENT realización I-TREATMENT fueron I-TREATMENT mínimos. I-TREATMENT Al I-TREATMENT finalizar I-TREATMENT la I-TREATMENT cirugía I-TREATMENT se I-TREATMENT aplicaron I-TREATMENT 2 I-TREATMENT mg I-TREATMENT de I-TREATMENT morfina I-TREATMENT intravenosos, I-TREATMENT se I-TREATMENT extubó I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT y I-TREATMENT fue I-TREATMENT llevada I-TREATMENT a I-TREATMENT recuperación I-TREATMENT para I-TREATMENT vigilancia I-TREATMENT donde I-TREATMENT se I-TREATMENT inició I-TREATMENT la I-TREATMENT infusión I-TREATMENT por I-TREATMENT el I-TREATMENT catéter I-TREATMENT caudal I-TREATMENT a I-TREATMENT 3 I-TREATMENT ml/h I-TREATMENT de I-TREATMENT una I-TREATMENT mezcla I-TREATMENT de I-TREATMENT fentanilo I-TREATMENT 3 I-TREATMENT µg/ml I-TREATMENT y I-TREATMENT bupivacaína I-TREATMENT al I-TREATMENT 0, I-TREATMENT 1% I-TREATMENT sin I-TREATMENT epinefrina. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION estable I-EVOLUTION en I-EVOLUTION recuperación I-EVOLUTION durante I-EVOLUTION 3 I-EVOLUTION horas I-EVOLUTION más I-EVOLUTION sin I-EVOLUTION requerir I-EVOLUTION suplementos I-EVOLUTION analgésicos I-EVOLUTION y I-EVOLUTION luego I-EVOLUTION fue I-EVOLUTION trasladada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION habitación I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION general I-EVOLUTION pediátrica. I-EVOLUTION Los B-TREATMENT medicamentos I-TREATMENT analgésicos I-TREATMENT que I-TREATMENT recibió I-TREATMENT adicionalmente I-TREATMENT durante I-TREATMENT su I-TREATMENT hospitalización I-TREATMENT fueron I-TREATMENT acetaminofeno I-TREATMENT 240 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 6 I-TREATMENT horas I-TREATMENT vía I-TREATMENT oral I-TREATMENT y I-TREATMENT diclofenaco I-TREATMENT 15 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT vía I-TREATMENT intravenosa I-TREATMENT por I-TREATMENT horario, I-TREATMENT con I-TREATMENT rescates I-TREATMENT de I-TREATMENT hidromorfona I-TREATMENT a I-TREATMENT necesidad. I-TREATMENT El B-EVOLUTION seguimiento I-EVOLUTION analgésico I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION se I-EVOLUTION detalla I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tabla I-EVOLUTION I. I-EVOLUTION No B-TREATMENT fueron I-TREATMENT requeridos I-TREATMENT rescates I-TREATMENT con I-TREATMENT opioides. I-TREATMENT El I-TREATMENT catéter I-TREATMENT fue I-TREATMENT retirado I-TREATMENT al I-TREATMENT tercer I-TREATMENT día I-TREATMENT postoperatorio I-TREATMENT después I-TREATMENT de I-TREATMENT 70 I-TREATMENT horas I-TREATMENT de I-TREATMENT colocado I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT El B-EVOLUTION mismo I-EVOLUTION día I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION con I-EVOLUTION adecuado I-EVOLUTION control I-EVOLUTION del I-EVOLUTION dolor, I-EVOLUTION medicación I-EVOLUTION oral I-EVOLUTION e I-EVOLUTION instrucciones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 48 I-PAST_MEDICAL_HISTORY kg, I-PAST_MEDICAL_HISTORY talla I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 156 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ASA I-PAST_MEDICAL_HISTORY III. I-PAST_MEDICAL_HISTORY Exfumadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY diarios, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ceguera I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY postraumática I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dificultad I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY marcha I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY apoyo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY estudiada. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS vascular I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS isquemia I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS grado I-PRESENT_ILLNESS IV, I-PRESENT_ILLNESS pendiente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS quirúrgico I-PRESENT_ILLNESS mediante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS amputación I-PRESENT_ILLNESS supracondílea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dicho I-PRESENT_ILLNESS miembro. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-EXPLORATION estudio I-EXPLORATION preoperatorio I-EXPLORATION mostró: I-EXPLORATION anemia I-EXPLORATION microcítica I-EXPLORATION - I-EXPLORATION hipocrómica, I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION bioquímica I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION un I-EXPLORATION trastorno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION repolarización I-EXPLORATION en I-EXPLORATION el I-EXPLORATION electrocardiograma. I-EXPLORATION I-EXPLORATION Durante I-EXPLORATION su I-EXPLORATION estancia I-EXPLORATION en I-EXPLORATION dicho I-EXPLORATION servicio I-EXPLORATION mantuvo I-EXPLORATION dolor I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION derecho, I-EXPLORATION continuo I-EXPLORATION y I-EXPLORATION progresivamente I-EXPLORATION intolerable, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT precisó I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT catéter I-TREATMENT epidural I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT L3-L4 I-TREATMENT para I-TREATMENT la I-TREATMENT conexión I-TREATMENT de I-TREATMENT una I-TREATMENT bomba I-TREATMENT de I-TREATMENT infusión I-TREATMENT PCA I-TREATMENT (Analgesia I-TREATMENT Controlada I-TREATMENT por I-TREATMENT el I-TREATMENT Paciente) I-TREATMENT y I-TREATMENT administración I-TREATMENT de I-TREATMENT una I-TREATMENT solución I-TREATMENT compuesta I-TREATMENT por I-TREATMENT ropivacaína I-TREATMENT 0, I-TREATMENT 2 I-TREATMENT % I-TREATMENT más I-TREATMENT cloruro I-TREATMENT mórfico I-TREATMENT 0, I-TREATMENT 004 I-TREATMENT % I-TREATMENT a I-TREATMENT una I-TREATMENT velocidad I-TREATMENT de I-TREATMENT 4 I-TREATMENT ml/h I-TREATMENT y I-TREATMENT bolos I-TREATMENT de I-TREATMENT rescate I-TREATMENT de I-TREATMENT 4 I-TREATMENT ml. I-TREATMENT La I-TREATMENT punción I-TREATMENT se I-TREATMENT realizó I-TREATMENT con I-TREATMENT una I-TREATMENT aguja I-TREATMENT Tuohy I-TREATMENT 18 I-TREATMENT G. I-TREATMENT La I-TREATMENT colocación I-TREATMENT del I-TREATMENT catéter I-TREATMENT fue I-TREATMENT técnicamente I-TREATMENT sencilla I-TREATMENT y I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT No I-TREATMENT hubo I-TREATMENT aspiración I-TREATMENT de I-TREATMENT sangre I-TREATMENT o I-TREATMENT de I-TREATMENT líquido I-TREATMENT cefalorraquídeo I-TREATMENT y I-TREATMENT la I-TREATMENT dosis I-TREATMENT test I-TREATMENT (4 I-TREATMENT ml I-TREATMENT de I-TREATMENT bupivacaína I-TREATMENT 0, I-TREATMENT 25 I-TREATMENT % I-TREATMENT con I-TREATMENT vasoconstrictor) I-TREATMENT fue I-TREATMENT negativa. I-TREATMENT La I-TREATMENT paciente I-TREATMENT no I-TREATMENT había I-TREATMENT recibido I-TREATMENT tratamiento I-TREATMENT anticoagulante I-TREATMENT durante I-TREATMENT las I-TREATMENT 12 I-TREATMENT horas I-TREATMENT previas I-TREATMENT a I-TREATMENT la I-TREATMENT colocación I-TREATMENT del I-TREATMENT catéter. I-TREATMENT Tras B-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION colocación I-EVOLUTION del I-EVOLUTION catéter I-EVOLUTION epidural I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION preexistentes: I-EVOLUTION mayor I-EVOLUTION severidad I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION del I-EVOLUTION miembro I-EVOLUTION inferior I-EVOLUTION derecho, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION un I-EVOLUTION bloqueo I-EVOLUTION motor I-EVOLUTION completo I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION miembros I-EVOLUTION inferiores. I-EVOLUTION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT suspender I-TREATMENT la I-TREATMENT perfusión I-TREATMENT a I-TREATMENT través I-TREATMENT del I-TREATMENT catéter I-TREATMENT epidural I-TREATMENT y I-TREATMENT se I-TREATMENT reevaluó I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT pasadas I-TREATMENT 2, I-TREATMENT 4 I-TREATMENT y I-TREATMENT 8 I-TREATMENT horas. I-TREATMENT I-TREATMENT La B-EXPLORATION exploración I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 8 I-EXPLORATION horas I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION monoplejía I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION una I-EXPLORATION monoparesia I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION izquierdo, I-EXPLORATION sin I-EXPLORATION incontinencia I-EXPLORATION del I-EXPLORATION esfínter I-EXPLORATION anal I-EXPLORATION (la I-EXPLORATION paciente I-EXPLORATION era I-EXPLORATION portadora I-EXPLORATION de I-EXPLORATION una I-EXPLORATION sonda I-EXPLORATION vesical). I-EXPLORATION En I-EXPLORATION todo I-EXPLORATION momento, I-EXPLORATION nuestra I-EXPLORATION paciente I-EXPLORATION negó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION lumbar. I-EXPLORATION I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT retirada I-TREATMENT del I-TREATMENT catéter I-TREATMENT epidural I-TREATMENT solicitándose B-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION con I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION lumbar I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION fracturas I-EXPLORATION vertebrales I-EXPLORATION L1, I-EXPLORATION L2 I-EXPLORATION y I-EXPLORATION L4 I-EXPLORATION y I-EXPLORATION protrusión I-EXPLORATION discal I-EXPLORATION L3-L4 I-EXPLORATION que I-EXPLORATION condicionaba I-EXPLORATION compromiso I-EXPLORATION radicular I-EXPLORATION (más I-EXPLORATION marcado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION derecho) I-EXPLORATION e I-EXPLORATION importante I-EXPLORATION estenosis I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION lumbar, I-EXPLORATION agravada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION epidural I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION a I-EXPLORATION dicho I-EXPLORATION nivel. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT dexametasona I-TREATMENT 4 I-TREATMENT mg/6 I-TREATMENT h, I-TREATMENT y I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT su I-TREATMENT traslado I-TREATMENT al I-TREATMENT servicio I-TREATMENT de I-TREATMENT neurocirugía I-TREATMENT para I-TREATMENT su I-TREATMENT valoración. I-TREATMENT I-TREATMENT Durante B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION neurocirugía I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION electromiografía, I-EXPLORATION objetivándose I-EXPLORATION una I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION nervioso I-EXPLORATION periférico I-EXPLORATION que I-EXPLORATION podría I-EXPLORATION corresponderse I-EXPLORATION con I-EXPLORATION una I-EXPLORATION polineuropatía I-EXPLORATION mixta. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION todos I-EXPLORATION estos I-EXPLORATION datos, I-EXPLORATION se I-EXPLORATION consideró I-EXPLORATION que I-EXPLORATION la I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION era I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION una I-EXPLORATION conjunción I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION patologías, I-EXPLORATION desestimándose I-EXPLORATION la I-EXPLORATION intervención I-EXPLORATION quirúrgica I-EXPLORATION dado I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION beneficiaría I-EXPLORATION de I-EXPLORATION dicho I-EXPLORATION tratamiento. I-EXPLORATION I-EXPLORATION Finalmente, B-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladada I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO vascular I-DERIVED_FROM/TO para I-DERIVED_FROM/TO completar I-DERIVED_FROM/TO el I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO quirúrgico. I-DERIVED_FROM/TO La B-TREATMENT amputación I-TREATMENT supracondílea I-TREATMENT del I-TREATMENT miembro I-TREATMENT inferior I-TREATMENT derecho I-TREATMENT se I-TREATMENT realizó I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT con I-TREATMENT mascarilla I-TREATMENT laríngea I-TREATMENT i-gel™ I-TREATMENT (Intersurgical I-TREATMENT Ltd., I-TREATMENT Wokingham, I-TREATMENT England) I-TREATMENT número I-TREATMENT 4. I-TREATMENT La I-TREATMENT inducción I-TREATMENT de I-TREATMENT la I-TREATMENT anestesia I-TREATMENT se I-TREATMENT realizó I-TREATMENT mediante I-TREATMENT la I-TREATMENT administración I-TREATMENT intravenosa I-TREATMENT de I-TREATMENT fentanilo I-TREATMENT 2 I-TREATMENT µg/kg I-TREATMENT y I-TREATMENT propofol I-TREATMENT 2 I-TREATMENT mg/kg. I-TREATMENT El I-TREATMENT mantenimiento I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT se I-TREATMENT realizó I-TREATMENT con I-TREATMENT sevofluorano I-TREATMENT 2 I-TREATMENT % I-TREATMENT en I-TREATMENT una I-TREATMENT mezcla I-TREATMENT de I-TREATMENT oxígeno I-TREATMENT - I-TREATMENT aire I-TREATMENT con I-TREATMENT un I-TREATMENT flujo I-TREATMENT de I-TREATMENT gas I-TREATMENT fresco I-TREATMENT de I-TREATMENT 2 I-TREATMENT l/min. I-TREATMENT La I-TREATMENT administración I-TREATMENT adicional I-TREATMENT de I-TREATMENT fentanilo I-TREATMENT durante I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT realizó I-TREATMENT según I-TREATMENT parámetros I-TREATMENT clínicos, I-TREATMENT cifras I-TREATMENT de I-TREATMENT tensión I-TREATMENT arterial I-TREATMENT y I-TREATMENT frecuencia I-TREATMENT cardiaca. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT monitorización I-TREATMENT estándar I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT constatándose I-TREATMENT estabilidad I-TREATMENT hemodinámica I-TREATMENT durante I-TREATMENT toda I-TREATMENT la I-TREATMENT cirugía. I-TREATMENT Al B-EVOLUTION finalizar I-EVOLUTION el I-EVOLUTION procedimiento I-EVOLUTION quirúrgico I-EVOLUTION se I-EVOLUTION retiró I-EVOLUTION la I-EVOLUTION mascarilla I-EVOLUTION laríngea I-EVOLUTION cuando I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION estuvo I-EVOLUTION completamente I-EVOLUTION despierta. I-EVOLUTION Fue I-EVOLUTION trasladada I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Recuperación I-EVOLUTION Postanestésica I-EVOLUTION donde I-EVOLUTION permaneció I-EVOLUTION durante I-EVOLUTION 2 I-EVOLUTION horas. I-EVOLUTION Su I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con I-PRESENT_ILLNESS SDRC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS extremidad I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS esguince I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS ocurrido I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS llegada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad. I-PRESENT_ILLNESS Colocación B-TREATMENT en I-TREATMENT quirófano, I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT de I-TREATMENT un I-TREATMENT electrodo I-TREATMENT octopolar I-TREATMENT (Octrode) I-TREATMENT de I-TREATMENT la I-TREATMENT firma I-TREATMENT ANS I-TREATMENT (Advances I-TREATMENT Neurological I-TREATMENT Systems I-TREATMENT Inc, I-TREATMENT Plano. I-TREATMENT USA) I-TREATMENT entre I-TREATMENT T8-T12 I-TREATMENT y I-TREATMENT conexión I-TREATMENT a I-TREATMENT un I-TREATMENT generador I-TREATMENT de I-TREATMENT impulsos I-TREATMENT eléctricos I-TREATMENT externo. I-TREATMENT Una I-TREATMENT vez I-TREATMENT despierta I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT llevó I-TREATMENT a I-TREATMENT cabo I-TREATMENT la I-TREATMENT programación I-TREATMENT del I-TREATMENT sistema I-TREATMENT hasta I-TREATMENT la I-TREATMENT localización I-TREATMENT de I-TREATMENT las I-TREATMENT parestesias I-TREATMENT sobre I-TREATMENT la I-TREATMENT zona I-TREATMENT afectada. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION revisó I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION observándose I-EVOLUTION una I-EVOLUTION buena I-EVOLUTION respuesta, I-EVOLUTION tanto I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION como I-EVOLUTION del I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION acompañante, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT la I-TREATMENT colocación, I-TREATMENT en I-TREATMENT quirófano I-TREATMENT y I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT de I-TREATMENT un I-TREATMENT generador I-TREATMENT de I-TREATMENT impulsos I-TREATMENT eléctricos I-TREATMENT implantable I-TREATMENT y I-TREATMENT programable, I-TREATMENT marca I-TREATMENT Génesis. I-TREATMENT I-TREATMENT Se B-EVOLUTION revisó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION semana, I-EVOLUTION 15 I-EVOLUTION y I-EVOLUTION 30 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION implantación I-EVOLUTION del I-EVOLUTION generador, I-EVOLUTION observando I-EVOLUTION que I-EVOLUTION había I-EVOLUTION iniciado I-EVOLUTION los I-EVOLUTION ejercicios I-EVOLUTION de I-EVOLUTION rehabilitación I-EVOLUTION que I-EVOLUTION antes I-EVOLUTION no I-EVOLUTION podía I-EVOLUTION hacer I-EVOLUTION por I-EVOLUTION el I-EVOLUTION intenso I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION alodinia I-EVOLUTION del I-EVOLUTION tobillo I-EVOLUTION y I-EVOLUTION pie, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION también I-EVOLUTION había I-EVOLUTION vuelto I-EVOLUTION al I-EVOLUTION colegio I-EVOLUTION primero I-EVOLUTION con I-EVOLUTION la I-EVOLUTION ayuda I-EVOLUTION de I-EVOLUTION una I-EVOLUTION muleta I-EVOLUTION y I-EVOLUTION después I-EVOLUTION sin I-EVOLUTION protección I-EVOLUTION alguna I-EVOLUTION haciendo I-EVOLUTION una I-EVOLUTION vida I-EVOLUTION completamente I-EVOLUTION normal I-EVOLUTION para I-EVOLUTION su I-EVOLUTION edad. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION implantación I-EVOLUTION del I-EVOLUTION generador, I-EVOLUTION en I-EVOLUTION la I-EVOLUTION revisión I-EVOLUTION realizada I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION encontramos I-EVOLUTION que, I-EVOLUTION tanto I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION como I-EVOLUTION el I-EVOLUTION edema I-EVOLUTION articular I-EVOLUTION estaban I-EVOLUTION haciendo I-EVOLUTION su I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION desde I-EVOLUTION hacía I-EVOLUTION una I-EVOLUTION semana. I-EVOLUTION Se B-EXPLORATION comprobó I-EXPLORATION que I-EXPLORATION la I-EXPLORATION batería I-EXPLORATION del I-EXPLORATION generador I-EXPLORATION implantable I-EXPLORATION se I-EXPLORATION estaba I-EXPLORATION agotando, I-EXPLORATION debido I-EXPLORATION al I-EXPLORATION funcionamiento I-EXPLORATION continuo I-EXPLORATION que I-EXPLORATION había I-EXPLORATION sido I-EXPLORATION necesario I-EXPLORATION hacer I-EXPLORATION para I-EXPLORATION mantener I-EXPLORATION controlados I-EXPLORATION los I-EXPLORATION síntomas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente, I-EXPLORATION ante B-TREATMENT esta I-TREATMENT situación I-TREATMENT se I-TREATMENT decidió I-TREATMENT implantar I-TREATMENT un I-TREATMENT generador I-TREATMENT recargable, I-TREATMENT marca I-TREATMENT EON I-TREATMENT Mini, I-TREATMENT que I-TREATMENT le I-TREATMENT permita I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT una I-TREATMENT prolongación I-TREATMENT en I-TREATMENT el I-TREATMENT tiempo I-TREATMENT de I-TREATMENT recambio I-TREATMENT del I-TREATMENT generador. I-TREATMENT Este I-TREATMENT nuevo I-TREATMENT generador I-TREATMENT también I-TREATMENT se I-TREATMENT implantó I-TREATMENT en I-TREATMENT quirófano I-TREATMENT y I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general. I-TREATMENT La B-EVOLUTION niña I-EVOLUTION ha I-EVOLUTION vuelto I-EVOLUTION al I-EVOLUTION colegio I-EVOLUTION con I-EVOLUTION control I-EVOLUTION tanto I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION como I-EVOLUTION del I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas, I-EVOLUTION permaneciendo, I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION totalmente I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Niña B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 13 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY diagnosticó I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY SDRC I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY extremidad I-PAST_MEDICAL_HISTORY inferior I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tobillo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Dolor I-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Traumatología I-DERIVED_FROM/TO Pediátrica. I-DERIVED_FROM/TO Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT sin I-TREATMENT resultado I-TREATMENT analgésico I-TREATMENT adecuado I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT (previa I-TREATMENT información I-TREATMENT y I-TREATMENT obtención I-TREATMENT del I-TREATMENT consentimiento I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT los I-TREATMENT padres) I-TREATMENT la I-TREATMENT implantación, I-TREATMENT en I-TREATMENT quirófano I-TREATMENT y I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT de I-TREATMENT un I-TREATMENT catéter I-TREATMENT epidural I-TREATMENT lumbar I-TREATMENT conectado I-TREATMENT a I-TREATMENT una I-TREATMENT bomba I-TREATMENT externa I-TREATMENT para I-TREATMENT administrar I-TREATMENT una I-TREATMENT infusión I-TREATMENT continua I-TREATMENT de I-TREATMENT bupivacaína I-TREATMENT durante I-TREATMENT dos I-TREATMENT semanas. I-TREATMENT Se B-EVOLUTION obtuvo I-EVOLUTION un I-EVOLUTION alivio I-EVOLUTION completo I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION así I-EVOLUTION como I-EVOLUTION del I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas, I-EVOLUTION pero I-EVOLUTION este I-EVOLUTION desapareció I-EVOLUTION una I-EVOLUTION vez I-EVOLUTION retirada I-EVOLUTION la I-EVOLUTION infusión I-EVOLUTION de I-EVOLUTION bupivacaína I-EVOLUTION volviendo I-EVOLUTION a I-EVOLUTION aparecer I-EVOLUTION tanto I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION como I-EVOLUTION el I-EVOLUTION resto I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION acompañantes. I-EVOLUTION I-EVOLUTION Previa B-TREATMENT información I-TREATMENT y I-TREATMENT consentimiento I-TREATMENT paterno I-TREATMENT se I-TREATMENT implantó I-TREATMENT en I-TREATMENT quirófano, I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT un I-TREATMENT electrodo I-TREATMENT octopolar I-TREATMENT en I-TREATMENT cordones I-TREATMENT medulares I-TREATMENT posteriores I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT T12-T9 I-TREATMENT y I-TREATMENT se I-TREATMENT conectó I-TREATMENT a I-TREATMENT un I-TREATMENT generador I-TREATMENT de I-TREATMENT impulsos I-TREATMENT eléctricos I-TREATMENT externo. I-TREATMENT Se B-EVOLUTION programó I-EVOLUTION una I-EVOLUTION vez I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION estaba I-EVOLUTION despierta I-EVOLUTION consiguiéndose I-EVOLUTION un I-EVOLUTION buen I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION parestesias I-EVOLUTION con I-EVOLUTION alivio I-EVOLUTION completo I-EVOLUTION del I-EVOLUTION dolor. I-EVOLUTION Ello I-EVOLUTION permitió I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION iniciara I-EVOLUTION la I-EVOLUTION rehabilitación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION afectada. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION se I-EVOLUTION revisó I-EVOLUTION observándose I-EVOLUTION que I-EVOLUTION continuaba I-EVOLUTION el I-EVOLUTION alivio I-EVOLUTION sin I-EVOLUTION que I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION utilizase I-EVOLUTION el I-EVOLUTION generador I-EVOLUTION de I-EVOLUTION impulsos I-EVOLUTION externo. I-EVOLUTION Ante B-TREATMENT esta I-TREATMENT situación I-TREATMENT se I-TREATMENT desconectó I-TREATMENT el I-TREATMENT generador I-TREATMENT externo I-TREATMENT y I-TREATMENT se I-TREATMENT continuó I-TREATMENT con I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT rehabilitador I-TREATMENT citando I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT cuatro I-TREATMENT semanas I-TREATMENT más I-TREATMENT tarde. I-TREATMENT Ante B-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION acompañantes, I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION (de I-EVOLUTION acuerdo I-EVOLUTION con I-EVOLUTION los I-EVOLUTION padres) I-EVOLUTION explantar I-EVOLUTION el I-EVOLUTION electrodo I-EVOLUTION medular. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION con I-EVOLUTION una I-EVOLUTION remisión I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS un I-PRESENT_ILLNESS esguince I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS Fue I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Traumatología I-PRESENT_ILLNESS Pediátrica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS remitido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS unidad I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS del I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuadro. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-TREATMENT inició I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT (gabapentina I-TREATMENT más I-TREATMENT tramadol) I-TREATMENT con I-TREATMENT remisión I-TREATMENT completa I-TREATMENT del I-TREATMENT cuadro I-TREATMENT de I-TREATMENT dolor I-TREATMENT que I-TREATMENT permitió I-TREATMENT el I-TREATMENT inicio I-TREATMENT de I-TREATMENT la I-TREATMENT rehabilitación I-TREATMENT del I-TREATMENT pie. I-TREATMENT Continúa B-EVOLUTION en I-EVOLUTION igual I-EVOLUTION situación. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS se I-PRESENT_ILLNESS inicia I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuadro. I-PRESENT_ILLNESS Presenta I-PRESENT_ILLNESS esguince I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS desarrollo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS SDRC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS Es B-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Dolor I-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Reumatología I-DERIVED_FROM/TO Pediátrica I-DERIVED_FROM/TO a I-DERIVED_FROM/TO los I-DERIVED_FROM/TO cuatro I-DERIVED_FROM/TO años I-DERIVED_FROM/TO del I-DERIVED_FROM/TO diagnóstico. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-TREATMENT le I-TREATMENT administra I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT más I-TREATMENT aplicación I-TREATMENT de I-TREATMENT parche I-TREATMENT de I-TREATMENT capsaicina I-TREATMENT al I-TREATMENT 8 I-TREATMENT % I-TREATMENT sin I-TREATMENT remisión I-TREATMENT del I-TREATMENT cuadro. I-TREATMENT Colocación I-TREATMENT en I-TREATMENT quirófano, I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT y I-TREATMENT previo I-TREATMENT consentimiento I-TREATMENT paterno, I-TREATMENT de I-TREATMENT un I-TREATMENT catéter I-TREATMENT epidural I-TREATMENT lumbar I-TREATMENT y I-TREATMENT conexión I-TREATMENT a I-TREATMENT una I-TREATMENT bomba I-TREATMENT externa I-TREATMENT para I-TREATMENT administración I-TREATMENT de I-TREATMENT una I-TREATMENT infusión I-TREATMENT continúa I-TREATMENT de I-TREATMENT bupivacaína I-TREATMENT durante I-TREATMENT dos I-TREATMENT semanas. I-TREATMENT Retirada I-TREATMENT del I-TREATMENT catéter I-TREATMENT pasado I-TREATMENT ese I-TREATMENT tiempo. I-TREATMENT Remisión B-EVOLUTION completa I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS se I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS diagnóstico. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS previo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS esguince I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS Fue B-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO 4 I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO después I-DERIVED_FROM/TO del I-DERIVED_FROM/TO diagnóstico. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-TREATMENT le I-TREATMENT administra I-TREATMENT tratamiento I-TREATMENT farmacológico I-TREATMENT más I-TREATMENT aplicación I-TREATMENT del I-TREATMENT parche I-TREATMENT de I-TREATMENT capsaicina I-TREATMENT al I-TREATMENT 8 I-TREATMENT %. I-TREATMENT Remisión B-EVOLUTION completa I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas I-PAST_MEDICAL_HISTORY conocidas I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 8 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS sacro I-PRESENT_ILLNESS incapacitante, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manera I-PRESENT_ILLNESS continua I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cierta I-PRESENT_ILLNESS irradiación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS porción I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS apreciaba I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS sensitivas I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS control I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esfínteres. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Por I-PRESENT_ILLNESS dicho I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS hospitales. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION practicaron I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION lumbar I-EXPLORATION que I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION relieve I-EXPLORATION un I-EXPLORATION hemangioma I-EXPLORATION en I-EXPLORATION L5, I-EXPLORATION una I-EXPLORATION RMN I-EXPLORATION de I-EXPLORATION pelvis I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION rotura I-EXPLORATION muscular I-EXPLORATION grado I-EXPLORATION I I-EXPLORATION del I-EXPLORATION glúteo I-EXPLORATION mayor I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION una I-EXPLORATION estructura I-EXPLORATION que I-EXPLORATION se I-EXPLORATION interpretó I-EXPLORATION como I-EXPLORATION quiste I-EXPLORATION de I-EXPLORATION Tarlov I-EXPLORATION sacro. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT paracetamol, I-TREATMENT nolotil, I-TREATMENT tramadol I-TREATMENT y I-TREATMENT gabapentina I-TREATMENT sin I-TREATMENT mejoría. I-TREATMENT Se I-TREATMENT le I-TREATMENT realizaron I-TREATMENT dos I-TREATMENT bloqueos I-TREATMENT facetarios I-TREATMENT e I-TREATMENT incluso I-TREATMENT un I-TREATMENT bloqueo I-TREATMENT del I-TREATMENT músculo I-TREATMENT piriforme I-TREATMENT izquierdo, I-TREATMENT todo I-TREATMENT ello I-TREATMENT sin I-TREATMENT resultados. I-TREATMENT En B-EVOLUTION este I-EVOLUTION último I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION quedó I-EVOLUTION con I-EVOLUTION una I-EVOLUTION hipoestesia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION inferior I-EVOLUTION izquierda I-EVOLUTION residual. I-EVOLUTION Fue B-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO del I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO ante I-DERIVED_FROM/TO la I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO que I-DERIVED_FROM/TO este I-DERIVED_FROM/TO pudiera I-DERIVED_FROM/TO ser I-DERIVED_FROM/TO causado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hemangioma I-DERIVED_FROM/TO de I-DERIVED_FROM/TO L5. I-DERIVED_FROM/TO La B-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION estaba I-EXPLORATION consciente I-EXPLORATION y I-EXPLORATION orientada. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lenguaje. I-EXPLORATION La I-EXPLORATION función I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pares I-EXPLORATION craneales I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION Presentaba I-EXPLORATION un I-EXPLORATION dolor I-EXPLORATION muy I-EXPLORATION importante I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION sacra I-EXPLORATION 8/10 I-EXPLORATION según I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION EVA, I-EXPLORATION aproximadamente I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION S2 I-EXPLORATION y I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION fuerza I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 4/5, I-EXPLORATION con I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION flexo-extensión I-EXPLORATION distal. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION la I-EXPLORATION fuerza I-EXPLORATION era I-EXPLORATION 5/5. I-EXPLORATION Se I-EXPLORATION advirtió I-EXPLORATION una I-EXPLORATION hipoestesia I-EXPLORATION en I-EXPLORATION territorio I-EXPLORATION de I-EXPLORATION L5. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Babinsky. I-EXPLORATION La I-EXPLORATION deambulación I-EXPLORATION era I-EXPLORATION dificultosa. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION general I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteraciones I-EXPLORATION destacables. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION RM I-EXPLORATION (Philips I-EXPLORATION Medical I-EXPLORATION Systems) I-EXPLORATION lumbosacra I-EXPLORATION en I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION visualizaban I-EXPLORATION hemangiomas I-EXPLORATION vertebrales I-EXPLORATION en I-EXPLORATION L2 I-EXPLORATION y I-EXPLORATION L5, I-EXPLORATION advirtiéndose I-EXPLORATION claramente I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION central I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION en I-EXPLORATION canal I-EXPLORATION espinal I-EXPLORATION sacro I-EXPLORATION a I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION transición I-EXPLORATION S2-S3. I-EXPLORATION Esta I-EXPLORATION estructura I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION práctica I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION y I-EXPLORATION remodelaba I-EXPLORATION parcialmente I-EXPLORATION el I-EXPLORATION contorno I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION dichos I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION y I-EXPLORATION elementos I-EXPLORATION posteriores. I-EXPLORATION Esta I-EXPLORATION formación I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION íntimo I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION ambas I-EXPLORATION raíces I-EXPLORATION S3 I-EXPLORATION y I-EXPLORATION S4 I-EXPLORATION sin I-EXPLORATION englobarlas. I-EXPLORATION Su I-EXPLORATION morfología I-EXPLORATION era I-EXPLORATION ovalada I-EXPLORATION y I-EXPLORATION los I-EXPLORATION contornos I-EXPLORATION nítidos I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION máximo I-EXPLORATION aproximado I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION X I-EXPLORATION 19 I-EXPLORATION X I-EXPLORATION 14 I-EXPLORATION mm. I-EXPLORATION Según I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION de I-EXPLORATION Nabors I-EXPLORATION correspondía I-EXPLORATION a I-EXPLORATION un I-EXPLORATION meningocele I-EXPLORATION intrasacro I-EXPLORATION oculto. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT punción I-TREATMENT (Needle I-TREATMENT Ostycut I-TREATMENT 150 I-TREATMENT mm I-TREATMENT 13G I-TREATMENT Angiomed) I-TREATMENT y I-TREATMENT evacuación I-TREATMENT del I-TREATMENT quiste I-TREATMENT sacro I-TREATMENT guiado I-TREATMENT por I-TREATMENT TC I-TREATMENT (GE I-TREATMENT Medical I-TREATMENT Systems I-TREATMENT BrightSpeed) I-TREATMENT obteniéndose I-TREATMENT unos I-TREATMENT 2 I-TREATMENT cc I-TREATMENT de I-TREATMENT un I-TREATMENT líquido I-TREATMENT hemático. I-TREATMENT El B-EXPLORATION examen I-EXPLORATION citológico I-EXPLORATION describió I-EXPLORATION una I-EXPLORATION celularidad I-EXPLORATION benigna. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION fue I-EVOLUTION de I-EVOLUTION mejoría I-EVOLUTION notable I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION sacro I-EVOLUTION que I-EVOLUTION en I-EVOLUTION la I-EVOLUTION escala I-EVOLUTION de I-EVOLUTION EVA I-EVOLUTION era I-EVOLUTION de I-EVOLUTION 3/10 I-EVOLUTION reiniciando I-EVOLUTION la I-EVOLUTION deambulación I-EVOLUTION sin I-EVOLUTION dificultad, I-EVOLUTION no I-EVOLUTION presentando I-EVOLUTION debilidad I-EVOLUTION en I-EVOLUTION la I-EVOLUTION pierna I-EVOLUTION izquierda I-EVOLUTION ni I-EVOLUTION hipoestesia. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que, B-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY molestias I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY parestesias I-PAST_MEDICAL_HISTORY (no I-PAST_MEDICAL_HISTORY dolor) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY espalda I-PAST_MEDICAL_HISTORY (región I-PAST_MEDICAL_HISTORY dorsal I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY lado I-PAST_MEDICAL_HISTORY izquierdo) I-PAST_MEDICAL_HISTORY junto I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY mayor I-PAST_MEDICAL_HISTORY sensibilidad I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY roce I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ropa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY esa I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY (hiperestesia I-PAST_MEDICAL_HISTORY mecánica). I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetivaba I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION hiperestesia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION escapular I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION hiperestesia I-EXPLORATION cutánea I-EXPLORATION y I-EXPLORATION dinámica, I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION circular I-EXPLORATION delimitada I-EXPLORATION que I-EXPLORATION no I-EXPLORATION correspondía I-EXPLORATION con I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION hiperpigmentación. I-EXPLORATION La I-EXPLORATION RMN I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION cervical I-EXPLORATION y I-EXPLORATION dorsal I-EXPLORATION mostraba I-EXPLORATION protrusiones I-EXPLORATION discales I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION C4, I-EXPLORATION C5, I-EXPLORATION C6 I-EXPLORATION y I-EXPLORATION D1, I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION radicular, I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION medular I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION neurofisiológico I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT no I-TREATMENT iniciar I-TREATMENT tratamiento, I-TREATMENT ya I-TREATMENT que I-TREATMENT al I-TREATMENT paciente I-TREATMENT no I-TREATMENT le I-TREATMENT molestaban I-TREATMENT dichos I-TREATMENT síntomas I-TREATMENT y I-TREATMENT tampoco I-TREATMENT era I-TREATMENT partidario I-TREATMENT de I-TREATMENT ello. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS manchas I-PRESENT_ILLNESS cutáneas I-PRESENT_ILLNESS extensas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS espalda, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS de I-PRESENT_ILLNESS picor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dichas I-PRESENT_ILLNESS zonas, I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS todo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS épocas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS calor. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION practicó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION una I-EXPLORATION de I-EXPLORATION ellas, I-EXPLORATION siendo I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION crónico I-EXPLORATION perivascular I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION melanófagos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION dermis I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION hiperpigmentación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION capa I-EXPLORATION basal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION epidermis. I-EXPLORATION Fue I-EXPLORATION Rojo I-EXPLORATION Congo I-EXPLORATION negativo. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION practicar I-EXPLORATION RMN I-EXPLORATION por I-EXPLORATION padecer I-EXPLORATION claustrofobia. I-EXPLORATION No B-TREATMENT requirió I-TREATMENT tratamiento. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS maculosa I-PRESENT_ILLNESS adyacente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS columna, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS de I-PRESENT_ILLNESS D5-D7, I-PRESENT_ILLNESS levemente I-PRESENT_ILLNESS pruriginosa, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION neurológica, I-EXPLORATION como I-EXPLORATION única I-EXPLORATION alteración I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION hiperestesia I-EXPLORATION al I-EXPLORATION pinchazo I-EXPLORATION justo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION RMN I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION dorsal I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Tampoco B-TREATMENT requirió I-TREATMENT tratamiento I-TREATMENT farmacológico. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS zonas I-PRESENT_ILLNESS paravertebrales I-PRESENT_ILLNESS diferenciadas, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS de I-PRESENT_ILLNESS D2 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS D7, I-PRESENT_ILLNESS paravertebrales I-PRESENT_ILLNESS ambas. I-PRESENT_ILLNESS Aumentaba I-PRESENT_ILLNESS el I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS solo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS época I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS calor. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION RMN I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION practicada. I-EXPLORATION Se B-TREATMENT intentó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT capsaicina I-TREATMENT tópica, I-TREATMENT pero I-TREATMENT como I-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT lo I-TREATMENT toleraba I-TREATMENT y I-TREATMENT en I-TREATMENT cambio I-TREATMENT sí I-TREATMENT el I-TREATMENT prurito, I-TREATMENT prefirió I-TREATMENT no I-TREATMENT probar I-TREATMENT otros I-TREATMENT tratamientos I-TREATMENT farmacológicos. I-TREATMENT I-TREATMENT En B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2001, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY produce I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY altercado I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY policial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY joven I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY localidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Bilbao. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY consecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY altercado I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY joven I-PAST_MEDICAL_HISTORY sufre I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY herida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY arma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fuego I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY nalga I-PAST_MEDICAL_HISTORY izquierda. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY disparo I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY producido I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY arma I-PAST_MEDICAL_HISTORY reglamentaria I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY munición I-PAST_MEDICAL_HISTORY utilizada I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY proyectil I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY mm I-PAST_MEDICAL_HISTORY Parabellum I-PAST_MEDICAL_HISTORY Sako-Luger I-PAST_MEDICAL_HISTORY KPO I-PAST_MEDICAL_HISTORY [1]. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Las I-PAST_MEDICAL_HISTORY declaraciones I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY lesionado I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY contradictorias. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY relató I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY joven, I-PAST_MEDICAL_HISTORY sentado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY asiento I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dentro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY turismo, I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY encaró I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY arma I-PAST_MEDICAL_HISTORY hallándose I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY exterior I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY vehículo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY puerta I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY abierta. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY actitud I-PAST_MEDICAL_HISTORY defensiva, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY relata I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY disparó I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY lesionado I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY hallaba I-PAST_MEDICAL_HISTORY dentro I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY vehículo I-PAST_MEDICAL_HISTORY y, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY disparo, I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY arrastró I-PAST_MEDICAL_HISTORY fuera I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY turismo. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY disparo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY escenario I-PAST_MEDICAL_HISTORY nº I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY correspondiente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY declaraciones I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY agente, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY esquematiza I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY imagen I-PAST_MEDICAL_HISTORY nº I-PAST_MEDICAL_HISTORY 1. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY declaraciones I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY lesionado I-PAST_MEDICAL_HISTORY indicó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY hallándose I-PAST_MEDICAL_HISTORY sentado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY asiento I-PAST_MEDICAL_HISTORY trasero I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY vehículo, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY abrió I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY puerta I-PAST_MEDICAL_HISTORY posterior I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY arrastrado I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY asfalto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY carretera I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY agente I-PAST_MEDICAL_HISTORY policial, I-PAST_MEDICAL_HISTORY cayendo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY él I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY decúbito I-PAST_MEDICAL_HISTORY prono I-PAST_MEDICAL_HISTORY sobre I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY quedando I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY pies I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY interior I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY turismo. I-PAST_MEDICAL_HISTORY Una I-PAST_MEDICAL_HISTORY vez I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY suelo, I-PAST_MEDICAL_HISTORY escuchó I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sintió I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY disparo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY nalga I-PAST_MEDICAL_HISTORY izquierda. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY disparo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY escenario I-PAST_MEDICAL_HISTORY nº I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY correspondiente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY declaraciones I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY lesionado, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY recoge I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY imagen I-PAST_MEDICAL_HISTORY nº I-PAST_MEDICAL_HISTORY 2. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY HALLAZGOS B-PRESENT_ILLNESS EXPLORATORIOS I-PRESENT_ILLNESS Y I-PRESENT_ILLNESS PRUEBAS I-PRESENT_ILLNESS COMPLEMENTARIAS: I-PRESENT_ILLNESS I-PRESENT_ILLNESS El I-PRESENT_ILLNESS lesionado I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS visto I-PRESENT_ILLNESS por I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS vez I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS forense I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Bilbao I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS hechos, I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS su I-PRESENT_ILLNESS estancia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS hospitalario I-PRESENT_ILLNESS y I-PRESENT_ILLNESS su I-PRESENT_ILLNESS asistencia I-PRESENT_ILLNESS urgente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS se I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS extracción I-PRESENT_ILLNESS del I-PRESENT_ILLNESS proyectil. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION en I-EXPLORATION esta I-EXPLORATION clínica I-EXPLORATION médico I-EXPLORATION forense I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION cicatriz I-EXPLORATION oval I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION x I-EXPLORATION 1.5 I-EXPLORATION cms I-EXPLORATION en I-EXPLORATION flanco I-EXPLORATION posterior I-EXPLORATION izquierdo I-EXPLORATION (imagen I-EXPLORATION 3). I-EXPLORATION I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION radiográficos I-EXPLORATION realizados I-EXPLORATION en I-EXPLORATION su I-EXPLORATION asistencia I-EXPLORATION en I-EXPLORATION urgencias I-EXPLORATION (radiografías I-EXPLORATION simples I-EXPLORATION AP I-EXPLORATION y I-EXPLORATION laterales I-EXPLORATION de I-EXPLORATION pelvis I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION pélvico) I-EXPLORATION indicaban I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION varios I-EXPLORATION fragmentos I-EXPLORATION radiopacos I-EXPLORATION irregulares I-EXPLORATION de I-EXPLORATION diversos I-EXPLORATION tamaños I-EXPLORATION localizados I-EXPLORATION en I-EXPLORATION región I-EXPLORATION glútea I-EXPLORATION izquierda I-EXPLORATION (imagen I-EXPLORATION 4). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION lesiones I-EXPLORATION óseas I-EXPLORATION asociadas. I-EXPLORATION I-EXPLORATION Dos B-TREATMENT años I-TREATMENT después I-TREATMENT de I-TREATMENT los I-TREATMENT hechos, I-TREATMENT se I-TREATMENT realiza I-TREATMENT la I-TREATMENT extracción I-TREATMENT quirúrgica I-TREATMENT de I-TREATMENT dos I-TREATMENT fragmentos I-TREATMENT de I-TREATMENT proyectil I-TREATMENT de I-TREATMENT la I-TREATMENT nalga I-TREATMENT izquierda. I-TREATMENT El I-TREATMENT médico I-TREATMENT forense I-TREATMENT se I-TREATMENT halla I-TREATMENT presente I-TREATMENT en I-TREATMENT la I-TREATMENT intervención I-TREATMENT y I-TREATMENT los I-TREATMENT fragmentos I-TREATMENT son I-TREATMENT recogidos I-TREATMENT y, I-TREATMENT sin I-TREATMENT manipulación I-TREATMENT previa, I-TREATMENT remitidos I-TREATMENT para I-TREATMENT estudio I-TREATMENT balístico. I-TREATMENT I-TREATMENT Se B-EXPLORATION practicaron I-EXPLORATION diversas I-EXPLORATION pruebas I-EXPLORATION complementarias: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Estudio I-EXPLORATION criminalístico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION prendas I-EXPLORATION del I-EXPLORATION lesionado: I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION camiseta I-EXPLORATION del I-EXPLORATION lesionado I-EXPLORATION indicó I-EXPLORATION que I-EXPLORATION existía I-EXPLORATION un I-EXPLORATION orifico I-EXPLORATION de I-EXPLORATION disparo I-EXPLORATION con I-EXPLORATION dos I-EXPLORATION grandes I-EXPLORATION desgarros I-EXPLORATION radiales, I-EXPLORATION ahumamiento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION (imagen I-EXPLORATION 5) I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION residuos I-EXPLORATION de I-EXPLORATION plomo, I-EXPLORATION bario I-EXPLORATION y I-EXPLORATION antimomio I-EXPLORATION que I-EXPLORATION indicaron I-EXPLORATION que I-EXPLORATION el I-EXPLORATION disparo I-EXPLORATION pudo I-EXPLORATION ser I-EXPLORATION producido I-EXPLORATION a I-EXPLORATION cañón I-EXPLORATION tocante I-EXPLORATION o I-EXPLORATION a I-EXPLORATION muy I-EXPLORATION corta I-EXPLORATION distancia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION camiseta. I-EXPLORATION El I-EXPLORATION orificio I-EXPLORATION se I-EXPLORATION hallaba I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION camiseta, I-EXPLORATION en I-EXPLORATION su I-EXPLORATION cuadrante I-EXPLORATION inferior I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Estudio I-EXPLORATION del I-EXPLORATION arma I-EXPLORATION reglamentaria I-EXPLORATION utilizada: I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION arma I-EXPLORATION no I-EXPLORATION permite I-EXPLORATION identificar I-EXPLORATION ninguna I-EXPLORATION anomalía I-EXPLORATION en I-EXPLORATION esta I-EXPLORATION que I-EXPLORATION pudiese I-EXPLORATION haber I-EXPLORATION producido I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION proyectil I-EXPLORATION [2]. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION fragmentos I-EXPLORATION de I-EXPLORATION proyectil I-EXPLORATION extraídos I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION del I-EXPLORATION lesionado: I-EXPLORATION se I-EXPLORATION identifican I-EXPLORATION ambos I-EXPLORATION fragmentos, I-EXPLORATION deformados I-EXPLORATION y I-EXPLORATION correspondientes I-EXPLORATION con I-EXPLORATION los I-EXPLORATION extremos I-EXPLORATION del I-EXPLORATION culote I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION punta I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proyectil I-EXPLORATION camisado I-EXPLORATION tipo I-EXPLORATION 9 I-EXPLORATION mm. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION los I-EXPLORATION fragmentos I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION residuos I-EXPLORATION químicos I-EXPLORATION de I-EXPLORATION tejidos I-EXPLORATION biológicos I-EXPLORATION y I-EXPLORATION algún I-EXPLORATION desinfectante, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION silicio. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION superficie, I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION surcos I-EXPLORATION irregulares I-EXPLORATION y I-EXPLORATION signos I-EXPLORATION del I-EXPLORATION labrado I-EXPLORATION del I-EXPLORATION ánima I-EXPLORATION del I-EXPLORATION arma. I-EXPLORATION La I-EXPLORATION conclusión I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION indica I-EXPLORATION que I-EXPLORATION ha I-EXPLORATION existido I-EXPLORATION fragmentación I-EXPLORATION y I-EXPLORATION rebote I-EXPLORATION del I-EXPLORATION proyectil I-EXPLORATION camisado I-EXPLORATION 9 I-EXPLORATION mm I-EXPLORATION contra I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION irregular. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION escena I-EXPLORATION descrita I-EXPLORATION en I-EXPLORATION el I-EXPLORATION atestado I-EXPLORATION policial: I-EXPLORATION según I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION del I-EXPLORATION atestado I-EXPLORATION policial, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lugar I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hechos I-EXPLORATION no I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION impactos I-EXPLORATION de I-EXPLORATION proyectil I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION el I-EXPLORATION vehículo I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION el I-EXPLORATION entorno. I-EXPLORATION Se I-EXPLORATION encuentra I-EXPLORATION un I-EXPLORATION casquillo I-EXPLORATION de I-EXPLORATION proyectil I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION asfalto I-EXPLORATION que I-EXPLORATION coincide I-EXPLORATION con I-EXPLORATION el I-EXPLORATION supuestamente I-EXPLORATION disparado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION agente. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION criminalísticos I-EXPLORATION practicados I-EXPLORATION y I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION derivados I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION del I-EXPLORATION atestado, I-EXPLORATION de I-EXPLORATION las I-EXPLORATION heridas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION imagen, I-EXPLORATION permitieron I-EXPLORATION establecer I-EXPLORATION que I-EXPLORATION el I-EXPLORATION disparo I-EXPLORATION practicado I-EXPLORATION había I-EXPLORATION presentado I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION características I-EXPLORATION generales: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Disparo I-EXPLORATION a I-EXPLORATION cañón I-EXPLORATION tocante I-EXPLORATION o I-EXPLORATION muy I-EXPLORATION próximo I-EXPLORATION al I-EXPLORATION contacto I-EXPLORATION en I-EXPLORATION la I-EXPLORATION camiseta. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Penetración I-EXPLORATION de I-EXPLORATION fragmentos I-EXPLORATION como I-EXPLORATION orificio I-EXPLORATION único I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION víctima I-EXPLORATION con I-EXPLORATION trayectoria I-EXPLORATION descrita I-EXPLORATION en I-EXPLORATION imágenes I-EXPLORATION 6 I-EXPLORATION y I-EXPLORATION 7. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Ausencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION óseas I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION fracturas I-EXPLORATION o I-EXPLORATION fisuras I-EXPLORATION evidenciables I-EXPLORATION con I-EXPLORATION estudios I-EXPLORATION radiográficos. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Proyectil I-EXPLORATION 9 I-EXPLORATION mm I-EXPLORATION Pb I-EXPLORATION KPO I-EXPLORATION Sako. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Análisis I-EXPLORATION balístico I-EXPLORATION con I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION rebote I-EXPLORATION (ricochet) I-EXPLORATION sobre I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION irregular. I-EXPLORATION Se I-EXPLORATION descarta I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION metálica I-EXPLORATION o I-EXPLORATION pulida I-EXPLORATION por I-EXPLORATION la I-EXPLORATION irregularidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION surcos. I-EXPLORATION La I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION silicio I-EXPLORATION sobre I-EXPLORATION los I-EXPLORATION restos I-EXPLORATION recogidos I-EXPLORATION no I-EXPLORATION permite I-EXPLORATION confirmar I-EXPLORATION impactos I-EXPLORATION sobre I-EXPLORATION asfalto. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Ausencia I-EXPLORATION de I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION anomalías I-EXPLORATION en I-EXPLORATION el I-EXPLORATION arma I-EXPLORATION que I-EXPLORATION pudieran I-EXPLORATION sugerir I-EXPLORATION alteraciones I-EXPLORATION del I-EXPLORATION proyectil I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION boca I-EXPLORATION del I-EXPLORATION cañón I-EXPLORATION que I-EXPLORATION simulasen I-EXPLORATION un I-EXPLORATION rebote I-EXPLORATION y I-EXPLORATION fragmentación I-EXPLORATION del I-EXPLORATION proyectil I-EXPLORATION [2]. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Ausencia I-EXPLORATION de I-EXPLORATION elementos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION indumentaria I-EXPLORATION del I-EXPLORATION lesionado I-EXPLORATION que I-EXPLORATION pudieran I-EXPLORATION haber I-EXPLORATION actuado I-EXPLORATION como I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION impacto I-EXPLORATION intermedio, I-EXPLORATION y I-EXPLORATION fuente I-EXPLORATION de I-EXPLORATION fragmentación I-EXPLORATION y I-EXPLORATION rebote, I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION arma I-EXPLORATION y I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION del I-EXPLORATION lesionado. I-EXPLORATION I-EXPLORATION El B-PRESENT_ILLNESS caso I-PRESENT_ILLNESS que I-PRESENT_ILLNESS traemos I-PRESENT_ILLNESS hoy I-PRESENT_ILLNESS a I-PRESENT_ILLNESS colación, I-PRESENT_ILLNESS es I-PRESENT_ILLNESS el I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS arpoximada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuarenta I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS Fuerzas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Seguridad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Estado, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS agónico, I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS heridas I-PRESENT_ILLNESS localizadas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS parietal I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS y I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS respectivamente. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION región I-EXPLORATION parietal I-EXPLORATION derecha I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION herida I-EXPLORATION contusa, I-EXPLORATION irregular, I-EXPLORATION estrellada, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION cavidad I-EXPLORATION anfractuosa I-EXPLORATION debida I-EXPLORATION al I-EXPLORATION despegue I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tegumentos, I-EXPLORATION con I-EXPLORATION algunos I-EXPLORATION depósitos I-EXPLORATION negruzcos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION parietofrontal I-EXPLORATION izquierda I-EXPLORATION hay I-EXPLORATION otra I-EXPLORATION herida I-EXPLORATION ovalada, I-EXPLORATION de I-EXPLORATION un I-EXPLORATION centímetro I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION aproximado I-EXPLORATION y I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION ligeramente I-EXPLORATION evertidos. I-EXPLORATION Otras I-EXPLORATION lesiones I-EXPLORATION asociadas I-EXPLORATION son I-EXPLORATION hematoma I-EXPLORATION en I-EXPLORATION gafas I-EXPLORATION y I-EXPLORATION epistaxis. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION autopsia, I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION una I-EXPLORATION fractura I-EXPLORATION radial I-EXPLORATION del I-EXPLORATION parietal I-EXPLORATION derecho, I-EXPLORATION que I-EXPLORATION converge I-EXPLORATION sobre I-EXPLORATION un I-EXPLORATION orificio I-EXPLORATION redondeado I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION cortantes I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION externa I-EXPLORATION del I-EXPLORATION hueso. I-EXPLORATION La I-EXPLORATION tabla I-EXPLORATION interna I-EXPLORATION biselada I-EXPLORATION a I-EXPLORATION modo I-EXPLORATION de I-EXPLORATION cono I-EXPLORATION truncado I-EXPLORATION con I-EXPLORATION la I-EXPLORATION base I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION del I-EXPLORATION cráneo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION hemicráneo I-EXPLORATION izquierdo I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION otro I-EXPLORATION orificio I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION parietofrontal I-EXPLORATION con I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION externa I-EXPLORATION biselada I-EXPLORATION con I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION más I-EXPLORATION ancha I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION exterior. I-EXPLORATION La I-EXPLORATION tabla I-EXPLORATION interna I-EXPLORATION presentaba I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION del I-EXPLORATION orificio I-EXPLORATION cortantes. I-EXPLORATION I-EXPLORATION COMENTARIO: B-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS España, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tasa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS suicidios I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS decenio I-PRESENT_ILLNESS comprendido I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS 1990 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 1999 I-PRESENT_ILLNESS era I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4, I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cien I-PRESENT_ILLNESS mil I-PRESENT_ILLNESS habitantes I-PRESENT_ILLNESS [1], I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cuarta I-PRESENT_ILLNESS causa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS muerte I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS jóvenes I-PRESENT_ILLNESS varones I-PRESENT_ILLNESS con I-PRESENT_ILLNESS edades I-PRESENT_ILLNESS comprendidas I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS [2]. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La I-PRESENT_ILLNESS modalidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS suicidio I-PRESENT_ILLNESS depende I-PRESENT_ILLNESS de I-PRESENT_ILLNESS numerosos I-PRESENT_ILLNESS factores; I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encuentran I-PRESENT_ILLNESS la I-PRESENT_ILLNESS disponibilidad I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fácil I-PRESENT_ILLNESS acceso I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS medios I-PRESENT_ILLNESS a I-PRESENT_ILLNESS utilizar, I-PRESENT_ILLNESS patología I-PRESENT_ILLNESS previa, I-PRESENT_ILLNESS influencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS medio, I-PRESENT_ILLNESS etc. I-PRESENT_ILLNESS Smith I-PRESENT_ILLNESS [3] I-PRESENT_ILLNESS encuentra I-PRESENT_ILLNESS una I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS positiva I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS la I-PRESENT_ILLNESS accesibilidad I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS armas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuego I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS proporción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS suicidios I-PRESENT_ILLNESS causados I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tales I-PRESENT_ILLNESS armas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS patología, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS editorial I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Revista I-PRESENT_ILLNESS Panamericana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Salud I-PRESENT_ILLNESS [4] I-PRESENT_ILLNESS indica I-PRESENT_ILLNESS como I-PRESENT_ILLNESS factores I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS riesgo I-PRESENT_ILLNESS para I-PRESENT_ILLNESS el I-PRESENT_ILLNESS suicidio I-PRESENT_ILLNESS el I-PRESENT_ILLNESS consumo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS drogas, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS alcoholismo, I-PRESENT_ILLNESS los I-PRESENT_ILLNESS trastornos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS personalidad, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS esquizofrenia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hombres I-PRESENT_ILLNESS y I-PRESENT_ILLNESS las I-PRESENT_ILLNESS psicosis I-PRESENT_ILLNESS orgánicas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mujeres. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La I-PRESENT_ILLNESS influencia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS juega, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS mismo, I-PRESENT_ILLNESS una I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS importancia, I-PRESENT_ILLNESS ascendiendo I-PRESENT_ILLNESS la I-PRESENT_ILLNESS proporción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS suicidios I-PRESENT_ILLNESS al I-PRESENT_ILLNESS 50, I-PRESENT_ILLNESS 3% I-PRESENT_ILLNESS en I-PRESENT_ILLNESS jóvenes I-PRESENT_ILLNESS hispanos I-PRESENT_ILLNESS residentes I-PRESENT_ILLNESS en I-PRESENT_ILLNESS USA I-PRESENT_ILLNESS utilizando I-PRESENT_ILLNESS armas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuego I-PRESENT_ILLNESS [5], I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ascendiendo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 1% I-PRESENT_ILLNESS en I-PRESENT_ILLNESS asiáticos I-PRESENT_ILLNESS residentes I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS continente I-PRESENT_ILLNESS al I-PRESENT_ILLNESS 45, I-PRESENT_ILLNESS 3% I-PRESENT_ILLNESS en I-PRESENT_ILLNESS asiáticos I-PRESENT_ILLNESS residentes I-PRESENT_ILLNESS en I-PRESENT_ILLNESS Estados I-PRESENT_ILLNESS Unidos I-PRESENT_ILLNESS para I-PRESENT_ILLNESS el I-PRESENT_ILLNESS grupo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edades I-PRESENT_ILLNESS comprendido I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS [6]. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Hay I-PRESENT_ILLNESS diversos I-PRESENT_ILLNESS indicios I-PRESENT_ILLNESS que I-PRESENT_ILLNESS nos I-PRESENT_ILLNESS permiten I-PRESENT_ILLNESS etiquetar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS muerte I-PRESENT_ILLNESS como I-PRESENT_ILLNESS suicida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS heridas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS arma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuego. I-PRESENT_ILLNESS Entre I-PRESENT_ILLNESS ellos I-PRESENT_ILLNESS encontramos I-PRESENT_ILLNESS la I-PRESENT_ILLNESS localización I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS herida, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS número I-PRESENT_ILLNESS de I-PRESENT_ILLNESS heridas, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS dirección I-PRESENT_ILLNESS del I-PRESENT_ILLNESS disparo, I-PRESENT_ILLNESS señales I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pólvora I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS distancia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS disparo I-PRESENT_ILLNESS [7]. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Para I-PRESENT_ILLNESS considerar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS muerte I-PRESENT_ILLNESS suicida I-PRESENT_ILLNESS el I-PRESENT_ILLNESS disparo I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estar I-PRESENT_ILLNESS realizado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS corta I-PRESENT_ILLNESS distancia, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS trayectoria I-PRESENT_ILLNESS compatible I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS acceso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mano. I-PRESENT_ILLNESS La B-EXPLORATION configuración I-EXPLORATION del I-EXPLORATION orifico I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION va I-EXPLORATION a I-EXPLORATION proporcionar I-EXPLORATION datos I-EXPLORATION valiosísimos I-EXPLORATION para I-EXPLORATION determinar I-EXPLORATION la I-EXPLORATION distancia I-EXPLORATION del I-EXPLORATION disparo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION líneas I-EXPLORATION generales, I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proyectil I-EXPLORATION suele I-EXPLORATION ser I-EXPLORATION circular I-EXPLORATION u I-EXPLORATION ovoide I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño I-EXPLORATION salvo I-EXPLORATION en I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION casos I-EXPLORATION [8]: I-EXPLORATION I-EXPLORATION ● I-EXPLORATION Disparos I-EXPLORATION a I-EXPLORATION cañón I-EXPLORATION tocante I-EXPLORATION o I-EXPLORATION muy I-EXPLORATION cercanos I-EXPLORATION en I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION situada I-EXPLORATION sobre I-EXPLORATION un I-EXPLORATION plano I-EXPLORATION óseo. I-EXPLORATION I-EXPLORATION ● I-EXPLORATION Disparos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cartucho I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION velocidad I-EXPLORATION (con I-EXPLORATION gran I-EXPLORATION energía I-EXPLORATION cinética) I-EXPLORATION o I-EXPLORATION con I-EXPLORATION proyectiles I-EXPLORATION de I-EXPLORATION caza I-EXPLORATION o I-EXPLORATION semiblindados. I-EXPLORATION I-EXPLORATION ● I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION proyectil I-EXPLORATION desestabilizado I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION impactar I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION víctima; I-EXPLORATION ya I-EXPLORATION sea I-EXPLORATION por I-EXPLORATION rebote I-EXPLORATION o I-EXPLORATION por I-EXPLORATION interposición I-EXPLORATION de I-EXPLORATION algún I-EXPLORATION material. I-EXPLORATION I-EXPLORATION Cuando I-EXPLORATION el I-EXPLORATION disparo I-EXPLORATION se I-EXPLORATION produce I-EXPLORATION a I-EXPLORATION cañón I-EXPLORATION tocante, I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION está I-EXPLORATION constituido I-EXPLORATION por I-EXPLORATION una I-EXPLORATION herida I-EXPLORATION contusa, I-EXPLORATION irregular, I-EXPLORATION estrellada, I-EXPLORATION y I-EXPLORATION sobre I-EXPLORATION una I-EXPLORATION cavidad I-EXPLORATION anfractuosa I-EXPLORATION debida I-EXPLORATION al I-EXPLORATION despegue I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tegumentos: I-EXPLORATION es I-EXPLORATION el I-EXPLORATION cuarto I-EXPLORATION de I-EXPLORATION mina, I-EXPLORATION cuyas I-EXPLORATION paredes I-EXPLORATION están I-EXPLORATION tapizadas I-EXPLORATION por I-EXPLORATION restos I-EXPLORATION negruzcos I-EXPLORATION compuestos I-EXPLORATION de I-EXPLORATION humo, I-EXPLORATION partículas I-EXPLORATION metálicas, I-EXPLORATION granos I-EXPLORATION de I-EXPLORATION pólvora I-EXPLORATION y I-EXPLORATION restos I-EXPLORATION tejidos I-EXPLORATION mezclados I-EXPLORATION con I-EXPLORATION sangre I-EXPLORATION [9]. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION configuración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION también I-EXPLORATION influye I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION los I-EXPLORATION gases I-EXPLORATION y I-EXPLORATION el I-EXPLORATION sobreestiramiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION [10]. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION último I-EXPLORATION la I-EXPLORATION dirección I-EXPLORATION del I-EXPLORATION disparo I-EXPLORATION ha I-EXPLORATION de I-EXPLORATION ser I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION mecanismo I-EXPLORATION suicida. I-EXPLORATION Un I-EXPLORATION sujeto I-EXPLORATION diestro I-EXPLORATION habitualmente I-EXPLORATION se I-EXPLORATION dispara I-EXPLORATION de I-EXPLORATION derecha I-EXPLORATION a I-EXPLORATION izquierda. I-EXPLORATION La I-EXPLORATION configuración I-EXPLORATION del I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION y I-EXPLORATION de I-EXPLORATION salida I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hueso I-EXPLORATION va I-EXPLORATION a I-EXPLORATION ser I-EXPLORATION primordial I-EXPLORATION para I-EXPLORATION la I-EXPLORATION interpretación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION dirección I-EXPLORATION del I-EXPLORATION disparo. I-EXPLORATION Cuando I-EXPLORATION el I-EXPLORATION proyectil I-EXPLORATION atraviesa I-EXPLORATION el I-EXPLORATION cráneo I-EXPLORATION la I-EXPLORATION confrontación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION orificios I-EXPLORATION constituye I-EXPLORATION un I-EXPLORATION fiel I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION cual I-EXPLORATION es I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION y I-EXPLORATION cual, I-EXPLORATION el I-EXPLORATION de I-EXPLORATION salida. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION dos I-EXPLORATION tablas I-EXPLORATION del I-EXPLORATION diploe I-EXPLORATION craneal, I-EXPLORATION la I-EXPLORATION segunda I-EXPLORATION atravesada I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION orifico I-EXPLORATION mayor I-EXPLORATION y I-EXPLORATION más I-EXPLORATION irregular, I-EXPLORATION adoptando I-EXPLORATION la I-EXPLORATION típica I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION cono I-EXPLORATION truncado I-EXPLORATION con I-EXPLORATION la I-EXPLORATION base I-EXPLORATION señalando I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION del I-EXPLORATION proyectil I-EXPLORATION [11]. I-EXPLORATION q I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS joven, I-PRESENT_ILLNESS conductor I-PRESENT_ILLNESS y I-PRESENT_ILLNESS único I-PRESENT_ILLNESS ocupante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS turismo, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS sufre I-PRESENT_ILLNESS una I-PRESENT_ILLNESS salida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS calzada I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS circulaba I-PRESENT_ILLNESS a I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 100 I-PRESENT_ILLNESS Km. I-PRESENT_ILLNESS según I-PRESENT_ILLNESS estimación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Atestados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Guardia I-PRESENT_ILLNESS Civil I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Tráfico. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS vehículo I-PRESENT_ILLNESS choca I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS acequia I-PRESENT_ILLNESS quedando I-PRESENT_ILLNESS deformado I-PRESENT_ILLNESS el I-PRESENT_ILLNESS habitáculo, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS necesaria I-PRESENT_ILLNESS la I-PRESENT_ILLNESS excarceración I-PRESENT_ILLNESS por I-PRESENT_ILLNESS parte I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS Bomberos. I-PRESENT_ILLNESS Según I-PRESENT_ILLNESS las I-PRESENT_ILLNESS mismas I-PRESENT_ILLNESS fuentes I-PRESENT_ILLNESS el I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS debió I-PRESENT_ILLNESS ocurrir I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS la I-PRESENT_ILLNESS 1.45 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS madrugada, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS que I-PRESENT_ILLNESS hubiese I-PRESENT_ILLNESS testigos I-PRESENT_ILLNESS presenciales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Ingresa B-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO UCI I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Regional I-DERIVED_FROM/TO en I-DERIVED_FROM/TO estado I-DERIVED_FROM/TO de I-DERIVED_FROM/TO coma I-DERIVED_FROM/TO procedente I-DERIVED_FROM/TO de I-DERIVED_FROM/TO otro I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO para I-DERIVED_FROM/TO su I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO por I-DERIVED_FROM/TO parte I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Neurocirugía, I-DERIVED_FROM/TO al I-DERIVED_FROM/TO parecer I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO haber I-DERIVED_FROM/TO sufrido I-DERIVED_FROM/TO un I-DERIVED_FROM/TO TCE I-DERIVED_FROM/TO severo I-DERIVED_FROM/TO en I-DERIVED_FROM/TO accidente I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tráfico. I-DERIVED_FROM/TO En B-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION practican, I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION con I-EXPLORATION esquirlas I-EXPLORATION óseas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION temporal I-EXPLORATION derecho I-EXPLORATION e I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION metálica, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proyectil I-EXPLORATION de I-EXPLORATION arma I-EXPLORATION de I-EXPLORATION fuego I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION contralateral. I-EXPLORATION Ante I-EXPLORATION ello, I-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION evidencia I-EXPLORATION que I-EXPLORATION presenta, I-EXPLORATION tras I-EXPLORATION rasurar I-EXPLORATION los I-EXPLORATION cabellos, I-EXPLORATION un I-EXPLORATION orifico I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION de I-EXPLORATION proyectil I-EXPLORATION en I-EXPLORATION región I-EXPLORATION parietal I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION orifico I-EXPLORATION de I-EXPLORATION salida. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION inmediata I-EVOLUTION es I-EVOLUTION hacia I-EVOLUTION clínica I-EVOLUTION de I-EVOLUTION muerte I-EVOLUTION encefálica, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION confirma I-EVOLUTION con I-EVOLUTION el I-EVOLUTION correspondiente I-EVOLUTION registro I-EVOLUTION electroencefalográfico. I-EVOLUTION Previa B-EXPLORATION autorización I-EXPLORATION judicial, I-EXPLORATION se I-EXPLORATION procede I-EXPLORATION a I-EXPLORATION la I-EXPLORATION extracción I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION para I-EXPLORATION trasplante I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION se I-EXPLORATION practica I-EXPLORATION la I-EXPLORATION autopsia I-EXPLORATION forense. I-EXPLORATION I-EXPLORATION Hallazgos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION autopsia I-EXPLORATION I-EXPLORATION Examen I-EXPLORATION Externo: I-EXPLORATION I-EXPLORATION Se I-EXPLORATION trata I-EXPLORATION del I-EXPLORATION cadáver I-EXPLORATION de I-EXPLORATION un I-EXPLORATION individuo I-EXPLORATION de I-EXPLORATION sexo I-EXPLORATION masculino, I-EXPLORATION raza I-EXPLORATION caucasoide, I-EXPLORATION de I-EXPLORATION 25 I-EXPLORATION años I-EXPLORATION de I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION de I-EXPLORATION constitución I-EXPLORATION leptosomática. I-EXPLORATION I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION a I-EXPLORATION los I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION violencia I-EXPLORATION corporal I-EXPLORATION reciente I-EXPLORATION se I-EXPLORATION aprecian: I-EXPLORATION un I-EXPLORATION orificio I-EXPLORATION redondeado I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION un I-EXPLORATION área I-EXPLORATION concéntrica I-EXPLORATION perilesional I-EXPLORATION de I-EXPLORATION excoriación I-EXPLORATION desecada I-EXPLORATION de I-EXPLORATION color I-EXPLORATION negro, I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION mm. I-EXPLORATION de I-EXPLORATION ancho I-EXPLORATION (cintilla I-EXPLORATION de I-EXPLORATION contusión), I-EXPLORATION con I-EXPLORATION tumefacción I-EXPLORATION y I-EXPLORATION enrojecimiento I-EXPLORATION periférico, I-EXPLORATION con I-EXPLORATION los I-EXPLORATION cabellos I-EXPLORATION rasurados I-EXPLORATION y I-EXPLORATION con I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION impregnación I-EXPLORATION antiséptica, I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION temporal I-EXPLORATION derecha, I-EXPLORATION a I-EXPLORATION 7 I-EXPLORATION cm. I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION externo I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 6 I-EXPLORATION cm. I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION auditivo I-EXPLORATION de I-EXPLORATION este I-EXPLORATION lado; I-EXPLORATION otorragia I-EXPLORATION bilateral; I-EXPLORATION epistaxis; I-EXPLORATION hematoma I-EXPLORATION en I-EXPLORATION anteojos; I-EXPLORATION excoriaciones I-EXPLORATION en I-EXPLORATION región I-EXPLORATION frontal I-EXPLORATION izquierda; I-EXPLORATION ángulo I-EXPLORATION externo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION derecho; I-EXPLORATION región I-EXPLORATION parieto-occipital I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION manos. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION herida I-EXPLORATION incisa I-EXPLORATION en I-EXPLORATION región I-EXPLORATION frontal I-EXPLORATION derecha, I-EXPLORATION equimosis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION reborde I-EXPLORATION costal I-EXPLORATION derecho, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION hematomas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION raíz I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION muslos, I-EXPLORATION rodilla I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION piernas, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION los I-EXPLORATION signos I-EXPLORATION característicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION manipulación I-EXPLORATION quirúrgica I-EXPLORATION para I-EXPLORATION la I-EXPLORATION extracción I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION para I-EXPLORATION trasplante. I-EXPLORATION I-EXPLORATION Examen I-EXPLORATION Interno: I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION autopsia I-EXPLORATION cefálica, I-EXPLORATION al I-EXPLORATION poner I-EXPLORATION al I-EXPLORATION descubierto I-EXPLORATION la I-EXPLORATION bóveda I-EXPLORATION craneal, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION colgajo I-EXPLORATION cutáneo I-EXPLORATION anterior I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION dos I-EXPLORATION infiltraciones I-EXPLORATION hemorrágicas, I-EXPLORATION una I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION correspondiente I-EXPLORATION al I-EXPLORATION reborde I-EXPLORATION supraorbitario I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION otra, I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION dimensión, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION externo I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION lado, I-EXPLORATION subyacentes I-EXPLORATION a I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION descritas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION externo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION región I-EXPLORATION temporal I-EXPLORATION derecha, I-EXPLORATION en I-EXPLORATION concordancia I-EXPLORATION con I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION cutáneo, I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION orificio I-EXPLORATION óseo I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION mm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION su I-EXPLORATION cara I-EXPLORATION externa I-EXPLORATION y I-EXPLORATION algo I-EXPLORATION mayor I-EXPLORATION en I-EXPLORATION la I-EXPLORATION interna I-EXPLORATION (signo I-EXPLORATION del I-EXPLORATION embudo). I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION colgajo I-EXPLORATION cutáneo I-EXPLORATION posterior I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION importante I-EXPLORATION hematoma I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION témporo-parietal I-EXPLORATION izquierda, I-EXPLORATION desprendiéndose I-EXPLORATION en I-EXPLORATION su I-EXPLORATION disección I-EXPLORATION un I-EXPLORATION fragmento I-EXPLORATION óseo I-EXPLORATION irregular, I-EXPLORATION de I-EXPLORATION 1.5 I-EXPLORATION x I-EXPLORATION 1.5 I-EXPLORATION cm., I-EXPLORATION situado I-EXPLORATION a I-EXPLORATION 12 I-EXPLORATION cm. I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION externo I-EXPLORATION del I-EXPLORATION ojo I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 9 I-EXPLORATION cm. I-EXPLORATION del I-EXPLORATION conducto I-EXPLORATION auditivo I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION lado, I-EXPLORATION con I-EXPLORATION borde I-EXPLORATION biselado, I-EXPLORATION correspondiendo I-EXPLORATION el I-EXPLORATION diámetro I-EXPLORATION mayor I-EXPLORATION al I-EXPLORATION diploe I-EXPLORATION externo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION este I-EXPLORATION lugar, I-EXPLORATION al I-EXPLORATION retirar I-EXPLORATION la I-EXPLORATION bóveda I-EXPLORATION craneal I-EXPLORATION aparece I-EXPLORATION un I-EXPLORATION proyectil I-EXPLORATION de I-EXPLORATION arma I-EXPLORATION de I-EXPLORATION fuego, I-EXPLORATION deformado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION punta, I-EXPLORATION situado I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION duramadre I-EXPLORATION y I-EXPLORATION el I-EXPLORATION hueso, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION mm. I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION y I-EXPLORATION unos I-EXPLORATION 13 I-EXPLORATION mm. I-EXPLORATION de I-EXPLORATION longitud, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION una I-EXPLORATION extensa I-EXPLORATION hemorragia I-EXPLORATION subaracnoidea I-EXPLORATION difusa. I-EXPLORATION Extraída I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION encefálica I-EXPLORATION se I-EXPLORATION comprueba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION fractura I-EXPLORATION conminuta I-EXPLORATION de I-EXPLORATION los I-EXPLORATION techos I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION órbitas I-EXPLORATION oculares. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION disección I-EXPLORATION del I-EXPLORATION cerebro I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION laceración I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION trayecto I-EXPLORATION que I-EXPLORATION une I-EXPLORATION los I-EXPLORATION orificios I-EXPLORATION descritos, I-EXPLORATION con I-EXPLORATION infiltración I-EXPLORATION hemorrágica I-EXPLORATION perifocal. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION necrópsico I-EXPLORATION del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION regiones I-EXPLORATION anatómicas I-EXPLORATION y I-EXPLORATION vísceras I-EXPLORATION que I-EXPLORATION no I-EXPLORATION fueron I-EXPLORATION extraídas I-EXPLORATION para I-EXPLORATION trasplante, I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION lesiones I-EXPLORATION macroscópicas I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION I-EXPLORATION Estudios I-EXPLORATION complementarios I-EXPLORATION I-EXPLORATION Se I-EXPLORATION remitió I-EXPLORATION al I-EXPLORATION Instituto I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Toxicología I-EXPLORATION y I-EXPLORATION Ciencias I-EXPLORATION Forenses I-EXPLORATION de I-EXPLORATION Sevilla I-EXPLORATION el I-EXPLORATION colgajo I-EXPLORATION cutáneo I-EXPLORATION de I-EXPLORATION cuero I-EXPLORATION cabelludo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION temporal I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION incluía I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION del I-EXPLORATION proyectil, I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION criminalístico, I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION revelaron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION residuos, I-EXPLORATION consistentes I-EXPLORATION en I-EXPLORATION negro I-EXPLORATION de I-EXPLORATION humo I-EXPLORATION y I-EXPLORATION elevadas I-EXPLORATION concentraciones I-EXPLORATION de I-EXPLORATION plomo, I-EXPLORATION antimonio I-EXPLORATION y I-EXPLORATION bario, I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION indica I-EXPLORATION que I-EXPLORATION el I-EXPLORATION disparo I-EXPLORATION que I-EXPLORATION originó I-EXPLORATION el I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION debió I-EXPLORATION realizarse I-EXPLORATION a I-EXPLORATION escasa I-EXPLORATION distancia. I-EXPLORATION I-EXPLORATION La I-EXPLORATION Policía I-EXPLORATION Judicial I-EXPLORATION envió I-EXPLORATION al I-EXPLORATION Departamento I-EXPLORATION de I-EXPLORATION Análisis I-EXPLORATION del I-EXPLORATION Centro I-EXPLORATION de I-EXPLORATION Investigación I-EXPLORATION y I-EXPLORATION Criminalística I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Guardia I-EXPLORATION Civil I-EXPLORATION tres I-EXPLORATION portamuestras I-EXPLORATION conteniendo I-EXPLORATION adhesivos I-EXPLORATION de I-EXPLORATION recogida I-EXPLORATION de I-EXPLORATION residuos I-EXPLORATION de I-EXPLORATION disparo, I-EXPLORATION aplicados I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION manos I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION sien I-EXPLORATION del I-EXPLORATION fallecido, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION un I-EXPLORATION casquillo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION encontrado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION coche I-EXPLORATION en I-EXPLORATION una I-EXPLORATION búsqueda I-EXPLORATION posterior I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION una I-EXPLORATION pistola I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION calibre, I-EXPLORATION a I-EXPLORATION raíz I-EXPLORATION de I-EXPLORATION las I-EXPLORATION investigaciones I-EXPLORATION oportunas I-EXPLORATION cuando I-EXPLORATION ya I-EXPLORATION el I-EXPLORATION vehículo I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION en I-EXPLORATION el I-EXPLORATION desguace, I-EXPLORATION dado I-EXPLORATION que I-EXPLORATION había I-EXPLORATION pasado I-EXPLORATION desapercibido I-EXPLORATION en I-EXPLORATION un I-EXPLORATION primer I-EXPLORATION momento. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION revelaron I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION portamuestras I-EXPLORATION aplicado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha, I-EXPLORATION de I-EXPLORATION partículas I-EXPLORATION propias I-EXPLORATION de I-EXPLORATION la I-EXPLORATION detonación I-EXPLORATION de I-EXPLORATION un I-EXPLORATION fulminante I-EXPLORATION similar I-EXPLORATION al I-EXPLORATION del I-EXPLORATION casquillo, I-EXPLORATION que I-EXPLORATION también I-EXPLORATION fue I-EXPLORATION remitido. I-EXPLORATION I-EXPLORATION A I-EXPLORATION efectos I-EXPLORATION de I-EXPLORATION Interpretación I-EXPLORATION Médico I-EXPLORATION Forense I-EXPLORATION se I-EXPLORATION hicieron I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION consideraciones: I-EXPLORATION I-EXPLORATION A.- I-EXPLORATION NATURALEZA I-EXPLORATION DE I-EXPLORATION LAS I-EXPLORATION LESIONES. I-EXPLORATION Se I-EXPLORATION han I-EXPLORATION encontrado I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION naturalezas I-EXPLORATION diferentes: I-EXPLORATION I-EXPLORATION 1. I-EXPLORATION Lesiones I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION contusa. I-EXPLORATION Consistentes I-EXPLORATION en I-EXPLORATION hematomas, I-EXPLORATION erosiones I-EXPLORATION y I-EXPLORATION heridas I-EXPLORATION contusas I-EXPLORATION que I-EXPLORATION por I-EXPLORATION sus I-EXPLORATION características I-EXPLORATION y I-EXPLORATION localización, I-EXPLORATION son I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION las I-EXPLORATION producidas I-EXPLORATION en I-EXPLORATION los I-EXPLORATION accidentes I-EXPLORATION de I-EXPLORATION tráfico. I-EXPLORATION Ninguna I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION reviste I-EXPLORATION importancia I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION vista I-EXPLORATION clínico, I-EXPLORATION considerándose I-EXPLORATION por I-EXPLORATION tanto I-EXPLORATION que I-EXPLORATION no I-EXPLORATION fueron I-EXPLORATION determinantes I-EXPLORATION en I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mecanismo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muerte. I-EXPLORATION I-EXPLORATION 2.- I-EXPLORATION Lesiones I-EXPLORATION por I-EXPLORATION proyectil I-EXPLORATION de I-EXPLORATION arma I-EXPLORATION de I-EXPLORATION fuego. I-EXPLORATION La I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION los I-EXPLORATION orificios I-EXPLORATION encontrados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cráneo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION hallazgo I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proyectil, I-EXPLORATION indica I-EXPLORATION que I-EXPLORATION nos I-EXPLORATION encontramos I-EXPLORATION ante I-EXPLORATION un I-EXPLORATION disparo I-EXPLORATION de I-EXPLORATION un I-EXPLORATION arma I-EXPLORATION de I-EXPLORATION fuego I-EXPLORATION de I-EXPLORATION proyectil I-EXPLORATION único. I-EXPLORATION La I-EXPLORATION herida I-EXPLORATION correspondiente I-EXPLORATION al I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION se I-EXPLORATION localiza I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION temporal I-EXPLORATION derecha. I-EXPLORATION Sigue I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION de I-EXPLORATION derecha-izquierda, I-EXPLORATION ligeramente I-EXPLORATION de I-EXPLORATION abajo-arriba I-EXPLORATION y I-EXPLORATION de I-EXPLORATION delante-atrás, I-EXPLORATION atravesando I-EXPLORATION completamente I-EXPLORATION la I-EXPLORATION masa I-EXPLORATION encefálica I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION llegar I-EXPLORATION a I-EXPLORATION salir I-EXPLORATION al I-EXPLORATION exterior, I-EXPLORATION quedando I-EXPLORATION el I-EXPLORATION proyectil I-EXPLORATION alojado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION del I-EXPLORATION cráneo. I-EXPLORATION Las I-EXPLORATION fracturas I-EXPLORATION del I-EXPLORATION techo I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION órbitas I-EXPLORATION pudieran I-EXPLORATION corresponder I-EXPLORATION a I-EXPLORATION las I-EXPLORATION denominadas I-EXPLORATION fracturas I-EXPLORATION secundarias I-EXPLORATION ocasionadas I-EXPLORATION por I-EXPLORATION la I-EXPLORATION energía I-EXPLORATION cinética I-EXPLORATION procedente I-EXPLORATION del I-EXPLORATION proyectil I-EXPLORATION [9]. I-EXPLORATION I-EXPLORATION B.- I-EXPLORATION ETIOLOGÍA I-EXPLORATION MÉDICO I-EXPLORATION LEGAL I-EXPLORATION I-EXPLORATION Las I-EXPLORATION investigaciones I-EXPLORATION policiales I-EXPLORATION posteriores, I-EXPLORATION indicaron I-EXPLORATION que I-EXPLORATION el I-EXPLORATION fallecido, I-EXPLORATION sin I-EXPLORATION antecedentes I-EXPLORATION médicos I-EXPLORATION de I-EXPLORATION interés, I-EXPLORATION no I-EXPLORATION tenía I-EXPLORATION problemas I-EXPLORATION económicos I-EXPLORATION conocidos, I-EXPLORATION siendo I-EXPLORATION significativo I-EXPLORATION el I-EXPLORATION hecho I-EXPLORATION de I-EXPLORATION que I-EXPLORATION poco I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hechos I-EXPLORATION había I-EXPLORATION contratado I-EXPLORATION un I-EXPLORATION seguro I-EXPLORATION de I-EXPLORATION vida I-EXPLORATION y I-EXPLORATION había I-EXPLORATION adquirido I-EXPLORATION una I-EXPLORATION pistola I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION ilegal. I-EXPLORATION El I-EXPLORATION minucioso I-EXPLORATION examen I-EXPLORATION del I-EXPLORATION vehículo, I-EXPLORATION una I-EXPLORATION vez I-EXPLORATION depositado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION desguace, I-EXPLORATION permitió I-EXPLORATION la I-EXPLORATION recogida I-EXPLORATION de I-EXPLORATION varios I-EXPLORATION cartuchos I-EXPLORATION de I-EXPLORATION pistola I-EXPLORATION de I-EXPLORATION calibre I-EXPLORATION 6, I-EXPLORATION 35 I-EXPLORATION mm., I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION percutido. I-EXPLORATION I-EXPLORATION En I-EXPLORATION base I-EXPLORATION a I-EXPLORATION estos I-EXPLORATION antecedentes I-EXPLORATION y I-EXPLORATION teniendo I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION la I-EXPLORATION localización I-EXPLORATION del I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada I-EXPLORATION (región I-EXPLORATION temporal I-EXPLORATION derecha), I-EXPLORATION la I-EXPLORATION distancia I-EXPLORATION del I-EXPLORATION disparo I-EXPLORATION (como I-EXPLORATION mínimo I-EXPLORATION a I-EXPLORATION corta I-EXPLORATION distancia I-EXPLORATION como I-EXPLORATION acredita I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION criminalístico), I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION residuos I-EXPLORATION de I-EXPLORATION disparo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION del I-EXPLORATION fallecido I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION circunstancias I-EXPLORATION del I-EXPLORATION caso I-EXPLORATION (único I-EXPLORATION ocupante I-EXPLORATION con I-EXPLORATION incarceración I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION e I-EXPLORATION intervención I-EXPLORATION de I-EXPLORATION bomberos I-EXPLORATION para I-EXPLORATION su I-EXPLORATION extracción, I-EXPLORATION presencia I-EXPLORATION del I-EXPLORATION arma I-EXPLORATION en I-EXPLORATION el I-EXPLORATION vehículo, I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION contratación I-EXPLORATION de I-EXPLORATION un I-EXPLORATION seguro, I-EXPLORATION etc.) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION datos I-EXPLORATION objetivos, I-EXPLORATION consideramos I-EXPLORATION que I-EXPLORATION pudiera I-EXPLORATION ser I-EXPLORATION perfectamente I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION acto I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION suicida. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS ex B-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY bebedor I-PAST_MEDICAL_HISTORY moderado I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS es I-PRESENT_ILLNESS hallado I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS pública. I-PRESENT_ILLNESS La B-EXPLORATION autopsia I-EXPLORATION se I-EXPLORATION practica I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 19 I-EXPLORATION horas I-EXPLORATION del I-EXPLORATION fallecimiento I-EXPLORATION según I-EXPLORATION las I-EXPLORATION recomendaciones I-EXPLORATION para I-EXPLORATION la I-EXPLORATION armonización I-EXPLORATION de I-EXPLORATION las I-EXPLORATION autopsias I-EXPLORATION médico-legales I-EXPLORATION del I-EXPLORATION Comité I-EXPLORATION de I-EXPLORATION Ministros I-EXPLORATION del I-EXPLORATION Consejo I-EXPLORATION de I-EXPLORATION Europa I-EXPLORATION [3]. I-EXPLORATION Concretamente I-EXPLORATION se I-EXPLORATION siguió I-EXPLORATION el I-EXPLORATION protocolo I-EXPLORATION aprobado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Red I-EXPLORATION de I-EXPLORATION Muerte I-EXPLORATION Súbita I-EXPLORATION que I-EXPLORATION incluye I-EXPLORATION peso, I-EXPLORATION talla I-EXPLORATION y I-EXPLORATION perímetro I-EXPLORATION abdominal I-EXPLORATION del I-EXPLORATION cadáver; I-EXPLORATION peso I-EXPLORATION y I-EXPLORATION examen I-EXPLORATION macroscópico-microscópico I-EXPLORATION de I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION órganos I-EXPLORATION así I-EXPLORATION como I-EXPLORATION investigación I-EXPLORATION químico-toxicológica I-EXPLORATION general I-EXPLORATION en I-EXPLORATION sangre. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION complementarios I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Delegación I-EXPLORATION de I-EXPLORATION Tenerife I-EXPLORATION (estudio I-EXPLORATION histopatológico) I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Departamento I-EXPLORATION de I-EXPLORATION Sevilla I-EXPLORATION (análisis I-EXPLORATION químico-toxicológico) I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Toxicología I-EXPLORATION y I-EXPLORATION Ciencias I-EXPLORATION Forenses. I-EXPLORATION I-EXPLORATION a) I-EXPLORATION Examen I-EXPLORATION de I-EXPLORATION autopsia: I-EXPLORATION I-EXPLORATION Talla I-EXPLORATION 162 I-EXPLORATION cm, I-EXPLORATION peso I-EXPLORATION 84 I-EXPLORATION kg, I-EXPLORATION perímetro I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION 104 I-EXPLORATION cm. I-EXPLORATION El I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION (IMC) I-EXPLORATION = I-EXPLORATION peso I-EXPLORATION (kg) I-EXPLORATION / I-EXPLORATION [talla I-EXPLORATION (m) I-EXPLORATION ] I-EXPLORATION ² I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 32 I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION significa I-EXPLORATION una I-EXPLORATION obesidad I-EXPLORATION de I-EXPLORATION grado I-EXPLORATION I I-EXPLORATION con I-EXPLORATION obesidad I-EXPLORATION visceral I-EXPLORATION [4, I-EXPLORATION 5]. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION externo I-EXPLORATION sólo I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION intensa I-EXPLORATION congestión I-EXPLORATION cefálica. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION interno I-EXPLORATION los I-EXPLORATION pulmones I-EXPLORATION estaban I-EXPLORATION aumentados I-EXPLORATION de I-EXPLORATION peso I-EXPLORATION (D: I-EXPLORATION 675 I-EXPLORATION g, I-EXPLORATION I: I-EXPLORATION 490 I-EXPLORATION g), I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION congestión I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION grado I-EXPLORATION importante. I-EXPLORATION Cardiomegalia I-EXPLORATION de I-EXPLORATION 485 I-EXPLORATION g, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION valor I-EXPLORATION medio I-EXPLORATION esperado I-EXPLORATION según I-EXPLORATION peso I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 358 I-EXPLORATION g I-EXPLORATION (rango I-EXPLORATION 271-473 I-EXPLORATION g) I-EXPLORATION [6]. I-EXPLORATION La I-EXPLORATION pared I-EXPLORATION libre I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION tenía I-EXPLORATION un I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION mm I-EXPLORATION (rango I-EXPLORATION 2-7 I-EXPLORATION mm) I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION septum I-EXPLORATION como I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION libre I-EXPLORATION (rango I-EXPLORATION 10-15 I-EXPLORATION mm). I-EXPLORATION Abundante I-EXPLORATION infiltrado I-EXPLORATION graso I-EXPLORATION en I-EXPLORATION miocardio I-EXPLORATION de I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION posterior I-EXPLORATION de I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION formando I-EXPLORATION una I-EXPLORATION banda I-EXPLORATION subepicárdica I-EXPLORATION de I-EXPLORATION 2.5 I-EXPLORATION x I-EXPLORATION 0.5 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION desde I-EXPLORATION mesocardio I-EXPLORATION hasta I-EXPLORATION ápex. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION otra I-EXPLORATION zona I-EXPLORATION más I-EXPLORATION pequeña I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION grasa I-EXPLORATION de I-EXPLORATION 0.5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION Las I-EXPLORATION arterias I-EXPLORATION coronarias I-EXPLORATION estaban I-EXPLORATION permeables I-EXPLORATION y I-EXPLORATION con I-EXPLORATION escasas I-EXPLORATION placas I-EXPLORATION de I-EXPLORATION ateroma I-EXPLORATION que I-EXPLORATION determinaban I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION luminal I-EXPLORATION inferior I-EXPLORATION al I-EXPLORATION 25%. I-EXPLORATION I-EXPLORATION b) I-EXPLORATION Estudio I-EXPLORATION microscópico: I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico, I-EXPLORATION utilizando I-EXPLORATION Tricrómico I-EXPLORATION de I-EXPLORATION Masson, I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION abundante I-EXPLORATION infiltrado I-EXPLORATION graso I-EXPLORATION en I-EXPLORATION el I-EXPLORATION miocardio I-EXPLORATION constituido I-EXPLORATION por I-EXPLORATION adipocitos I-EXPLORATION maduros I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION islotes I-EXPLORATION de I-EXPLORATION miocardiocitos I-EXPLORATION con I-EXPLORATION estructura I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION mínima I-EXPLORATION fibrosis I-EXPLORATION intersticial. I-EXPLORATION Las I-EXPLORATION arterias I-EXPLORATION coronarias I-EXPLORATION presentan I-EXPLORATION placas I-EXPLORATION fibrolipídicas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION íntima I-EXPLORATION determinando I-EXPLORATION una I-EXPLORATION estenosis I-EXPLORATION luminal I-EXPLORATION no I-EXPLORATION superior I-EXPLORATION al I-EXPLORATION 25% I-EXPLORATION (aterosclerosis I-EXPLORATION leve). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION ni I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION miocárdica I-EXPLORATION reciente I-EXPLORATION y/o I-EXPLORATION fibrosis I-EXPLORATION de I-EXPLORATION reparación. I-EXPLORATION I-EXPLORATION c) I-EXPLORATION Análisis I-EXPLORATION químico-toxicológico: I-EXPLORATION I-EXPLORATION La I-EXPLORATION investigación I-EXPLORATION toxicológica I-EXPLORATION general I-EXPLORATION detectó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION alcohol I-EXPLORATION etílico I-EXPLORATION en I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION 2.59 I-EXPLORATION g/L. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Sra. I-PRESENT_ILLNESS A, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS viene I-PRESENT_ILLNESS citada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS programada I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS un I-PRESENT_ILLNESS juzgado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS instrucción, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS fin I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dilucidar I-PRESENT_ILLNESS si I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS víctima I-PRESENT_ILLNESS o I-PRESENT_ILLNESS no I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS negligencia I-PRESENT_ILLNESS médica. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Como I-PRESENT_ILLNESS prolegómeno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS caso, I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS hospitalarias I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS sufrido I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS fuera I-PRESENT_ILLNESS catalogado I-PRESENT_ILLNESS como I-PRESENT_ILLNESS una I-PRESENT_ILLNESS luxación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rodilla I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS resolvió I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manera I-PRESENT_ILLNESS espontánea. I-PRESENT_ILLNESS Se B-TREATMENT actúa I-TREATMENT de I-TREATMENT forma I-TREATMENT conservadora, I-TREATMENT observándose I-TREATMENT tras I-TREATMENT dos I-TREATMENT semanas I-TREATMENT de I-TREATMENT inmovilización I-TREATMENT inguino-pédica I-TREATMENT una I-TREATMENT buena I-TREATMENT evolución I-TREATMENT clínica I-TREATMENT que I-TREATMENT no I-TREATMENT se I-TREATMENT corresponde I-TREATMENT con I-TREATMENT la I-TREATMENT percepción I-TREATMENT de I-TREATMENT la I-TREATMENT propia I-TREATMENT lesionada. I-TREATMENT Desde I-TREATMENT entonces I-TREATMENT se I-TREATMENT manifiesta I-TREATMENT como I-TREATMENT un I-TREATMENT cuadro I-TREATMENT clínico I-TREATMENT de I-TREATMENT anquilosis I-TREATMENT de I-TREATMENT rodilla, I-TREATMENT siendo I-TREATMENT sometida I-TREATMENT a I-TREATMENT tratamiento I-TREATMENT rehabilitador I-TREATMENT sin I-TREATMENT éxito I-TREATMENT alguno. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION fue I-EVOLUTION tórpida, I-EVOLUTION proponiéndose I-EVOLUTION finalmente I-EVOLUTION intervención I-EVOLUTION quirúrgica I-EVOLUTION de I-EVOLUTION rodilla I-EVOLUTION bajo I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION clínico I-EVOLUTION de I-EVOLUTION "artrofibrosis", I-EVOLUTION que I-EVOLUTION es I-EVOLUTION suspendida I-EVOLUTION a I-EVOLUTION criterio I-EVOLUTION del I-EVOLUTION cirujano, I-EVOLUTION por I-EVOLUTION no I-EVOLUTION encontrar I-EVOLUTION base I-EVOLUTION clínica I-EVOLUTION que I-EVOLUTION justificara I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION padecida. I-EVOLUTION I-EVOLUTION Tras I-EVOLUTION este I-EVOLUTION último I-EVOLUTION episodio, I-EVOLUTION la I-EVOLUTION interesada I-EVOLUTION decide I-EVOLUTION emitir I-EVOLUTION denuncia I-EVOLUTION por I-EVOLUTION negligencia I-EVOLUTION médica, I-EVOLUTION haciéndola I-EVOLUTION extensible I-EVOLUTION a I-EVOLUTION todos I-EVOLUTION aquellos I-EVOLUTION especialistas I-EVOLUTION que I-EVOLUTION estuvieron I-EVOLUTION atendiéndola I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION principio. I-EVOLUTION I-EVOLUTION Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS Médico I-PRESENT_ILLNESS Forense I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS asistencia I-PRESENT_ILLNESS recibida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS urgencias, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS poco I-PRESENT_ILLNESS tiempo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS emitida I-PRESENT_ILLNESS la I-PRESENT_ILLNESS denuncia, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS citada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS programada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS dependencias I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Instituto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Medicina I-PRESENT_ILLNESS Legal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Huelva, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS en I-PRESENT_ILLNESS compañía I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS cónyuge I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS muleta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS descarga. I-PRESENT_ILLNESS Se B-EXPLORATION aprecia I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION hipotrofia I-EXPLORATION moderada I-EXPLORATION global I-EXPLORATION de I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION una I-EXPLORATION total I-EXPLORATION falta I-EXPLORATION de I-EXPLORATION movilidad I-EXPLORATION de I-EXPLORATION rodilla I-EXPLORATION homolateral I-EXPLORATION en I-EXPLORATION flexoextensión. I-EXPLORATION No I-EXPLORATION existe I-EXPLORATION componente I-EXPLORATION inflamatorio I-EXPLORATION asociado I-EXPLORATION y I-EXPLORATION presenta I-EXPLORATION genu I-EXPLORATION valgo I-EXPLORATION bilateral. I-EXPLORATION Se I-EXPLORATION detecta I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION entrevista I-EXPLORATION un I-EXPLORATION marcado I-EXPLORATION componente I-EXPLORATION conversivo. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION mediante I-EXPLORATION entrevista I-EXPLORATION semiestructurada I-EXPLORATION bajo I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION propuestos I-EXPLORATION por I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION DSM I-EXPLORATION IV-TR. I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION acordarse I-EXPLORATION entrevista I-EXPLORATION y I-EXPLORATION exploración I-EXPLORATION pormenorizada I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Psicólogo I-EXPLORATION Forense I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION pasar I-EXPLORATION el I-EXPLORATION test I-EXPLORATION MMPI I-EXPLORATION (Inventario I-EXPLORATION Multifásico I-EXPLORATION de I-EXPLORATION Personalidad I-EXPLORATION de I-EXPLORATION Minessotta), I-EXPLORATION destacando I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION un I-EXPLORATION marcado I-EXPLORATION perfil I-EXPLORATION represivo I-EXPLORATION y I-EXPLORATION una I-EXPLORATION elevada I-EXPLORATION preocupación I-EXPLORATION por I-EXPLORATION la I-EXPLORATION salud I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION hipocondría, I-EXPLORATION que I-EXPLORATION daría I-EXPLORATION finalmente I-EXPLORATION lugar I-EXPLORATION a I-EXPLORATION las I-EXPLORATION manifestaciones I-EXPLORATION histéricas I-EXPLORATION a I-EXPLORATION modo I-EXPLORATION de I-EXPLORATION quejas I-EXPLORATION somáticas I-EXPLORATION (somatizaciones). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION corroborar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION mediante I-EXPLORATION sesión I-EXPLORATION programada I-EXPLORATION de I-EXPLORATION hipnosis, I-EXPLORATION previo I-EXPLORATION consentimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION interesada, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION objetivo I-EXPLORATION de I-EXPLORATION conseguir I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION anquilosada. I-EXPLORATION I-EXPLORATION Método: I-EXPLORATION I-EXPLORATION El I-EXPLORATION proceso I-EXPLORATION hipnótico I-EXPLORATION se I-EXPLORATION desarrolla I-EXPLORATION en I-EXPLORATION las I-EXPLORATION propias I-EXPLORATION dependencias I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION Legal I-EXPLORATION de I-EXPLORATION Huelva, I-EXPLORATION previa I-EXPLORATION sesión I-EXPLORATION preparatoria I-EXPLORATION en I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION explican I-EXPLORATION las I-EXPLORATION bases I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION y I-EXPLORATION se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION conseguir I-EXPLORATION un I-EXPLORATION adecuado I-EXPLORATION vínculo I-EXPLORATION explorador-explorada, I-EXPLORATION estando I-EXPLORATION presentes I-EXPLORATION durante I-EXPLORATION su I-EXPLORATION desarrollo I-EXPLORATION tanto I-EXPLORATION el I-EXPLORATION Médico I-EXPLORATION Forense I-EXPLORATION como I-EXPLORATION el I-EXPLORATION Psicólogo I-EXPLORATION Forense I-EXPLORATION encargado I-EXPLORATION de I-EXPLORATION llevarlo I-EXPLORATION a I-EXPLORATION cabo. I-EXPLORATION Para I-EXPLORATION ello I-EXPLORATION se I-EXPLORATION coloca I-EXPLORATION a I-EXPLORATION la I-EXPLORATION Sra. I-EXPLORATION A I-EXPLORATION en I-EXPLORATION posición I-EXPLORATION de I-EXPLORATION decúbito I-EXPLORATION supino, I-EXPLORATION sobre I-EXPLORATION una I-EXPLORATION camilla I-EXPLORATION estándar I-EXPLORATION de I-EXPLORATION consulta, I-EXPLORATION cuya I-EXPLORATION base I-EXPLORATION basculante I-EXPLORATION fue I-EXPLORATION recogida, I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION que I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION sana I-EXPLORATION cayera I-EXPLORATION en I-EXPLORATION flexión I-EXPLORATION por I-EXPLORATION el I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION gravedad, I-EXPLORATION quedando I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION izquierda I-EXPLORATION en I-EXPLORATION extensión I-EXPLORATION completa I-EXPLORATION y I-EXPLORATION sobresaliendo I-EXPLORATION de I-EXPLORATION los I-EXPLORATION límites I-EXPLORATION de I-EXPLORATION la I-EXPLORATION camilla. I-EXPLORATION I-EXPLORATION El I-EXPLORATION proceso I-EXPLORATION se I-EXPLORATION desarrolló I-EXPLORATION bajo I-EXPLORATION una I-EXPLORATION atmósfera I-EXPLORATION empática I-EXPLORATION y I-EXPLORATION relajada, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION buena I-EXPLORATION predisposición I-EXPLORATION a I-EXPLORATION la I-EXPLORATION colaboración I-EXPLORATION por I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente. I-EXPLORATION La I-EXPLORATION inducción I-EXPLORATION hipnótica I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION instrucciones I-EXPLORATION dirigidas I-EXPLORATION a I-EXPLORATION favorecer I-EXPLORATION la I-EXPLORATION relajación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente, I-EXPLORATION empleando I-EXPLORATION para I-EXPLORATION ello I-EXPLORATION una I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION relajación I-EXPLORATION muscular I-EXPLORATION (visualización I-EXPLORATION corporal I-EXPLORATION o I-EXPLORATION "imaging"), I-EXPLORATION seguida I-EXPLORATION de I-EXPLORATION "instrucciones I-EXPLORATION de I-EXPLORATION imaginación" I-EXPLORATION (visualización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION escalera I-EXPLORATION por I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION desciende I-EXPLORATION peldaño I-EXPLORATION a I-EXPLORATION peldaño, I-EXPLORATION acompañando I-EXPLORATION ésta I-EXPLORATION del I-EXPLORATION mensaje I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION "profundización I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estado I-EXPLORATION hipnótico") I-EXPLORATION y I-EXPLORATION finalizando I-EXPLORATION este I-EXPLORATION primer I-EXPLORATION estadio I-EXPLORATION con I-EXPLORATION instrucciones I-EXPLORATION de I-EXPLORATION actuación, I-EXPLORATION en I-EXPLORATION concreto I-EXPLORATION la I-EXPLORATION de I-EXPLORATION "elevación I-EXPLORATION del I-EXPLORATION brazo". I-EXPLORATION Dichas I-EXPLORATION técnicas I-EXPLORATION están I-EXPLORATION encaminadas I-EXPLORATION tanto I-EXPLORATION a I-EXPLORATION una I-EXPLORATION mayor I-EXPLORATION predisposición I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sugestión I-EXPLORATION como I-EXPLORATION a I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION que I-EXPLORATION la I-EXPLORATION Inducción I-EXPLORATION Hipnótica I-EXPLORATION ha I-EXPLORATION logrado I-EXPLORATION que I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION focalice I-EXPLORATION su I-EXPLORATION atención I-EXPLORATION en I-EXPLORATION las I-EXPLORATION instrucciones I-EXPLORATION emitidas I-EXPLORATION por I-EXPLORATION el I-EXPLORATION psicólogo I-EXPLORATION y I-EXPLORATION que I-EXPLORATION otras I-EXPLORATION fuentes I-EXPLORATION de I-EXPLORATION información I-EXPLORATION pasen I-EXPLORATION a I-EXPLORATION ser I-EXPLORATION secundarias I-EXPLORATION (ruidos I-EXPLORATION ambientales, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION personas, I-EXPLORATION etcétera), I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION logrado I-EXPLORATION una I-EXPLORATION buena I-EXPLORATION disposición I-EXPLORATION a I-EXPLORATION que I-EXPLORATION las I-EXPLORATION instrucciones I-EXPLORATION hipnóticas I-EXPLORATION cobren I-EXPLORATION más I-EXPLORATION relevancia I-EXPLORATION y I-EXPLORATION se I-EXPLORATION pueda I-EXPLORATION iniciar I-EXPLORATION el I-EXPLORATION trabajo I-EXPLORATION sugestivo I-EXPLORATION propuesto. I-EXPLORATION Logrado I-EXPLORATION el I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION sugestionabilidad I-EXPLORATION perseguido, I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION orientar I-EXPLORATION las I-EXPLORATION sugestiones I-EXPLORATION hacia I-EXPLORATION el I-EXPLORATION síntoma I-EXPLORATION motor, I-EXPLORATION ligando I-EXPLORATION elementos I-EXPLORATION de I-EXPLORATION relajación I-EXPLORATION muscular I-EXPLORATION con I-EXPLORATION mensajes I-EXPLORATION de I-EXPLORATION carácter I-EXPLORATION positivo I-EXPLORATION centrados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION [12, I-EXPLORATION 13]. I-EXPLORATION Tras B-EVOLUTION aproximadamente I-EVOLUTION una I-EVOLUTION hora I-EVOLUTION de I-EVOLUTION proceso, I-EVOLUTION iniciado I-EVOLUTION con I-EVOLUTION la I-EVOLUTION técnica I-EVOLUTION de I-EVOLUTION relajación I-EVOLUTION y I-EVOLUTION finalizado I-EVOLUTION con I-EVOLUTION la I-EVOLUTION recuperación I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION de I-EVOLUTION vigilia, I-EVOLUTION se I-EVOLUTION acabó I-EVOLUTION consiguiendo I-EVOLUTION una I-EVOLUTION flexión I-EVOLUTION de I-EVOLUTION rodilla I-EVOLUTION izquierda I-EVOLUTION de I-EVOLUTION 90º, I-EVOLUTION recuperando I-EVOLUTION la I-EVOLUTION posición I-EVOLUTION anquilótica I-EVOLUTION inicial I-EVOLUTION una I-EVOLUTION vez I-EVOLUTION concluido. I-EVOLUTION I-EVOLUTION Posteriormente I-EVOLUTION se I-EVOLUTION realizaron I-EVOLUTION dos I-EVOLUTION entrevistas I-EVOLUTION adicionales I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Sra. I-EVOLUTION A, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION otra I-EVOLUTION a I-EVOLUTION su I-EVOLUTION cónyuge, I-EVOLUTION con I-EVOLUTION el I-EVOLUTION fin I-EVOLUTION de I-EVOLUTION conocer I-EVOLUTION mejor I-EVOLUTION el I-EVOLUTION entorno I-EVOLUTION psicobiográfico I-EVOLUTION y I-EVOLUTION contextualizar I-EVOLUTION adecuadamente I-EVOLUTION el I-EVOLUTION proceso I-EVOLUTION psicogénico. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS segunda I-PRESENT_ILLNESS hija I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hermano I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sano, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS derivada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lenta I-PRESENT_ILLNESS somatometría I-PRESENT_ILLNESS (Percentil I-PRESENT_ILLNESS 3), I-PRESENT_ILLNESS IMC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS kg/m2 I-PRESENT_ILLNESS (desnutrición I-PRESENT_ILLNESS leve) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rechazo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alimento. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION desnutrición, I-EXPLORATION acrocianosis I-EXPLORATION que I-EXPLORATION aumentaba I-EXPLORATION con I-EXPLORATION el I-EXPLORATION llanto, I-EXPLORATION taquicardia, I-EXPLORATION ligera I-EXPLORATION disnea I-EXPLORATION y I-EXPLORATION soplo I-EXPLORATION pansistólico I-EXPLORATION II-III I-EXPLORATION en I-EXPLORATION varias I-EXPLORATION localizaciones I-EXPLORATION a I-EXPLORATION la I-EXPLORATION auscultación. I-EXPLORATION Fue B-TREATMENT diagnosticada I-TREATMENT de I-TREATMENT cardiopatía I-TREATMENT congénita: I-TREATMENT Transposición I-TREATMENT de I-TREATMENT grandes I-TREATMENT vasos I-TREATMENT con I-TREATMENT septum I-TREATMENT integro I-TREATMENT (TGV I-TREATMENT con I-TREATMENT SI), I-TREATMENT siendo I-TREATMENT intervenida I-TREATMENT quirúrgicamente I-TREATMENT de I-TREATMENT forma I-TREATMENT urgente. I-TREATMENT En I-TREATMENT primer I-TREATMENT lugar I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT ampliación I-TREATMENT mediante I-TREATMENT cateterismo I-TREATMENT del I-TREATMENT foramen I-TREATMENT oval, I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT realizó I-TREATMENT fístula I-TREATMENT subclavia-pulmonar I-TREATMENT y I-TREATMENT banding I-TREATMENT en I-TREATMENT arteria I-TREATMENT pulmonar. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION fue I-EVOLUTION desfavorable, I-EVOLUTION falleciendo I-EVOLUTION en I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION de I-EVOLUTION pediatría I-EVOLUTION 8 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION del I-EVOLUTION ingreso. I-EVOLUTION I-EVOLUTION Los B-EXPLORATION padres I-EXPLORATION solicitaron I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION autopsia I-EXPLORATION médico-legal I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION una I-EXPLORATION mala I-EXPLORATION actuación I-EXPLORATION facultativa. I-EXPLORATION I-EXPLORATION Autopsia: I-EXPLORATION I-EXPLORATION a) I-EXPLORATION Examen I-EXPLORATION Externo I-EXPLORATION I-EXPLORATION Peso I-EXPLORATION de I-EXPLORATION 6440 I-EXPLORATION g, I-EXPLORATION talla I-EXPLORATION de I-EXPLORATION 64 I-EXPLORATION cm I-EXPLORATION (IMC: I-EXPLORATION 15.6 I-EXPLORATION kg/m2), I-EXPLORATION perímetro I-EXPLORATION cefálico I-EXPLORATION de I-EXPLORATION 39.5 I-EXPLORATION cm, I-EXPLORATION perímetro I-EXPLORATION torácico I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION abdominal I-EXPLORATION de I-EXPLORATION 42 I-EXPLORATION cm. I-EXPLORATION I-EXPLORATION b) I-EXPLORATION Examen I-EXPLORATION Interno I-EXPLORATION I-EXPLORATION Encéfalo I-EXPLORATION de I-EXPLORATION 620 I-EXPLORATION g I-EXPLORATION con I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION cerebral I-EXPLORATION isquémico I-EXPLORATION extenso I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION parieto-occipital I-EXPLORATION izquierdo I-EXPLORATION correspondiente I-EXPLORATION al I-EXPLORATION territorio I-EXPLORATION de I-EXPLORATION irrigación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION media. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION extracción I-EXPLORATION y I-EXPLORATION fijación I-EXPLORATION del I-EXPLORATION bloque I-EXPLORATION cardiopulmonar I-EXPLORATION para I-EXPLORATION su I-EXPLORATION posterior I-EXPLORATION examen I-EXPLORATION macroscópico, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION TGV I-EXPLORATION intervenida I-EXPLORATION quirúrgicamente I-EXPLORATION presentando I-EXPLORATION un I-EXPLORATION banding I-EXPLORATION en I-EXPLORATION arteria I-EXPLORATION pulmonar, I-EXPLORATION una I-EXPLORATION fístula I-EXPLORATION entre I-EXPLORATION subclavia I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION arteria I-EXPLORATION pulmonar, I-EXPLORATION y I-EXPLORATION ampliación I-EXPLORATION de I-EXPLORATION comunicación I-EXPLORATION interauricular I-EXPLORATION (foramen I-EXPLORATION oval), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION hipertrofia I-EXPLORATION de I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION adelgazamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo. I-EXPLORATION Presentaba I-EXPLORATION a I-EXPLORATION su I-EXPLORATION vez I-EXPLORATION una I-EXPLORATION anomalía I-EXPLORATION de I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION coronarias, I-EXPLORATION observándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION ostium I-EXPLORATION coronarios I-EXPLORATION que I-EXPLORATION salían I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION seno. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION histológico I-EXPLORATION del I-EXPLORATION corazón I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION pericarditis I-EXPLORATION serofibrinosa I-EXPLORATION y, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION miocardio, I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION subendocárdica I-EXPLORATION con I-EXPLORATION calcificación I-EXPLORATION distrófica I-EXPLORATION secundarios I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION pulmones I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION membranas I-EXPLORATION hialinas I-EXPLORATION como I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION distrés I-EXPLORATION respiratorio. I-EXPLORATION Por I-EXPLORATION otro I-EXPLORATION lado, I-EXPLORATION el I-EXPLORATION encéfalo I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION encefalopatía I-EXPLORATION anóxica I-EXPLORATION e I-EXPLORATION infarto I-EXPLORATION parietal I-EXPLORATION reciente. I-EXPLORATION I-EXPLORATION Así, I-EXPLORATION a I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION macro I-EXPLORATION y I-EXPLORATION microscópicos, I-EXPLORATION se I-EXPLORATION determinó I-EXPLORATION que I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muerte I-EXPLORATION fue I-EXPLORATION un I-EXPLORATION Infarto I-EXPLORATION cerebral I-EXPLORATION isquémico I-EXPLORATION en I-EXPLORATION paciente I-EXPLORATION intervenida I-EXPLORATION de I-EXPLORATION Transposición I-EXPLORATION de I-EXPLORATION grandes I-EXPLORATION arterias. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS reporta I-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 género I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tercer I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS por I-PRESENT_ILLNESS sangrado I-PRESENT_ILLNESS vaginal, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antecedente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS previo. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY hay I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY abuso I-PAST_MEDICAL_HISTORY sexual I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY genital. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION abundante I-EXPLORATION sangrado I-EXPLORATION genital I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION consideraron I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION diagnósticos I-EXPLORATION diferenciales: I-EXPLORATION trauma, I-EXPLORATION abuso I-EXPLORATION sexual I-EXPLORATION y I-EXPLORATION maltrato I-EXPLORATION infantil, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION caso I-EXPLORATION es I-EXPLORATION reportado I-EXPLORATION a I-EXPLORATION la I-EXPLORATION autoridad, I-EXPLORATION quienes I-EXPLORATION por I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION un I-EXPLORATION grupo I-EXPLORATION élite I-EXPLORATION de I-EXPLORATION manejo I-EXPLORATION de I-EXPLORATION delitos I-EXPLORATION sexuales, I-EXPLORATION deciden I-EXPLORATION remitir I-EXPLORATION para I-EXPLORATION examen I-EXPLORATION médico-legal. I-EXPLORATION I-EXPLORATION Durante I-EXPLORATION la I-EXPLORATION anamnesis, I-EXPLORATION el I-EXPLORATION médico I-EXPLORATION especialista I-EXPLORATION forense I-EXPLORATION tomó I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION información I-EXPLORATION disponible I-EXPLORATION y I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION información I-EXPLORATION aportada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION madre, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION recalcaba I-EXPLORATION que I-EXPLORATION no I-EXPLORATION sospechaba I-EXPLORATION de I-EXPLORATION abuso I-EXPLORATION sexual, I-EXPLORATION prosiguió I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION genital, I-EXPLORATION encontrando I-EXPLORATION que I-EXPLORATION la I-EXPLORATION menor I-EXPLORATION presentaba I-EXPLORATION genitales I-EXPLORATION femeninos I-EXPLORATION infantiles I-EXPLORATION normoconfigurados I-EXPLORATION con I-EXPLORATION hematoma I-EXPLORATION en I-EXPLORATION el I-EXPLORATION meridiano I-EXPLORATION de I-EXPLORATION las I-EXPLORATION 12 I-EXPLORATION de I-EXPLORATION 0.3 I-EXPLORATION x I-EXPLORATION 0.3 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION no I-EXPLORATION permitía I-EXPLORATION ver I-EXPLORATION el I-EXPLORATION borde I-EXPLORATION libre I-EXPLORATION del I-EXPLORATION himen, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION fue I-EXPLORATION posible I-EXPLORATION descartar I-EXPLORATION desgarros I-EXPLORATION a I-EXPLORATION éste I-EXPLORATION nivel, I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION sangrado I-EXPLORATION reciente I-EXPLORATION en I-EXPLORATION región I-EXPLORATION vaginal, I-EXPLORATION pañal I-EXPLORATION y I-EXPLORATION pantalón. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION otras I-EXPLORATION lesiones. I-EXPLORATION I-EXPLORATION El I-EXPLORATION grupo I-EXPLORATION élite I-EXPLORATION de I-EXPLORATION manejo I-EXPLORATION de I-EXPLORATION delitos I-EXPLORATION sexuales I-EXPLORATION entregó I-EXPLORATION al I-EXPLORATION médico I-EXPLORATION especialista I-EXPLORATION forense I-EXPLORATION muestras I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION tomadas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION centro I-EXPLORATION hospitalario I-EXPLORATION donde I-EXPLORATION fue I-EXPLORATION inicialmente I-EXPLORATION valorada I-EXPLORATION la I-EXPLORATION menor, I-EXPLORATION muestras I-EXPLORATION que I-EXPLORATION ante I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION el I-EXPLORATION médico I-EXPLORATION especialista I-EXPLORATION forense I-EXPLORATION consideró I-EXPLORATION pertinente I-EXPLORATION enviar I-EXPLORATION al I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION biología I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION Nacional I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION Legal I-EXPLORATION y I-EXPLORATION Ciencias I-EXPLORATION Forenses I-EXPLORATION para I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION evidencia I-EXPLORATION traza I-EXPLORATION (espermatozoides I-EXPLORATION y I-EXPLORATION ADN) I-EXPLORATION bajo I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION custodia. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION conclusión, I-EXPLORATION el I-EXPLORATION médico I-EXPLORATION especialista I-EXPLORATION forense I-EXPLORATION asocia I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION encontrada I-EXPLORATION con I-EXPLORATION trauma I-EXPLORATION genital I-EXPLORATION y I-EXPLORATION describe I-EXPLORATION que I-EXPLORATION no I-EXPLORATION es I-EXPLORATION posible I-EXPLORATION con I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION determinar I-EXPLORATION si I-EXPLORATION es I-EXPLORATION de I-EXPLORATION origen I-EXPLORATION accidental I-EXPLORATION o I-EXPLORATION no. I-EXPLORATION I-EXPLORATION Posterior B-DERIVED_FROM/TO al I-DERIVED_FROM/TO examen I-DERIVED_FROM/TO médico-legal, I-DERIVED_FROM/TO la I-DERIVED_FROM/TO menor I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO un I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Infantil, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO gran I-DERIVED_FROM/TO experiencia I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO manejo I-DERIVED_FROM/TO del I-DERIVED_FROM/TO abuso I-DERIVED_FROM/TO sexual I-DERIVED_FROM/TO y I-DERIVED_FROM/TO el I-DERIVED_FROM/TO maltrato I-DERIVED_FROM/TO infantil. I-DERIVED_FROM/TO El B-EXPLORATION personal I-EXPLORATION médico I-EXPLORATION de I-EXPLORATION dicho I-EXPLORATION Hospital I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION valoración I-EXPLORATION por I-EXPLORATION otro I-EXPLORATION médico I-EXPLORATION especialista I-EXPLORATION forense, I-EXPLORATION quien I-EXPLORATION acude I-EXPLORATION al I-EXPLORATION Hospital I-EXPLORATION para I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION examen. I-EXPLORATION Dicho I-EXPLORATION examen I-EXPLORATION es I-EXPLORATION realizado I-EXPLORATION bajo I-EXPLORATION sedación, I-EXPLORATION utilizando I-EXPLORATION lupa I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION genital, I-EXPLORATION encontrando I-EXPLORATION que I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION descrita I-EXPLORATION por I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION médico I-EXPLORATION no I-EXPLORATION era I-EXPLORATION más I-EXPLORATION que I-EXPLORATION mucosa I-EXPLORATION uretral I-EXPLORATION prolapsada, I-EXPLORATION que I-EXPLORATION simulaba I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION en I-EXPLORATION el I-EXPLORATION meridiano I-EXPLORATION de I-EXPLORATION las I-EXPLORATION 12 I-EXPLORATION horas. I-EXPLORATION Se I-EXPLORATION hace I-EXPLORATION entonces I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION prolapso I-EXPLORATION uretral. I-EXPLORATION La B-EVOLUTION menor I-EVOLUTION es I-EVOLUTION llevada I-EVOLUTION a I-EVOLUTION manejo I-EVOLUTION quirúrgico I-EVOLUTION con I-EVOLUTION corrección I-EVOLUTION del I-EVOLUTION prolapso. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS joven I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontraba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS aguas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS playa I-PRESENT_ILLNESS Red I-PRESENT_ILLNESS Frog I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Isla I-PRESENT_ILLNESS Bastimentos. I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS testigos I-PRESENT_ILLNESS observaron I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS joven I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontraba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS "pidió I-PRESENT_ILLNESS ayuda", I-PRESENT_ILLNESS se I-PRESENT_ILLNESS sumergió I-PRESENT_ILLNESS y I-PRESENT_ILLNESS volvió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS salir I-PRESENT_ILLNESS a I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS metros I-PRESENT_ILLNESS de I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS había I-PRESENT_ILLNESS sumergido I-PRESENT_ILLNESS y I-PRESENT_ILLNESS no I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS volvieron I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ver. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION recuperó I-EXPLORATION el I-EXPLORATION cadáver I-EXPLORATION tres I-EXPLORATION días I-EXPLORATION después, I-EXPLORATION en I-EXPLORATION avanzado I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION descomposición, I-EXPLORATION sin I-EXPLORATION prendas I-EXPLORATION de I-EXPLORATION vestir, I-EXPLORATION con I-EXPLORATION antropofagia I-EXPLORATION cadavérica I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION rostro. I-EXPLORATION Presentaba I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION parrilla I-EXPLORATION costal I-EXPLORATION bilateralmente, I-EXPLORATION también I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION pélvica I-EXPLORATION anterior I-EXPLORATION cubriendo I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION 39 I-EXPLORATION x I-EXPLORATION 22 I-EXPLORATION cm. I-EXPLORATION La I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION músculos I-EXPLORATION presentaban I-EXPLORATION bordes I-EXPLORATION desgarrados, I-EXPLORATION las I-EXPLORATION costillas I-EXPLORATION presentaban I-EXPLORATION fracturas I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION astillados. I-EXPLORATION Había I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION todos I-EXPLORATION los I-EXPLORATION órganos I-EXPLORATION internos I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION torácico I-EXPLORATION y I-EXPLORATION abdominal I-EXPLORATION a I-EXPLORATION excepción I-EXPLORATION del I-EXPLORATION tercio I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION esófago I-EXPLORATION y I-EXPLORATION vías I-EXPLORATION respiratorias I-EXPLORATION altas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION región I-EXPLORATION subescapular I-EXPLORATION bilateral I-EXPLORATION presentaba I-EXPLORATION lesiones I-EXPLORATION contuso-cortantes I-EXPLORATION (aspecto I-EXPLORATION de I-EXPLORATION sierra) I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION semiovalada. I-EXPLORATION Además I-EXPLORATION presentaba I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION músculos I-EXPLORATION del I-EXPLORATION glúteo I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION avulsivo I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION muscular I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION muslo I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Un B-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS residente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Puerto I-PAST_MEDICAL_HISTORY Vallarta, I-PAST_MEDICAL_HISTORY se B-PRESENT_ILLNESS encontraba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pareja I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS interior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS golf I-PRESENT_ILLNESS y I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS orilla I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS trampa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agua, I-PRESENT_ILLNESS alrededor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 22: I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS h. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS sujeto I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS permiso I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS del I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS golf I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS de I-PRESENT_ILLNESS acceso I-PRESENT_ILLNESS restringido. I-PRESENT_ILLNESS Según I-PRESENT_ILLNESS relata I-PRESENT_ILLNESS la I-PRESENT_ILLNESS víctima, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS tocó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS espejo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agua I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS trampa I-PRESENT_ILLNESS (se I-PRESENT_ILLNESS asume I-PRESENT_ILLNESS que I-PRESENT_ILLNESS esto I-PRESENT_ILLNESS ocurrió I-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS sostenía I-PRESENT_ILLNESS coito I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pareja), I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS río I-PRESENT_ILLNESS o I-PRESENT_ILLNESS americano I-PRESENT_ILLNESS mayor I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS metros I-PRESENT_ILLNESS de I-PRESENT_ILLNESS largo, I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS sujetó I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pie. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bomberos I-PRESENT_ILLNESS municipal I-PRESENT_ILLNESS arribó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS auxilio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS observó I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS mantenía I-PRESENT_ILLNESS sujeto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS extremidad I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS se I-PRESENT_ILLNESS aferraba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS brazos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS árbol I-PRESENT_ILLNESS cercano I-PRESENT_ILLNESS (al I-PRESENT_ILLNESS menos I-PRESENT_ILLNESS permaneció I-PRESENT_ILLNESS un I-PRESENT_ILLNESS par I-PRESENT_ILLNESS de I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS esta I-PRESENT_ILLNESS situación I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS recibir I-PRESENT_ILLNESS ayuda). I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS bomberos I-PRESENT_ILLNESS le I-PRESENT_ILLNESS arrojaron I-PRESENT_ILLNESS una I-PRESENT_ILLNESS cuerda I-PRESENT_ILLNESS para I-PRESENT_ILLNESS rescatarlo I-PRESENT_ILLNESS (ya I-PRESENT_ILLNESS que I-PRESENT_ILLNESS parte I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontraba I-PRESENT_ILLNESS dentro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS trampa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agua); I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS embargo, I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS tensaron I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cuerda I-PRESENT_ILLNESS para I-PRESENT_ILLNESS liberarlo, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS realizó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS giro I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS su I-PRESENT_ILLNESS propio I-PRESENT_ILLNESS cuerpo, I-PRESENT_ILLNESS conocido I-PRESENT_ILLNESS como I-PRESENT_ILLNESS "giro I-PRESENT_ILLNESS mortal", I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS provocó I-PRESENT_ILLNESS politraumatismo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS pantorrilla I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS fracturas I-PRESENT_ILLNESS expuestas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS espiral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS compuesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tibia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS peroné, I-PRESENT_ILLNESS conminuta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS astrágalo I-PRESENT_ILLNESS con I-PRESENT_ILLNESS partes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conexión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tejidos I-PRESENT_ILLNESS blandos, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS laceraciones I-PRESENT_ILLNESS mayores I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS músculos I-PRESENT_ILLNESS gastrocnemio, I-PRESENT_ILLNESS sóleo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tibial I-PRESENT_ILLNESS anterior. I-PRESENT_ILLNESS Al B-TREATMENT rescatarlo I-TREATMENT y I-TREATMENT llevarlo I-TREATMENT al I-TREATMENT hospital, I-TREATMENT los I-TREATMENT médicos I-TREATMENT decidieron I-TREATMENT amputarle I-TREATMENT la I-TREATMENT extremidad I-TREATMENT izquierda I-TREATMENT por I-TREATMENT debajo I-TREATMENT de I-TREATMENT la I-TREATMENT rodilla. I-TREATMENT I-TREATMENT Un B-PRESENT_ILLNESS joven I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS manifestó I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS agredido I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cocodrilo. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS encontró I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS shock I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 01: I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS inmediaciones I-PRESENT_ILLNESS del I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS golf I-PRESENT_ILLNESS Marina I-PRESENT_ILLNESS Vallarta I-PRESENT_ILLNESS (la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS está I-PRESENT_ILLNESS limitada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS cerca I-PRESENT_ILLNESS perimetral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alambre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS púas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tiene I-PRESENT_ILLNESS letreros I-PRESENT_ILLNESS informativos I-PRESENT_ILLNESS que I-PRESENT_ILLNESS prohíben I-PRESENT_ILLNESS ingresar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS privada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alertan I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cocodrilos). I-PRESENT_ILLNESS La B-EXPLORATION víctima I-EXPLORATION tenía I-EXPLORATION amputado I-EXPLORATION el I-EXPLORATION brazo I-EXPLORATION izquierdo, I-EXPLORATION a I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION húmero. I-EXPLORATION Fue B-TREATMENT asistido I-TREATMENT en I-TREATMENT primera I-TREATMENT instancia I-TREATMENT por I-TREATMENT elementos I-TREATMENT de I-TREATMENT la I-TREATMENT policía I-TREATMENT municipal I-TREATMENT y, I-TREATMENT posteriormente, I-TREATMENT recibió I-TREATMENT atención I-TREATMENT de I-TREATMENT socorristas I-TREATMENT de I-TREATMENT un I-TREATMENT hospital I-TREATMENT privado, I-TREATMENT quienes I-TREATMENT le I-TREATMENT aplicaron I-TREATMENT sedantes. I-TREATMENT Se I-TREATMENT le I-TREATMENT trasladó I-TREATMENT al I-TREATMENT nosocomio, I-TREATMENT donde I-TREATMENT se I-TREATMENT le I-TREATMENT práctico I-TREATMENT la I-TREATMENT amputación I-TREATMENT total I-TREATMENT del I-TREATMENT brazo I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT administró I-TREATMENT como I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT inicio I-TREATMENT 100 I-TREATMENT mg I-TREATMENT de I-TREATMENT Pentamin, I-TREATMENT 1 I-TREATMENT g I-TREATMENT de I-TREATMENT Amikasina, I-TREATMENT 2 I-TREATMENT g I-TREATMENT de I-TREATMENT Rosephin® I-TREATMENT y I-TREATMENT 500 I-TREATMENT mg I-TREATMENT de I-TREATMENT Histaline. I-TREATMENT Como I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT mantenimiento, I-TREATMENT se I-TREATMENT le I-TREATMENT aplicó I-TREATMENT una I-TREATMENT ámpula I-TREATMENT de I-TREATMENT Pantosin I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h, I-TREATMENT 1 I-TREATMENT g I-TREATMENT cada I-TREATMENT 24 I-TREATMENT h I-TREATMENT vía I-TREATMENT intravenosa I-TREATMENT de I-TREATMENT Amikasina, I-TREATMENT 30 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h I-TREATMENT vía I-TREATMENT intravenosa I-TREATMENT de I-TREATMENT Ketorolaco, I-TREATMENT una I-TREATMENT ámpula I-TREATMENT de I-TREATMENT Pantozol® I-TREATMENT cada I-TREATMENT 24 I-TREATMENT h I-TREATMENT vía I-TREATMENT intravenosa, I-TREATMENT una I-TREATMENT ámpula I-TREATMENT de I-TREATMENT Stadium® I-TREATMENT cada I-TREATMENT 8 I-TREATMENT h I-TREATMENT vía I-TREATMENT intravenosa, I-TREATMENT un I-TREATMENT ámpula I-TREATMENT de I-TREATMENT toxoide I-TREATMENT tetánico I-TREATMENT y I-TREATMENT una I-TREATMENT tableta I-TREATMENT de I-TREATMENT Gabapentina; I-TREATMENT además I-TREATMENT de I-TREATMENT solución I-TREATMENT Hartmann I-TREATMENT y I-TREATMENT solución I-TREATMENT salina I-TREATMENT 0.9% I-TREATMENT alternadas. I-TREATMENT I-TREATMENT La B-PRESENT_ILLNESS víctima, I-PRESENT_ILLNESS residente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Guadalajara, I-PRESENT_ILLNESS Jalisco, I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS entrevistada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS relató I-PRESENT_ILLNESS no I-PRESENT_ILLNESS recordar I-PRESENT_ILLNESS lapsos I-PRESENT_ILLNESS del I-PRESENT_ILLNESS incidente. I-PRESENT_ILLNESS Sin I-PRESENT_ILLNESS embargo, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esto I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS declararse I-PRESENT_ILLNESS también I-PRESENT_ILLNESS desorientada I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ataque, I-PRESENT_ILLNESS recuerda I-PRESENT_ILLNESS encontrarse I-PRESENT_ILLNESS dentro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS trampas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agua I-PRESENT_ILLNESS del I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS golf I-PRESENT_ILLNESS (cercana I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS playa). I-PRESENT_ILLNESS En I-PRESENT_ILLNESS este I-PRESENT_ILLNESS espacio, I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS arremetida I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS veces I-PRESENT_ILLNESS a I-PRESENT_ILLNESS mordeduras I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sacudidas I-PRESENT_ILLNESS (giros) I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS (presentó I-PRESENT_ILLNESS heridas I-PRESENT_ILLNESS avulsivas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS exterior I-PRESENT_ILLNESS e I-PRESENT_ILLNESS interior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS porción I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pecho, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS escoriaciones I-PRESENT_ILLNESS leves I-PRESENT_ILLNESS en I-PRESENT_ILLNESS genitales). I-PRESENT_ILLNESS Comenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS joven I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS golpeó I-PRESENT_ILLNESS repetidamente I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cabeza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS las I-PRESENT_ILLNESS rocas, I-PRESENT_ILLNESS además I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sentir I-PRESENT_ILLNESS cómo I-PRESENT_ILLNESS el I-PRESENT_ILLNESS reptil I-PRESENT_ILLNESS le I-PRESENT_ILLNESS sujetaba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS pierna, I-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS luchaba I-PRESENT_ILLNESS por I-PRESENT_ILLNESS mantenerse I-PRESENT_ILLNESS asido I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS ramas I-PRESENT_ILLNESS cercanas I-PRESENT_ILLNESS (no I-PRESENT_ILLNESS recuerda I-PRESENT_ILLNESS si I-PRESENT_ILLNESS para I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS momento, I-PRESENT_ILLNESS ya I-PRESENT_ILLNESS había I-PRESENT_ILLNESS perdido I-PRESENT_ILLNESS su I-PRESENT_ILLNESS brazo). I-PRESENT_ILLNESS Una I-PRESENT_ILLNESS vez I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS soltó, I-PRESENT_ILLNESS logró I-PRESENT_ILLNESS llegar I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS orilla I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS perdió I-PRESENT_ILLNESS el I-PRESENT_ILLNESS conocimiento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS ocasiones. I-PRESENT_ILLNESS Ingresó I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS trampa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agua, I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS llegar I-PRESENT_ILLNESS al I-PRESENT_ILLNESS edificio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS condominios I-PRESENT_ILLNESS aledaño I-PRESENT_ILLNESS al I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS golf I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS asistido I-PRESENT_ILLNESS por I-PRESENT_ILLNESS los I-PRESENT_ILLNESS condóminos I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS la I-PRESENT_ILLNESS llegada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS policía I-PRESENT_ILLNESS y I-PRESENT_ILLNESS socorristas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Un B-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS residente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Puerto I-PAST_MEDICAL_HISTORY Vallarta, I-PAST_MEDICAL_HISTORY fue B-PRESENT_ILLNESS atacado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS río I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 8: I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS del I-PRESENT_ILLNESS día I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS junio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2010 I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS orilla I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estero I-PRESENT_ILLNESS Boca I-PRESENT_ILLNESS Negra, I-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS realizaba I-PRESENT_ILLNESS faenas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pesca I-PRESENT_ILLNESS con I-PRESENT_ILLNESS atarraya. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS víctima I-PRESENT_ILLNESS relata I-PRESENT_ILLNESS que I-PRESENT_ILLNESS observó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS "saltar" I-PRESENT_ILLNESS fuera I-PRESENT_ILLNESS del I-PRESENT_ILLNESS agua I-PRESENT_ILLNESS y, I-PRESENT_ILLNESS aunque I-PRESENT_ILLNESS intentó I-PRESENT_ILLNESS esquivarlo, I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS atrapado I-PRESENT_ILLNESS del I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS Posteriormente, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS reptil I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS haló I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS el I-PRESENT_ILLNESS agua I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS hundió. I-PRESENT_ILLNESS Aunque I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hombre I-PRESENT_ILLNESS logró I-PRESENT_ILLNESS liberarse, I-PRESENT_ILLNESS sufrió I-PRESENT_ILLNESS amputación I-PRESENT_ILLNESS por I-PRESENT_ILLNESS desgarre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS antebrazo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS músculo I-PRESENT_ILLNESS braquiorradial I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tríceps I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cabeza I-PRESENT_ILLNESS lateral I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tríceps I-PRESENT_ILLNESS braquial, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS exposición I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cóndilo I-PRESENT_ILLNESS humeral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS articulación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS fragmento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cúbito I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tuberosidad I-PRESENT_ILLNESS radial. I-PRESENT_ILLNESS La B-EVOLUTION persona I-EVOLUTION fue I-EVOLUTION trasladada I-EVOLUTION al I-EVOLUTION hospital I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION recuperó I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION lesiones. I-EVOLUTION Cabe B-PRESENT_ILLNESS destacar I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS víctima I-PRESENT_ILLNESS manifiesta I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS golpeado I-PRESENT_ILLNESS los I-PRESENT_ILLNESS ojos I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cocodrilo I-PRESENT_ILLNESS para I-PRESENT_ILLNESS lograr I-PRESENT_ILLNESS su I-PRESENT_ILLNESS liberación. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cadáver I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 36 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY melanoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY coroides I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY derecho I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY quirúrgicamente I-PAST_MEDICAL_HISTORY (enucleación) I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY fallecimiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY que, I-PAST_MEDICAL_HISTORY posteriormente, I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatectomía I-PAST_MEDICAL_HISTORY parcial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cistectomía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY posibles I-PAST_MEDICAL_HISTORY metástasis I-PAST_MEDICAL_HISTORY (un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY inicial I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tumor I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY coroides). I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY entonces, I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY revisiones I-PAST_MEDICAL_HISTORY médicas, I-PAST_MEDICAL_HISTORY según I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY familia, I-PAST_MEDICAL_HISTORY han I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY Inesperadamente B-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS respiratoria, I-PRESENT_ILLNESS falleciendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS súbita I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS minutos, I-PRESENT_ILLNESS encontrándose I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS al I-PRESENT_ILLNESS cadáver, I-PRESENT_ILLNESS restos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS biliosos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION externo I-EXPLORATION destaca I-EXPLORATION tinte I-EXPLORATION ictérico I-EXPLORATION generalizado, I-EXPLORATION restos I-EXPLORATION biliosos I-EXPLORATION que I-EXPLORATION salen I-EXPLORATION por I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION nasal I-EXPLORATION derecha, I-EXPLORATION edema I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION (sobre I-EXPLORATION todo I-EXPLORATION en I-EXPLORATION pie, I-EXPLORATION antepié I-EXPLORATION y I-EXPLORATION tobillo), I-EXPLORATION congestión I-EXPLORATION conjuntival I-EXPLORATION en I-EXPLORATION ojo I-EXPLORATION izquierdo, I-EXPLORATION prótesis I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION derecho, I-EXPLORATION abdomen I-EXPLORATION globuloso I-EXPLORATION con I-EXPLORATION protusión I-EXPLORATION umbilical, I-EXPLORATION cicatrices I-EXPLORATION quirúrgicas I-EXPLORATION antiguas I-EXPLORATION en I-EXPLORATION región I-EXPLORATION subcostal I-EXPLORATION y I-EXPLORATION flanco I-EXPLORATION abdominal I-EXPLORATION derechos. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION interno I-EXPLORATION apreciamos I-EXPLORATION una I-EXPLORATION nodulación I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION encefálica I-EXPLORATION frontal I-EXPLORATION derecha, I-EXPLORATION que I-EXPLORATION penetra I-EXPLORATION en I-EXPLORATION la I-EXPLORATION sustancia I-EXPLORATION blanca I-EXPLORATION y I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION pardo-negruzca. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION torácica I-EXPLORATION encontramos I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION derrame I-EXPLORATION pericárdico I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION turbio. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION disección I-EXPLORATION de I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION pulmonares I-EXPLORATION observamos I-EXPLORATION un I-EXPLORATION trombo I-EXPLORATION de I-EXPLORATION características I-EXPLORATION vitales I-EXPLORATION adherido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION se I-EXPLORATION introduce I-EXPLORATION por I-EXPLORATION las I-EXPLORATION ramas I-EXPLORATION intraparenquimatosas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION x I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION adherida I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION latero-interna, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION orejuela, I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION pardo-negruzca I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION pediculado I-EXPLORATION con I-EXPLORATION amplia I-EXPLORATION base I-EXPLORATION de I-EXPLORATION implantación. I-EXPLORATION La I-EXPLORATION superficie I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION discretamente I-EXPLORATION excavada I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION hemorrágico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuadrante I-EXPLORATION infero-interno. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION abdominal I-EXPLORATION existían I-EXPLORATION 1.500 I-EXPLORATION cc I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION ascítico I-EXPLORATION con I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION heces, I-EXPLORATION adherencias I-EXPLORATION peritoneales I-EXPLORATION marcadas, I-EXPLORATION nódulos I-EXPLORATION linfáticos I-EXPLORATION paravertebrales I-EXPLORATION aumentados I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION negruzca I-EXPLORATION y I-EXPLORATION duros I-EXPLORATION al I-EXPLORATION corte. I-EXPLORATION Así I-EXPLORATION mismo, I-EXPLORATION también I-EXPLORATION encontramos I-EXPLORATION nódulos I-EXPLORATION con I-EXPLORATION semejantes I-EXPLORATION características I-EXPLORATION adheridos I-EXPLORATION a I-EXPLORATION las I-EXPLORATION paredes I-EXPLORATION peritoneales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hígado I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION con I-EXPLORATION restos I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION coagulada I-EXPLORATION y I-EXPLORATION material I-EXPLORATION necrótico I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION verduzca I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior. I-EXPLORATION La I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas I-EXPLORATION tenía I-EXPLORATION aspecto I-EXPLORATION congestivo I-EXPLORATION y I-EXPLORATION al I-EXPLORATION tacto I-EXPLORATION presentaba I-EXPLORATION consistencia I-EXPLORATION dura I-EXPLORATION y I-EXPLORATION fibrosa. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION paredes I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION aparecían I-EXPLORATION adelgazadas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION necrótico, I-EXPLORATION con I-EXPLORATION perforaciones I-EXPLORATION en I-EXPLORATION íleon I-EXPLORATION y I-EXPLORATION yeyuno I-EXPLORATION que I-EXPLORATION permitían I-EXPLORATION la I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION material I-EXPLORATION fecaloideo I-EXPLORATION y I-EXPLORATION alimenticio I-EXPLORATION sin I-EXPLORATION digerir. I-EXPLORATION Existían I-EXPLORATION segmentos I-EXPLORATION intestinales I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION obstructivo, I-EXPLORATION que I-EXPLORATION coincidían I-EXPLORATION con I-EXPLORATION implantes I-EXPLORATION tumorales I-EXPLORATION necróticos. I-EXPLORATION I-EXPLORATION El I-EXPLORATION intestino I-EXPLORATION grueso I-EXPLORATION presentaba I-EXPLORATION también I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION infiltración I-EXPLORATION tumoral I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION pardo-negruzca. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION estudios I-EXPLORATION químico-toxicológicos I-EXPLORATION de I-EXPLORATION sangre, I-EXPLORATION humor I-EXPLORATION vítreo I-EXPLORATION y I-EXPLORATION líquido I-EXPLORATION ascítico I-EXPLORATION y I-EXPLORATION estudios I-EXPLORATION histopatológicos I-EXPLORATION de I-EXPLORATION encéfalo, I-EXPLORATION corazón, I-EXPLORATION pulmón I-EXPLORATION y I-EXPLORATION trombos I-EXPLORATION pulmonares, I-EXPLORATION hígado, I-EXPLORATION páncreas, I-EXPLORATION intestino I-EXPLORATION (duodeno, I-EXPLORATION yeyuno I-EXPLORATION e I-EXPLORATION íleon) I-EXPLORATION y I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION paravertebrales I-EXPLORATION y I-EXPLORATION nódulos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION del I-EXPLORATION peritoneo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION los I-EXPLORATION primeros I-EXPLORATION se I-EXPLORATION obtuvieron I-EXPLORATION resultados I-EXPLORATION negativos I-EXPLORATION a I-EXPLORATION todas I-EXPLORATION aquellas I-EXPLORATION sustancias I-EXPLORATION estudiadas. I-EXPLORATION I-EXPLORATION En I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION histopatológicos I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION compuesta I-EXPLORATION por I-EXPLORATION células I-EXPLORATION poligonales I-EXPLORATION y I-EXPLORATION fusiformes I-EXPLORATION dispuestas I-EXPLORATION formando I-EXPLORATION sábanas I-EXPLORATION o I-EXPLORATION nidos I-EXPLORATION sólidos. I-EXPLORATION Estos I-EXPLORATION crecimientos I-EXPLORATION tumorales I-EXPLORATION infiltraban I-EXPLORATION el I-EXPLORATION miocardio I-EXPLORATION auricular I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION se I-EXPLORATION acompañaban I-EXPLORATION de I-EXPLORATION reacción I-EXPLORATION desmoplásica. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION neoplasia I-EXPLORATION existen I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION externa I-EXPLORATION se I-EXPLORATION identifica I-EXPLORATION un I-EXPLORATION trombo I-EXPLORATION adherido I-EXPLORATION a I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION ulcerada. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION tumorales I-EXPLORATION presentaban I-EXPLORATION nucléolos I-EXPLORATION prominentes I-EXPLORATION y I-EXPLORATION frecuentes I-EXPLORATION figuras I-EXPLORATION de I-EXPLORATION mitosis. I-EXPLORATION Con I-EXPLORATION frecuencia, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION citoplasma I-EXPLORATION existía I-EXPLORATION abundante I-EXPLORATION pigmento I-EXPLORATION melánico. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION émbolos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION en I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION pulmonares I-EXPLORATION presentaban I-EXPLORATION distintos I-EXPLORATION estadios I-EXPLORATION evolutivos. I-EXPLORATION Unos I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION organización, I-EXPLORATION observándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION fibroblastos I-EXPLORATION y I-EXPLORATION yemas I-EXPLORATION vasculares I-EXPLORATION que I-EXPLORATION iban I-EXPLORATION infiltrando I-EXPLORATION la I-EXPLORATION formación I-EXPLORATION trombótica I-EXPLORATION ; I-EXPLORATION otros, I-EXPLORATION en I-EXPLORATION cambio, I-EXPLORATION estaban I-EXPLORATION completamente I-EXPLORATION tapizados I-EXPLORATION de I-EXPLORATION endotelio I-EXPLORATION y I-EXPLORATION en I-EXPLORATION su I-EXPLORATION seno I-EXPLORATION comenzaban I-EXPLORATION a I-EXPLORATION proliferar I-EXPLORATION los I-EXPLORATION vasos I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION arterial; I-EXPLORATION y, I-EXPLORATION por I-EXPLORATION último, I-EXPLORATION los I-EXPLORATION más I-EXPLORATION recientes I-EXPLORATION estaban I-EXPLORATION constituidos I-EXPLORATION por I-EXPLORATION fibrina I-EXPLORATION y I-EXPLORATION ocluían I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION luz I-EXPLORATION residual I-EXPLORATION y I-EXPLORATION fueron I-EXPLORATION los I-EXPLORATION responsables I-EXPLORATION del I-EXPLORATION fallecimiento I-EXPLORATION repentino I-EXPLORATION del I-EXPLORATION paciente. I-EXPLORATION La I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION émbolos I-EXPLORATION en I-EXPLORATION diferentes I-EXPLORATION estadios I-EXPLORATION evolutivos I-EXPLORATION implica I-EXPLORATION que, I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION trombo I-EXPLORATION adherido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION la I-EXPLORATION metástasis I-EXPLORATION auricular, I-EXPLORATION se I-EXPLORATION han I-EXPLORATION ido I-EXPLORATION desprendiendo I-EXPLORATION numerosos I-EXPLORATION émbolos I-EXPLORATION en I-EXPLORATION un I-EXPLORATION espacio I-EXPLORATION de I-EXPLORATION tiempo I-EXPLORATION que I-EXPLORATION puede I-EXPLORATION oscilar I-EXPLORATION entre I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION 4 I-EXPLORATION semanas I-EXPLORATION de I-EXPLORATION evolución. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION macroscópicos I-EXPLORATION y I-EXPLORATION microscópicos I-EXPLORATION sustentan I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION muerte I-EXPLORATION súbita, I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION un I-EXPLORATION tromboembolismo I-EXPLORATION pulmonar I-EXPLORATION masivo, I-EXPLORATION que I-EXPLORATION ha I-EXPLORATION tenido I-EXPLORATION su I-EXPLORATION origen I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION maligna I-EXPLORATION metastásica I-EXPLORATION de I-EXPLORATION un I-EXPLORATION melanoma I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION ido I-EXPLORATION organizando I-EXPLORATION en I-EXPLORATION distintos I-EXPLORATION estadios I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION o I-EXPLORATION 4 I-EXPLORATION semanas I-EXPLORATION y I-EXPLORATION que I-EXPLORATION ha I-EXPLORATION finalizado I-EXPLORATION ocluyendo I-EXPLORATION completamente I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION pulmonares I-EXPLORATION y I-EXPLORATION ocasionando I-EXPLORATION la I-EXPLORATION muerte I-EXPLORATION del I-EXPLORATION sujeto. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION otro I-EXPLORATION lado, I-EXPLORATION y I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION anterior, I-EXPLORATION nos I-EXPLORATION encontramos I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION de I-EXPLORATION shock I-EXPLORATION séptico I-EXPLORATION por I-EXPLORATION peritonitis I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION una I-EXPLORATION perforación I-EXPLORATION intestinal, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION marco I-EXPLORATION de I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION metastásica I-EXPLORATION generalizada I-EXPLORATION cuyo I-EXPLORATION origen I-EXPLORATION es I-EXPLORATION el I-EXPLORATION melanoma I-EXPLORATION de I-EXPLORATION coroides. I-EXPLORATION I-EXPLORATION En B-PRESENT_ILLNESS enero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encontró I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cadáver I-PRESENT_ILLNESS en I-PRESENT_ILLNESS avanzado I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS descomposición I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS orilla I-PRESENT_ILLNESS del I-PRESENT_ILLNESS embalse I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Canales I-PRESENT_ILLNESS (Granada). I-PRESENT_ILLNESS Presentaba B-EXPLORATION mancha I-EXPLORATION verde I-EXPLORATION generalizada, I-EXPLORATION red I-EXPLORATION vascular I-EXPLORATION muy I-EXPLORATION definida, I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION adipocera, I-EXPLORATION maceración I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION faneras I-EXPLORATION y I-EXPLORATION entomofauna I-EXPLORATION sarcosaprófaga. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION los I-EXPLORATION procesos I-EXPLORATION putrefactivos, I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION positiva I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION los I-EXPLORATION rasgos I-EXPLORATION faciales I-EXPLORATION era I-EXPLORATION imposible, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION sospechó I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trataba I-EXPLORATION de I-EXPLORATION un I-EXPLORATION varón I-EXPLORATION que I-EXPLORATION desapareció I-EXPLORATION de I-EXPLORATION su I-EXPLORATION domicilio I-EXPLORATION a I-EXPLORATION finales I-EXPLORATION de I-EXPLORATION noviembre I-EXPLORATION del I-EXPLORATION año I-EXPLORATION anterior I-EXPLORATION ya I-EXPLORATION que, I-EXPLORATION según I-EXPLORATION informó I-EXPLORATION la I-EXPLORATION Policía, I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION era I-EXPLORATION frecuentada I-EXPLORATION por I-EXPLORATION el I-EXPLORATION desaparecido I-EXPLORATION desde I-EXPLORATION que I-EXPLORATION inició I-EXPLORATION los I-EXPLORATION trámites I-EXPLORATION de I-EXPLORATION divorcio. I-EXPLORATION La I-EXPLORATION temperatura I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION levantamiento I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 5oC. I-EXPLORATION I-EXPLORATION El I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION levantamiento I-EXPLORATION consistía I-EXPLORATION en I-EXPLORATION una I-EXPLORATION cornisa I-EXPLORATION de I-EXPLORATION terreno I-EXPLORATION que I-EXPLORATION se I-EXPLORATION levantaba I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION pantano I-EXPLORATION de I-EXPLORATION Canales. I-EXPLORATION El I-EXPLORATION piso I-EXPLORATION era I-EXPLORATION de I-EXPLORATION textura I-EXPLORATION arenosa I-EXPLORATION con I-EXPLORATION algunas I-EXPLORATION formaciones I-EXPLORATION arbustivas I-EXPLORATION de I-EXPLORATION escasa I-EXPLORATION frondosidad. I-EXPLORATION Se I-EXPLORATION describieron I-EXPLORATION restos I-EXPLORATION mucilaginosos I-EXPLORATION de I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION pudieron I-EXPLORATION ser I-EXPLORATION algas I-EXPLORATION que I-EXPLORATION quedaron I-EXPLORATION depositadas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION descenso I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION llenado I-EXPLORATION del I-EXPLORATION embalse. I-EXPLORATION Debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION dificultad I-EXPLORATION de I-EXPLORATION acceso I-EXPLORATION al I-EXPLORATION lugar I-EXPLORATION exacto I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION hallaba I-EXPLORATION el I-EXPLORATION cadáver, I-EXPLORATION tuvieron I-EXPLORATION que I-EXPLORATION intervenir I-EXPLORATION efectivos I-EXPLORATION de I-EXPLORATION Protección I-EXPLORATION Civil I-EXPLORATION para I-EXPLORATION trasladar I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION en I-EXPLORATION lancha I-EXPLORATION hasta I-EXPLORATION un I-EXPLORATION lugar I-EXPLORATION seguro I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION continuaron I-EXPLORATION las I-EXPLORATION diligencias I-EXPLORATION oportunas. I-EXPLORATION I-EXPLORATION El I-EXPLORATION caso I-EXPLORATION que I-EXPLORATION presentamos I-EXPLORATION es I-EXPLORATION paradigmático I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION se I-EXPLORATION sospecha I-EXPLORATION una I-EXPLORATION inmersión I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION previa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION colonización I-EXPLORATION por I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION dípteros I-EXPLORATION necrófagos I-EXPLORATION y, I-EXPLORATION por I-EXPLORATION tanto, I-EXPLORATION un I-EXPLORATION retraso I-EXPLORATION considerable I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION fallecimiento I-EXPLORATION y I-EXPLORATION la I-EXPLORATION llegada I-EXPLORATION de I-EXPLORATION los I-EXPLORATION primeros I-EXPLORATION insectos I-EXPLORATION de I-EXPLORATION interés I-EXPLORATION forense. I-EXPLORATION A I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION meteorológicos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION conocimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION secuencia I-EXPLORATION temporal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION desarrollo I-EXPLORATION larvario I-EXPLORATION de I-EXPLORATION una I-EXPLORATION especie I-EXPLORATION de I-EXPLORATION díptero I-EXPLORATION necrófago I-EXPLORATION hallada I-EXPLORATION sobre I-EXPLORATION los I-EXPLORATION restos I-EXPLORATION humanos, I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION podido I-EXPLORATION determinar I-EXPLORATION el I-EXPLORATION intervalo I-EXPLORATION mínimo I-EXPLORATION que I-EXPLORATION transcurrió I-EXPLORATION desde I-EXPLORATION que I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION emergió I-EXPLORATION del I-EXPLORATION agua I-EXPLORATION hasta I-EXPLORATION su I-EXPLORATION hallazgo. I-EXPLORATION I-EXPLORATION El B-DERIVED_FROM/TO cuerpo I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Instituto I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Medicina I-DERIVED_FROM/TO Legal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Granada, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO practicó I-DERIVED_FROM/TO la I-DERIVED_FROM/TO autopsia I-DERIVED_FROM/TO según I-DERIVED_FROM/TO la I-DERIVED_FROM/TO normativa I-DERIVED_FROM/TO europea12. I-DERIVED_FROM/TO La I-DERIVED_FROM/TO recogida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO evidencias I-DERIVED_FROM/TO entomológicas I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO la I-DERIVED_FROM/TO práctica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO autopsia I-DERIVED_FROM/TO y I-DERIVED_FROM/TO su I-DERIVED_FROM/TO interpretación I-DERIVED_FROM/TO en I-DERIVED_FROM/TO todas I-DERIVED_FROM/TO las I-DERIVED_FROM/TO fases I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO investigación I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realizó I-DERIVED_FROM/TO siguiendo I-DERIVED_FROM/TO las I-DERIVED_FROM/TO recomendaciones I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO European I-DERIVED_FROM/TO Association I-DERIVED_FROM/TO for I-DERIVED_FROM/TO Forensic I-DERIVED_FROM/TO Entomology I-DERIVED_FROM/TO (EAFE) I-DERIVED_FROM/TO 13. I-DERIVED_FROM/TO Las B-EXPLORATION muestras I-EXPLORATION fueron I-EXPLORATION fotografiadas I-EXPLORATION con I-EXPLORATION testigo I-EXPLORATION métrico I-EXPLORATION y I-EXPLORATION recogidas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION cefálica I-EXPLORATION por I-EXPLORATION la I-EXPLORATION médico I-EXPLORATION forense I-EXPLORATION encargada I-EXPLORATION de I-EXPLORATION la I-EXPLORATION autopsia, I-EXPLORATION se I-EXPLORATION conservaron I-EXPLORATION a I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 18oC I-EXPLORATION y I-EXPLORATION fueron I-EXPLORATION trasportadas I-EXPLORATION en I-EXPLORATION recipiente I-EXPLORATION isotérmico I-EXPLORATION dos I-EXPLORATION horas I-EXPLORATION después I-EXPLORATION por I-EXPLORATION el I-EXPLORATION responsable I-EXPLORATION del I-EXPLORATION análisis I-EXPLORATION entomológico I-EXPLORATION forense. I-EXPLORATION Doce I-EXPLORATION larvas I-EXPLORATION vivas I-EXPLORATION fueron I-EXPLORATION criadas I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION adulta I-EXPLORATION en I-EXPLORATION una I-EXPLORATION incubadora I-EXPLORATION Heraeus I-EXPLORATION B-12, I-EXPLORATION a I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 25oC, I-EXPLORATION humedad I-EXPLORATION relativa I-EXPLORATION del I-EXPLORATION 80% I-EXPLORATION y I-EXPLORATION alimentadas I-EXPLORATION con I-EXPLORATION hígado I-EXPLORATION de I-EXPLORATION cerdo I-EXPLORATION ad I-EXPLORATION libitum I-EXPLORATION para I-EXPLORATION realizar I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION especie I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION adulta. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION fueron I-EXPLORATION sacrificadas I-EXPLORATION sumergiéndolas I-EXPLORATION en I-EXPLORATION agua I-EXPLORATION cercana I-EXPLORATION a I-EXPLORATION la I-EXPLORATION ebullición I-EXPLORATION durante I-EXPLORATION 1 I-EXPLORATION minuto I-EXPLORATION y, I-EXPLORATION posteriormente, I-EXPLORATION conservadas I-EXPLORATION en I-EXPLORATION alcohol I-EXPLORATION al I-EXPLORATION 70% I-EXPLORATION para I-EXPLORATION la I-EXPLORATION identificación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION larvas. I-EXPLORATION De I-EXPLORATION las I-EXPLORATION larvas I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION criadas, I-EXPLORATION emergieron I-EXPLORATION 9 I-EXPLORATION adultos. I-EXPLORATION Dos I-EXPLORATION larvas I-EXPLORATION de I-EXPLORATION las I-EXPLORATION que I-EXPLORATION se I-EXPLORATION remitieron I-EXPLORATION muertas I-EXPLORATION fueron I-EXPLORATION sometidas I-EXPLORATION a I-EXPLORATION un I-EXPLORATION aclaramiento I-EXPLORATION en I-EXPLORATION una I-EXPLORATION disolución I-EXPLORATION de I-EXPLORATION hidróxido I-EXPLORATION sódico I-EXPLORATION al I-EXPLORATION 10% I-EXPLORATION m/v I-EXPLORATION durante I-EXPLORATION 24 I-EXPLORATION horas. I-EXPLORATION Posteriormente, I-EXPLORATION se I-EXPLORATION montaron I-EXPLORATION en I-EXPLORATION una I-EXPLORATION preparación I-EXPLORATION microscópica I-EXPLORATION con I-EXPLORATION DPX I-EXPLORATION (VWR I-EXPLORATION International®) I-EXPLORATION para I-EXPLORATION observar I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION detalle I-EXPLORATION las I-EXPLORATION características I-EXPLORATION morfoanatómicas. I-EXPLORATION De I-EXPLORATION los I-EXPLORATION adultos, I-EXPLORATION el I-EXPLORATION muerto I-EXPLORATION fue I-EXPLORATION directamente I-EXPLORATION conservado I-EXPLORATION en I-EXPLORATION alcohol I-EXPLORATION al I-EXPLORATION 70% I-EXPLORATION y I-EXPLORATION el I-EXPLORATION otro I-EXPLORATION sacrificado I-EXPLORATION con I-EXPLORATION acetato I-EXPLORATION de I-EXPLORATION etilo I-EXPLORATION y I-EXPLORATION posteriormente I-EXPLORATION conservado I-EXPLORATION con I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION método I-EXPLORATION que I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION que I-EXPLORATION se I-EXPLORATION remitió I-EXPLORATION muerta. I-EXPLORATION La I-EXPLORATION totalidad I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION fueron I-EXPLORATION identificadas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION especie14, I-EXPLORATION 15. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION recogieron I-EXPLORATION muestras I-EXPLORATION entomológicas I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION levantamiento I-EXPLORATION del I-EXPLORATION cadáver. I-EXPLORATION I-EXPLORATION Datos I-EXPLORATION ambientales I-EXPLORATION I-EXPLORATION Los I-EXPLORATION datos I-EXPLORATION meteorológicos I-EXPLORATION diarios I-EXPLORATION (en I-EXPLORATION el I-EXPLORATION presente I-EXPLORATION trabajo, I-EXPLORATION tomamos I-EXPLORATION las I-EXPLORATION temperaturas I-EXPLORATION diarias I-EXPLORATION al I-EXPLORATION no I-EXPLORATION disponer I-EXPLORATION de I-EXPLORATION las I-EXPLORATION horarias) I-EXPLORATION fueron I-EXPLORATION tomados I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION estaciones I-EXPLORATION agroclimáticas I-EXPLORATION distintas I-EXPLORATION con I-EXPLORATION el I-EXPLORATION fin I-EXPLORATION de I-EXPLORATION evaluar I-EXPLORATION cuál I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION se I-EXPLORATION ajustaba I-EXPLORATION mejor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION temperatura I-EXPLORATION del I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION levantamiento16, I-EXPLORATION 17, I-EXPLORATION ambas I-EXPLORATION pertenecientes I-EXPLORATION a I-EXPLORATION la I-EXPLORATION red I-EXPLORATION de I-EXPLORATION estaciones I-EXPLORATION agroclimáticas I-EXPLORATION del I-EXPLORATION Instituto I-EXPLORATION de I-EXPLORATION Investigación I-EXPLORATION Agraria I-EXPLORATION y I-EXPLORATION Pesquera I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Junta I-EXPLORATION de I-EXPLORATION Andalucía. I-EXPLORATION La I-EXPLORATION estación I-EXPLORATION 1 I-EXPLORATION (IFAPA I-EXPLORATION de I-EXPLORATION Camino I-EXPLORATION del I-EXPLORATION Purchil, I-EXPLORATION coordenadas I-EXPLORATION UTM I-EXPLORATION X=443423.0 I-EXPLORATION Y=4114357.0, I-EXPLORATION altura I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION mar: I-EXPLORATION 630 I-EXPLORATION metros) I-EXPLORATION está I-EXPLORATION situada I-EXPLORATION a I-EXPLORATION unos I-EXPLORATION 13 I-EXPLORATION kilómetros I-EXPLORATION del I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION levantamiento, I-EXPLORATION la I-EXPLORATION estación I-EXPLORATION 2 I-EXPLORATION (Jerez I-EXPLORATION del I-EXPLORATION Marquesado, I-EXPLORATION coordenadas I-EXPLORATION UTM, I-EXPLORATION X=486806.0 I-EXPLORATION Y=4116224.0, I-EXPLORATION altura I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION mar: I-EXPLORATION 1212 I-EXPLORATION metros) I-EXPLORATION se I-EXPLORATION halla I-EXPLORATION a I-EXPLORATION una I-EXPLORATION distancia I-EXPLORATION de I-EXPLORATION 27 I-EXPLORATION kilómetros I-EXPLORATION del I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION levantamiento. I-EXPLORATION Para I-EXPLORATION poder I-EXPLORATION llevar I-EXPLORATION a I-EXPLORATION cabo I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION de I-EXPLORATION ese I-EXPLORATION ajuste I-EXPLORATION de I-EXPLORATION temperaturas, I-EXPLORATION se I-EXPLORATION colocó I-EXPLORATION un I-EXPLORATION data I-EXPLORATION logger I-EXPLORATION (ILOG I-EXPLORATION S/INT-ESCORT®) I-EXPLORATION en I-EXPLORATION las I-EXPLORATION proximidades I-EXPLORATION del I-EXPLORATION lugar I-EXPLORATION del I-EXPLORATION hallazgo I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION imposibilidad I-EXPLORATION de I-EXPLORATION acceder I-EXPLORATION al I-EXPLORATION sitio I-EXPLORATION exacto I-EXPLORATION del I-EXPLORATION levantamiento I-EXPLORATION y I-EXPLORATION se I-EXPLORATION registraron I-EXPLORATION las I-EXPLORATION temperaturas I-EXPLORATION máximas I-EXPLORATION y I-EXPLORATION mínimas I-EXPLORATION durante I-EXPLORATION cinco I-EXPLORATION días, I-EXPLORATION concretamente I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION 1 I-EXPLORATION de I-EXPLORATION febrero I-EXPLORATION de I-EXPLORATION 2011 I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION día I-EXPLORATION 5 I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION mes. I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION fueron I-EXPLORATION analizados I-EXPLORATION con I-EXPLORATION el I-EXPLORATION paquete I-EXPLORATION estadístico I-EXPLORATION SPSS I-EXPLORATION 15.0 I-EXPLORATION y I-EXPLORATION complementados I-EXPLORATION con I-EXPLORATION UNStat, I-EXPLORATION aplicación I-EXPLORATION desarrollada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION Universidad I-EXPLORATION de I-EXPLORATION Navarra. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION diferenciar I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION larvas I-EXPLORATION que I-EXPLORATION todavía I-EXPLORATION se I-EXPLORATION están I-EXPLORATION alimentando I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION en I-EXPLORATION descomposición I-EXPLORATION y I-EXPLORATION las I-EXPLORATION que I-EXPLORATION se I-EXPLORATION están I-EXPLORATION alejando I-EXPLORATION ya I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fuente I-EXPLORATION de I-EXPLORATION alimentación I-EXPLORATION para I-EXPLORATION pupar, I-EXPLORATION se I-EXPLORATION diseccionan I-EXPLORATION dorsalmente I-EXPLORATION las I-EXPLORATION larvas I-EXPLORATION y I-EXPLORATION se I-EXPLORATION comprueba I-EXPLORATION si I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION depósito I-EXPLORATION de I-EXPLORATION grasa I-EXPLORATION subcuticular I-EXPLORATION que I-EXPLORATION impida I-EXPLORATION la I-EXPLORATION observación I-EXPLORATION dorsal I-EXPLORATION del I-EXPLORATION tracto I-EXPLORATION digestivo I-EXPLORATION relleno I-EXPLORATION de I-EXPLORATION alimento. I-EXPLORATION Ese I-EXPLORATION depósito I-EXPLORATION es I-EXPLORATION observable I-EXPLORATION en I-EXPLORATION las I-EXPLORATION larvas I-EXPLORATION migratorias3. I-EXPLORATION Además, I-EXPLORATION la I-EXPLORATION medición I-EXPLORATION de I-EXPLORATION la I-EXPLORATION longitud I-EXPLORATION del I-EXPLORATION tracto I-EXPLORATION digestivo I-EXPLORATION relleno I-EXPLORATION permite I-EXPLORATION discernir I-EXPLORATION entre I-EXPLORATION ambas I-EXPLORATION fases18. I-EXPLORATION Mientras I-EXPLORATION las I-EXPLORATION larvas I-EXPLORATION se I-EXPLORATION alimenten, I-EXPLORATION el I-EXPLORATION contenido I-EXPLORATION digestivo I-EXPLORATION va I-EXPLORATION aumentando I-EXPLORATION su I-EXPLORATION longitud I-EXPLORATION de I-EXPLORATION relleno I-EXPLORATION mientras I-EXPLORATION que, I-EXPLORATION cuando I-EXPLORATION entran I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION migratoria, I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION vaciado I-EXPLORATION del I-EXPLORATION contenido I-EXPLORATION digestivo I-EXPLORATION que I-EXPLORATION implica I-EXPLORATION un I-EXPLORATION acortamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION longitud I-EXPLORATION de I-EXPLORATION tracto I-EXPLORATION digestivo I-EXPLORATION relleno. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida, I-PAST_MEDICAL_HISTORY fumadora. I-PAST_MEDICAL_HISTORY Múltiples I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY hospitalarios, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellos I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY muerte, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sobreinfección I-PAST_MEDICAL_HISTORY respiratoria. I-PAST_MEDICAL_HISTORY Antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fiebre I-PAST_MEDICAL_HISTORY reumática I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY infancia. I-PAST_MEDICAL_HISTORY Diagnosticada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY dilatada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY posible I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY enólico, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY aórtica I-PAST_MEDICAL_HISTORY moderada, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardiaca I-PAST_MEDICAL_HISTORY congestiva, I-PAST_MEDICAL_HISTORY EPOC I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY depresivo. I-PAST_MEDICAL_HISTORY Múltiples I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY hospitalarios I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipoventilación I-PAST_MEDICAL_HISTORY asociada, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellos I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY muerte I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardiaca I-PAST_MEDICAL_HISTORY congestiva I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY respiratoria I-PAST_MEDICAL_HISTORY global I-PAST_MEDICAL_HISTORY reagudizada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sobre-infección I-PAST_MEDICAL_HISTORY respiratoria. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS primeras I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS mañana I-PRESENT_ILLNESS del I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS fallecimiento, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS respiratoria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seguidamente I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia. I-PRESENT_ILLNESS Avisados B-EVOLUTION los I-EVOLUTION Servicios I-EVOLUTION de I-EVOLUTION Urgencia I-EVOLUTION y I-EVOLUTION tras I-EVOLUTION aplicar I-EVOLUTION maniobras I-EVOLUTION de I-EVOLUTION RCP I-EVOLUTION avanzada, I-EVOLUTION acreditan I-EVOLUTION su I-EVOLUTION defunción. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 87 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY constancia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS inespecífico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS visitada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS administró I-PRESENT_ILLNESS metoclopramida. I-PRESENT_ILLNESS Falleció B-EVOLUTION a I-EVOLUTION las I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION atención I-EVOLUTION médica, I-EVOLUTION motivo I-EVOLUTION por I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION se I-EVOLUTION practicó I-EVOLUTION autopsia I-EVOLUTION judicial. I-EVOLUTION I-EVOLUTION Del B-EXPLORATION examen I-EXPLORATION externo I-EXPLORATION destacó I-EXPLORATION la I-EXPLORATION palidez I-EXPLORATION cutáneo-mucosa I-EXPLORATION y I-EXPLORATION disposición I-EXPLORATION en I-EXPLORATION martillo I-EXPLORATION de I-EXPLORATION los I-EXPLORATION segundos I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION pies. I-EXPLORATION Durante I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION interno I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION calcificación I-EXPLORATION mitral, I-EXPLORATION ateromatosis I-EXPLORATION coronaria I-EXPLORATION con I-EXPLORATION obstrucción I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mismas I-EXPLORATION de I-EXPLORATION entre I-EXPLORATION un I-EXPLORATION 25-50%, I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION concéntrica, I-EXPLORATION ateromatosis I-EXPLORATION generalizada I-EXPLORATION de I-EXPLORATION los I-EXPLORATION grandes I-EXPLORATION vasos I-EXPLORATION y I-EXPLORATION hemoperitoneo I-EXPLORATION de I-EXPLORATION 3.000 I-EXPLORATION cc, I-EXPLORATION parcialmente I-EXPLORATION coagulado. I-EXPLORATION Hígado I-EXPLORATION con I-EXPLORATION un I-EXPLORATION peso I-EXPLORATION de I-EXPLORATION 1.585 I-EXPLORATION g I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION macroscópicamente I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION cirrosis I-EXPLORATION macronodular I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lóbulo I-EXPLORATION hepático I-EXPLORATION izquierdo I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION esférica I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION sin I-EXPLORATION pedículo, I-EXPLORATION blanda I-EXPLORATION y I-EXPLORATION móvil I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION con I-EXPLORATION cápsula I-EXPLORATION de I-EXPLORATION color I-EXPLORATION gris-amarillento, I-EXPLORATION muy I-EXPLORATION vascularizada, I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION rotura I-EXPLORATION parcial. I-EXPLORATION Al I-EXPLORATION corte I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION que I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION hepática I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION coloración I-EXPLORATION más I-EXPLORATION pálida I-EXPLORATION que I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION circundante, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION heterogéneo, I-EXPLORATION con I-EXPLORATION escasa I-EXPLORATION pigmentación I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION zonas I-EXPLORATION necrohemorrágicas I-EXPLORATION cercanas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION rotura I-EXPLORATION capsular. I-EXPLORATION La I-EXPLORATION histopatología I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION hepatocelular I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION interpretó I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION muerte I-EXPLORATION como I-EXPLORATION consecuencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION shock I-EXPLORATION hipovolémico I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION hemoperitoneo I-EXPLORATION por I-EXPLORATION rotura I-EXPLORATION del I-EXPLORATION carcinoma I-EXPLORATION hepatocelular I-EXPLORATION (según I-EXPLORATION clasificación I-EXPLORATION CIE I-EXPLORATION 10: I-EXPLORATION C22.0). I-EXPLORATION Siendo I-EXPLORATION este I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION complicación I-EXPLORATION es I-EXPLORATION extremadamente I-EXPLORATION infrecuente I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION medio. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS se I-PRESENT_ILLNESS desplomó I-PRESENT_ILLNESS súbitamente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS pública. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY clínicos I-PAST_MEDICAL_HISTORY constaba I-PAST_MEDICAL_HISTORY estar I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Noonan I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY desarrollo I-PAST_MEDICAL_HISTORY psicomotor I-PAST_MEDICAL_HISTORY normal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY óbito. I-PAST_MEDICAL_HISTORY En B-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY no I-FAMILY_HISTORY existían I-FAMILY_HISTORY otros I-FAMILY_HISTORY miembros I-FAMILY_HISTORY que I-FAMILY_HISTORY tuvieran I-FAMILY_HISTORY un I-FAMILY_HISTORY fenotipo I-FAMILY_HISTORY similar. I-FAMILY_HISTORY I-FAMILY_HISTORY Hallazgos B-EXPLORATION destacados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION externo: I-EXPLORATION cadáver I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION varón I-EXPLORATION de I-EXPLORATION 175 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION altura I-EXPLORATION y I-EXPLORATION 78 I-EXPLORATION Kg I-EXPLORATION de I-EXPLORATION peso I-EXPLORATION (IMC I-EXPLORATION 25, I-EXPLORATION 5 I-EXPLORATION kg/m2) I-EXPLORATION con I-EXPLORATION diversas I-EXPLORATION características I-EXPLORATION anatómicas I-EXPLORATION destacadas: I-EXPLORATION frente I-EXPLORATION amplia, I-EXPLORATION mentón I-EXPLORATION prominente, I-EXPLORATION pabellones I-EXPLORATION auriculares I-EXPLORATION de I-EXPLORATION inserción I-EXPLORATION baja I-EXPLORATION y I-EXPLORATION con I-EXPLORATION lóbulos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION orejas I-EXPLORATION hacia I-EXPLORATION delante, I-EXPLORATION ojos I-EXPLORATION con I-EXPLORATION hendiduras I-EXPLORATION palpebrales I-EXPLORATION hacia I-EXPLORATION abajo, I-EXPLORATION puente I-EXPLORATION nasal I-EXPLORATION grueso, I-EXPLORATION cuello I-EXPLORATION corto, I-EXPLORATION deformidad I-EXPLORATION esternal I-EXPLORATION con I-EXPLORATION pectus I-EXPLORATION carinatum I-EXPLORATION (tórax I-EXPLORATION en I-EXPLORATION quilla) I-EXPLORATION prominencia I-EXPLORATION del I-EXPLORATION pubis I-EXPLORATION y I-EXPLORATION primer I-EXPLORATION dedo I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION pies I-EXPLORATION en I-EXPLORATION garra. I-EXPLORATION I-EXPLORATION Hallazgos I-EXPLORATION destacados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION interno: I-EXPLORATION corazón I-EXPLORATION de I-EXPLORATION 395 I-EXPLORATION g I-EXPLORATION de I-EXPLORATION peso I-EXPLORATION (valor I-EXPLORATION medio I-EXPLORATION según I-EXPLORATION peso I-EXPLORATION corporal: I-EXPLORATION 345 I-EXPLORATION g I-EXPLORATION [rango I-EXPLORATION 261-455 I-EXPLORATION g]). I-EXPLORATION Grosor I-EXPLORATION pared I-EXPLORATION ventrículo I-EXPLORATION izquierdo: I-EXPLORATION 1, I-EXPLORATION 1cm, I-EXPLORATION tabique I-EXPLORATION interventricular: I-EXPLORATION 1, I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION ventrículo I-EXPLORATION derecho: I-EXPLORATION 0, I-EXPLORATION 1 I-EXPLORATION cm. I-EXPLORATION Agujero I-EXPLORATION oval I-EXPLORATION no I-EXPLORATION permeable. I-EXPLORATION Válvulas I-EXPLORATION aurículo-ventriculares I-EXPLORATION y I-EXPLORATION pulmonar I-EXPLORATION normales. I-EXPLORATION Válvula I-EXPLORATION aórtica I-EXPLORATION bicúspide. I-EXPLORATION Severa I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION raíz I-EXPLORATION aórtica I-EXPLORATION con I-EXPLORATION disección I-EXPLORATION circular I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION íntima I-EXPLORATION arterial I-EXPLORATION a I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION del I-EXPLORATION anillo I-EXPLORATION de I-EXPLORATION inserción I-EXPLORATION valvular I-EXPLORATION con I-EXPLORATION desprendimiento I-EXPLORATION completo I-EXPLORATION e I-EXPLORATION intususpección I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION de I-EXPLORATION la I-EXPLORATION capa I-EXPLORATION interna I-EXPLORATION disecada I-EXPLORATION hasta I-EXPLORATION un I-EXPLORATION área I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION calibre I-EXPLORATION del I-EXPLORATION cayado I-EXPLORATION aórtico, I-EXPLORATION extendiéndose I-EXPLORATION por I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION subclavia I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tronco I-EXPLORATION braquiocefálico, I-EXPLORATION y I-EXPLORATION obstruyendo I-EXPLORATION completamente I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION luces I-EXPLORATION vasculares. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION ofreció I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION interés: I-EXPLORATION signos I-EXPLORATION moderados I-EXPLORATION de I-EXPLORATION hipertrofia I-EXPLORATION miocitaria I-EXPLORATION en I-EXPLORATION miocardio I-EXPLORATION ventricular I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION desorganizativo I-EXPLORATION focal I-EXPLORATION en I-EXPLORATION tabique I-EXPLORATION interventricular. I-EXPLORATION Infiltración I-EXPLORATION adiposa I-EXPLORATION miocárdica I-EXPLORATION ventricular I-EXPLORATION derecha I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION con I-EXPLORATION fibrosis I-EXPLORATION intersticial I-EXPLORATION sin I-EXPLORATION reacción I-EXPLORATION inflamatoria I-EXPLORATION crónica. I-EXPLORATION Necrosis I-EXPLORATION quística I-EXPLORATION de I-EXPLORATION la I-EXPLORATION media I-EXPLORATION arterial I-EXPLORATION aórtica. I-EXPLORATION Arterioloesclerosis I-EXPLORATION renal I-EXPLORATION con I-EXPLORATION microlitiasis I-EXPLORATION y I-EXPLORATION esteatosis I-EXPLORATION hepática I-EXPLORATION en I-EXPLORATION grado I-EXPLORATION leve. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS sujeto I-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS soltero, B-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY convive I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS cuidaba I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS menor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS vecino I-PRESENT_ILLNESS del I-PRESENT_ILLNESS lugar I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS reside, I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS sorprendido I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pequeño I-PRESENT_ILLNESS cuando I-PRESENT_ILLNESS tocaba I-PRESENT_ILLNESS los I-PRESENT_ILLNESS genitales I-PRESENT_ILLNESS del I-PRESENT_ILLNESS niño, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS colocaba I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pene I-PRESENT_ILLNESS en I-PRESENT_ILLNESS erección I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS glútea I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pequeño. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS acusado I-PRESENT_ILLNESS acepta I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS cometido I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hecho I-PRESENT_ILLNESS y I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS no I-PRESENT_ILLNESS tener I-PRESENT_ILLNESS explicación I-PRESENT_ILLNESS ante I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS ocurrido. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY comprobó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY estuvo I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2003 I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY Hospital I-PAST_MEDICAL_HISTORY Psiquiátrico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Habana I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY Trastorno I-PAST_MEDICAL_HISTORY Orgánico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Personalidad. I-PAST_MEDICAL_HISTORY Refiere I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY producto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY múltiple I-PAST_MEDICAL_HISTORY (trillizos) I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY solo I-PAST_MEDICAL_HISTORY él I-PAST_MEDICAL_HISTORY sobrevivió. I-PAST_MEDICAL_HISTORY Estudió I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY enseñanza I-PAST_MEDICAL_HISTORY especial I-PAST_MEDICAL_HISTORY alcanzando I-PAST_MEDICAL_HISTORY 9o I-PAST_MEDICAL_HISTORY grado, I-PAST_MEDICAL_HISTORY luego I-PAST_MEDICAL_HISTORY abandonó I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY estudios. I-PAST_MEDICAL_HISTORY Huérfano I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY padre I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Trauma I-PAST_MEDICAL_HISTORY craneoencefálico I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conciencia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY atención I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY neurología. I-PAST_MEDICAL_HISTORY Lleva I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY desvinculado I-PAST_MEDICAL_HISTORY laboralmente. I-PAST_MEDICAL_HISTORY Según I-PAST_MEDICAL_HISTORY explicó I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY única I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pareja I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY juventud. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue B-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO institución I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO objetivo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO realizar I-DERIVED_FROM/TO una I-DERIVED_FROM/TO evaluación I-DERIVED_FROM/TO psiquiátrica I-DERIVED_FROM/TO forense. I-DERIVED_FROM/TO Los B-EXPLORATION peritos I-EXPLORATION psiquiatras I-EXPLORATION actuantes I-EXPLORATION solicitaron I-EXPLORATION una I-EXPLORATION evaluación I-EXPLORATION por I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION Laboratorio I-EXPLORATION de I-EXPLORATION Neurofisiología I-EXPLORATION Clínica I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION entrevista I-EXPLORATION clínica I-EXPLORATION al I-EXPLORATION paciente, I-EXPLORATION se I-EXPLORATION registró I-EXPLORATION un I-EXPLORATION EEG I-EXPLORATION en I-EXPLORATION condiciones I-EXPLORATION basales I-EXPLORATION en I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION vigilia I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION Medicid I-EXPLORATION V I-EXPLORATION y I-EXPLORATION el I-EXPLORATION programa I-EXPLORATION Track I-EXPLORATION Walker I-EXPLORATION (Neuronic, I-EXPLORATION SA I-EXPLORATION Cuba). I-EXPLORATION Se I-EXPLORATION registraron I-EXPLORATION 3 I-EXPLORATION minutos I-EXPLORATION con I-EXPLORATION los I-EXPLORATION ojos I-EXPLORATION cerrados, I-EXPLORATION 2 I-EXPLORATION minutos I-EXPLORATION con I-EXPLORATION los I-EXPLORATION ojos I-EXPLORATION abiertos, I-EXPLORATION 3 I-EXPLORATION minutos I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION hiperventilación I-EXPLORATION y I-EXPLORATION 2 I-EXPLORATION minutos I-EXPLORATION de I-EXPLORATION recuperación. I-EXPLORATION Se I-EXPLORATION seleccionaron I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION a I-EXPLORATION 24 I-EXPLORATION ventanas I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION ojos I-EXPLORATION cerrados, I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION artefactos I-EXPLORATION y I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION al I-EXPLORATION análisis I-EXPLORATION cuantitativo I-EXPLORATION del I-EXPLORATION EEG I-EXPLORATION comparándose I-EXPLORATION con I-EXPLORATION individuos I-EXPLORATION de I-EXPLORATION su I-EXPLORATION misma I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION sexo I-EXPLORATION y I-EXPLORATION que I-EXPLORATION forman I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION datos I-EXPLORATION normativa I-EXPLORATION cubana. I-EXPLORATION Se I-EXPLORATION calculó I-EXPLORATION el I-EXPLORATION espectro I-EXPLORATION de I-EXPLORATION frecuencia I-EXPLORATION en I-EXPLORATION cada I-EXPLORATION una I-EXPLORATION de I-EXPLORATION las I-EXPLORATION derivaciones I-EXPLORATION y I-EXPLORATION luego I-EXPLORATION las I-EXPLORATION medidas I-EXPLORATION espectrales I-EXPLORATION de I-EXPLORATION banda I-EXPLORATION ancha; I-EXPLORATION el I-EXPLORATION Poder I-EXPLORATION Absoluto I-EXPLORATION (PA), I-EXPLORATION que I-EXPLORATION representa I-EXPLORATION la I-EXPLORATION energía I-EXPLORATION que I-EXPLORATION contiene I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION EEG I-EXPLORATION (PA I-EXPLORATION Total) I-EXPLORATION o I-EXPLORATION la I-EXPLORATION contenida I-EXPLORATION en I-EXPLORATION una I-EXPLORATION banda I-EXPLORATION de I-EXPLORATION frecuencia I-EXPLORATION particular I-EXPLORATION (delta, I-EXPLORATION theta, I-EXPLORATION alfa I-EXPLORATION y I-EXPLORATION beta); I-EXPLORATION el I-EXPLORATION Poder I-EXPLORATION Relativo I-EXPLORATION (PR), I-EXPLORATION que I-EXPLORATION no I-EXPLORATION es I-EXPLORATION más I-EXPLORATION que I-EXPLORATION la I-EXPLORATION contribución I-EXPLORATION de I-EXPLORATION cada I-EXPLORATION banda I-EXPLORATION del I-EXPLORATION EEG I-EXPLORATION a I-EXPLORATION la I-EXPLORATION energía I-EXPLORATION total I-EXPLORATION del I-EXPLORATION espectro, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION Frecuencia I-EXPLORATION Media I-EXPLORATION (FM), I-EXPLORATION que I-EXPLORATION se I-EXPLORATION corresponde I-EXPLORATION con I-EXPLORATION los I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION frecuencia I-EXPLORATION (en I-EXPLORATION Hz) I-EXPLORATION que I-EXPLORATION constituyen I-EXPLORATION el I-EXPLORATION "centro I-EXPLORATION de I-EXPLORATION gravedad", I-EXPLORATION ya I-EXPLORATION sea I-EXPLORATION de I-EXPLORATION una I-EXPLORATION banda I-EXPLORATION o I-EXPLORATION bien I-EXPLORATION de I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION espectro. I-EXPLORATION Se I-EXPLORATION estimaron I-EXPLORATION los I-EXPLORATION generadores I-EXPLORATION de I-EXPLORATION la I-EXPLORATION actividad I-EXPLORATION lenta I-EXPLORATION en I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION 7.031 I-EXPLORATION Hz, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION programa I-EXPLORATION Localizador I-EXPLORATION de I-EXPLORATION Fuentes I-EXPLORATION (Neuronic, I-EXPLORATION SA I-EXPLORATION Cuba) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION modelo I-EXPLORATION bayesiano I-EXPLORATION promediado I-EXPLORATION (BMA) I-EXPLORATION 12, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION permite I-EXPLORATION encontrar I-EXPLORATION la I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION corriente I-EXPLORATION primaria I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION cerebro, I-EXPLORATION sin I-EXPLORATION estar I-EXPLORATION condicionada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION modelo I-EXPLORATION asumido. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION evaluó I-EXPLORATION la I-EXPLORATION respuesta I-EXPLORATION simpática I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel, I-EXPLORATION utilizando I-EXPLORATION dos I-EXPLORATION diseños I-EXPLORATION experimentales, I-EXPLORATION el I-EXPLORATION primero I-EXPLORATION conformado I-EXPLORATION con I-EXPLORATION 16 I-EXPLORATION imágenes I-EXPLORATION neutras I-EXPLORATION obtenidas I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION estandarizadas I-EXPLORATION del I-EXPLORATION Sistema I-EXPLORATION Internacional I-EXPLORATION de I-EXPLORATION Imágenes I-EXPLORATION Afectivas I-EXPLORATION (IAPS; I-EXPLORATION Center I-EXPLORATION for I-EXPLORATION the I-EXPLORATION Study I-EXPLORATION of I-EXPLORATION Emotion I-EXPLORATION and I-EXPLORATION Attention-NIMH, I-EXPLORATION 1999) I-EXPLORATION 13 I-EXPLORATION y I-EXPLORATION 6 I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION menores I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION sexos I-EXPLORATION desnudos, I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION utilizó I-EXPLORATION 16 I-EXPLORATION fotos I-EXPLORATION neutras I-EXPLORATION y I-EXPLORATION 6 I-EXPLORATION que I-EXPLORATION son I-EXPLORATION representativas I-EXPLORATION de I-EXPLORATION estímulos I-EXPLORATION sexuales I-EXPLORATION de I-EXPLORATION adultos I-EXPLORATION (parejas I-EXPLORATION eróticas), I-EXPLORATION todas I-EXPLORATION obtenidas I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION internacional I-EXPLORATION antes I-EXPLORATION referido. I-EXPLORATION Este I-EXPLORATION tipo I-EXPLORATION de I-EXPLORATION evaluación I-EXPLORATION forma I-EXPLORATION parte I-EXPLORATION de I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION método I-EXPLORATION para I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION experimental I-EXPLORATION de I-EXPLORATION las I-EXPLORATION emociones, I-EXPLORATION tiene I-EXPLORATION además I-EXPLORATION la I-EXPLORATION ventaja I-EXPLORATION de I-EXPLORATION emplear I-EXPLORATION estímulos I-EXPLORATION que I-EXPLORATION pueden I-EXPLORATION ser I-EXPLORATION fácilmente I-EXPLORATION presentados I-EXPLORATION en I-EXPLORATION contextos I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION formato I-EXPLORATION analógico I-EXPLORATION como I-EXPLORATION digitalizado, I-EXPLORATION permitiendo I-EXPLORATION el I-EXPLORATION control I-EXPLORATION preciso I-EXPLORATION de I-EXPLORATION su I-EXPLORATION momento I-EXPLORATION y I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION exposición. I-EXPLORATION El I-EXPLORATION IAPS I-EXPLORATION consiste I-EXPLORATION en I-EXPLORATION un I-EXPLORATION conjunto I-EXPLORATION estandarizado I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION en I-EXPLORATION color I-EXPLORATION con I-EXPLORATION capacidad I-EXPLORATION para I-EXPLORATION evocar I-EXPLORATION emociones I-EXPLORATION y I-EXPLORATION cuyos I-EXPLORATION contenidos I-EXPLORATION recorren I-EXPLORATION un I-EXPLORATION amplio I-EXPLORATION abanico I-EXPLORATION de I-EXPLORATION categorías: I-EXPLORATION deporte, I-EXPLORATION moda, I-EXPLORATION paisajes, I-EXPLORATION desastres I-EXPLORATION naturales, I-EXPLORATION erotismo, I-EXPLORATION violencia, I-EXPLORATION etc., I-EXPLORATION además, I-EXPLORATION facilita I-EXPLORATION enormemente I-EXPLORATION las I-EXPLORATION tareas I-EXPLORATION de I-EXPLORATION selección I-EXPLORATION y I-EXPLORATION control I-EXPLORATION de I-EXPLORATION los I-EXPLORATION estímulos. I-EXPLORATION Cada I-EXPLORATION imagen I-EXPLORATION del I-EXPLORATION IAPS I-EXPLORATION posee I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION que I-EXPLORATION ha I-EXPLORATION sido I-EXPLORATION normalizado I-EXPLORATION en I-EXPLORATION las I-EXPLORATION dimensiones I-EXPLORATION bipolares I-EXPLORATION de I-EXPLORATION valencia I-EXPLORATION afectiva I-EXPLORATION (con I-EXPLORATION un I-EXPLORATION rango I-EXPLORATION que I-EXPLORATION va I-EXPLORATION desde I-EXPLORATION lo I-EXPLORATION agradable I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION desagradable) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION arousal I-EXPLORATION o I-EXPLORATION activación I-EXPLORATION (cuyo I-EXPLORATION rango I-EXPLORATION oscila I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION excitación I-EXPLORATION y I-EXPLORATION la I-EXPLORATION calma). I-EXPLORATION I-EXPLORATION Los I-EXPLORATION experimentos I-EXPLORATION fueron I-EXPLORATION diseñados I-EXPLORATION en I-EXPLORATION el I-EXPLORATION programa I-EXPLORATION Mindtracer I-EXPLORATION (Neuronic I-EXPLORATION SA, I-EXPLORATION Cuba). I-EXPLORATION Cada I-EXPLORATION estímulo I-EXPLORATION tenía I-EXPLORATION una I-EXPLORATION duración I-EXPLORATION de I-EXPLORATION 2000 I-EXPLORATION milisegundos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION intervalo I-EXPLORATION inter-estímulo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 200.000 I-EXPLORATION milisegundos. I-EXPLORATION El I-EXPLORATION registro I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION con I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION BioDerm I-EXPLORATION Modelo I-EXPLORATION 2701 I-EXPLORATION y I-EXPLORATION dos I-EXPLORATION electrodos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION colocaron I-EXPLORATION en I-EXPLORATION la I-EXPLORATION falange I-EXPLORATION media I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION índice I-EXPLORATION y I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION dominante. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS practicó I-PRESENT_ILLNESS autopsia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY buen I-PAST_MEDICAL_HISTORY desarrollo I-PAST_MEDICAL_HISTORY óseo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY muscular, I-PAST_MEDICAL_HISTORY pastora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rebaño I-PAST_MEDICAL_HISTORY caprino, I-PAST_MEDICAL_HISTORY quien I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY encontrada I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY atacada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY felino I-PAST_MEDICAL_HISTORY salvaje I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY pre-Puna I-PAST_MEDICAL_HISTORY salteña, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Finca I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY Alfarcito, I-PAST_MEDICAL_HISTORY situada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY entrada I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY Cerro I-PAST_MEDICAL_HISTORY Negro, I-PAST_MEDICAL_HISTORY departamento I-PAST_MEDICAL_HISTORY Rosario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Lerma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Salta, I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY Noroeste I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY República I-PAST_MEDICAL_HISTORY Argentina. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION externo I-EXPLORATION presentaba I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION lesiones I-EXPLORATION traumáticas. I-EXPLORATION I-EXPLORATION Tres I-EXPLORATION excoriaciones I-EXPLORATION en I-EXPLORATION región I-EXPLORATION maxilar I-EXPLORATION y I-EXPLORATION submaxilar I-EXPLORATION inferior I-EXPLORATION izquierda, I-EXPLORATION inmediatamente I-EXPLORATION por I-EXPLORATION debajo I-EXPLORATION de I-EXPLORATION éstas, I-EXPLORATION en I-EXPLORATION región I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION izquierda I-EXPLORATION del I-EXPLORATION cuello, I-EXPLORATION presentaba I-EXPLORATION tres I-EXPLORATION heridas I-EXPLORATION cortantes, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION con I-EXPLORATION retracción I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION hemática, I-EXPLORATION separadas I-EXPLORATION una I-EXPLORATION de I-EXPLORATION otra I-EXPLORATION por I-EXPLORATION puentes I-EXPLORATION cutáneos, I-EXPLORATION las I-EXPLORATION mismas I-EXPLORATION medían I-EXPLORATION 4x2 I-EXPLORATION cm, I-EXPLORATION 3, I-EXPLORATION 5x1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION 2, I-EXPLORATION 5x1 I-EXPLORATION cm I-EXPLORATION respectivamente, I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION lesiones I-EXPLORATION por I-EXPLORATION garras I-EXPLORATION de I-EXPLORATION felino. I-EXPLORATION I-EXPLORATION En I-EXPLORATION región I-EXPLORATION clavicular I-EXPLORATION izquierda I-EXPLORATION presentaba I-EXPLORATION excoriaciones I-EXPLORATION pequeñas I-EXPLORATION sobre I-EXPLORATION equimosis. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION región I-EXPLORATION posterior I-EXPLORATION del I-EXPLORATION cuello, I-EXPLORATION en I-EXPLORATION su I-EXPLORATION parte I-EXPLORATION media, I-EXPLORATION herida I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares, I-EXPLORATION retraídos I-EXPLORATION e I-EXPLORATION infiltrados, I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION que I-EXPLORATION interesa I-EXPLORATION piel, I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION y I-EXPLORATION músculos I-EXPLORATION angular I-EXPLORATION y I-EXPLORATION escaleno; I-EXPLORATION con I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION descendente I-EXPLORATION de I-EXPLORATION arriba I-EXPLORATION hacia I-EXPLORATION abajo. I-EXPLORATION I-EXPLORATION Presentaba I-EXPLORATION herida I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION irregulares I-EXPLORATION en I-EXPLORATION dedo I-EXPLORATION pulgar I-EXPLORATION de I-EXPLORATION mano I-EXPLORATION izquierda I-EXPLORATION a I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION del I-EXPLORATION pliegue I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION 1a I-EXPLORATION con I-EXPLORATION la I-EXPLORATION 2a I-EXPLORATION falange. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION interno I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION descritas I-EXPLORATION en I-EXPLORATION región I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION izquierda I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION comprometían I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo, I-EXPLORATION aponeurosis I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profunda I-EXPLORATION de I-EXPLORATION cuello, I-EXPLORATION músculos I-EXPLORATION esternocleidomastoideo, I-EXPLORATION esternocleidohioideo I-EXPLORATION y I-EXPLORATION esternohioideo, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION desgarrado. I-EXPLORATION I-EXPLORATION Compromiso I-EXPLORATION de I-EXPLORATION vasos I-EXPLORATION superficiales I-EXPLORATION y I-EXPLORATION profundos, I-EXPLORATION con I-EXPLORATION sección I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION yugular I-EXPLORATION interna I-EXPLORATION izquierda; I-EXPLORATION provocando I-EXPLORATION una I-EXPLORATION hemorragia I-EXPLORATION aguda I-EXPLORATION vital, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION fue I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION del I-EXPLORATION deceso. I-EXPLORATION I-EXPLORATION El B-PRESENT_ILLNESS cadáver I-PRESENT_ILLNESS carbonizado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS campesina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY vivía I-PAST_MEDICAL_HISTORY sola I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY apartado I-PAST_MEDICAL_HISTORY lugar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Panamá, I-PAST_MEDICAL_HISTORY fue B-PRESENT_ILLNESS encontrado I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS restos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS vivienda I-PRESENT_ILLNESS rural I-PRESENT_ILLNESS de I-PRESENT_ILLNESS madera, I-PRESENT_ILLNESS completamente I-PRESENT_ILLNESS quemada. I-PRESENT_ILLNESS El B-DERIVED_FROM/TO cuerpo I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO morgue I-DERIVED_FROM/TO judicial I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ciudad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Panamá I-DERIVED_FROM/TO para I-DERIVED_FROM/TO su I-DERIVED_FROM/TO identificación I-DERIVED_FROM/TO y I-DERIVED_FROM/TO determinación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO causa I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO muerte. I-DERIVED_FROM/TO No B-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY registros I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY fallecida. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Examen B-EXPLORATION necrópsico I-EXPLORATION I-EXPLORATION Se I-EXPLORATION recibió I-EXPLORATION un I-EXPLORATION cuerpo I-EXPLORATION incompleto, I-EXPLORATION quemado I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION carbonización, I-EXPLORATION con I-EXPLORATION amputaciones I-EXPLORATION térmicas I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION anatómicas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION los I-EXPLORATION miembros. I-EXPLORATION Fue I-EXPLORATION identificado I-EXPLORATION por I-EXPLORATION sus I-EXPLORATION características I-EXPLORATION antropológicas I-EXPLORATION y I-EXPLORATION por I-EXPLORATION la I-EXPLORATION información I-EXPLORATION recibida I-EXPLORATION de I-EXPLORATION los I-EXPLORATION investigadores. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION revisar I-EXPLORATION las I-EXPLORATION cavidades, I-EXPLORATION las I-EXPLORATION vísceras I-EXPLORATION estaban I-EXPLORATION bien I-EXPLORATION conservadas. I-EXPLORATION Había I-EXPLORATION coágulos I-EXPLORATION cocidos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemitórax I-EXPLORATION izquierdo. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION vías I-EXPLORATION aéreas I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION partículas I-EXPLORATION de I-EXPLORATION carbón, I-EXPLORATION y I-EXPLORATION tampoco I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION partículas I-EXPLORATION de I-EXPLORATION hollín I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION microscópico. I-EXPLORATION El I-EXPLORATION saco I-EXPLORATION pericárdico I-EXPLORATION estaba I-EXPLORATION roto I-EXPLORATION y I-EXPLORATION contenía I-EXPLORATION coágulos I-EXPLORATION cocidos I-EXPLORATION ; I-EXPLORATION al I-EXPLORATION evacuarlos, I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION herida I-EXPLORATION punzo-cortante, I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION × I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION interesaba I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION microscópico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION fragmentación I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION miocárdicas I-EXPLORATION y I-EXPLORATION hemorragia I-EXPLORATION reciente. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION estableció I-EXPLORATION que I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muerte I-EXPLORATION fue I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION punzo-cortante I-EXPLORATION que I-EXPLORATION interesó I-EXPLORATION el I-EXPLORATION corazón, I-EXPLORATION y I-EXPLORATION que I-EXPLORATION el I-EXPLORATION deceso I-EXPLORATION ocurrió I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exposición I-EXPLORATION térmica. I-EXPLORATION Basándose B-EVOLUTION en I-EVOLUTION los I-EVOLUTION resultados I-EVOLUTION de I-EVOLUTION la I-EVOLUTION necropsia, I-EVOLUTION los I-EVOLUTION investigadores I-EVOLUTION interrogaron I-EVOLUTION a I-EVOLUTION un I-EVOLUTION familiar I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fallecida, I-EVOLUTION quien I-EVOLUTION confesó I-EVOLUTION ser I-EVOLUTION el I-EVOLUTION autor I-EVOLUTION del I-EVOLUTION femicidio. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS soltera, B-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY niños I-PAST_MEDICAL_HISTORY menores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuales I-PAST_MEDICAL_HISTORY convivía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY les I-PAST_MEDICAL_HISTORY provocó I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY muerte. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY mantenía I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY adecuada I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY respectivos I-PAST_MEDICAL_HISTORY padres. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY hecho I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY embarazada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY resultó I-PAST_MEDICAL_HISTORY evidente I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY actitud I-PAST_MEDICAL_HISTORY irresponsable I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY sexuales I-PAST_MEDICAL_HISTORY íntimas, I-PAST_MEDICAL_HISTORY ya I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY mantenía I-PAST_MEDICAL_HISTORY protección, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY asistido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY captarse I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY embarazo, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY resultó I-PAST_MEDICAL_HISTORY finalmente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY aborto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY solicitud I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY evaluada, I-PAST_MEDICAL_HISTORY argumentando I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY hijo I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY deseado, I-PAST_MEDICAL_HISTORY pues I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pareja I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY rota. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY vínculo I-PAST_MEDICAL_HISTORY laboral I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY psicosocial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY evaluada I-PAST_MEDICAL_HISTORY destacan I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY siguientes I-PAST_MEDICAL_HISTORY elementos: I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY pequeña I-PAST_MEDICAL_HISTORY consideró I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hija I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY deseada, I-PAST_MEDICAL_HISTORY sintiendo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY esto I-PAST_MEDICAL_HISTORY resentimiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY celos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY hermanos. I-PAST_MEDICAL_HISTORY Nunca I-PAST_MEDICAL_HISTORY "sintió" I-PAST_MEDICAL_HISTORY amor I-PAST_MEDICAL_HISTORY maternal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY reconoció I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY figura I-PAST_MEDICAL_HISTORY afectiva I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY padre, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY pesar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY padres I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY divorciaron I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY ella I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY desarrolló I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY medio I-PAST_MEDICAL_HISTORY familiar I-PAST_MEDICAL_HISTORY disfuncional, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY padrastro I-PAST_MEDICAL_HISTORY maltratador I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY todas I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY casa. I-PAST_MEDICAL_HISTORY Refirió I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sufrido I-PAST_MEDICAL_HISTORY maltrato, I-PAST_MEDICAL_HISTORY incluso I-PAST_MEDICAL_HISTORY físico, I-PAST_MEDICAL_HISTORY proveniente I-PAST_MEDICAL_HISTORY tanto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY padrastro. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY desarrollo I-PAST_MEDICAL_HISTORY escolar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enseñanza I-PAST_MEDICAL_HISTORY primaria I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY adecuado; I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY gustaba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pequeña I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY líder I-PAST_MEDICAL_HISTORY ante I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY amigos. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY adolescente I-PAST_MEDICAL_HISTORY rebelde I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY impulsiva. I-PAST_MEDICAL_HISTORY Ha I-PAST_MEDICAL_HISTORY tenido I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY parejas, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellas I-PAST_MEDICAL_HISTORY considera I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY formales, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY relaciones I-PAST_MEDICAL_HISTORY también I-PAST_MEDICAL_HISTORY han I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY caracterizadas I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY maltrato. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY comprobó I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY estuvo I-PAST_MEDICAL_HISTORY ingresada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2012, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Sala I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Psiquiatría I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY Hospital I-PAST_MEDICAL_HISTORY General, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY atentado I-PAST_MEDICAL_HISTORY contra I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY menores, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY diagnosticó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY situacional I-PAST_MEDICAL_HISTORY ansioso. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION mental I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION realizado I-EXPLORATION el I-EXPLORATION día I-EXPLORATION de I-EXPLORATION los I-EXPLORATION hechos I-EXPLORATION no I-EXPLORATION se I-EXPLORATION describen I-EXPLORATION alteraciones I-EXPLORATION psiquiátricas. I-EXPLORATION Explica I-EXPLORATION que I-EXPLORATION estaba I-EXPLORATION "cansada I-EXPLORATION de I-EXPLORATION pasar I-EXPLORATION trabajo, I-EXPLORATION que I-EXPLORATION intentó I-EXPLORATION matarse I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION pudo". I-EXPLORATION Redactó I-EXPLORATION tres I-EXPLORATION notas I-EXPLORATION que I-EXPLORATION se I-EXPLORATION dirigían I-EXPLORATION a I-EXPLORATION los I-EXPLORATION padres I-EXPLORATION de I-EXPLORATION las I-EXPLORATION víctimas I-EXPLORATION y I-EXPLORATION a I-EXPLORATION su I-EXPLORATION madre. I-EXPLORATION Sobre I-EXPLORATION el I-EXPLORATION hecho I-EXPLORATION refirió I-EXPLORATION "mi I-EXPLORATION cabeza I-EXPLORATION tenía I-EXPLORATION deseos I-EXPLORATION de I-EXPLORATION hacer I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION hice, I-EXPLORATION pero I-EXPLORATION que I-EXPLORATION nos I-EXPLORATION fuéramos I-EXPLORATION los I-EXPLORATION tres I-EXPLORATION juntos, I-EXPLORATION lo I-EXPLORATION intenté I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION pude". I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 27 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hemoptisis. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacan I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY neumonía I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY año, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY resolución I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY mejoría I-PAST_MEDICAL_HISTORY radiológica I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY convencional, I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY persistencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY infiltrado I-PAST_MEDICAL_HISTORY alveolar I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY radiografías I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tórax I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY control. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY VIH, I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY inmunosupresión. I-PAST_MEDICAL_HISTORY Trabaja I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY mecánico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY contacto I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ambientes I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY usan I-PAST_MEDICAL_HISTORY soldaduras, I-PAST_MEDICAL_HISTORY grasas, I-PAST_MEDICAL_HISTORY ácidos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY irritantes. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION analítica I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION respiratoria I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION que I-EXPLORATION revela I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION alveolar I-EXPLORATION bilateral I-EXPLORATION similar I-EXPLORATION a I-EXPLORATION las I-EXPLORATION radiografías I-EXPLORATION anteriores. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION entonces I-EXPLORATION hacer I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION torácica I-EXPLORATION con I-EXPLORATION cortes I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION resolución, I-EXPLORATION que I-EXPLORATION consiste I-EXPLORATION en I-EXPLORATION cortes I-EXPLORATION finos I-EXPLORATION de I-EXPLORATION 1mm I-EXPLORATION de I-EXPLORATION colimación I-EXPLORATION a I-EXPLORATION intervalos I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION pulmonar, I-EXPLORATION en I-EXPLORATION inspiración I-EXPLORATION y I-EXPLORATION con I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION decúbito I-EXPLORATION supino. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION muestra I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION opacificación I-EXPLORATION alveolar I-EXPLORATION en I-EXPLORATION vidrio I-EXPLORATION deslustrado I-EXPLORATION dispersos I-EXPLORATION con I-EXPLORATION superposición I-EXPLORATION de I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION liso I-EXPLORATION lineal I-EXPLORATION septal I-EXPLORATION inter I-EXPLORATION e I-EXPLORATION intralobular, I-EXPLORATION conocido I-EXPLORATION como I-EXPLORATION patrón I-EXPLORATION 'crazy-paving' I-EXPLORATION o I-EXPLORATION en I-EXPLORATION empedrado, I-EXPLORATION con I-EXPLORATION extensa I-EXPLORATION afectación I-EXPLORATION dispersa I-EXPLORATION y I-EXPLORATION parcheada I-EXPLORATION del I-EXPLORATION pulmón I-EXPLORATION izquierdo I-EXPLORATION así I-EXPLORATION como I-EXPLORATION perihiliar I-EXPLORATION y I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION medio I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Teniendo I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION el I-EXPLORATION patrón I-EXPLORATION radiológico I-EXPLORATION en I-EXPLORATION la I-EXPLORATION TCAR I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exposición I-EXPLORATION a I-EXPLORATION agentes I-EXPLORATION tóxicos I-EXPLORATION inhalados, I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION se I-EXPLORATION reduce I-EXPLORATION a I-EXPLORATION PAP I-EXPLORATION y I-EXPLORATION a I-EXPLORATION neumonía I-EXPLORATION lipoidea. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION entonces I-EXPLORATION fibrobroncoscopia I-EXPLORATION con I-EXPLORATION BAL, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION resulta I-EXPLORATION concluyente, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION completa I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION transbronquial; I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION ultraestructural I-EXPLORATION identifica I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION de I-EXPLORATION los I-EXPLORATION alvéolos I-EXPLORATION un I-EXPLORATION material I-EXPLORATION granular I-EXPLORATION amorfo I-EXPLORATION eosinófilo I-EXPLORATION PAS I-EXPLORATION positivo I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION alveolar I-EXPLORATION algún I-EXPLORATION lipófago I-EXPLORATION con I-EXPLORATION microvacuolas, I-EXPLORATION llegando I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION PAP. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO con I-DERIVED_FROM/TO disminución I-DERIVED_FROM/TO del I-DERIVED_FROM/TO nivel I-DERIVED_FROM/TO de I-DERIVED_FROM/TO conciencia I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO consumo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO heroína I-DERIVED_FROM/TO con I-DERIVED_FROM/TO depresión I-DERIVED_FROM/TO respiratoria I-DERIVED_FROM/TO (presión I-DERIVED_FROM/TO parcial I-DERIVED_FROM/TO de I-DERIVED_FROM/TO O2 I-DERIVED_FROM/TO en I-DERIVED_FROM/TO sangre I-DERIVED_FROM/TO arterial: I-DERIVED_FROM/TO 73 I-DERIVED_FROM/TO mmHg I-DERIVED_FROM/TO con I-DERIVED_FROM/TO fracción I-DERIVED_FROM/TO de I-DERIVED_FROM/TO oxígeno I-DERIVED_FROM/TO inspirado I-DERIVED_FROM/TO del I-DERIVED_FROM/TO 50%), I-DERIVED_FROM/TO que I-DERIVED_FROM/TO revierte I-DERIVED_FROM/TO tras I-DERIVED_FROM/TO la I-DERIVED_FROM/TO oxigenoterapia I-DERIVED_FROM/TO y I-DERIVED_FROM/TO naloxona. I-DERIVED_FROM/TO Presenta I-DERIVED_FROM/TO tumefacción I-DERIVED_FROM/TO de I-DERIVED_FROM/TO brazo I-DERIVED_FROM/TO y I-DERIVED_FROM/TO glúteo I-DERIVED_FROM/TO derechos I-DERIVED_FROM/TO y I-DERIVED_FROM/TO anuria. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacan I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION datos: I-EXPLORATION GOT: I-EXPLORATION 1.212 I-EXPLORATION UI/l, I-EXPLORATION GPT: I-EXPLORATION 343 I-EXPLORATION UI/l, I-EXPLORATION CPK I-EXPLORATION a I-EXPLORATION las I-EXPLORATION pocas I-EXPLORATION horas I-EXPLORATION del I-EXPLORATION ingreso: I-EXPLORATION 47.876 I-EXPLORATION UI/l, I-EXPLORATION creatinina: I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION potasio: I-EXPLORATION 6, I-EXPLORATION 1 I-EXPLORATION mmol/l. I-EXPLORATION A I-EXPLORATION tenor I-EXPLORATION de I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION se I-EXPLORATION diagnostica I-EXPLORATION de I-EXPLORATION posible I-EXPLORATION síndrome I-EXPLORATION compartimental I-EXPLORATION con I-EXPLORATION rabdomiolisis I-EXPLORATION e I-EXPLORATION IRA I-EXPLORATION secundaria. I-EXPLORATION Se B-TREATMENT decide I-TREATMENT su I-TREATMENT paso I-TREATMENT a I-TREATMENT quirófano I-TREATMENT donde I-TREATMENT se I-TREATMENT realizan I-TREATMENT fasciotomías I-TREATMENT de I-TREATMENT tríceps I-TREATMENT y I-TREATMENT glúteo I-TREATMENT derechos, I-TREATMENT se I-TREATMENT inicia I-TREATMENT perfusión I-TREATMENT de I-TREATMENT dopamina I-TREATMENT a I-TREATMENT dosis I-TREATMENT pre-ß, I-TREATMENT manitol I-TREATMENT a I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT g/kg I-TREATMENT y I-TREATMENT corrección I-TREATMENT de I-TREATMENT la I-TREATMENT hiperpotasemia I-TREATMENT con I-TREATMENT la I-TREATMENT terapia I-TREATMENT habitual: I-TREATMENT sueros I-TREATMENT glucosados I-TREATMENT con I-TREATMENT insulina I-TREATMENT y I-TREATMENT bicarbonato. I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION presenta I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION edema I-EVOLUTION agudo I-EVOLUTION de I-EVOLUTION pulmón I-EVOLUTION por I-EVOLUTION sobrecarga I-EVOLUTION hídrica I-EVOLUTION que I-EVOLUTION responde I-EVOLUTION bien I-EVOLUTION al I-EVOLUTION tratamiento. I-EVOLUTION Es I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION secuelas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 76 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cardiología I-PRESENT_ILLNESS por I-PRESENT_ILLNESS infarto I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miocardio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS localización I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS complicado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS cardiaca. I-PRESENT_ILLNESS Se B-TREATMENT decide I-TREATMENT la I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT catéter I-TREATMENT venoso I-TREATMENT central I-TREATMENT accediendo I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT subclavia I-TREATMENT derecha. I-TREATMENT I-TREATMENT La B-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION de I-EXPLORATION control I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION anómalo I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION que I-EXPLORATION desciende I-EXPLORATION por I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION derecho I-EXPLORATION del I-EXPLORATION mediastino I-EXPLORATION para I-EXPLORATION desviarse I-EXPLORATION posteriormente I-EXPLORATION siguiendo I-EXPLORATION un I-EXPLORATION perfil I-EXPLORATION cardiaco I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION objetivo I-EXPLORATION de I-EXPLORATION descartar I-EXPLORATION la I-EXPLORATION canulación I-EXPLORATION de I-EXPLORATION un I-EXPLORATION vaso I-EXPLORATION arterial I-EXPLORATION (subclavia I-EXPLORATION o I-EXPLORATION carótida I-EXPLORATION común I-EXPLORATION derechas), I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION gasometría I-EXPLORATION (pH: I-EXPLORATION 7, I-EXPLORATION 35, I-EXPLORATION pO2: I-EXPLORATION 40, I-EXPLORATION pCO2: I-EXPLORATION 48) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION registra I-EXPLORATION la I-EXPLORATION curva I-EXPLORATION de I-EXPLORATION presión I-EXPLORATION intraluminal I-EXPLORATION (15 I-EXPLORATION mmHg). I-EXPLORATION Ambas I-EXPLORATION demuestran I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION flujo I-EXPLORATION venoso I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía. I-EXPLORATION I-EXPLORATION A B-TREATMENT continuación, I-TREATMENT se I-TREATMENT implanta I-TREATMENT un I-TREATMENT catéter I-TREATMENT de I-TREATMENT Swan-Ganz I-TREATMENT en I-TREATMENT la I-TREATMENT rama I-TREATMENT principal I-TREATMENT derecha I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT pulmonar, I-TREATMENT también I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT subclavia I-TREATMENT derecha. I-TREATMENT Se B-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION coronario I-EXPLORATION (diámetro I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm). I-EXPLORATION En I-EXPLORATION el I-EXPLORATION interior I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION coronario I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION el I-EXPLORATION catéter I-EXPLORATION abocando I-EXPLORATION a I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha, I-EXPLORATION al I-EXPLORATION ventrículo I-EXPLORATION derecho I-EXPLORATION y, I-EXPLORATION finalmente, I-EXPLORATION a I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar. I-EXPLORATION Ninguna I-EXPLORATION otra I-EXPLORATION vena I-EXPLORATION conecta I-EXPLORATION con I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION Todos I-EXPLORATION estos I-EXPLORATION datos I-EXPLORATION son I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION una I-EXPLORATION malformación I-EXPLORATION venosa I-EXPLORATION que I-EXPLORATION consiste I-EXPLORATION en I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION VCSI I-EXPLORATION con I-EXPLORATION desembocadura I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION coronario, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION permeabilidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anastomosis I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION sistema I-EXPLORATION venoso I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION el I-EXPLORATION izquierdo. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 89 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY aurícular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY EPOC, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS cutaneomucosa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS coluria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS astenia. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION palpaba I-EXPLORATION zona I-EXPLORATION indurada I-EXPLORATION no I-EXPLORATION dolorosa I-EXPLORATION en I-EXPLORATION epigastrio I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION irrelevante. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION destacaban I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION parámetros: I-EXPLORATION bilirrubina I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 88 I-EXPLORATION mg/dl I-EXPLORATION (rango, I-EXPLORATION 0, I-EXPLORATION 1-1), I-EXPLORATION bilirrubina I-EXPLORATION directa I-EXPLORATION de I-EXPLORATION 9, I-EXPLORATION 92 I-EXPLORATION mg/dl I-EXPLORATION (rango, I-EXPLORATION 0, I-EXPLORATION 01-0, I-EXPLORATION 25), I-EXPLORATION AST I-EXPLORATION de I-EXPLORATION 244 I-EXPLORATION U/L I-EXPLORATION (rango, I-EXPLORATION 5-35), I-EXPLORATION ALT I-EXPLORATION de I-EXPLORATION 272 I-EXPLORATION U/L I-EXPLORATION (rango, I-EXPLORATION 5-44), I-EXPLORATION GGT I-EXPLORATION de I-EXPLORATION 420 I-EXPLORATION U/L I-EXPLORATION (rango, I-EXPLORATION 5-46) I-EXPLORATION y I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION de I-EXPLORATION 1.926 I-EXPLORATION U/L I-EXPLORATION (rango, I-EXPLORATION 90-360) I-EXPLORATION con I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION parámetros I-EXPLORATION bioquímicos, I-EXPLORATION incluidos I-EXPLORATION amilasa I-EXPLORATION y I-EXPLORATION lipasa, I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION urgencia, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION voluminosa I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION pancreática, I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION quístico I-EXPLORATION multitabicada I-EXPLORATION y I-EXPLORATION de I-EXPLORATION contornos I-EXPLORATION lobulados, I-EXPLORATION con I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION principal I-EXPLORATION y I-EXPLORATION las I-EXPLORATION vías I-EXPLORATION biliares I-EXPLORATION intrahepáticas. I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION del I-EXPLORATION páncreas, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION multiquístico I-EXPLORATION con I-EXPLORATION tabiques I-EXPLORATION y I-EXPLORATION calcificaciones I-EXPLORATION «en I-EXPLORATION puesta I-EXPLORATION de I-EXPLORATION sol», I-EXPLORATION que I-EXPLORATION provocaba I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION y I-EXPLORATION de I-EXPLORATION Wirsung; I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION cistoadenoma I-EXPLORATION seroso I-EXPLORATION pancreático. I-EXPLORATION Además I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION biliar I-EXPLORATION muy I-EXPLORATION distendida I-EXPLORATION y I-EXPLORATION marcada I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática I-EXPLORATION y I-EXPLORATION del I-EXPLORATION colédoco. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT edad I-TREATMENT y I-TREATMENT los I-TREATMENT antecedentes I-TREATMENT personales I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT fue I-TREATMENT considerada I-TREATMENT subsidiaria I-TREATMENT de I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT y B-EXPLORATION se I-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION colangiopancreatografía I-EXPLORATION retrógrada I-EXPLORATION endoscópica I-EXPLORATION (CPRE). I-EXPLORATION Al I-EXPLORATION realizar I-EXPLORATION la I-EXPLORATION CPRE I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION cierta I-EXPLORATION dificultad I-EXPLORATION de I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION rodilla I-EXPLORATION duodenal I-EXPLORATION superior, I-EXPLORATION en I-EXPLORATION probable I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION compresión I-EXPLORATION por I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION primaria I-EXPLORATION pancreática. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION colangiografía I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION colédoco I-EXPLORATION proximal I-EXPLORATION con I-EXPLORATION estenosis I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 3-4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud. I-EXPLORATION Se B-TREATMENT colocó I-TREATMENT una I-TREATMENT prótesis I-TREATMENT biliar I-TREATMENT metálica I-TREATMENT autoexpandible I-TREATMENT tipo I-TREATMENT Wallstent I-TREATMENT (Boston I-TREATMENT Scientific, I-TREATMENT Natick, I-TREATMENT MA, I-TREATMENT USA) I-TREATMENT de I-TREATMENT 8 I-TREATMENT cm I-TREATMENT de I-TREATMENT longitud I-TREATMENT y I-TREATMENT 1 I-TREATMENT cm I-TREATMENT de I-TREATMENT calibre I-TREATMENT sin I-TREATMENT incidencias, I-TREATMENT comprobando I-TREATMENT la I-TREATMENT correcta I-TREATMENT colocación I-TREATMENT y I-TREATMENT drenaje I-TREATMENT posterior. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION progresiva I-EVOLUTION despigmentación I-EVOLUTION cutaneomucosa I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION de I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION bilirrubina. I-EVOLUTION Finalmente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 69 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Guinea I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY llevaba I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY mes I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY España. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS atención I-PRESENT_ILLNESS primaria I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tiempo I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración, I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS mialgias, I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS se I-PRESENT_ILLNESS objetiva I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta). I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION remiten I-EXPLORATION muestras I-EXPLORATION al I-EXPLORATION laboratorio I-EXPLORATION para I-EXPLORATION bioquímica I-EXPLORATION básica I-EXPLORATION y I-EXPLORATION hemograma. I-EXPLORATION Sólo I-EXPLORATION son I-EXPLORATION destacables I-EXPLORATION una I-EXPLORATION ligera I-EXPLORATION anemia I-EXPLORATION 11, I-EXPLORATION 3 I-EXPLORATION g/dL I-EXPLORATION de I-EXPLORATION hemoglobina I-EXPLORATION y I-EXPLORATION eosinofilia I-EXPLORATION 2, I-EXPLORATION 6*1.000/ml. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION revisión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION teñida I-EXPLORATION con I-EXPLORATION Giemsa I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION microfilarias I-EXPLORATION envainadas. I-EXPLORATION B-EVOLUTION Dadas I-EVOLUTION las I-EVOLUTION diferencias I-EVOLUTION de I-EVOLUTION periodicidad I-EVOLUTION de I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION las I-EVOLUTION microfilarias I-EVOLUTION en I-EVOLUTION sangre I-EVOLUTION periférica I-EVOLUTION (diurna I-EVOLUTION y I-EVOLUTION nocturna), I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION ingresar I-EVOLUTION a I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION para I-EVOLUTION tomar I-EVOLUTION una I-EVOLUTION segunda I-EVOLUTION muestra I-EVOLUTION de I-EVOLUTION sangre I-EVOLUTION que I-EVOLUTION confirmase I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION filariasis. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION segunda I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica, I-EXPLORATION tras I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION Knott I-EXPLORATION y I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION Giemsa, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION microfilarias I-EXPLORATION envainadas I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION envainar. I-EXPLORATION I-EXPLORATION Se B-DERIVED_FROM/TO remitió I-DERIVED_FROM/TO la I-DERIVED_FROM/TO muestra I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Centro I-DERIVED_FROM/TO Nacional I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Microbiología, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO identificaron I-DERIVED_FROM/TO como I-DERIVED_FROM/TO Loa I-DERIVED_FROM/TO loa I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Mansonella I-DERIVED_FROM/TO perstans. I-DERIVED_FROM/TO Se B-TREATMENT inició I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT dietilcarbamicina I-TREATMENT 6 I-TREATMENT mg I-TREATMENT en I-TREATMENT dosis I-TREATMENT única I-TREATMENT y I-TREATMENT 100 I-TREATMENT mg I-TREATMENT de I-TREATMENT mebendazol I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 30 I-TREATMENT días I-TREATMENT bajo I-TREATMENT supervisión I-TREATMENT médica I-TREATMENT los I-TREATMENT primeros I-TREATMENT días I-TREATMENT en I-TREATMENT previsión I-TREATMENT de I-TREATMENT una I-TREATMENT posible I-TREATMENT reacción I-TREATMENT de I-TREATMENT Herxheimer. I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION buena, I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cifra I-EVOLUTION de I-EVOLUTION eosinófilos, I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION prurito I-EVOLUTION y I-EVOLUTION desaparición I-EVOLUTION de I-EVOLUTION las I-EVOLUTION microfilarias I-EVOLUTION en I-EVOLUTION sangre I-EVOLUTION periférica. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS no B-PAST_MEDICAL_HISTORY fumador. I-PAST_MEDICAL_HISTORY Como I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY hospitalarios I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY intoxicación I-PAST_MEDICAL_HISTORY aguda I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY organofosforados. I-PAST_MEDICAL_HISTORY Aporta I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY informes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY reconocimientos I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY periódicos I-PAST_MEDICAL_HISTORY realizados I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 23 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY trabajado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY empresa I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fabricaba I-PAST_MEDICAL_HISTORY diversos I-PAST_MEDICAL_HISTORY productos I-PAST_MEDICAL_HISTORY fitosanitarios I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY obtención I-PAST_MEDICAL_HISTORY empleaba I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY amplio I-PAST_MEDICAL_HISTORY número I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY disolventes I-PAST_MEDICAL_HISTORY orgánicos, I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY ellos I-PAST_MEDICAL_HISTORY acetona, I-PAST_MEDICAL_HISTORY acetofenona, I-PAST_MEDICAL_HISTORY ciclohexanona, I-PAST_MEDICAL_HISTORY nafta, I-PAST_MEDICAL_HISTORY tolueno I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY xileno, I-PAST_MEDICAL_HISTORY donde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY único I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY específico I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY esporádicamente I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY exposición I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY organofosforados I-PAST_MEDICAL_HISTORY (determinación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY acetilcolinesterasa I-PAST_MEDICAL_HISTORY intraeritrocitaria), I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nefropatías, I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY analíticas I-PAST_MEDICAL_HISTORY generales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sangre I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY orina I-PAST_MEDICAL_HISTORY son I-PAST_MEDICAL_HISTORY normales, I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY tensiones I-PAST_MEDICAL_HISTORY arteriales I-PAST_MEDICAL_HISTORY oscilan I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 100/60 I-PAST_MEDICAL_HISTORY mm/Hg I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY 120/80 I-PAST_MEDICAL_HISTORY mm/Hg. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY uno I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY reconocimientos I-PAST_MEDICAL_HISTORY realizados I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY detectó I-PAST_MEDICAL_HISTORY proteinuria I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY microhematuria, I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY sérica I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY 06 I-PAST_MEDICAL_HISTORY mg/dl; I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nuevo I-PAST_MEDICAL_HISTORY reconocimiento I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY siguiente I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY 43 I-PAST_MEDICAL_HISTORY mg/dl, I-PAST_MEDICAL_HISTORY hematuria I-PAST_MEDICAL_HISTORY (10 I-PAST_MEDICAL_HISTORY hematíes/campo), I-PAST_MEDICAL_HISTORY proteinuria I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY g/día. I-PAST_MEDICAL_HISTORY Hace B-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS glomerulonefritis I-PRESENT_ILLNESS proliferativa I-PRESENT_ILLNESS mesangial I-PRESENT_ILLNESS difusa I-PRESENT_ILLNESS con I-PRESENT_ILLNESS depósitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS IgA. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION 20% I-EXPLORATION de I-EXPLORATION glomérulos I-EXPLORATION con I-EXPLORATION esclerosis I-EXPLORATION severa, I-EXPLORATION un I-EXPLORATION 10% I-EXPLORATION estaban I-EXPLORATION obliterados, I-EXPLORATION había I-EXPLORATION una I-EXPLORATION fibrosis I-EXPLORATION intersticial, I-EXPLORATION atrofia I-EXPLORATION tubular, I-EXPLORATION discreto I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION crónico I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION inmunofluorescencia I-EXPLORATION se I-EXPLORATION detectaban I-EXPLORATION depósitos I-EXPLORATION mesangiales I-EXPLORATION difusos I-EXPLORATION de I-EXPLORATION IgA I-EXPLORATION y I-EXPLORATION C3; I-EXPLORATION a B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION ello, I-EVOLUTION siguió I-EVOLUTION trabajando I-EVOLUTION hasta I-EVOLUTION hace I-EVOLUTION un I-EVOLUTION año, I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION diagnosticado I-EVOLUTION de I-EVOLUTION una I-EVOLUTION enfermedad I-EVOLUTION renal I-EVOLUTION crónica I-EVOLUTION de I-EVOLUTION grado I-EVOLUTION 3. I-EVOLUTION I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION de I-EVOLUTION las I-EVOLUTION analíticas I-EVOLUTION renales, I-EVOLUTION realizadas I-EVOLUTION cada I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION desde I-EVOLUTION que I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION vienen I-EVOLUTION expresadas I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tabla I-EVOLUTION 2. I-EVOLUTION Las I-EVOLUTION determinaciones I-EVOLUTION puntuales I-EVOLUTION de I-EVOLUTION beta I-EVOLUTION 2-microglobulina I-EVOLUTION y I-EVOLUTION NAG I-EVOLUTION urinarios I-EVOLUTION se I-EVOLUTION encontraban I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION normalidad. I-EVOLUTION Después I-EVOLUTION de I-EVOLUTION un I-EVOLUTION año I-EVOLUTION de I-EVOLUTION haber I-EVOLUTION cesado I-EVOLUTION su I-EVOLUTION actividad I-EVOLUTION laboral I-EVOLUTION la I-EVOLUTION proteinuria I-EVOLUTION y I-EVOLUTION la I-EVOLUTION hematuria I-EVOLUTION se I-EVOLUTION normalizaron I-EVOLUTION pero I-EVOLUTION la I-EVOLUTION creatinina I-EVOLUTION sérica I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION 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 74 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY conocidas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bronquitis I-PAST_MEDICAL_HISTORY asmática, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY portadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY marcapasos I-PAST_MEDICAL_HISTORY (desde I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años), I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY quirúrgicamente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY prótesis I-PAST_MEDICAL_HISTORY valvular I-PAST_MEDICAL_HISTORY mitral I-PAST_MEDICAL_HISTORY (hacía I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mama I-PAST_MEDICAL_HISTORY (dieciocho I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes). I-PAST_MEDICAL_HISTORY Seguía B-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS habitual I-PRESENT_ILLNESS con I-PRESENT_ILLNESS acenocumarol, I-PRESENT_ILLNESS furosemida, I-PRESENT_ILLNESS bisoprolol, I-PRESENT_ILLNESS espironolactona, I-PRESENT_ILLNESS enalapril, I-PRESENT_ILLNESS pantoprazol I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hierro I-PRESENT_ILLNESS oral. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS clínica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS occipital I-PRESENT_ILLNESS unilateral, I-PRESENT_ILLNESS irradiada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS frontal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS temporal, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS opresivo, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS cedía I-PRESENT_ILLNESS con I-PRESENT_ILLNESS analgésicos I-PRESENT_ILLNESS habituales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS hiporexia, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS ponderal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS Kg I-PRESENT_ILLNESS y I-PRESENT_ILLNESS claudicación I-PRESENT_ILLNESS mandibular I-PRESENT_ILLNESS intermitente. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION destacaba I-EXPLORATION palidez I-EXPLORATION de I-EXPLORATION mucosas. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenopatías. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION como I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION craneal. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION no I-EXPLORATION existía I-EXPLORATION anemia I-EXPLORATION y I-EXPLORATION sí I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION neutrofilia. I-EXPLORATION Asimismo I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION glucemia I-EXPLORATION de I-EXPLORATION 128 I-EXPLORATION mg/dl. I-EXPLORATION La I-EXPLORATION PCR I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 99 I-EXPLORATION mg/dl. I-EXPLORATION La I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION (VSG) I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 83 I-EXPLORATION mm I-EXPLORATION (en I-EXPLORATION la I-EXPLORATION 1a I-EXPLORATION hora). I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION otras I-EXPLORATION alteraciones I-EXPLORATION analíticas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION craneal I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION lesiones I-EXPLORATION ocupantes I-EXPLORATION de I-EXPLORATION espacio I-EXPLORATION y I-EXPLORATION sí I-EXPLORATION una I-EXPLORATION hiperostosis I-EXPLORATION cortical I-EXPLORATION frontoparietal I-EXPLORATION interna. I-EXPLORATION Con B-TREATMENT la I-TREATMENT sospecha I-TREATMENT inicial I-TREATMENT de I-TREATMENT arteritis I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT temporal, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT corticoideo I-TREATMENT con I-TREATMENT metilprednisolona I-TREATMENT a I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT 1 I-TREATMENT mg/Kg I-TREATMENT vía I-TREATMENT oral, I-TREATMENT mejorando I-TREATMENT la I-TREATMENT clínica I-TREATMENT inicial. I-TREATMENT Tres B-EXPLORATION días I-EXPLORATION después I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION temporal, I-EXPLORATION confirmándose I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION cuarenta I-EVOLUTION y I-EVOLUTION ocho I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION dicha I-EVOLUTION biopsia, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION dolor I-EVOLUTION intenso I-EVOLUTION en I-EVOLUTION la I-EVOLUTION lengua, I-EVOLUTION con I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION lesión I-EVOLUTION ulcerada I-EVOLUTION en I-EVOLUTION hemilengua I-EVOLUTION derecha, I-EVOLUTION realizándose B-EXPLORATION cultivos I-EXPLORATION microbiológicos, I-EXPLORATION siendo I-EXPLORATION negativos, I-EXPLORATION TC I-EXPLORATION cervical, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION hemilengua I-EXPLORATION derecha I-EXPLORATION sin I-EXPLORATION adenopatías I-EXPLORATION y I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION de I-EXPLORATION etiología I-EXPLORATION isquémica. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION resolviéndose I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION lingual I-EVOLUTION espontáneamente, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION para I-EVOLUTION realizar I-EVOLUTION seguimiento I-EVOLUTION y I-EVOLUTION control I-EVOLUTION de I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION externas. I-EVOLUTION I-EVOLUTION Dos I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION debilidad I-EVOLUTION en I-EVOLUTION hemicuerpo I-EVOLUTION derecho I-EVOLUTION y I-EVOLUTION alteración I-EVOLUTION del I-EVOLUTION lenguaje. I-EVOLUTION A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION hemiparesia I-EXPLORATION derecha I-EXPLORATION (balance I-EXPLORATION motor I-EXPLORATION de I-EXPLORATION extremidad I-EXPLORATION superior I-EXPLORATION 3-/5 I-EXPLORATION y I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION 2/5), I-EXPLORATION afasia I-EXPLORATION global, I-EXPLORATION paresia I-EXPLORATION facial I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION hemianopsia I-EXPLORATION homónima I-EXPLORATION derecha. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION craneal I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION extenso I-EXPLORATION infarto I-EXPLORATION agudo I-EXPLORATION isquémico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION territorio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION media I-EXPLORATION y I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION posterior I-EXPLORATION izquierdas. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION electrocardiograma I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION ritmo I-EXPLORATION de I-EXPLORATION marcapasos. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION coagulación, I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION INR I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 48. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION otras I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION como I-EXPLORATION angiorresonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral, I-EXPLORATION ecografía-doppler I-EXPLORATION transcraneal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION troncos I-EXPLORATION supraaórticos, I-EXPLORATION ni I-EXPLORATION ecocardiograma I-EXPLORATION (transtorácico I-EXPLORATION ni I-EXPLORATION transesofágico). I-EXPLORATION La B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO un I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO larga I-DERIVED_FROM/TO estancia I-DERIVED_FROM/TO para I-DERIVED_FROM/TO realización I-DERIVED_FROM/TO de I-DERIVED_FROM/TO rehabilitación I-DERIVED_FROM/TO intensiva. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 77 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS disartria, I-PRESENT_ILLNESS disfasia I-PRESENT_ILLNESS expresiva, I-PRESENT_ILLNESS hemiparesia I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deterioro I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia. I-PRESENT_ILLNESS Fue B-PAST_MEDICAL_HISTORY informado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY esencial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY miligramos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY captopril I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY horas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aspirina I-PAST_MEDICAL_HISTORY 100 I-PAST_MEDICAL_HISTORY miligramos I-PAST_MEDICAL_HISTORY diarios. I-PAST_MEDICAL_HISTORY Adicionalmente, I-PAST_MEDICAL_HISTORY informaron I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY occipital I-PAST_MEDICAL_HISTORY cerrado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY transitoria I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conciencia, I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY tropezar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY caer; I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY embargo, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY aquel I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY acudió I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY atención I-PAST_MEDICAL_HISTORY médica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION presentaba I-EXPLORATION intensa I-EXPLORATION agitación I-EXPLORATION motora, I-EXPLORATION con I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION 175/98 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION Hg, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 96 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION de I-EXPLORATION 20/minuto I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 36, I-EXPLORATION 4 I-EXPLORATION grados I-EXPLORATION centígrados. I-EXPLORATION Se I-EXPLORATION encontró I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION excoriación I-EXPLORATION superficial I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION cicatrización I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION parieto-occipital I-EXPLORATION izquierda. I-EXPLORATION Las I-EXPLORATION pupilas I-EXPLORATION eran I-EXPLORATION iguales I-EXPLORATION y I-EXPLORATION reaccionaban I-EXPLORATION simétricamente I-EXPLORATION al I-EXPLORATION reflejo I-EXPLORATION foto-motor I-EXPLORATION directo I-EXPLORATION y I-EXPLORATION consensual. I-EXPLORATION Al I-EXPLORATION realizar I-EXPLORATION estímulos I-EXPLORATION dolorosos, I-EXPLORATION realizaba I-EXPLORATION apertura I-EXPLORATION ocular, I-EXPLORATION emitía I-EXPLORATION palabras I-EXPLORATION y I-EXPLORATION localizaba I-EXPLORATION el I-EXPLORATION sitio I-EXPLORATION estimulado, I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION con I-EXPLORATION hemiparesia I-EXPLORATION derecha I-EXPLORATION (Escala I-EXPLORATION de I-EXPLORATION coma I-EXPLORATION de I-EXPLORATION Glasgow: I-EXPLORATION 10/15). I-EXPLORATION El I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Babinski I-EXPLORATION estaba I-EXPLORATION presente I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION bilateral. I-EXPLORATION I-EXPLORATION Fue I-EXPLORATION realizado I-EXPLORATION un I-EXPLORATION escáner I-EXPLORATION cerebral I-EXPLORATION de I-EXPLORATION urgencia, I-EXPLORATION previa B-TREATMENT administración I-TREATMENT de I-TREATMENT haloperidol I-TREATMENT para I-TREATMENT disminuir I-TREATMENT la I-TREATMENT agitación, I-TREATMENT la B-EVOLUTION cual I-EVOLUTION tuvo I-EVOLUTION pobre I-EVOLUTION calidad I-EVOLUTION técnica I-EVOLUTION dada I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION los I-EVOLUTION movimientos I-EVOLUTION del I-EVOLUTION paciente. I-EVOLUTION En B-EXPLORATION dicho I-EXPLORATION estudio, I-EXPLORATION fue I-EXPLORATION observada I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION extra-axial, I-EXPLORATION hiperdensa I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION al I-EXPLORATION parénquima I-EXPLORATION cerebral, I-EXPLORATION con I-EXPLORATION forma I-EXPLORATION semilunar I-EXPLORATION de I-EXPLORATION concavidad I-EXPLORATION medial I-EXPLORATION de I-EXPLORATION 17 I-EXPLORATION milímetros I-EXPLORATION de I-EXPLORATION espesor, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION frontal, I-EXPLORATION parietal I-EXPLORATION y I-EXPLORATION occipital I-EXPLORATION izquierda, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION desviaba I-EXPLORATION las I-EXPLORATION estructuras I-EXPLORATION de I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION en I-EXPLORATION 14 I-EXPLORATION milímetros, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION parecía I-EXPLORATION corresponder I-EXPLORATION con I-EXPLORATION un I-EXPLORATION hematoma I-EXPLORATION subdural. I-EXPLORATION La I-EXPLORATION magnitud I-EXPLORATION desproporcionada I-EXPLORATION del I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION y I-EXPLORATION el I-EXPLORATION edema I-EXPLORATION adyacente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION alertaron I-EXPLORATION sobre I-EXPLORATION las I-EXPLORATION posibles I-EXPLORATION características I-EXPLORATION neoplásicas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION demostró I-EXPLORATION una I-EXPLORATION imagen, I-EXPLORATION extra-axial, I-EXPLORATION hiperdensa I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION al I-EXPLORATION parénquima I-EXPLORATION cerebral, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION dorso-lateral I-EXPLORATION fronto-temporo-parietal I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION intensa I-EXPLORATION captación I-EXPLORATION del I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION endovenoso, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION infiltraba I-EXPLORATION la I-EXPLORATION profundidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION surcos I-EXPLORATION cerebrales I-EXPLORATION frontales. I-EXPLORATION Adicionalmente, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ventana I-EXPLORATION ósea I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION adelgazamiento I-EXPLORATION del I-EXPLORATION cráneo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION temporo-parietal I-EXPLORATION izquierda I-EXPLORATION a I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT craneotomía I-TREATMENT fronto-parietal I-TREATMENT izquierda I-TREATMENT durante I-TREATMENT la I-TREATMENT cual I-TREATMENT se I-TREATMENT encontró I-TREATMENT el I-TREATMENT hueso I-TREATMENT erosionado I-TREATMENT e I-TREATMENT infiltrado I-TREATMENT por I-TREATMENT una I-TREATMENT lesión I-TREATMENT violácea, I-TREATMENT firme, I-TREATMENT muy I-TREATMENT vascularizada, I-TREATMENT la I-TREATMENT cual I-TREATMENT se I-TREATMENT extendía I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT duramadre, I-TREATMENT llegando I-TREATMENT a I-TREATMENT las I-TREATMENT leptomeninges, I-TREATMENT infiltrándolas I-TREATMENT y I-TREATMENT más I-TREATMENT profundamente I-TREATMENT al I-TREATMENT parénquima I-TREATMENT cerebral I-TREATMENT de I-TREATMENT la I-TREATMENT región I-TREATMENT frontal, I-TREATMENT temporal I-TREATMENT y I-TREATMENT parietal. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT resección I-TREATMENT parcial, I-TREATMENT dejando I-TREATMENT material I-TREATMENT anormal I-TREATMENT adherido I-TREATMENT a I-TREATMENT la I-TREATMENT superficie I-TREATMENT cerebral. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION de I-EVOLUTION conciencia, I-EVOLUTION alcanzando I-EVOLUTION a I-EVOLUTION estar I-EVOLUTION alerta, I-EVOLUTION con I-EVOLUTION notable I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fuerza I-EVOLUTION muscular I-EVOLUTION en I-EVOLUTION el I-EVOLUTION lado I-EVOLUTION derecho, I-EVOLUTION aunque I-EVOLUTION con I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION disfasia I-EVOLUTION sensitiva. I-EVOLUTION I-EVOLUTION Ante B-EXPLORATION la I-EXPLORATION impresión I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION una I-EXPLORATION metástasis I-EXPLORATION meníngea I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION primario I-EXPLORATION desconocido I-EXPLORATION fueron I-EXPLORATION solicitadas I-EXPLORATION tomografía I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION cuales I-EXPLORATION solo I-EXPLORATION se I-EXPLORATION documento I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION la I-EXPLORATION próstata. I-EXPLORATION Al I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION prostático I-EXPLORATION pétreo I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION indefinidos I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION El I-EXPLORATION antígeno I-EXPLORATION prostático I-EXPLORATION específico I-EXPLORATION sérico I-EXPLORATION obtenido I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 588 I-EXPLORATION ng/dL, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION próstata I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION demostró I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION pobremente I-EXPLORATION diferenciado. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION intracraneal I-EXPLORATION también I-EXPLORATION correspondió I-EXPLORATION a I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION metastásico I-EXPLORATION pobremente I-EXPLORATION diferenciado. I-EXPLORATION I-EXPLORATION Por B-TREATMENT deseo I-TREATMENT de I-TREATMENT sus I-TREATMENT familiares, I-TREATMENT el I-TREATMENT paciente I-TREATMENT no I-TREATMENT fue I-TREATMENT sometido I-TREATMENT a I-TREATMENT ningún I-TREATMENT tratamiento I-TREATMENT oncológico I-TREATMENT complementario I-TREATMENT y B-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con B-TREATMENT cuidados I-TREATMENT ambulatorios I-TREATMENT paliativos. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 75 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS curso I-PRESENT_ILLNESS lentamente I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS describe I-PRESENT_ILLNESS como I-PRESENT_ILLNESS «pinchazos» I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS puntas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dedos, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS «acorchamiento», I-PRESENT_ILLNESS que I-PRESENT_ILLNESS inicialmente I-PRESENT_ILLNESS notaba I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS manos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tacto, I-PRESENT_ILLNESS pero I-PRESENT_ILLNESS que, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS último I-PRESENT_ILLNESS mes, I-PRESENT_ILLNESS también I-PRESENT_ILLNESS afecta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS pies. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION neurológica, I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION hipoestesia I-EXPLORATION táctil I-EXPLORATION con I-EXPLORATION distribución I-EXPLORATION en I-EXPLORATION «guante» I-EXPLORATION y I-EXPLORATION «calcetín», I-EXPLORATION apalestesia I-EXPLORATION maleolar I-EXPLORATION e I-EXPLORATION hipopalestesia I-EXPLORATION en I-EXPLORATION crestas I-EXPLORATION tibiales I-EXPLORATION y I-EXPLORATION codos. I-EXPLORATION Los I-EXPLORATION reflejos I-EXPLORATION estaban I-EXPLORATION presentes I-EXPLORATION y I-EXPLORATION eran I-EXPLORATION simétricos. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION parestesias, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensibilidad I-EXPLORATION vibratoria I-EXPLORATION y I-EXPLORATION preservación I-EXPLORATION de I-EXPLORATION reflejos I-EXPLORATION en I-EXPLORATION las I-EXPLORATION exploración I-EXPLORATION neurológica, I-EXPLORATION obliga I-EXPLORATION a I-EXPLORATION considerar I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION sufra I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION medular I-EXPLORATION cervical I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cordones I-EXPLORATION posteriores. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION analítica I-EXPLORATION (incluyendo I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12), I-EXPLORATION una I-EXPLORATION RM I-EXPLORATION cervical I-EXPLORATION y I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION neurofisiológico. I-EXPLORATION I-EXPLORATION La I-EXPLORATION RM I-EXPLORATION cervical I-EXPLORATION (Magnetom-Trio, I-EXPLORATION Siemens, I-EXPLORATION Erlangen, I-EXPLORATION Germany) I-EXPLORATION mostró I-EXPLORATION en I-EXPLORATION secuencias I-EXPLORATION potenciadas I-EXPLORATION en I-EXPLORATION T2 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION plano I-EXPLORATION sagital I-EXPLORATION una I-EXPLORATION hiperintensidad I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION sin I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cordonal I-EXPLORATION posterior I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION desde I-EXPLORATION C1-C2 I-EXPLORATION a I-EXPLORATION C6-C7. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION cortes I-EXPLORATION axiales I-EXPLORATION y I-EXPLORATION coronales I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION que I-EXPLORATION la I-EXPLORATION afectación I-EXPLORATION era I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION simétrica. I-EXPLORATION Estos I-EXPLORATION hallazgos I-EXPLORATION son I-EXPLORATION característicos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION DCS. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION polineuropatía I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION velocidades I-EXPLORATION de I-EXPLORATION conducción, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION los I-EXPLORATION potenciales I-EXPLORATION evocados I-EXPLORATION somatosensoriales I-EXPLORATION estaban I-EXPLORATION desestructurados I-EXPLORATION y I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION latencias I-EXPLORATION en I-EXPLORATION los I-EXPLORATION cuatro I-EXPLORATION miembros, I-EXPLORATION indicando I-EXPLORATION una I-EXPLORATION afectación I-EXPLORATION cordonal I-EXPLORATION posterior. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION anemia I-EXPLORATION megaloblástica, I-EXPLORATION con I-EXPLORATION 4, I-EXPLORATION 44 I-EXPLORATION 10E12/L I-EXPLORATION de I-EXPLORATION hematíes I-EXPLORATION (4, I-EXPLORATION 7-5, I-EXPLORATION 1 I-EXPLORATION 10E12/L), I-EXPLORATION VCM: I-EXPLORATION 108 I-EXPLORATION fL I-EXPLORATION (80-95 I-EXPLORATION fL) I-EXPLORATION y I-EXPLORATION HCM: I-EXPLORATION 34, I-EXPLORATION 9 I-EXPLORATION pg I-EXPLORATION (27-31 I-EXPLORATION pg), I-EXPLORATION siendo I-EXPLORATION la I-EXPLORATION hemoglobina I-EXPLORATION (15, I-EXPLORATION 5 I-EXPLORATION g/dl) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION hematocrito I-EXPLORATION (47,9%) I-EXPLORATION normales. I-EXPLORATION Los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION en I-EXPLORATION suero I-EXPLORATION fueron I-EXPLORATION de I-EXPLORATION 78 I-EXPLORATION pg/mL I-EXPLORATION (210-930 I-EXPLORATION pg/mL) I-EXPLORATION y I-EXPLORATION los I-EXPLORATION de I-EXPLORATION ácido I-EXPLORATION fólico I-EXPLORATION de I-EXPLORATION 26, I-EXPLORATION 5 I-EXPLORATION ng/mL I-EXPLORATION (2, I-EXPLORATION 2-16, I-EXPLORATION 9 I-EXPLORATION ng/mL), I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION las I-EXPLORATION determinaciones I-EXPLORATION bioquímicas I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION normales. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION células I-EXPLORATION parietales I-EXPLORATION gástricas I-EXPLORATION fueron I-EXPLORATION positivos I-EXPLORATION (1/40), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION los I-EXPLORATION anticuerpos I-EXPLORATION anti-FI I-EXPLORATION (factor I-EXPLORATION intrínseco) I-EXPLORATION (>97, I-EXPLORATION 9; I-EXPLORATION normal: I-EXPLORATION 0-25). I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION gástrica I-EXPLORATION mostró I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION atrófico, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION infiltrado I-EXPLORATION inflamatorio. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT DSC I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratado I-TREATMENT con I-TREATMENT cianocobalamina I-TREATMENT (1.000 I-TREATMENT µ/día I-TREATMENT por I-TREATMENT vía I-TREATMENT intramuscular, I-TREATMENT durante I-TREATMENT dos I-TREATMENT semanas I-TREATMENT y I-TREATMENT después I-TREATMENT mensualmente). I-TREATMENT En B-EVOLUTION los I-EVOLUTION meses I-EVOLUTION siguientes I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION progresiva I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION las I-EVOLUTION alteraciones I-EVOLUTION sensitivas. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refería I-EVOLUTION una I-EVOLUTION leve I-EVOLUTION e I-EVOLUTION inconstante I-EVOLUTION sensación I-EVOLUTION de I-EVOLUTION «hormigueos» I-EVOLUTION en I-EVOLUTION los I-EVOLUTION pies I-EVOLUTION y B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION solo I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION hipopalestesia I-EXPLORATION maleolar. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION resolución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION anemia I-EXPLORATION megaloblásica I-EXPLORATION así I-EXPLORATION como I-EXPLORATION de I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION (438 I-EXPLORATION pg/mL). I-EXPLORATION Una I-EXPLORATION RM I-EXPLORATION medular I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION equipo, I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION completa I-EXPLORATION desaparición I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION intensidad I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION del I-EXPLORATION cordón I-EXPLORATION medular. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY destacan I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial, I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida, 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 con I-PAST_MEDICAL_HISTORY anemia I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hiperparatiroidismo I-PAST_MEDICAL_HISTORY secundarios, I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mama I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY QT I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY RT, I-PAST_MEDICAL_HISTORY valvulopatía I-PAST_MEDICAL_HISTORY mitral I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardiaca, I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular, I-PAST_MEDICAL_HISTORY HTA, I-PAST_MEDICAL_HISTORY DM I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY glaucoma I-PAST_MEDICAL_HISTORY bilateral, I-PAST_MEDICAL_HISTORY colelitiasis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY colecistitis I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematoquecia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS cambios I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ritmo I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS asociados I-PRESENT_ILLNESS y I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS un I-PRESENT_ILLNESS marcado I-PRESENT_ILLNESS empeoramiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS habitual. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION molestia I-EXPLORATION difusa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho, I-EXPLORATION y I-EXPLORATION analíticamente I-EXPLORATION presentaba I-EXPLORATION anemia I-EXPLORATION con I-EXPLORATION Hb I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 3 I-EXPLORATION g/dl I-EXPLORATION (N: I-EXPLORATION 12-16), I-EXPLORATION fibrinógeno I-EXPLORATION de I-EXPLORATION 727 I-EXPLORATION mg/dl I-EXPLORATION (N:150-400), I-EXPLORATION hiperglucemia I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION renal I-EXPLORATION ya I-EXPLORATION conocida I-EXPLORATION con I-EXPLORATION cifra I-EXPLORATION de I-EXPLORATION urea I-EXPLORATION de I-EXPLORATION 148 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 1 I-EXPLORATION mg/dl, I-EXPLORATION ambas I-EXPLORATION cifras I-EXPLORATION similares I-EXPLORATION a I-EXPLORATION las I-EXPLORATION de I-EXPLORATION analíticas I-EXPLORATION previas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION colonoscopia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION doble I-EXPLORATION luz I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION del I-EXPLORATION colon, I-EXPLORATION presentando I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION natural I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION luz I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION calibre, I-EXPLORATION por I-EXPLORATION la I-EXPLORATION que I-EXPLORATION salía I-EXPLORATION un I-EXPLORATION contenido I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION bilioso. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION TC I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION aerobilia, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION escleroatrófica I-EXPLORATION en I-EXPLORATION íntimo I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION el I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION del I-EXPLORATION colon, I-EXPLORATION cuya I-EXPLORATION pared I-EXPLORATION aparecía I-EXPLORATION engrosada, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION subyacente. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION decidió I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION un I-EXPLORATION enema I-EXPLORATION opaco I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION finalmente I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION trayecto I-EXPLORATION fistuloso I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION del I-EXPLORATION colon, I-EXPLORATION de I-EXPLORATION un I-EXPLORATION calibre I-EXPLORATION aproximado I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 6 I-EXPLORATION mm, I-EXPLORATION que I-EXPLORATION parecía I-EXPLORATION comunicar I-EXPLORATION con I-EXPLORATION el I-EXPLORATION colédoco, I-EXPLORATION obteniéndose I-EXPLORATION posteriormente I-EXPLORATION relleno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vía I-EXPLORATION biliar I-EXPLORATION intrahepática. I-EXPLORATION I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION final I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION colecistitis I-EXPLORATION crónica I-EXPLORATION con I-EXPLORATION fístula I-EXPLORATION biliar I-EXPLORATION interna I-EXPLORATION a I-EXPLORATION ángulo I-EXPLORATION hepático I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION y I-EXPLORATION hemorragia I-EXPLORATION digestiva I-EXPLORATION baja I-EXPLORATION secundaria. I-EXPLORATION I-EXPLORATION Durante B-TREATMENT su I-TREATMENT ingreso I-TREATMENT precisó I-TREATMENT transfusión I-TREATMENT de I-TREATMENT 4 I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes, I-TREATMENT permaneciendo B-EVOLUTION hemodinámicamente I-EVOLUTION estable I-EVOLUTION y I-EVOLUTION afebril, I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION diarrea I-EVOLUTION ni I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION hematoquecia. I-EVOLUTION Dada B-TREATMENT la I-TREATMENT pluripatología I-TREATMENT de I-TREATMENT base I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT y I-TREATMENT la I-TREATMENT buena I-TREATMENT evolución I-TREATMENT del I-TREATMENT cuadro I-TREATMENT agudo I-TREATMENT se I-TREATMENT decidió I-TREATMENT un I-TREATMENT manejo I-TREATMENT conservador, I-TREATMENT descartando I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT y I-TREATMENT CPRE I-TREATMENT terapeútica. I-TREATMENT Evolucionó B-EVOLUTION favorablemente I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION Continuaba I-EVOLUTION asintomática I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION alta I-EVOLUTION aunque I-EVOLUTION falleció I-EVOLUTION un I-EVOLUTION tiempo I-EVOLUTION después I-EVOLUTION por I-EVOLUTION patología I-EVOLUTION cardiorrespiratoria. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tiroidectomía I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY linfadenectomía I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY papilar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tiroides I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY levotiroxina I-PAST_MEDICAL_HISTORY sódica I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipercolesterolemia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY pravastatina. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS blanquecina, I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea. I-PRESENT_ILLNESS Inicialmente B-TREATMENT fue I-TREATMENT tratada I-TREATMENT con I-TREATMENT dos I-TREATMENT ciclos I-TREATMENT de I-TREATMENT antibióticos I-TREATMENT con I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT fiebre. I-TREATMENT Posteriormente B-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS hemoptoica, I-PRESENT_ILLNESS autolimitada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS días I-PRESENT_ILLNESS siguientes. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS general. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION (IMC) I-EXPLORATION de I-EXPLORATION 38, I-EXPLORATION 67 I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION obesidad I-EXPLORATION grado I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION roncus I-EXPLORATION espiratorios I-EXPLORATION bilaterales. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteraciones I-EXPLORATION y I-EXPLORATION el I-EXPLORATION Mantoux I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION pulmonar I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION obstrucción I-EXPLORATION muy I-EXPLORATION leve I-EXPLORATION al I-EXPLORATION flujo I-EXPLORATION aéreo I-EXPLORATION (capacidad I-EXPLORATION vital I-EXPLORATION forzada I-EXPLORATION [CVF] I-EXPLORATION 2.570 I-EXPLORATION cc I-EXPLORATION (110% I-EXPLORATION del I-EXPLORATION valor I-EXPLORATION teórico); I-EXPLORATION volumen I-EXPLORATION espirado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION primer I-EXPLORATION segundo I-EXPLORATION [VEF1] I-EXPLORATION 1.730 I-EXPLORATION cc I-EXPLORATION (92,7%); I-EXPLORATION FEV1/FVC I-EXPLORATION 67%; I-EXPLORATION test I-EXPLORATION broncodilatador I-EXPLORATION negativo). I-EXPLORATION I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION puso I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION inferior I-EXPLORATION derecho I-EXPLORATION (LID). I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION atelectasia I-EXPLORATION sin I-EXPLORATION broncograma I-EXPLORATION aéreo I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION LID I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION proximal I-EXPLORATION del I-EXPLORATION bronquio I-EXPLORATION de I-EXPLORATION dicho I-EXPLORATION segmento, I-EXPLORATION ocupado I-EXPLORATION por I-EXPLORATION material I-EXPLORATION hipodenso I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION densidad I-EXPLORATION grasa I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION nodular, I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 6 I-EXPLORATION cm.. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION fibrobroncoscopia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION polipoide I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION lisa I-EXPLORATION que I-EXPLORATION obstruía I-EXPLORATION por I-EXPLORATION completo I-EXPLORATION el I-EXPLORATION bronquio I-EXPLORATION basal I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION LID. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION bronquial I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION bronquial I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION maduro I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION lipoma I-EXPLORATION endobronquial. I-EXPLORATION I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT lipoma I-TREATMENT endobronquial I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT endoscópico I-TREATMENT mediante I-TREATMENT resección I-TREATMENT láser. I-TREATMENT Se I-TREATMENT procedió I-TREATMENT a I-TREATMENT fotocoagulación I-TREATMENT superficial I-TREATMENT con I-TREATMENT láser I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT un I-TREATMENT intento I-TREATMENT infructuoso I-TREATMENT de I-TREATMENT extracción I-TREATMENT con I-TREATMENT asa I-TREATMENT de I-TREATMENT diatermia I-TREATMENT por I-TREATMENT dificultad I-TREATMENT para I-TREATMENT ver I-TREATMENT la I-TREATMENT parte I-TREATMENT distal I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT extrayéndose I-TREATMENT sólo I-TREATMENT una I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT que I-TREATMENT se I-TREATMENT envió I-TREATMENT para I-TREATMENT análisis I-TREATMENT anatomopatológico, I-TREATMENT quedando I-TREATMENT el I-TREATMENT resto I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT fotocoagulada I-TREATMENT de I-TREATMENT forma I-TREATMENT superficial. I-TREATMENT Un B-EVOLUTION mes I-EVOLUTION después, I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION un I-EVOLUTION segundo I-EVOLUTION procedimiento, I-EVOLUTION siendo I-EVOLUTION extraído I-EVOLUTION todo I-EVOLUTION el I-EVOLUTION material I-EVOLUTION restante. I-EVOLUTION No I-EVOLUTION se I-EVOLUTION objetivaron I-EVOLUTION complicaciones I-EVOLUTION tras I-EVOLUTION los I-EVOLUTION procedimientos. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 69 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS presentando I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS peneano I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS erección I-PRESENT_ILLNESS no I-PRESENT_ILLNESS completa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas, I-PRESENT_ILLNESS hemoglobina I-PRESENT_ILLNESS en I-PRESENT_ILLNESS sangre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 8, I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS mg/dl I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 140 I-PRESENT_ILLNESS hematíes I-PRESENT_ILLNESS por I-PRESENT_ILLNESS campo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS análisis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS orina. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encuentra I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2001 I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY vesical I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY urotelio I-PAST_MEDICAL_HISTORY T2b, I-PAST_MEDICAL_HISTORY G3 I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY RTU I-PAST_MEDICAL_HISTORY vesical I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY ciclos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY quimioterapia I-PAST_MEDICAL_HISTORY consistente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY taxol I-PAST_MEDICAL_HISTORY 245 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY cisplatino I-PAST_MEDICAL_HISTORY 136 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY gemcitabina I-PAST_MEDICAL_HISTORY 1.456 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY radioterapia I-PAST_MEDICAL_HISTORY externa I-PAST_MEDICAL_HISTORY 64Gy I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY mitad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ciclos I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY concluyó I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY remisión I-PAST_MEDICAL_HISTORY completa I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 2005. I-PAST_MEDICAL_HISTORY Los I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY sucesivos I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY recidivas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tumores I-PAST_MEDICAL_HISTORY vesicales I-PAST_MEDICAL_HISTORY superficiales I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY electrocoagulan. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2008 I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY elevación I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY PSA I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY ng/ml I-PAST_MEDICAL_HISTORY realizando I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY informada I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY 3+3, I-PAST_MEDICAL_HISTORY Gleason I-PAST_MEDICAL_HISTORY 6. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY trató I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY braquiterapia I-PAST_MEDICAL_HISTORY intersticial I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY semillas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Iodo125 I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2009. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY finales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2010 I-PAST_MEDICAL_HISTORY refirió I-PAST_MEDICAL_HISTORY molestias I-PAST_MEDICAL_HISTORY premiccionales I-PAST_MEDICAL_HISTORY observando I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY cistoscopia I-PAST_MEDICAL_HISTORY lesión I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY uretra I-PAST_MEDICAL_HISTORY prostática. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realizó I-EXPLORATION RTU-biópsica I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION urotelio I-EXPLORATION con I-EXPLORATION diferenciación I-EXPLORATION escamosa. I-EXPLORATION La B-TREATMENT lesión I-TREATMENT fue I-TREATMENT tratada I-TREATMENT mediante I-TREATMENT resección I-TREATMENT y I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT consistente I-TREATMENT en I-TREATMENT gemcitabina I-TREATMENT 3.300 I-TREATMENT mg I-TREATMENT (1.750 I-TREATMENT mg/m2), I-TREATMENT cisplatino I-TREATMENT 94 I-TREATMENT mg I-TREATMENT (50 I-TREATMENT mg/m2) I-TREATMENT finalizado I-TREATMENT en I-TREATMENT marzo I-TREATMENT de I-TREATMENT 2011. I-TREATMENT I-TREATMENT En B-EVOLUTION revisión I-EVOLUTION de I-EVOLUTION abril I-EVOLUTION de I-EVOLUTION 2012 I-EVOLUTION continuaba I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION PSA I-EVOLUTION hasta I-EVOLUTION valor I-EVOLUTION de I-EVOLUTION 0, I-EVOLUTION 6 I-EVOLUTION ng/ml; I-EVOLUTION la B-EXPLORATION cistoscopia I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio-cicatricial I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION uretra I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION por I-EXPLORATION emisión I-EXPLORATION de I-EXPLORATION positrones I-EXPLORATION (PET/CT). I-EXPLORATION Se I-EXPLORATION veían I-EXPLORATION varias I-EXPLORATION imágenes I-EXPLORATION hipermetabólicas, I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION e I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION vejiga, I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION vesícula I-EXPLORATION seminal I-EXPLORATION y I-EXPLORATION depósito I-EXPLORATION en I-EXPLORATION uretra I-EXPLORATION peneana I-EXPLORATION englobando I-EXPLORATION cuerpo I-EXPLORATION cavernoso I-EXPLORATION izquierdo, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION afectación I-EXPLORATION ganglionar. I-EXPLORATION Se B-TREATMENT le I-TREATMENT recomendó I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT que I-TREATMENT no I-TREATMENT llegó I-TREATMENT a I-TREATMENT recibir. I-TREATMENT I-TREATMENT Revisada I-TREATMENT su I-TREATMENT historia I-TREATMENT clínica I-TREATMENT en I-TREATMENT el I-TREATMENT servicio I-TREATMENT de I-TREATMENT Urgencias I-TREATMENT se I-TREATMENT decidió I-TREATMENT el I-TREATMENT ingreso. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT sintomático, I-TREATMENT transfusión I-TREATMENT de I-TREATMENT hemoderivados, I-TREATMENT tomografía I-TREATMENT axial I-TREATMENT computerizada I-TREATMENT de I-TREATMENT abdomen I-TREATMENT (TAC) I-TREATMENT para I-TREATMENT re-estadificación I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT de I-TREATMENT segunda I-TREATMENT línea I-TREATMENT mediante I-TREATMENT vinflunina I-TREATMENT bitartrato I-TREATMENT 500 I-TREATMENT mg I-TREATMENT (280 I-TREATMENT mg/m2) I-TREATMENT dosis I-TREATMENT única. I-TREATMENT I-TREATMENT El B-EVOLUTION edema I-EVOLUTION y I-EVOLUTION la I-EVOLUTION erección I-EVOLUTION desaparecieron I-EVOLUTION y I-EVOLUTION recibió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION tras I-EVOLUTION cinco I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION después. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS brusca I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dificultad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS progresó I-PRESENT_ILLNESS rápidamente I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS paraplejia I-PRESENT_ILLNESS completa. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY penicilina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY clasificada I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY idiopática, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY siete I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enalapril-hidroclorotiazida I-PAST_MEDICAL_HISTORY (20-12.5mg/24h). I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refirió I-PRESENT_ILLNESS un I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS súbito, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS llegó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS despertar I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS noche. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS se I-PRESENT_ILLNESS irradiaba I-PRESENT_ILLNESS hacia I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dificultaba I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS negaba I-PRESENT_ILLNESS antecedente I-PRESENT_ILLNESS traumático I-PRESENT_ILLNESS alguno. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION inicial I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION balance I-EXPLORATION motor I-EXPLORATION de I-EXPLORATION 3/5 I-EXPLORATION en I-EXPLORATION psoas I-EXPLORATION y I-EXPLORATION cuádriceps I-EXPLORATION con I-EXPLORATION 0/5 I-EXPLORATION en I-EXPLORATION la I-EXPLORATION flexo-extensión I-EXPLORATION plantar. I-EXPLORATION Igualmente I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION anestesia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION hipoestesia I-EXPLORATION termoalgésica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION inferior I-EXPLORATION izquierda I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION anestesia I-EXPLORATION perineal, I-EXPLORATION globo I-EXPLORATION vesical I-EXPLORATION e I-EXPLORATION incontinencia I-EXPLORATION fecal. I-EXPLORATION El I-EXPLORATION balance I-EXPLORATION motor I-EXPLORATION en I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 5/5. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION fiebre I-EXPLORATION o I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION meníngea. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION urgente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION lumbar, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteración I-EXPLORATION alguna. I-EXPLORATION Ante I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RMN) I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION lumbar I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION intradural I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION del I-EXPLORATION saco I-EXPLORATION dural I-EXPLORATION en I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION L2-L3-L4 I-EXPLORATION con I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION satélite I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION sacro. I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT sospecha I-TREATMENT clínica I-TREATMENT y I-TREATMENT radiológica I-TREATMENT inicial I-TREATMENT de I-TREATMENT ependimoma I-TREATMENT se I-TREATMENT intervino I-TREATMENT de I-TREATMENT urgencia I-TREATMENT practicando I-TREATMENT una I-TREATMENT laminectomía I-TREATMENT y I-TREATMENT fijación I-TREATMENT pedicular I-TREATMENT L2-L3-L4. I-TREATMENT Al I-TREATMENT proceder I-TREATMENT a I-TREATMENT la I-TREATMENT apertura I-TREATMENT dural I-TREATMENT observamos I-TREATMENT una I-TREATMENT tumoración I-TREATMENT de I-TREATMENT color I-TREATMENT rojo I-TREATMENT violáceo, I-TREATMENT encapsulada, I-TREATMENT que I-TREATMENT desplazaba I-TREATMENT las I-TREATMENT raíces I-TREATMENT nerviosas I-TREATMENT lateralmente. I-TREATMENT Mediante I-TREATMENT microcirugía I-TREATMENT se I-TREATMENT disecó I-TREATMENT con I-TREATMENT facilidad I-TREATMENT el I-TREATMENT tumor I-TREATMENT de I-TREATMENT las I-TREATMENT raíces I-TREATMENT adyacentes I-TREATMENT y I-TREATMENT se I-TREATMENT extirpó I-TREATMENT en I-TREATMENT su I-TREATMENT totalidad I-TREATMENT en I-TREATMENT una I-TREATMENT única I-TREATMENT pieza. I-TREATMENT La I-TREATMENT lesión I-TREATMENT se I-TREATMENT encontraba I-TREATMENT adherida I-TREATMENT únicamente I-TREATMENT al I-TREATMENT filum I-TREATMENT terminal. I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION transcurrió I-EVOLUTION sin I-EVOLUTION complicaciones, I-EVOLUTION experimentando I-EVOLUTION una I-EVOLUTION progresiva I-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION función I-EVOLUTION motora I-EVOLUTION e I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION control I-EVOLUTION de I-EVOLUTION esfínteres. I-EVOLUTION Ante I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION anatomopatológico I-EVOLUTION de I-EVOLUTION paraganglioma, I-EVOLUTION se I-EVOLUTION solicitaron I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION catecolaminas I-EVOLUTION en I-EVOLUTION sangre I-EVOLUTION y I-EVOLUTION en I-EVOLUTION orina, I-EVOLUTION resultando I-EVOLUTION todos I-EVOLUTION ellos I-EVOLUTION normales. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION un I-EVOLUTION centro I-EVOLUTION rehabilitador I-EVOLUTION para I-EVOLUTION completar I-EVOLUTION su I-EVOLUTION recuperación. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY estudiado B-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alteración I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ritmo I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rectorragias, I-PRESENT_ILLNESS que B-EXPLORATION tras I-EXPLORATION endoscopia I-EXPLORATION y I-EXPLORATION biopsia I-EXPLORATION es I-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION de I-EXPLORATION recto, I-EXPLORATION bien I-EXPLORATION diferenciado, I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado, I-EXPLORATION con I-EXPLORATION diferenciación I-EXPLORATION mucinosa I-EXPLORATION en I-EXPLORATION menos I-EXPLORATION del I-EXPLORATION 50%, I-EXPLORATION con I-EXPLORATION estadiaje I-EXPLORATION clínico-radiológico I-EXPLORATION (tomografía I-EXPLORATION computerizada I-EXPLORATION y I-EXPLORATION resonancia I-EXPLORATION magnética) I-EXPLORATION T3 I-EXPLORATION N2M0. I-EXPLORATION I-EXPLORATION El B-TREATMENT paciente I-TREATMENT fue I-TREATMENT tratado I-TREATMENT inicialmente I-TREATMENT con I-TREATMENT radioquimioterapia I-TREATMENT neoadyuvante; I-TREATMENT radioterapia I-TREATMENT en I-TREATMENT esquema I-TREATMENT de I-TREATMENT ciclo I-TREATMENT largo I-TREATMENT con I-TREATMENT una I-TREATMENT dosis I-TREATMENT total I-TREATMENT de I-TREATMENT 50, I-TREATMENT 4 I-TREATMENT Gy I-TREATMENT durante I-TREATMENT 5 I-TREATMENT semanas, I-TREATMENT y I-TREATMENT capecitabina I-TREATMENT vía I-TREATMENT oral I-TREATMENT a I-TREATMENT razón I-TREATMENT de I-TREATMENT 825 I-TREATMENT mg/m2/12h I-TREATMENT (1650 I-TREATMENT mg/12h), I-TREATMENT cada I-TREATMENT 15 I-TREATMENT días. I-TREATMENT I-TREATMENT Ocho I-TREATMENT semanas I-TREATMENT después I-TREATMENT de I-TREATMENT finalizar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT fue I-TREATMENT intervenido I-TREATMENT quirúrgicamente I-TREATMENT realizándose I-TREATMENT una I-TREATMENT amputación I-TREATMENT abdominoperineal I-TREATMENT extendida. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION mucinoso I-EXPLORATION de I-EXPLORATION recto, I-EXPLORATION a I-EXPLORATION 4, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION margen I-EXPLORATION anal, I-EXPLORATION cuya I-EXPLORATION infiltración I-EXPLORATION sobrepasaba I-EXPLORATION 2 I-EXPLORATION mm I-EXPLORATION la I-EXPLORATION muscular I-EXPLORATION propia, I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION quirúrgicos I-EXPLORATION proximal I-EXPLORATION y I-EXPLORATION distal I-EXPLORATION sin I-EXPLORATION tumor, I-EXPLORATION y I-EXPLORATION margen I-EXPLORATION de I-EXPLORATION resección I-EXPLORATION circular I-EXPLORATION a I-EXPLORATION 20 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 2 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION metastatizada, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION ganglios I-EXPLORATION positivos I-EXPLORATION de I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION disecados. I-EXPLORATION La I-EXPLORATION escisión I-EXPLORATION mesorrectal I-EXPLORATION (en I-EXPLORATION el I-EXPLORATION plano I-EXPLORATION del I-EXPLORATION mesorrecto) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION canal I-EXPLORATION anal I-EXPLORATION (en I-EXPLORATION el I-EXPLORATION plano I-EXPLORATION de I-EXPLORATION los I-EXPLORATION elevadores) I-EXPLORATION fueron I-EXPLORATION satisfactorias I-EXPLORATION (ypT3bN1). I-EXPLORATION I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION cursó I-EVOLUTION sin I-EVOLUTION complicaciones, I-EVOLUTION y B-TREATMENT posteriormente I-TREATMENT recibió I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT capecitabina I-TREATMENT vía I-TREATMENT oral I-TREATMENT a I-TREATMENT razón I-TREATMENT de I-TREATMENT 2.000 I-TREATMENT mg/12h I-TREATMENT cada I-TREATMENT 21 I-TREATMENT días. I-TREATMENT I-TREATMENT En B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION controlado I-EVOLUTION por I-EVOLUTION los I-EVOLUTION servicios I-EVOLUTION de I-EVOLUTION Oncología I-EVOLUTION y I-EVOLUTION Cirugía I-EVOLUTION General, I-EVOLUTION con I-EVOLUTION TC, I-EVOLUTION colonoscopia I-EVOLUTION y I-EVOLUTION marcadores I-EVOLUTION tumorales I-EVOLUTION normales I-EVOLUTION al I-EVOLUTION año I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION En I-EVOLUTION su I-EVOLUTION revisión I-EVOLUTION rutinaria I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION nódulos I-EVOLUTION subcutáneos I-EVOLUTION faciales I-EVOLUTION en I-EVOLUTION zona I-EVOLUTION frontal, I-EVOLUTION en I-EVOLUTION axila I-EVOLUTION izquierda, I-EVOLUTION pectoral I-EVOLUTION derecho, I-EVOLUTION flanco I-EVOLUTION izquierdo I-EVOLUTION y I-EVOLUTION extremidades I-EVOLUTION inferiores. I-EVOLUTION A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION corrobora I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION nódulos I-EXPLORATION subcutáneos I-EXPLORATION de I-EXPLORATION entre I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION y I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION las I-EXPLORATION localizaciones I-EXPLORATION descritas, I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica I-EXPLORATION y I-EXPLORATION rodaderos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TC I-EXPLORATION tóracoabdominal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION hepático I-EXPLORATION y I-EXPLORATION pulmonar, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION lesiones I-EXPLORATION subcutáneas I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION pectoral I-EXPLORATION derecha I-EXPLORATION área I-EXPLORATION axilar I-EXPLORATION izquierda, I-EXPLORATION pared I-EXPLORATION abdominal I-EXPLORATION anterior, I-EXPLORATION flanco I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION áreas I-EXPLORATION glúteas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION exéresis-biopsia I-EXPLORATION de I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nódulos I-EXPLORATION subcutáneos I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION región I-EXPLORATION pectoral I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION subcutánea I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION bien I-EXPLORATION diferenciado I-EXPLORATION de I-EXPLORATION recto. I-EXPLORATION Ante B-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION tumoral I-EVOLUTION diseminada I-EVOLUTION se I-EVOLUTION valoró I-EVOLUTION nuevamente I-EVOLUTION tratamiento I-EVOLUTION quimioterápico I-EVOLUTION que I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION llegó I-EVOLUTION a I-EVOLUTION recibir I-EVOLUTION por I-EVOLUTION el I-EVOLUTION rápido I-EVOLUTION deterioro I-EVOLUTION de I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION que I-EVOLUTION le I-EVOLUTION llevó I-EVOLUTION al I-EVOLUTION exitus. I-EVOLUTION I-EVOLUTION Secundigesta B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Colombia, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY obesidad I-PAST_MEDICAL_HISTORY mórbida I-PAST_MEDICAL_HISTORY (IMC I-PAST_MEDICAL_HISTORY 43) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cólicos I-PAST_MEDICAL_HISTORY biliares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS 30+ I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gestación I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS generalizado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS pseudogripal I-PRESENT_ILLNESS con I-PRESENT_ILLNESS febrícula, I-PRESENT_ILLNESS artromialgias I-PRESENT_ILLNESS y I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION rascado I-EXPLORATION sin I-EXPLORATION lesiones I-EXPLORATION urticariformes I-EXPLORATION y I-EXPLORATION febrícula I-EXPLORATION de I-EXPLORATION 37oC. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION el I-EXPLORATION bienestar I-EXPLORATION fetal I-EXPLORATION mediante I-EXPLORATION ecografía I-EXPLORATION obstétrica I-EXPLORATION (feto I-EXPLORATION en I-EXPLORATION cefálica I-EXPLORATION dorso I-EXPLORATION anterior, I-EXPLORATION placenta I-EXPLORATION posterior I-EXPLORATION normoinserta, I-EXPLORATION y I-EXPLORATION líquido I-EXPLORATION amniótico I-EXPLORATION normal) I-EXPLORATION y I-EXPLORATION registro I-EXPLORATION cardiotocográfico I-EXPLORATION (patrón I-EXPLORATION reactivo, I-EXPLORATION adinamia). I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION hemograma I-EXPLORATION que I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION alteraciones I-EXPLORATION significativas, I-EXPLORATION excepto I-EXPLORATION anemia I-EXPLORATION moderada I-EXPLORATION (Hb I-EXPLORATION 10 I-EXPLORATION g/dl), I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION transaminasas I-EXPLORATION (AST I-EXPLORATION y I-EXPLORATION ALT I-EXPLORATION 208 I-EXPLORATION y I-EXPLORATION 238 I-EXPLORATION U/L) I-EXPLORATION y I-EXPLORATION ácidos I-EXPLORATION biliares I-EXPLORATION 56, I-EXPLORATION 9 I-EXPLORATION µmol/L. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT el I-TREATMENT ingreso I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT por I-TREATMENT colestasis I-TREATMENT gravídica I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ácido I-TREATMENT ursodesoxicólico I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 13 I-TREATMENT mg/kg/día, I-TREATMENT loratadina I-TREATMENT 10 I-TREATMENT mg/ I-TREATMENT 24h I-TREATMENT y I-TREATMENT colestiramina I-TREATMENT 3 I-TREATMENT gr/ I-TREATMENT 8h. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION fiebre I-EVOLUTION de I-EVOLUTION hasta I-EVOLUTION 38, I-EVOLUTION 6 I-EVOLUTION oC, I-EVOLUTION tos I-EVOLUTION no I-EVOLUTION productiva, I-EVOLUTION disnea I-EVOLUTION y I-EVOLUTION otalgia, I-EVOLUTION siendo I-EVOLUTION la I-EVOLUTION auscultación I-EVOLUTION broncopulmonar I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION la I-EVOLUTION saturación I-EVOLUTION de I-EVOLUTION 98%. I-EVOLUTION Se B-TREATMENT solicitó I-TREATMENT radiografía I-TREATMENT de I-TREATMENT tórax, I-TREATMENT hemocultivos I-TREATMENT y I-TREATMENT frotis I-TREATMENT nasofaríngeo I-TREATMENT (PCR I-TREATMENT gripe) I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT ampicilina I-TREATMENT 2g/4h, I-TREATMENT gentamicina I-TREATMENT 240 I-TREATMENT mg/24h I-TREATMENT y I-TREATMENT oseltamivir I-TREATMENT 75 I-TREATMENT mg. I-TREATMENT Al B-EXPLORATION mismo I-EXPLORATION tiempo, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION colelitiasis/colecistitis I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION frecuente I-EXPLORATION asociación I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION procesos I-EXPLORATION con I-EXPLORATION colestasis, I-EXPLORATION sobre I-EXPLORATION todo I-EXPLORATION en I-EXPLORATION mujeres I-EXPLORATION obesas I-EXPLORATION y I-EXPLORATION multíparas, I-EXPLORATION condiciones I-EXPLORATION que I-EXPLORATION cumplía I-EXPLORATION la I-EXPLORATION paciente. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION analítica I-EXPLORATION y I-EXPLORATION los I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION cólicos I-EXPLORATION biliares, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION segunda I-EXPLORATION ecografía I-EXPLORATION que, I-EXPLORATION en I-EXPLORATION esta I-EXPLORATION ocasión, I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION colelitiasis. I-EXPLORATION I-EXPLORATION El I-EXPLORATION frotis I-EXPLORATION nasofaríngeo I-EXPLORATION para I-EXPLORATION gripe I-EXPLORATION resultó I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemocultivo I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION Listeria I-EXPLORATION monocytogenes I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION ampicilina, I-EXPLORATION gentamicina I-EXPLORATION y I-EXPLORATION penicilina I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT oseltamivir I-TREATMENT y I-TREATMENT se I-TREATMENT continuó I-TREATMENT con I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT pautado. I-TREATMENT Así I-TREATMENT mismo, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT preparados I-TREATMENT orales I-TREATMENT de I-TREATMENT hierro. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION tórpida I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION colestasis I-EVOLUTION con I-EVOLUTION descenso I-EVOLUTION parcial I-EVOLUTION de I-EVOLUTION las I-EVOLUTION transaminasas I-EVOLUTION y I-EVOLUTION episodios I-EVOLUTION aislados I-EVOLUTION de I-EVOLUTION prurito I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION del I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Las I-EVOLUTION determinaciones I-EVOLUTION analíticas I-EVOLUTION sucesivas I-EVOLUTION evidenciaron I-EVOLUTION modificaciones I-EVOLUTION con I-EVOLUTION elevaciones I-EVOLUTION y I-EVOLUTION descensos I-EVOLUTION de I-EVOLUTION transaminasas I-EVOLUTION y I-EVOLUTION ácidos I-EVOLUTION biliares, I-EVOLUTION tal I-EVOLUTION y I-EVOLUTION como I-EVOLUTION se I-EVOLUTION recoge I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tabla I-EVOLUTION 1. I-EVOLUTION I-EVOLUTION El I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION listeriosis I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION permaneciendo I-EVOLUTION apirética I-EVOLUTION y I-EVOLUTION evidenciándose I-EVOLUTION el I-EVOLUTION descenso I-EVOLUTION paulatino I-EVOLUTION de I-EVOLUTION PCR I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION antibiótico. I-EVOLUTION I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION control I-EXPLORATION de I-EXPLORATION bienestar I-EXPLORATION fetal I-EXPLORATION seriado I-EXPLORATION mediante I-EXPLORATION ecografía I-EXPLORATION obstétrica I-EXPLORATION y I-EXPLORATION registro I-EXPLORATION cardiotocográfico I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION semana I-EXPLORATION 32+ I-EXPLORATION 4, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION espontánea I-EXPLORATION el I-EXPLORATION trabajo I-EXPLORATION de I-EXPLORATION parto I-EXPLORATION tras I-EXPLORATION completar I-EXPLORATION 14 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION ampicilina I-EXPLORATION y I-EXPLORATION 7 I-EXPLORATION días I-EXPLORATION con I-EXPLORATION gentamicina, I-EXPLORATION ambas I-EXPLORATION por I-EXPLORATION vía I-EXPLORATION endovenosa. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION comprobó I-EXPLORATION bienestar I-EXPLORATION fetal I-EXPLORATION intraparto I-EXPLORATION mediante I-EXPLORATION monitorización I-EXPLORATION maternofetal, I-EXPLORATION objetivando I-EXPLORATION líquido I-EXPLORATION amniótico I-EXPLORATION meconial. I-EXPLORATION El B-EVOLUTION parto I-EVOLUTION fue I-EVOLUTION eutócico, I-EVOLUTION obteniendo I-EVOLUTION una I-EVOLUTION niña I-EVOLUTION de I-EVOLUTION 2.225 I-EVOLUTION g I-EVOLUTION de I-EVOLUTION peso, I-EVOLUTION test I-EVOLUTION de I-EVOLUTION Apgar I-EVOLUTION 9/10 I-EVOLUTION y I-EVOLUTION pH I-EVOLUTION de I-EVOLUTION cordón I-EVOLUTION 7, I-EVOLUTION 36 I-EVOLUTION arterial I-EVOLUTION y I-EVOLUTION 7, I-EVOLUTION 37 I-EVOLUTION venoso. I-EVOLUTION I-EVOLUTION La I-EVOLUTION RN I-EVOLUTION ingresó I-EVOLUTION en I-EVOLUTION neonatología I-EVOLUTION por I-EVOLUTION prematuridad I-EVOLUTION y I-EVOLUTION antecedente I-EVOLUTION de I-EVOLUTION listeriosis I-EVOLUTION materna. I-EVOLUTION Los B-EXPLORATION cultivos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizaron I-EXPLORATION (frotis I-EXPLORATION faríngeo, I-EXPLORATION vermis, I-EXPLORATION umbilical, I-EXPLORATION hemocultivo, I-EXPLORATION urocultivo I-EXPLORATION y I-EXPLORATION coprocultivo) I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION siendo I-EXPLORATION dada I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 10 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION vida. I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION puerperal I-EVOLUTION fue I-EVOLUTION normal I-EVOLUTION con I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION parto. I-EVOLUTION I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION placenta I-EXPLORATION evidenció I-EXPLORATION múltiples I-EXPLORATION infartos I-EXPLORATION «sépticos» I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION aisladas I-EXPLORATION formaciones I-EXPLORATION bacilares I-EXPLORATION Gram I-EXPLORATION positivas, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION Listeria. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Marruecos, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY reside I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY España I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY intermitente I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY motivos I-PAST_MEDICAL_HISTORY laborales. I-PAST_MEDICAL_HISTORY Fue B-PRESENT_ILLNESS trasladado I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS su I-PRESENT_ILLNESS país I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS ingresado I-PRESENT_ILLNESS los I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS suboclusivo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS respondió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS médico. I-PRESENT_ILLNESS En B-TREATMENT el I-TREATMENT informe I-TREATMENT que I-TREATMENT aportó I-TREATMENT constaba I-TREATMENT que I-TREATMENT se I-TREATMENT le I-TREATMENT practicó I-TREATMENT enterolisis I-TREATMENT después I-TREATMENT de I-TREATMENT un I-TREATMENT mes I-TREATMENT de I-TREATMENT ayuno I-TREATMENT terapéutico I-TREATMENT sin I-TREATMENT observarse I-TREATMENT mejoría. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION presentó I-EVOLUTION retraso I-EVOLUTION del I-EVOLUTION vaciado I-EVOLUTION gástrico I-EVOLUTION e I-EVOLUTION íleo I-EVOLUTION prolongado, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION tuvo I-EVOLUTION que I-EVOLUTION ser I-EVOLUTION reintervenido. I-EVOLUTION Se B-TREATMENT le I-TREATMENT hizo I-TREATMENT una I-TREATMENT colectomía I-TREATMENT derecha I-TREATMENT ampliada, I-TREATMENT anastomosis I-TREATMENT gastroyeyunal, I-TREATMENT ileostomía I-TREATMENT lateral I-TREATMENT derecha I-TREATMENT y I-TREATMENT colostomía I-TREATMENT lateral I-TREATMENT izquierda. I-TREATMENT En B-EXPLORATION el I-EXPLORATION informe I-EXPLORATION anatomopatológico I-EXPLORATION constaba I-EXPLORATION que I-EXPLORATION en I-EXPLORATION los I-EXPLORATION 14 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION íleon I-EXPLORATION y I-EXPLORATION 140 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION que I-EXPLORATION se I-EXPLORATION le I-EXPLORATION extirparon, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION unas I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION retráctiles I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION muy I-EXPLORATION dilatadas, I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION inflamadas I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION con I-EXPLORATION extensa I-EXPLORATION necrosis, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION fibrosis I-EXPLORATION peritonítica I-EXPLORATION extensa I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION adherencias, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION encontraron I-EXPLORATION lesiones I-EXPLORATION específicas. I-EXPLORATION Después B-TREATMENT de I-TREATMENT dos I-TREATMENT meses I-TREATMENT de I-TREATMENT ayuno I-TREATMENT total I-TREATMENT con I-TREATMENT fluidoterapia I-TREATMENT iv I-TREATMENT por I-TREATMENT intolerancia I-TREATMENT a I-TREATMENT la I-TREATMENT nutrición I-TREATMENT enteral I-TREATMENT (NE), I-TREATMENT y B-EVOLUTION habiendo I-EVOLUTION perdido I-EVOLUTION más I-EVOLUTION de I-EVOLUTION 25 I-EVOLUTION kilos I-EVOLUTION de I-EVOLUTION peso, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION solicitó I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION voluntaria I-EVOLUTION para I-EVOLUTION trasladarse I-EVOLUTION a I-EVOLUTION España. I-EVOLUTION I-EVOLUTION El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuadros I-PAST_MEDICAL_HISTORY suboclusivos I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY resueltos I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY intervenciones I-PAST_MEDICAL_HISTORY quirúrgicas: I-PAST_MEDICAL_HISTORY laparoscopia I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vólvulo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 13 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY resección I-PAST_MEDICAL_HISTORY duodenal I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY gastroenteroanastomosis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 29 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY drenaje I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY absceso I-PAST_MEDICAL_HISTORY perihepático I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY afectación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pared I-PAST_MEDICAL_HISTORY intercostal I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY probable I-PAST_MEDICAL_HISTORY perforación I-PAST_MEDICAL_HISTORY duodenal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY etiología I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY filiada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Entre B-FAMILY_HISTORY los I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY destacaba I-FAMILY_HISTORY un I-FAMILY_HISTORY hermano I-FAMILY_HISTORY fallecido I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 39 I-FAMILY_HISTORY años I-FAMILY_HISTORY en I-FAMILY_HISTORY una I-FAMILY_HISTORY cirugía I-FAMILY_HISTORY abdominal I-FAMILY_HISTORY urgente I-FAMILY_HISTORY (supuestamente I-FAMILY_HISTORY por I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY de I-FAMILY_HISTORY colon I-FAMILY_HISTORY sin I-FAMILY_HISTORY ser I-FAMILY_HISTORY documentado I-FAMILY_HISTORY por I-FAMILY_HISTORY autopsia) I-FAMILY_HISTORY e I-FAMILY_HISTORY hijo I-FAMILY_HISTORY de I-FAMILY_HISTORY 8 I-FAMILY_HISTORY años I-FAMILY_HISTORY con I-FAMILY_HISTORY cuadros I-FAMILY_HISTORY suboclusivos I-FAMILY_HISTORY similares I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY que I-FAMILY_HISTORY presenta I-FAMILY_HISTORY el I-FAMILY_HISTORY paciente I-FAMILY_HISTORY desde I-FAMILY_HISTORY su I-FAMILY_HISTORY infancia. I-FAMILY_HISTORY I-FAMILY_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presentaba I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION desnutrición I-EXPLORATION severa I-EXPLORATION y I-EXPLORATION anasarca, I-EXPLORATION y I-EXPLORATION edemas I-EXPLORATION con I-EXPLORATION fóvea I-EXPLORATION hasta I-EXPLORATION rodillas. I-EXPLORATION Abdomen I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible I-EXPLORATION con I-EXPLORATION molestias I-EXPLORATION difusas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION y I-EXPLORATION peristaltismo I-EXPLORATION ausente. I-EXPLORATION No I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal. I-EXPLORATION Dos I-EXPLORATION estomas I-EXPLORATION sin I-EXPLORATION contenido I-EXPLORATION en I-EXPLORATION línea I-EXPLORATION de I-EXPLORATION laparatomía I-EXPLORATION media. I-EXPLORATION Peso I-EXPLORATION 58, I-EXPLORATION 6 I-EXPLORATION Kg I-EXPLORATION (IMC I-EXPLORATION 16, I-EXPLORATION 2 I-EXPLORATION Kg/m2). I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION salvo I-EXPLORATION los I-EXPLORATION parámetros I-EXPLORATION analíticos. I-EXPLORATION I-EXPLORATION Fue I-EXPLORATION ingresado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION Cirugía; I-EXPLORATION se I-EXPLORATION le I-EXPLORATION colocó I-EXPLORATION una I-EXPLORATION sonda I-EXPLORATION de I-EXPLORATION aspiración, I-EXPLORATION se I-EXPLORATION pautó I-EXPLORATION antieméticos I-EXPLORATION y I-EXPLORATION procinéticos, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION comenzó I-EXPLORATION a I-EXPLORATION renutrir I-EXPLORATION progresivamente I-EXPLORATION con I-EXPLORATION nutrición I-EXPLORATION parenteral I-EXPLORATION total I-EXPLORATION (NPT). I-EXPLORATION Se B-EVOLUTION mantuvo I-EVOLUTION la I-EVOLUTION NPT I-EVOLUTION durante I-EVOLUTION dos I-EVOLUTION meses I-EVOLUTION hasta I-EVOLUTION que I-EVOLUTION se I-EVOLUTION pasó I-EVOLUTION a I-EVOLUTION NE I-EVOLUTION continua, I-EVOLUTION y I-EVOLUTION finalmente, I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION retirar I-EVOLUTION la I-EVOLUTION sonda I-EVOLUTION de I-EVOLUTION aspiración I-EVOLUTION e I-EVOLUTION introducir I-EVOLUTION nutrición I-EVOLUTION oral I-EVOLUTION con I-EVOLUTION ayuda I-EVOLUTION de I-EVOLUTION procinéticos I-EVOLUTION y I-EVOLUTION medidas I-EVOLUTION higiénico-dietéticas I-EVOLUTION favorecedoras I-EVOLUTION del I-EVOLUTION peristaltismo. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 14 I-EVOLUTION semanas I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION se I-EVOLUTION le I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION un I-EVOLUTION peso I-EVOLUTION de I-EVOLUTION 79 I-EVOLUTION Kg I-EVOLUTION (IMC I-EVOLUTION 21, I-EVOLUTION 9 I-EVOLUTION Kg/m2). I-EVOLUTION I-EVOLUTION Tres I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION ingresar I-EVOLUTION en I-EVOLUTION el I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION Cirugía I-EVOLUTION por I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION deshidratación I-EVOLUTION hiponatrémica I-EVOLUTION severa I-EVOLUTION debido I-EVOLUTION al I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION débito I-EVOLUTION por I-EVOLUTION ileostomía I-EVOLUTION de I-EVOLUTION unos I-EVOLUTION 3-4 I-EVOLUTION litros/día I-EVOLUTION e I-EVOLUTION intolerancia I-EVOLUTION oral I-EVOLUTION de I-EVOLUTION varios I-EVOLUTION días I-EVOLUTION de I-EVOLUTION evolución; I-EVOLUTION episodio I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION relacionado I-EVOLUTION con I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION suboclusivo I-EVOLUTION según I-EVOLUTION los I-EVOLUTION resultados I-EVOLUTION de I-EVOLUTION las I-EVOLUTION pruebas I-EVOLUTION complementarias I-EVOLUTION que I-EVOLUTION se I-EVOLUTION le I-EVOLUTION hicieron. I-EVOLUTION Se I-EVOLUTION le I-EVOLUTION corrigieron I-EVOLUTION las I-EVOLUTION alteraciones I-EVOLUTION hidroelectolíticas I-EVOLUTION que I-EVOLUTION presentaba, I-EVOLUTION y I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION intolerancia I-EVOLUTION oral, I-EVOLUTION se I-EVOLUTION comenzó I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION la I-EVOLUTION NPT I-EVOLUTION y I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION siguientes. I-EVOLUTION I-EVOLUTION En B-TREATMENT el I-TREATMENT cuarto I-TREATMENT mes I-TREATMENT del I-TREATMENT segundo I-TREATMENT ingreso, I-TREATMENT al I-TREATMENT paciente I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT enterolisis I-TREATMENT de I-TREATMENT todo I-TREATMENT el I-TREATMENT paquete I-TREATMENT intestinal, I-TREATMENT se I-TREATMENT desmontó I-TREATMENT la I-TREATMENT gastroenteroanastomosis I-TREATMENT previa, I-TREATMENT se I-TREATMENT resecó I-TREATMENT el I-TREATMENT intestino I-TREATMENT delgado I-TREATMENT a I-TREATMENT unos I-TREATMENT 40-50 I-TREATMENT cm I-TREATMENT del I-TREATMENT ángulo I-TREATMENT de I-TREATMENT Treiz I-TREATMENT y I-TREATMENT se I-TREATMENT extirparon I-TREATMENT 80 I-TREATMENT y I-TREATMENT 130 I-TREATMENT cm I-TREATMENT de I-TREATMENT íleon I-TREATMENT de I-TREATMENT sendos I-TREATMENT extremos, I-TREATMENT se I-TREATMENT liberó I-TREATMENT el I-TREATMENT colon I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT anastomosis I-TREATMENT íleo-cólica I-TREATMENT latero-lateral I-TREATMENT mecánica. I-TREATMENT Dos I-TREATMENT meses I-TREATMENT después, I-TREATMENT tuvo I-TREATMENT que I-TREATMENT ser I-TREATMENT reintervenido I-TREATMENT por I-TREATMENT mal I-TREATMENT paso I-TREATMENT en I-TREATMENT anastomosis, I-TREATMENT se I-TREATMENT resecó I-TREATMENT la I-TREATMENT zona I-TREATMENT anastomótica I-TREATMENT anterior I-TREATMENT con I-TREATMENT la I-TREATMENT extirpación I-TREATMENT de I-TREATMENT 12 I-TREATMENT cm I-TREATMENT de I-TREATMENT íleon I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT una I-TREATMENT nueva I-TREATMENT anastomosis I-TREATMENT íleo-cólica I-TREATMENT termino-lateral I-TREATMENT manual. I-TREATMENT En B-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION boca I-EXPLORATION de I-EXPLORATION ileostomía I-EXPLORATION y I-EXPLORATION colostomía I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION hiperganglionosis I-EXPLORATION en I-EXPLORATION plexos I-EXPLORATION parasimpáticos, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION ganglios I-EXPLORATION inmaduros I-EXPLORATION bcl2+ I-EXPLORATION y I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION intraepiteliales, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION células I-EXPLORATION intersticiales I-EXPLORATION de I-EXPLORATION Cajal, I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION DNIB. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION se I-EVOLUTION le I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION malabsorción I-EVOLUTION y I-EVOLUTION esteatorrea I-EVOLUTION crónica I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION intervenciones I-EVOLUTION previas, I-EVOLUTION se I-EVOLUTION pautaron I-EVOLUTION medidas I-EVOLUTION dietéticas I-EVOLUTION y I-EVOLUTION enzimas I-EVOLUTION pancreáticos I-EVOLUTION en I-EVOLUTION cada I-EVOLUTION ingesta, I-EVOLUTION junto I-EVOLUTION con I-EVOLUTION un I-EVOLUTION antidiarreico I-EVOLUTION y I-EVOLUTION resíncolestiramina I-EVOLUTION a I-EVOLUTION demanda. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION revisión I-EVOLUTION con I-EVOLUTION excelente I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION hace I-EVOLUTION vida I-EVOLUTION normal, I-EVOLUTION sigue I-EVOLUTION los I-EVOLUTION consejos I-EVOLUTION dietéticos I-EVOLUTION que I-EVOLUTION se I-EVOLUTION le I-EVOLUTION indicaron, I-EVOLUTION hace I-EVOLUTION 2-3 I-EVOLUTION deposiciones I-EVOLUTION diarias I-EVOLUTION no I-EVOLUTION esteatorreicas, I-EVOLUTION toma I-EVOLUTION 4-6 I-EVOLUTION comprimidos I-EVOLUTION al I-EVOLUTION día I-EVOLUTION de I-EVOLUTION suplementos I-EVOLUTION enzimáticos I-EVOLUTION (Kreon®10000) I-EVOLUTION y I-EVOLUTION su I-EVOLUTION peso I-EVOLUTION es I-EVOLUTION 90, I-EVOLUTION 5 I-EVOLUTION kilos I-EVOLUTION (IMC I-EVOLUTION 25, I-EVOLUTION 1 I-EVOLUTION Kg/m2). I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY vascular I-PAST_MEDICAL_HISTORY (hipertensión I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dislipemia). I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destacaban: I-PAST_MEDICAL_HISTORY diverticulosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY adenomatosos I-PAST_MEDICAL_HISTORY tubulares. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY intervenida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY amígdalas, I-PAST_MEDICAL_HISTORY apéndice I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY eventración I-PAST_MEDICAL_HISTORY abdominal. I-PAST_MEDICAL_HISTORY Como B-FAMILY_HISTORY antecedente I-FAMILY_HISTORY familiar I-FAMILY_HISTORY destacaba I-FAMILY_HISTORY su I-FAMILY_HISTORY hija I-FAMILY_HISTORY fallecida I-FAMILY_HISTORY a I-FAMILY_HISTORY los I-FAMILY_HISTORY 52 I-FAMILY_HISTORY años I-FAMILY_HISTORY de I-FAMILY_HISTORY cáncer I-FAMILY_HISTORY gástrico. I-FAMILY_HISTORY I-FAMILY_HISTORY Acudió B-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS persistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hemiabdomen I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS y I-PRESENT_ILLNESS región I-PRESENT_ILLNESS periumbilical I-PRESENT_ILLNESS de I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS postprandial, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nauseas I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS un I-PRESENT_ILLNESS ritmo I-PRESENT_ILLNESS intestinal I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tendencia I-PRESENT_ILLNESS al I-PRESENT_ILLNESS estreñimiento I-PRESENT_ILLNESS exacerbado I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS dicho I-PRESENT_ILLNESS periodo. I-PRESENT_ILLNESS Presentaba I-PRESENT_ILLNESS además I-PRESENT_ILLNESS anorexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS ponderal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 7kg. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Estaba B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con: I-PAST_MEDICAL_HISTORY artilog I-PAST_MEDICAL_HISTORY 200 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY 0-1-0, I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY 1-0-0, I-PAST_MEDICAL_HISTORY nerdipina I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY 1-0-1, I-PAST_MEDICAL_HISTORY pantoprazol I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY 1-0-0, I-PAST_MEDICAL_HISTORY simvastatina I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY 0-0-1, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY venlafaxina I-PAST_MEDICAL_HISTORY 75 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY 0-0-1. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presentaba: I-EXPLORATION tensión I-EXPLORATION arterial: I-EXPLORATION 120/80; I-EXPLORATION frecuencia I-EXPLORATION cardiaca: I-EXPLORATION 81 I-EXPLORATION latidos/min. I-EXPLORATION Afebril. I-EXPLORATION Regular I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION Bien I-EXPLORATION hidratada I-EXPLORATION y I-EXPLORATION ligera I-EXPLORATION palidez I-EXPLORATION mucocutánea. I-EXPLORATION Nódulo I-EXPLORATION supraclavicular I-EXPLORATION izquierdo, I-EXPLORATION duro I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION móvil, I-EXPLORATION no I-EXPLORATION doloroso. I-EXPLORATION Auscultación I-EXPLORATION cardiaca I-EXPLORATION normal. I-EXPLORATION Auscultación I-EXPLORATION pulmonar I-EXPLORATION sin I-EXPLORATION hallazgos. I-EXPLORATION Abdomen I-EXPLORATION blando, I-EXPLORATION depresible, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION periumbilical, I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION ni I-EXPLORATION megalias, I-EXPLORATION peristaltismo I-EXPLORATION disminuido. I-EXPLORATION Extremidades I-EXPLORATION inferiores I-EXPLORATION sin I-EXPLORATION edemas I-EXPLORATION ni I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION venosa I-EXPLORATION profunda. I-EXPLORATION I-EXPLORATION En I-EXPLORATION las I-EXPLORATION exploraciones I-EXPLORATION complementarias: I-EXPLORATION radiología I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION nódulo I-EXPLORATION pulmonar I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION LSD. I-EXPLORATION ECG: I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION a I-EXPLORATION 86 I-EXPLORATION latidos/min. I-EXPLORATION Analítica I-EXPLORATION de I-EXPLORATION sangre: I-EXPLORATION anemia I-EXPLORATION microcítica I-EXPLORATION (Hb: I-EXPLORATION 10 I-EXPLORATION g/dl I-EXPLORATION (11,9-16,5), I-EXPLORATION VCM: I-EXPLORATION 77, I-EXPLORATION 4 I-EXPLORATION (80,2-99,4). I-EXPLORATION Leucocitosis I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (20.000 I-EXPLORATION leucocitos/ml I-EXPLORATION (3,5-10,5) I-EXPLORATION con I-EXPLORATION 84% I-EXPLORATION de I-EXPLORATION neutrófilos I-EXPLORATION (37-73). I-EXPLORATION VSG I-EXPLORATION 67 I-EXPLORATION mm/h I-EXPLORATION (2-10). I-EXPLORATION PCR I-EXPLORATION 150 I-EXPLORATION mg/l I-EXPLORATION (0-10). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION con I-EXPLORATION perfil I-EXPLORATION férrico I-EXPLORATION completo: I-EXPLORATION hierro I-EXPLORATION sérico I-EXPLORATION 14 I-EXPLORATION µg/dl I-EXPLORATION (37-145 I-EXPLORATION µg/dl), I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION transferrina I-EXPLORATION 15% I-EXPLORATION (20-50%) I-EXPLORATION y I-EXPLORATION ferritina I-EXPLORATION 463 I-EXPLORATION ng/ml I-EXPLORATION (valores<30ng/ml I-EXPLORATION implica I-EXPLORATION ferropenia). I-EXPLORATION También I-EXPLORATION se I-EXPLORATION determinó I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario I-EXPLORATION (CEA) I-EXPLORATION pensando I-EXPLORATION en I-EXPLORATION neoplasias I-EXPLORATION malignas I-EXPLORATION gastrointestinales I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION anti-transglutaminasa I-EXPLORATION siendo I-EXPLORATION sus I-EXPLORATION valores I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION del I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION requería I-EXPLORATION de I-EXPLORATION opiáceos I-EXPLORATION intravenosos I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION adenopatías I-EXPLORATION mesentéricas I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION patológico, I-EXPLORATION completándose I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION tomografia I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION abdomino-pélvica. I-EXPLORATION I-EXPLORATION En I-EXPLORATION dicha I-EXPLORATION TAC I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION mural I-EXPLORATION de I-EXPLORATION un I-EXPLORATION segmento I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 4, I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION que I-EXPLORATION se I-EXPLORATION acompañaba I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION adenopatías I-EXPLORATION mesentéricas I-EXPLORATION con I-EXPLORATION centro I-EXPLORATION hipodenso. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION enteroscopia I-EXPLORATION anterógrada I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION ángulo I-EXPLORATION de I-EXPLORATION Treitz, I-EXPLORATION formación I-EXPLORATION polipoidea I-EXPLORATION con I-EXPLORATION ulceración I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 15 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias. I-EXPLORATION Se I-EXPLORATION introdujo I-EXPLORATION el I-EXPLORATION endoscopio I-EXPLORATION hasta I-EXPLORATION yeyuno I-EXPLORATION proximal I-EXPLORATION (50-60 I-EXPLORATION cm I-EXPLORATION distales I-EXPLORATION a I-EXPLORATION píloro) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION tomaron I-EXPLORATION biopsias I-EXPLORATION de I-EXPLORATION una I-EXPLORATION neoformación I-EXPLORATION ulcerada, I-EXPLORATION rígida I-EXPLORATION y I-EXPLORATION friable, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION y I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION circunferencia, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION que I-EXPLORATION no I-EXPLORATION impidió I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION endoscopio. I-EXPLORATION A I-EXPLORATION unos I-EXPLORATION 30 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION píloro I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION otra I-EXPLORATION zona I-EXPLORATION ulcerada, I-EXPLORATION rígida, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 2 I-EXPLORATION cms I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION que I-EXPLORATION se I-EXPLORATION biopsió I-EXPLORATION (C).. I-EXPLORATION I-EXPLORATION El I-EXPLORATION análisis I-EXPLORATION histológico I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION yeyunales I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION pobremente I-EXPLORATION diferenciado. I-EXPLORATION Tanto I-EXPLORATION la I-EXPLORATION morfología I-EXPLORATION como I-EXPLORATION el I-EXPLORATION inmunofenotipo I-EXPLORATION fueron I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes I-EXPLORATION de I-EXPLORATION pulmón. I-EXPLORATION I-EXPLORATION Inmunofenotipo: I-EXPLORATION citoqueratinas I-EXPLORATION AE1-AE3: I-EXPLORATION (+); I-EXPLORATION S100, I-EXPLORATION HMB I-EXPLORATION 45: I-EXPLORATION (-); I-EXPLORATION citoqueratina I-EXPLORATION 20: I-EXPLORATION (-), I-EXPLORATION citoqueratina I-EXPLORATION 7: I-EXPLORATION (+); I-EXPLORATION TTF1: I-EXPLORATION (-); I-EXPLORATION napsina: I-EXPLORATION (-); I-EXPLORATION vimentina: I-EXPLORATION (+); I-EXPLORATION p63: I-EXPLORATION (+); I-EXPLORATION cd10: I-EXPLORATION (-); I-EXPLORATION WT1: I-EXPLORATION (-) I-EXPLORATION ; I-EXPLORATION GCDFP I-EXPLORATION 15: I-EXPLORATION (-); I-EXPLORATION citoqueratina I-EXPLORATION 19: I-EXPLORATION (+); I-EXPLORATION citoqueratina I-EXPLORATION 5-6: I-EXPLORATION (-), I-EXPLORATION citoqueratina I-EXPLORATION 34 I-EXPLORATION beta I-EXPLORATION 12; I-EXPLORATION CDX2: I-EXPLORATION (-). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION torácico I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION pulmonar I-EXPLORATION sólido I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION espiculado I-EXPLORATION en I-EXPLORATION apex I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION contacto I-EXPLORATION pleural; I-EXPLORATION adenopatías I-EXPLORATION mediastínicas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION compartimento I-EXPLORATION paratraqueal I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION pretraqueales, I-EXPLORATION hiliares I-EXPLORATION derechas I-EXPLORATION y I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bifurcación I-EXPLORATION bronquial. I-EXPLORATION Adenopatías I-EXPLORATION supraclaviculares I-EXPLORATION bilaterales. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT edad I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT y I-TREATMENT el I-TREATMENT estadio I-TREATMENT avanzado I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT y I-TREATMENT la I-TREATMENT presentación I-TREATMENT un I-TREATMENT ECOG I-TREATMENT 3 I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT paliativo, I-TREATMENT falleciendo I-TREATMENT la I-TREATMENT paciente I-TREATMENT a I-TREATMENT los I-TREATMENT 22 I-TREATMENT días I-TREATMENT de I-TREATMENT su I-TREATMENT alta I-TREATMENT hospitalaria. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS incapacitante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS calma I-PRESENT_ILLNESS con I-PRESENT_ILLNESS analgésicos. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY traumático. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cartílagos I-EXPLORATION costales I-EXPLORATION es I-EXPLORATION dolorosa, I-EXPLORATION refiriendo I-EXPLORATION como I-EXPLORATION punto I-EXPLORATION más I-EXPLORATION doloroso I-EXPLORATION la I-EXPLORATION 7a I-EXPLORATION unión I-EXPLORATION costoesternal I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION apreciarse I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contorno I-EXPLORATION ni I-EXPLORATION signos I-EXPLORATION inflamatorios I-EXPLORATION cutáneos. I-EXPLORATION La I-EXPLORATION maniobra I-EXPLORATION del I-EXPLORATION gancho, I-EXPLORATION que I-EXPLORATION consiste I-EXPLORATION en I-EXPLORATION producir I-EXPLORATION una I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cartílagos I-EXPLORATION costales I-EXPLORATION inferiores I-EXPLORATION mediante I-EXPLORATION la I-EXPLORATION introducción I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION del I-EXPLORATION explorador I-EXPLORATION por I-EXPLORATION debajo I-EXPLORATION del I-EXPLORATION último I-EXPLORATION arco I-EXPLORATION costal I-EXPLORATION y I-EXPLORATION traccionando I-EXPLORATION de I-EXPLORATION él I-EXPLORATION en I-EXPLORATION sentido I-EXPLORATION craneal, I-EXPLORATION es I-EXPLORATION muy I-EXPLORATION dolorosa. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Dada B-TREATMENT la I-TREATMENT exploración I-TREATMENT tan I-TREATMENT característica, I-TREATMENT se I-TREATMENT pensó I-TREATMENT en I-TREATMENT el I-TREATMENT SCD I-TREATMENT y I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT conservador I-TREATMENT con I-TREATMENT antiinflamatorios I-TREATMENT orales. I-TREATMENT I-TREATMENT Tras I-TREATMENT un I-TREATMENT mes I-TREATMENT sin I-TREATMENT mejoría, I-TREATMENT se I-TREATMENT le I-TREATMENT propuso I-TREATMENT bloqueo I-TREATMENT anestésico I-TREATMENT intercostal I-TREATMENT o I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT definitivo. I-TREATMENT Dado I-TREATMENT que I-TREATMENT el I-TREATMENT dolor I-TREATMENT de I-TREATMENT la I-TREATMENT niña I-TREATMENT cada I-TREATMENT vez I-TREATMENT es I-TREATMENT más I-TREATMENT limitante I-TREATMENT y I-TREATMENT que I-TREATMENT la I-TREATMENT primera I-TREATMENT opción I-TREATMENT aportaría I-TREATMENT un I-TREATMENT alivio I-TREATMENT temporal, I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica. I-TREATMENT Al I-TREATMENT año I-TREATMENT del I-TREATMENT diagnóstico, I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT y I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT una I-TREATMENT incisión I-TREATMENT transversa I-TREATMENT de I-TREATMENT 4 I-TREATMENT cm I-TREATMENT sobre I-TREATMENT el I-TREATMENT arco I-TREATMENT costal I-TREATMENT afectado, I-TREATMENT extirpamos I-TREATMENT el I-TREATMENT 7o, I-TREATMENT 8o I-TREATMENT y I-TREATMENT 9o I-TREATMENT cartílagos I-TREATMENT costales, I-TREATMENT preservando I-TREATMENT el I-TREATMENT pericondrio. I-TREATMENT I-TREATMENT Transcurrido B-EVOLUTION un I-EVOLUTION año, I-EVOLUTION el I-EVOLUTION resultado I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION satisfactorio. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY (por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY anticoagulante) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY libre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS precordial I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hipocondrio I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mínimos I-PRESENT_ILLNESS esfuerzos. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION la I-EXPLORATION sintomatología I-EXPLORATION había I-EXPLORATION disminuido. I-EXPLORATION Inicialmente I-EXPLORATION se I-EXPLORATION diagnosticó I-EXPLORATION como I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION síndrome I-EXPLORATION coronario I-EXPLORATION agudo I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION tratamiento I-EXPLORATION y I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION enzimas I-EXPLORATION de I-EXPLORATION daño I-EXPLORATION miocárdico I-EXPLORATION y I-EXPLORATION un I-EXPLORATION electrocardiograma I-EXPLORATION que I-EXPLORATION no I-EXPLORATION presentaban I-EXPLORATION anomalías. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION refería I-EXPLORATION astenia I-EXPLORATION y I-EXPLORATION molestias I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION evolución, I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION dolor I-EXPLORATION y I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION era I-EXPLORATION anodina I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION tras I-EXPLORATION ser I-EXPLORATION valorado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION Cardiología I-EXPLORATION se I-EXPLORATION dio I-EXPLORATION de I-EXPLORATION alta. I-EXPLORATION I-EXPLORATION Seis B-EVOLUTION días I-EVOLUTION después I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION acudió I-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION por I-EVOLUTION persistencia I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION derecho I-EVOLUTION acompañado I-EVOLUTION de I-EVOLUTION naúseas I-EVOLUTION e I-EVOLUTION hiporexia. I-EVOLUTION No B-EXPLORATION presentaba I-EXPLORATION fiebre I-EXPLORATION ni I-EXPLORATION otra I-EXPLORATION clínica I-EXPLORATION acompañante. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION distendido, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION hipocondrio I-EXPLORATION y I-EXPLORATION flanco I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION defensa I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION Blumberg I-EXPLORATION y I-EXPLORATION Murphy I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION g/dl, I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 32, I-EXPLORATION 6%, I-EXPLORATION leucocitos I-EXPLORATION 14.000 I-EXPLORATION con I-EXPLORATION 74% I-EXPLORATION de I-EXPLORATION neutrófilos, I-EXPLORATION INR I-EXPLORATION 2, I-EXPLORATION 95 I-EXPLORATION y I-EXPLORATION fibrinógeno I-EXPLORATION 816 I-EXPLORATION mg/dl. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION con I-EXPLORATION paredes I-EXPLORATION mal I-EXPLORATION definidas I-EXPLORATION y I-EXPLORATION colelitiasis, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION hipoecoica I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION líquido I-EXPLORATION libre I-EXPLORATION perivesicular I-EXPLORATION que I-EXPLORATION se I-EXPLORATION interpretó I-EXPLORATION como I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION perforada I-EXPLORATION y I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC). I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION vesícula I-EXPLORATION con I-EXPLORATION paredes I-EXPLORATION mal I-EXPLORATION definidas I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION 7x3 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION alteraba I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION circundante I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION colecistitis I-EXPLORATION aguda I-EXPLORATION perforada. I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION estable I-EXPLORATION y I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION el I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION planta I-EXPLORATION de I-EXPLORATION Cirugía I-EXPLORATION para I-EXPLORATION tratamiento I-EXPLORATION conservador. I-EXPLORATION Se B-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT analgésico I-TREATMENT y I-TREATMENT antibiótico I-TREATMENT (Piperacilina-Tazobactan). I-TREATMENT A B-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION ingreso I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION continuaba I-EVOLUTION con I-EVOLUTION molestias I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION derecho I-EVOLUTION y I-EVOLUTION en I-EVOLUTION los I-EVOLUTION análisis I-EVOLUTION de I-EVOLUTION control I-EVOLUTION persistía I-EVOLUTION la I-EVOLUTION leucocitosis I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION realizar I-EVOLUTION una I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION prueba I-EVOLUTION de I-EVOLUTION imagen I-EVOLUTION se I-EVOLUTION confirmó I-EVOLUTION la I-EVOLUTION mala I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION líquido I-EVOLUTION libre I-EVOLUTION intraabdominal. I-EVOLUTION Con B-TREATMENT estos I-TREATMENT hallazgos I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT urgente. I-TREATMENT I-TREATMENT Fue I-TREATMENT intervenido I-TREATMENT mediante I-TREATMENT una I-TREATMENT incisión I-TREATMENT subcostal I-TREATMENT derecha I-TREATMENT por I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT accedió I-TREATMENT a I-TREATMENT la I-TREATMENT cavidad I-TREATMENT peritoneal. I-TREATMENT Se I-TREATMENT localizó I-TREATMENT un I-TREATMENT plastrón I-TREATMENT de I-TREATMENT epiplón I-TREATMENT que I-TREATMENT cubría I-TREATMENT la I-TREATMENT vesícula, I-TREATMENT de I-TREATMENT aspecto I-TREATMENT tumoral, I-TREATMENT con I-TREATMENT sufusión I-TREATMENT hemorrágica I-TREATMENT en I-TREATMENT espacio I-TREATMENT subfrénico I-TREATMENT y I-TREATMENT perirrenal, I-TREATMENT así I-TREATMENT como I-TREATMENT un I-TREATMENT hemoperitoneo I-TREATMENT de I-TREATMENT 2, I-TREATMENT 7 I-TREATMENT litros I-TREATMENT sin I-TREATMENT apreciarse I-TREATMENT punto I-TREATMENT de I-TREATMENT hemorragia. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT colecistectomía I-TREATMENT subtotal I-TREATMENT por I-TREATMENT invasión I-TREATMENT tumoral I-TREATMENT del I-TREATMENT parénquima I-TREATMENT hepático I-TREATMENT y I-TREATMENT se I-TREATMENT extirpó I-TREATMENT la I-TREATMENT mayor I-TREATMENT parte I-TREATMENT del I-TREATMENT epiplón I-TREATMENT quedando I-TREATMENT residuo I-TREATMENT tumoral I-TREATMENT macroscópico. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION postoperatoria I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION 6o I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION A I-EVOLUTION la I-EVOLUTION semana I-EVOLUTION del I-EVOLUTION alta, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION reingresó I-EVOLUTION por I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION en I-EVOLUTION hipocondrio I-EVOLUTION derecho I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION astenia I-EVOLUTION y I-EVOLUTION anorexia. I-EVOLUTION En B-EXPLORATION los I-EXPLORATION análisis I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 7, I-EXPLORATION 5 I-EXPLORATION g/dL, I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 22, I-EXPLORATION 7% I-EXPLORATION y I-EXPLORATION 32.500 I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION izquierda. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION mal I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION mesogastrio I-EXPLORATION e I-EXPLORATION hipocondrio I-EXPLORATION derecho. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION 4x4 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lecho I-EXPLORATION quirúrgico. I-EXPLORATION I-EXPLORATION Se B-TREATMENT estableció I-TREATMENT tratamiento I-TREATMENT sintomático I-TREATMENT pero I-TREATMENT el I-TREATMENT paciente I-TREATMENT presentó I-TREATMENT un I-TREATMENT deterioro I-TREATMENT progresivo I-TREATMENT durante I-TREATMENT los I-TREATMENT días I-TREATMENT siguientes I-TREATMENT marcado I-TREATMENT por I-TREATMENT disnea, I-TREATMENT dolor I-TREATMENT abdominal I-TREATMENT en I-TREATMENT aumento, I-TREATMENT melenas I-TREATMENT y I-TREATMENT una I-TREATMENT anemización I-TREATMENT progresiva I-TREATMENT asociada I-TREATMENT a I-TREATMENT hipotensión I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT transfusiones I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT finalmente I-TREATMENT falleció I-TREATMENT a I-TREATMENT los I-TREATMENT 20 I-TREATMENT días I-TREATMENT de I-TREATMENT ser I-TREATMENT intervenido. I-TREATMENT I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION muestras I-EXPLORATION remitidas I-EXPLORATION a I-EXPLORATION anatomía I-EXPLORATION patológica. I-EXPLORATION En I-EXPLORATION ellas I-EXPLORATION se I-EXPLORATION identificaron I-EXPLORATION áreas I-EXPLORATION con I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION en I-EXPLORATION células I-EXPLORATION entremezclado I-EXPLORATION con I-EXPLORATION focos I-EXPLORATION hemorrágicos I-EXPLORATION y I-EXPLORATION zonas I-EXPLORATION en I-EXPLORATION donde I-EXPLORATION las I-EXPLORATION células I-EXPLORATION se I-EXPLORATION disponen I-EXPLORATION formando I-EXPLORATION canales I-EXPLORATION vasculares. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION un I-EXPLORATION análisis I-EXPLORATION inmunohistoquímico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION queratina I-EXPLORATION 7 I-EXPLORATION positivo I-EXPLORATION intenso, I-EXPLORATION D2.40, I-EXPLORATION CD-31 I-EXPLORATION y I-EXPLORATION vimentina I-EXPLORATION intensamente I-EXPLORATION positivo. I-EXPLORATION Todo I-EXPLORATION ello I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION angiosarcoma I-EXPLORATION epitelioide I-EXPLORATION primario I-EXPLORATION de I-EXPLORATION vesícula I-EXPLORATION biliar. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intenso, I-PRESENT_ILLNESS rectorragia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS náuseas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY mes I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY cólico I-PAST_MEDICAL_HISTORY recidivante. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY alteraciones I-PAST_MEDICAL_HISTORY analíticas I-PAST_MEDICAL_HISTORY relevantes. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION distendido, I-EXPLORATION timpanizado, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION peritonismo. I-EXPLORATION El I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION mostró I-EXPLORATION restos I-EXPLORATION hemáticos. I-EXPLORATION La I-EXPLORATION colonoscopia I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION friable I-EXPLORATION y I-EXPLORATION violácea, I-EXPLORATION en I-EXPLORATION válvula I-EXPLORATION ileocecal, I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION rotación I-EXPLORATION o I-EXPLORATION invaginación. I-EXPLORATION El I-EXPLORATION TAC I-EXPLORATION evidenció I-EXPLORATION una I-EXPLORATION invaginación I-EXPLORATION ileo-cólica I-EXPLORATION de I-EXPLORATION 12 I-EXPLORATION cm I-EXPLORATION con I-EXPLORATION sus I-EXPLORATION paredes I-EXPLORATION engrosadas I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION obstrucción I-EXPLORATION intestinal. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT quirúrgico, I-TREATMENT objetivando I-TREATMENT la I-TREATMENT invaginación I-TREATMENT ileocecal I-TREATMENT y I-TREATMENT un I-TREATMENT pequeño I-TREATMENT deserosamiento I-TREATMENT de I-TREATMENT ciego. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT una I-TREATMENT resección I-TREATMENT ampliada I-TREATMENT de I-TREATMENT ciego I-TREATMENT con I-TREATMENT anastomosis I-TREATMENT ileocólica I-TREATMENT mecánica. I-TREATMENT El B-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION invaginación I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION delgado I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION polipoide I-EXPLORATION formada I-EXPLORATION por I-EXPLORATION adipocitos I-EXPLORATION maduros I-EXPLORATION sin I-EXPLORATION lipoblastos, I-EXPLORATION que I-EXPLORATION es I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION invaginada. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION postoperatoria. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 55 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ulcus I-PAST_MEDICAL_HISTORY bulbar I-PAST_MEDICAL_HISTORY (Helicobacter I-PAST_MEDICAL_HISTORY pylori I-PAST_MEDICAL_HISTORY positivo, I-PAST_MEDICAL_HISTORY erradicada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2005), I-PAST_MEDICAL_HISTORY tromboembolismo I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2012 I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY intervenido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY inguinal I-PAST_MEDICAL_HISTORY derecha. I-PAST_MEDICAL_HISTORY Fumador, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY acumulado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY paquetes/año. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inestabilidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lateropulsión I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS bradipsiquia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS disnomia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION craneal I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION en I-EXPLORATION hemisferio I-EXPLORATION cerebeloso I-EXPLORATION derecho. I-EXPLORATION Tras I-EXPLORATION completar I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION toraco-abdominal, I-EXPLORATION RM I-EXPLORATION craneal, I-EXPLORATION broncoscopia I-EXPLORATION y I-EXPLORATION PET I-EXPLORATION fue I-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION cerebral I-EXPLORATION sugestiva I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION de I-EXPLORATION una I-EXPLORATION posible I-EXPLORATION neoplasia I-EXPLORATION pulmonar I-EXPLORATION localizada. I-EXPLORATION Se B-TREATMENT decidió I-TREATMENT realizar I-TREATMENT metastasectomía I-TREATMENT cerebral I-TREATMENT diagnóstico-terapéutica. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION microcítico I-EXPLORATION de I-EXPLORATION pulmón. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION CPCP I-EXPLORATION T1N0M1b, I-EXPLORATION estadio I-EXPLORATION IV. I-EXPLORATION Se B-TREATMENT administró I-TREATMENT tratamiento I-TREATMENT adyuvante I-TREATMENT con I-TREATMENT radioterapia I-TREATMENT holocraneal I-TREATMENT hasta I-TREATMENT alcanzar I-TREATMENT dosis I-TREATMENT total I-TREATMENT de I-TREATMENT 37.5 I-TREATMENT Gys I-TREATMENT que I-TREATMENT finalizó I-TREATMENT en I-TREATMENT julio I-TREATMENT de I-TREATMENT 2011 I-TREATMENT tras I-TREATMENT lo I-TREATMENT cual I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT cisplatino I-TREATMENT -VP16. I-TREATMENT I-TREATMENT Precisó I-TREATMENT cambio I-TREATMENT a I-TREATMENT carboplatino I-TREATMENT por I-TREATMENT emesis I-TREATMENT e I-TREATMENT insuficiencia I-TREATMENT renal I-TREATMENT recibiendo I-TREATMENT en I-TREATMENT total I-TREATMENT 4 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT mala I-TREATMENT tolerancia I-TREATMENT clínica I-TREATMENT y I-TREATMENT hematológica I-TREATMENT finalizando I-TREATMENT en I-TREATMENT octubre I-TREATMENT de I-TREATMENT 2011. I-TREATMENT Posteriormente, I-TREATMENT en I-TREATMENT diciembre I-TREATMENT de I-TREATMENT 2011, I-TREATMENT recibió I-TREATMENT radioterapia I-TREATMENT torácica I-TREATMENT de I-TREATMENT consolidación, I-TREATMENT 45 I-TREATMENT Gys I-TREATMENT en I-TREATMENT 15 I-TREATMENT fracciones I-TREATMENT siguiendo I-TREATMENT las I-TREATMENT recomendaciones I-TREATMENT RTOG I-TREATMENT 09372, I-TREATMENT consiguiendo I-TREATMENT mantener I-TREATMENT la I-TREATMENT estabilidad I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT en I-TREATMENT los I-TREATMENT siguientes I-TREATMENT controles. I-TREATMENT I-TREATMENT En B-EVOLUTION julio I-EVOLUTION de I-EVOLUTION 2012 I-EVOLUTION ingresó I-EVOLUTION procedente I-EVOLUTION del I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION por I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION fuerza I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION inferior I-EVOLUTION izquierda I-EVOLUTION de I-EVOLUTION varios I-EVOLUTION días I-EVOLUTION de I-EVOLUTION evolución. I-EVOLUTION Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION RM I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION metástasis I-EXPLORATION leptomeníngeas I-EXPLORATION con I-EXPLORATION implante I-EXPLORATION dorsal I-EXPLORATION (D2-D3) I-EXPLORATION que I-EXPLORATION provocaba I-EXPLORATION una I-EXPLORATION compresión I-EXPLORATION medular I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT radioterapia I-TREATMENT sobre I-TREATMENT niveles I-TREATMENT D1-D4 I-TREATMENT administrándose I-TREATMENT 20 I-TREATMENT Gy I-TREATMENT en I-TREATMENT 5 I-TREATMENT fracciones I-TREATMENT con I-TREATMENT excelente I-TREATMENT respuesta I-TREATMENT clínica. I-TREATMENT I-TREATMENT Asimismo B-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION toracoabdominal I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION adenopatía I-EXPLORATION hiliar I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION nueva I-EXPLORATION aparición I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT carboplatino-etopósido, I-TREATMENT con I-TREATMENT respuesta I-TREATMENT parcial I-TREATMENT tras I-TREATMENT 3 I-TREATMENT ciclos I-TREATMENT y I-TREATMENT estabilización I-TREATMENT tras I-TREATMENT el I-TREATMENT 6o I-TREATMENT ciclo I-TREATMENT que I-TREATMENT se I-TREATMENT administró I-TREATMENT en I-TREATMENT diciembre I-TREATMENT de I-TREATMENT 2012. I-TREATMENT I-TREATMENT En B-EXPLORATION RM I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION en I-EXPLORATION junio I-EXPLORATION de I-EXPLORATION 2013 I-EXPLORATION se I-EXPLORATION visualizaron I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION captación I-EXPLORATION puntiformes I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION diseminación I-EXPLORATION leptomeníngea I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION del I-EXPLORATION raquis, I-EXPLORATION tanto I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION dorsal I-EXPLORATION como I-EXPLORATION lumbar, I-EXPLORATION encontrándose I-EXPLORATION los I-EXPLORATION implantes I-EXPLORATION más I-EXPLORATION destacables I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION lumbar I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION planificó I-EXPLORATION RT I-EXPLORATION a I-EXPLORATION ese I-EXPLORATION nivel I-EXPLORATION (L1-L5). I-EXPLORATION Se B-TREATMENT administraron I-TREATMENT 20 I-TREATMENT Gys I-TREATMENT en I-TREATMENT 5 I-TREATMENT fracciones I-TREATMENT el I-TREATMENT mismo I-TREATMENT mes I-TREATMENT de I-TREATMENT junio I-TREATMENT de I-TREATMENT 2013. I-TREATMENT I-TREATMENT En B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mediante I-EXPLORATION TAC I-EXPLORATION toracoabdominal I-EXPLORATION en I-EXPLORATION junio I-EXPLORATION de I-EXPLORATION ese I-EXPLORATION año I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION que I-EXPLORATION la I-EXPLORATION adenopatía I-EXPLORATION hiliar I-EXPLORATION derecha I-EXPLORATION había I-EXPLORATION aumentado I-EXPLORATION ligeramente I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION TAC I-EXPLORATION previo I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT administrar I-TREATMENT radioterapia I-TREATMENT sobre I-TREATMENT la I-TREATMENT lesión I-TREATMENT hiliar I-TREATMENT con I-TREATMENT un I-TREATMENT esquema I-TREATMENT de I-TREATMENT 40 I-TREATMENT Gy I-TREATMENT en I-TREATMENT 15 I-TREATMENT fracciones, I-TREATMENT finalizando I-TREATMENT tratamiento I-TREATMENT en I-TREATMENT noviembre I-TREATMENT 2013. I-TREATMENT I-TREATMENT Desde B-EVOLUTION entonces I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION revisiones, I-EVOLUTION con I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION vida I-EVOLUTION activa I-EVOLUTION e I-EVOLUTION independiente I-EVOLUTION para I-EVOLUTION las I-EVOLUTION actividades I-EVOLUTION básicas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION vida I-EVOLUTION diaria. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION estudios I-EVOLUTION de I-EVOLUTION control I-EVOLUTION no I-EVOLUTION hay I-EVOLUTION datos I-EVOLUTION de I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION enfermedad. I-EVOLUTION No B-EXPLORATION se I-EXPLORATION observan I-EXPLORATION realces I-EXPLORATION patológicos I-EXPLORATION leptomeníngeos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION última I-EXPLORATION RM I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION y I-EXPLORATION se I-EXPLORATION ha I-EXPLORATION comprobado I-EXPLORATION por I-EXPLORATION TAC I-EXPLORATION la I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION adenopatía I-EXPLORATION hiliar I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION en I-EXPLORATION estos I-EXPLORATION momentos I-EXPLORATION es I-EXPLORATION infracentimétrica. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS varón, I-PRESENT_ILLNESS fruto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS gestación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 I-PRESENT_ILLNESS años. I-PRESENT_ILLNESS El B-EXPLORATION embarazo I-EXPLORATION había I-EXPLORATION transcurrido I-EXPLORATION sin I-EXPLORATION incidencias, I-EXPLORATION con I-EXPLORATION cribado I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION trimestre I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION riesgo. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION serológicos I-EXPLORATION habituales I-EXPLORATION estaban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION antenatal I-EXPLORATION se I-EXPLORATION detecta I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 37 I-EXPLORATION semanas I-EXPLORATION de I-EXPLORATION edad I-EXPLORATION gestacional I-EXPLORATION la I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION lateral I-EXPLORATION derecho, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION anomalías I-EXPLORATION morfológicas I-EXPLORATION a I-EXPLORATION destacar. I-EXPLORATION I-EXPLORATION El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY nació I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 39+3 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY vaginal I-PAST_MEDICAL_HISTORY instrumentado. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY presentación I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY cefálica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY puntuación I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY test I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 9-9-10. I-PAST_MEDICAL_HISTORY La B-EXPLORATION exploración I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION parto I-EXPLORATION mostraba I-EXPLORATION buen I-EXPLORATION tono I-EXPLORATION y I-EXPLORATION vitalidad; I-EXPLORATION fontanela I-EXPLORATION anterior I-EXPLORATION normotensa, I-EXPLORATION sin I-EXPLORATION anomalías I-EXPLORATION morfológicas I-EXPLORATION a I-EXPLORATION destacar I-EXPLORATION ni I-EXPLORATION disrafismos. I-EXPLORATION Reflejos I-EXPLORATION arcaicos I-EXPLORATION presentes. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION analíticos, I-EXPLORATION serológicos, I-EXPLORATION el I-EXPLORATION cribado I-EXPLORATION de I-EXPLORATION metabolopatías I-EXPLORATION y I-EXPLORATION de I-EXPLORATION sordera I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normal I-EXPLORATION El I-EXPLORATION ecocardiograma I-EXPLORATION demostró I-EXPLORATION comunicación I-EXPLORATION interauricular I-EXPLORATION sin I-EXPLORATION repercusión I-EXPLORATION hemodinámica. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION transfontanelar I-EXPLORATION demostró I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION lateral I-EXPLORATION derecho, I-EXPLORATION en I-EXPLORATION probable I-EXPLORATION relación I-EXPLORATION a I-EXPLORATION obstrucción I-EXPLORATION del I-EXPLORATION foramen I-EXPLORATION de I-EXPLORATION Monro I-EXPLORATION derecho. I-EXPLORATION En I-EXPLORATION este I-EXPLORATION momento I-EXPLORATION el I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION resistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pericallosa I-EXPLORATION se I-EXPLORATION situaba I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad, I-EXPLORATION sin I-EXPLORATION aumentar I-EXPLORATION tras I-EXPLORATION ejercer I-EXPLORATION presión I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fontanela I-EXPLORATION anterior. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION semana I-EXPLORATION de I-EXPLORATION su I-EXPLORATION nacimiento I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION cerebral I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION dilatación I-EXPLORATION ventricular I-EXPLORATION con I-EXPLORATION calibre I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION asta I-EXPLORATION frontal, I-EXPLORATION 32 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION asta I-EXPLORATION occipital I-EXPLORATION y I-EXPLORATION 14 I-EXPLORATION mm I-EXPLORATION del I-EXPLORATION asta I-EXPLORATION temporal. I-EXPLORATION Se I-EXPLORATION asociaba I-EXPLORATION a I-EXPLORATION un I-EXPLORATION desplazamiento I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media, I-EXPLORATION sin I-EXPLORATION observarse I-EXPLORATION masas I-EXPLORATION ni I-EXPLORATION tabiques I-EXPLORATION intraventriculares. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION sistema I-EXPLORATION ventricular I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Por I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION hipertensión I-EXPLORATION intracraneal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION seguimiento I-EXPLORATION inicial I-EXPLORATION clínico I-EXPLORATION y I-EXPLORATION radiológico I-EXPLORATION mediante I-EXPLORATION ecografías I-EXPLORATION seriadas. I-EXPLORATION I-EXPLORATION A I-EXPLORATION las I-EXPLORATION 10 I-EXPLORATION semanas I-EXPLORATION de I-EXPLORATION edad, I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION transfontanelar I-EXPLORATION demostró I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION dilatación I-EXPLORATION (asta I-EXPLORATION frontal I-EXPLORATION 11 I-EXPLORATION mm, I-EXPLORATION occipital I-EXPLORATION 27 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION temporal I-EXPLORATION 19 I-EXPLORATION mm), I-EXPLORATION desplazamiento I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION e I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION resistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pericallosa I-EXPLORATION incrementado, I-EXPLORATION aumentando I-EXPLORATION de I-EXPLORATION manera I-EXPLORATION significativa I-EXPLORATION tras I-EXPLORATION presión I-EXPLORATION ligera I-EXPLORATION sobre I-EXPLORATION fontanela I-EXPLORATION anterior, I-EXPLORATION hallazgo I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION hidrocefalia I-EXPLORATION a I-EXPLORATION tensión. I-EXPLORATION Ante B-TREATMENT estos I-TREATMENT hallazgos, I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT presentaba I-TREATMENT perímetro I-TREATMENT cefálico I-TREATMENT normal I-TREATMENT y I-TREATMENT exploración I-TREATMENT clínica I-TREATMENT normal, I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT de I-TREATMENT la I-TREATMENT hidrocefalia. I-TREATMENT I-TREATMENT El I-TREATMENT paciente I-TREATMENT fue I-TREATMENT intervenido I-TREATMENT a I-TREATMENT los I-TREATMENT 3 I-TREATMENT meses I-TREATMENT de I-TREATMENT edad. I-TREATMENT Se I-TREATMENT empleó I-TREATMENT un I-TREATMENT ventriculoscopio I-TREATMENT rígido I-TREATMENT a I-TREATMENT 0o I-TREATMENT (Kart I-TREATMENT Storz I-TREATMENT ®, I-TREATMENT Tuttlingen, I-TREATMENT Alemania). I-TREATMENT Bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT colocó I-TREATMENT en I-TREATMENT decúbito I-TREATMENT supino, I-TREATMENT con I-TREATMENT la I-TREATMENT cabeza I-TREATMENT neutra I-TREATMENT elevada I-TREATMENT unos I-TREATMENT 20o. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT un I-TREATMENT agujero I-TREATMENT de I-TREATMENT trépano I-TREATMENT derecho, I-TREATMENT justo I-TREATMENT anterior I-TREATMENT a I-TREATMENT la I-TREATMENT sutura I-TREATMENT coronal I-TREATMENT y I-TREATMENT 3 I-TREATMENT cm I-TREATMENT lateral I-TREATMENT a I-TREATMENT la I-TREATMENT línea I-TREATMENT media. I-TREATMENT El I-TREATMENT acceso I-TREATMENT al I-TREATMENT ventrículo I-TREATMENT se I-TREATMENT realizó I-TREATMENT siguiendo I-TREATMENT las I-TREATMENT referencias I-TREATMENT anatómicas I-TREATMENT habituales, I-TREATMENT dirigiendo I-TREATMENT el I-TREATMENT endoscopio I-TREATMENT hacia I-TREATMENT el I-TREATMENT canto I-TREATMENT interno I-TREATMENT del I-TREATMENT ojo I-TREATMENT ipsilateral I-TREATMENT en I-TREATMENT el I-TREATMENT plano I-TREATMENT coronal I-TREATMENT y I-TREATMENT hacia I-TREATMENT el I-TREATMENT conducto I-TREATMENT auditivo I-TREATMENT externo I-TREATMENT en I-TREATMENT el I-TREATMENT plano I-TREATMENT sagital. I-TREATMENT Tras I-TREATMENT acceder I-TREATMENT al I-TREATMENT asta I-TREATMENT frontal I-TREATMENT derecha, I-TREATMENT se I-TREATMENT identificó I-TREATMENT la I-TREATMENT anatomía I-TREATMENT ventricular I-TREATMENT y I-TREATMENT se I-TREATMENT localizó I-TREATMENT la I-TREATMENT ubicación I-TREATMENT teórica I-TREATMENT del I-TREATMENT foramen I-TREATMENT de I-TREATMENT Monro I-TREATMENT siguiendo I-TREATMENT las I-TREATMENT venas I-TREATMENT talamoestriada I-TREATMENT y I-TREATMENT septal I-TREATMENT anterior I-TREATMENT y I-TREATMENT el I-TREATMENT plexo I-TREATMENT coroideo. I-TREATMENT Se I-TREATMENT identificó I-TREATMENT una I-TREATMENT membrana I-TREATMENT avascular I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT cual I-TREATMENT se I-TREATMENT intuía I-TREATMENT por I-TREATMENT transparencia I-TREATMENT el I-TREATMENT foramen I-TREATMENT de I-TREATMENT Monro. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT coagulación I-TREATMENT y I-TREATMENT posterior I-TREATMENT apertura I-TREATMENT de I-TREATMENT esta I-TREATMENT membrana I-TREATMENT empleando I-TREATMENT la I-TREATMENT punta I-TREATMENT bipolar I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT dilató I-TREATMENT con I-TREATMENT un I-TREATMENT balón I-TREATMENT de I-TREATMENT Fogarty I-TREATMENT de I-TREATMENT 4 I-TREATMENT French. I-TREATMENT A I-TREATMENT través I-TREATMENT del I-TREATMENT nuevo I-TREATMENT foramen I-TREATMENT creado, I-TREATMENT se I-TREATMENT introdujo I-TREATMENT el I-TREATMENT endoscopio I-TREATMENT hasta I-TREATMENT visualizar I-TREATMENT el I-TREATMENT tercer I-TREATMENT ventrículo. I-TREATMENT Tras I-TREATMENT crear I-TREATMENT una I-TREATMENT adecuada I-TREATMENT comunicación I-TREATMENT del I-TREATMENT asta I-TREATMENT frontal I-TREATMENT derecha I-TREATMENT con I-TREATMENT el I-TREATMENT tercer I-TREATMENT ventrículo, I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT fenestración I-TREATMENT en I-TREATMENT la I-TREATMENT porción I-TREATMENT anterior I-TREATMENT del I-TREATMENT septo I-TREATMENT pellucidum, I-TREATMENT para I-TREATMENT asegurar I-TREATMENT otra I-TREATMENT vía I-TREATMENT de I-TREATMENT comunicación I-TREATMENT entre I-TREATMENT las I-TREATMENT astas I-TREATMENT frontales I-TREATMENT de I-TREATMENT los I-TREATMENT ventrículos I-TREATMENT laterales. I-TREATMENT I-TREATMENT El B-EVOLUTION postoperatorio I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION cursó I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION La I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION perímetro I-EVOLUTION craneal I-EVOLUTION y I-EVOLUTION la I-EVOLUTION exploración I-EVOLUTION física I-EVOLUTION y I-EVOLUTION neurológica I-EVOLUTION en I-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION fueron I-EVOLUTION normales. I-EVOLUTION Las I-EVOLUTION ecografias I-EVOLUTION transfontanelares I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION mostraron I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION dilatación I-EVOLUTION del I-EVOLUTION ventrículo I-EVOLUTION lateral I-EVOLUTION derecho, I-EVOLUTION con I-EVOLUTION índice I-EVOLUTION de I-EVOLUTION la I-EVOLUTION arteria I-EVOLUTION pericallosa I-EVOLUTION dentro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION normalidad. I-EVOLUTION La I-EVOLUTION RM I-EVOLUTION realizada I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 9 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION edad I-EVOLUTION confirmó I-EVOLUTION estos I-EVOLUTION hallazgos I-EVOLUTION de I-EVOLUTION ecografía. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS ingresado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Unidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cuidados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Intensivos I-PRESENT_ILLNESS (UCI) I-PRESENT_ILLNESS en I-PRESENT_ILLNESS situación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS daño I-PRESENT_ILLNESS cerebral I-PRESENT_ILLNESS catastrófico I-PRESENT_ILLNESS secundario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS cerebrovascular I-PRESENT_ILLNESS isquémico I-PRESENT_ILLNESS establecido I-PRESENT_ILLNESS en I-PRESENT_ILLNESS territorio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS arteria I-PRESENT_ILLNESS cerebral I-PRESENT_ILLNESS media I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS con I-PRESENT_ILLNESS transformación I-PRESENT_ILLNESS hemorrágica. I-PRESENT_ILLNESS Tras B-EXPLORATION cuatro I-EXPLORATION días I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION UCI I-EXPLORATION y I-EXPLORATION ante I-EXPLORATION el I-EXPLORATION infausto I-EXPLORATION pronóstico I-EXPLORATION neurológico, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION aplicar I-EXPLORATION LTSV I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION consensuada I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION equipo I-EXPLORATION de I-EXPLORATION UCI I-EXPLORATION y I-EXPLORATION la I-EXPLORATION familia. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION establecida I-EXPLORATION la I-EXPLORATION LTSV, I-EXPLORATION y I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION pudiera I-EXPLORATION ser I-EXPLORATION donante I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION en I-EXPLORATION asistolia I-EXPLORATION controlada, I-EXPLORATION el I-EXPLORATION coordinador I-EXPLORATION de I-EXPLORATION trasplantes I-EXPLORATION se I-EXPLORATION entrevistó I-EXPLORATION con I-EXPLORATION los I-EXPLORATION familiares I-EXPLORATION que I-EXPLORATION mostraron I-EXPLORATION su I-EXPLORATION deseo I-EXPLORATION de I-EXPLORATION donación I-EXPLORATION y I-EXPLORATION firmaron I-EXPLORATION el I-EXPLORATION consiguiente I-EXPLORATION consentimiento I-EXPLORATION informado I-EXPLORATION (que I-EXPLORATION incluye I-EXPLORATION canulación I-EXPLORATION y I-EXPLORATION heparinización I-EXPLORATION premortem). I-EXPLORATION I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION clínicas I-EXPLORATION y I-EXPLORATION analíticas I-EXPLORATION necesarias, I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION canulación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION y I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION femorales I-EXPLORATION derechas I-EXPLORATION (necesarias I-EXPLORATION para I-EXPLORATION la I-EXPLORATION NECMO), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION femoral I-EXPLORATION contralateral I-EXPLORATION para I-EXPLORATION la I-EXPLORATION colocación I-EXPLORATION de I-EXPLORATION un I-EXPLORATION catéter I-EXPLORATION de I-EXPLORATION oclusión I-EXPLORATION aórtico I-EXPLORATION tipo I-EXPLORATION Fogarty. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION confirmada I-EXPLORATION la I-EXPLORATION adecuada I-EXPLORATION colocación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cánulas I-EXPLORATION de I-EXPLORATION NECMO I-EXPLORATION y I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION Fogarty, I-EXPLORATION el I-EXPLORATION enfermo I-EXPLORATION fue I-EXPLORATION trasladado I-EXPLORATION a I-EXPLORATION quirófano I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION LTSV I-EXPLORATION acordada. I-EXPLORATION Tras I-EXPLORATION la I-EXPLORATION retirada I-EXPLORATION de I-EXPLORATION soporte I-EXPLORATION vital I-EXPLORATION se I-EXPLORATION administraron I-EXPLORATION 300 I-EXPLORATION UI/Kg I-EXPLORATION de I-EXPLORATION heparina I-EXPLORATION sódica I-EXPLORATION i.v., I-EXPLORATION y I-EXPLORATION 12 I-EXPLORATION minutos I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION comenzó I-EXPLORATION con I-EXPLORATION hipoperfusión I-EXPLORATION verdadera I-EXPLORATION (tensión I-EXPLORATION arterial I-EXPLORATION sistólica I-EXPLORATION (TAS) I-EXPLORATION menor I-EXPLORATION de I-EXPLORATION 60 I-EXPLORATION mmHg), I-EXPLORATION presentando I-EXPLORATION asistolia I-EXPLORATION cinco I-EXPLORATION minutos I-EXPLORATION después I-EXPLORATION y I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION fallecimiento I-EXPLORATION otros I-EXPLORATION cinco I-EXPLORATION minutos I-EXPLORATION más I-EXPLORATION tarde. I-EXPLORATION Así, I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION isquemia I-EXPLORATION caliente I-EXPLORATION total I-EXPLORATION (TICT, I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION retirada I-EXPLORATION de I-EXPLORATION soporte I-EXPLORATION vital I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION perfusión I-EXPLORATION fría I-EXPLORATION o I-EXPLORATION NECMO) I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION minutos I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION isquemia I-EXPLORATION caliente I-EXPLORATION funcional I-EXPLORATION (TICF, I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION comienzo I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hipoperfusión I-EXPLORATION significativa I-EXPLORATION -TAS<60 I-EXPLORATION mmHg- I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION perfusión I-EXPLORATION fría I-EXPLORATION o I-EXPLORATION NECMO) I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION minutos. I-EXPLORATION Se I-EXPLORATION puede I-EXPLORATION ver I-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION del I-EXPLORATION potencial I-EXPLORATION donante I-EXPLORATION durante I-EXPLORATION este I-EXPLORATION período I-EXPLORATION de I-EXPLORATION observación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Tabla I-EXPLORATION 1. I-EXPLORATION I-EXPLORATION LTSV: I-EXPLORATION limitación I-EXPLORATION del I-EXPLORATION tratamiento I-EXPLORATION de I-EXPLORATION soporte I-EXPLORATION vital; I-EXPLORATION min: I-EXPLORATION minutos; I-EXPLORATION TAS: I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION sistólica; I-EXPLORATION TAD: I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION diastólica; I-EXPLORATION FC: I-EXPLORATION frecuencia I-EXPLORATION cardíaca; I-EXPLORATION FR: I-EXPLORATION frecuencia I-EXPLORATION respiratoria; I-EXPLORATION Sat. I-EXPLORATION O2: I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION oxígeno; I-EXPLORATION lpm: I-EXPLORATION latidos/minuto; I-EXPLORATION rpm: I-EXPLORATION respiraciones/minuto; I-EXPLORATION ml: I-EXPLORATION mililitros I-EXPLORATION I-EXPLORATION En I-EXPLORATION cuanto I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION muerte, I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION la I-EXPLORATION NECMO I-EXPLORATION (previo I-EXPLORATION hinchado I-EXPLORATION del I-EXPLORATION balón I-EXPLORATION de I-EXPLORATION Fogarty I-EXPLORATION contralateral) I-EXPLORATION con I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION intubado I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION iniciar I-EXPLORATION ventilación I-EXPLORATION (tubo I-EXPLORATION al I-EXPLORATION aire). I-EXPLORATION Seguidamente, I-EXPLORATION el I-EXPLORATION cirujano I-EXPLORATION torácico I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION esternotomía I-EXPLORATION rápida I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION un I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION 7-8 I-EXPLORATION minutos, I-EXPLORATION revisó I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION torácica I-EXPLORATION y I-EXPLORATION clampó I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION torácica I-EXPLORATION justo I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION de I-EXPLORATION Fogarty. I-EXPLORATION Inmediatamente I-EXPLORATION después I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION ventilación I-EXPLORATION mecánica I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fracción I-EXPLORATION inspirada I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION (FiO2) I-EXPLORATION del I-EXPLORATION 100%, I-EXPLORATION presión I-EXPLORATION positiva I-EXPLORATION al I-EXPLORATION final I-EXPLORATION de I-EXPLORATION la I-EXPLORATION espiración I-EXPLORATION (PEEP) I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION y I-EXPLORATION 12 I-EXPLORATION respiraciones/minuto. I-EXPLORATION El I-EXPLORATION cirujano I-EXPLORATION canuló I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION se I-EXPLORATION perfundieron I-EXPLORATION los I-EXPLORATION pulmones I-EXPLORATION con I-EXPLORATION Perfadex I-EXPLORATION (solución I-EXPLORATION de I-EXPLORATION preservación I-EXPLORATION de I-EXPLORATION órganos) I-EXPLORATION hasta I-EXPLORATION alcanzar I-EXPLORATION la I-EXPLORATION limpieza I-EXPLORATION del I-EXPLORATION circuito I-EXPLORATION pulmonar, I-EXPLORATION como I-EXPLORATION en I-EXPLORATION una I-EXPLORATION extracción I-EXPLORATION reglada, I-EXPLORATION realizando I-EXPLORATION maniobras I-EXPLORATION de I-EXPLORATION Valsalva I-EXPLORATION (o I-EXPLORATION suspiros) I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION distensibilidad I-EXPLORATION del I-EXPLORATION pulmón. I-EXPLORATION Simultáneamente, I-EXPLORATION la I-EXPLORATION NECMO I-EXPLORATION siguió I-EXPLORATION funcionando I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cirujano I-EXPLORATION hepático I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION media I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION viabilidad I-EXPLORATION y I-EXPLORATION confirmar I-EXPLORATION la I-EXPLORATION adecuada I-EXPLORATION perfusión I-EXPLORATION hepática. I-EXPLORATION Preventivamente I-EXPLORATION se I-EXPLORATION infundieron I-EXPLORATION dos I-EXPLORATION concentrados I-EXPLORATION de I-EXPLORATION hematíes I-EXPLORATION y I-EXPLORATION un I-EXPLORATION litro I-EXPLORATION de I-EXPLORATION suero I-EXPLORATION salino I-EXPLORATION 0, I-EXPLORATION 9%, I-EXPLORATION para I-EXPLORATION así I-EXPLORATION aumentar I-EXPLORATION el I-EXPLORATION circuito I-EXPLORATION de I-EXPLORATION ECMO I-EXPLORATION previo I-EXPLORATION al I-EXPLORATION clampaje I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION en I-EXPLORATION que I-EXPLORATION el I-EXPLORATION cirujano I-EXPLORATION torácico I-EXPLORATION informó I-EXPLORATION de I-EXPLORATION que I-EXPLORATION iba I-EXPLORATION a I-EXPLORATION ligar I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior I-EXPLORATION en I-EXPLORATION la I-EXPLORATION desembocadura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha, I-EXPLORATION ambos I-EXPLORATION cirujanos I-EXPLORATION movilizaron I-EXPLORATION conjuntamente I-EXPLORATION la I-EXPLORATION cánula I-EXPLORATION venosa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ECMO I-EXPLORATION para I-EXPLORATION bajarla I-EXPLORATION varios I-EXPLORATION centímetros I-EXPLORATION y I-EXPLORATION dejar I-EXPLORATION el I-EXPLORATION extremo I-EXPLORATION distal I-EXPLORATION por I-EXPLORATION debajo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION recolocada I-EXPLORATION la I-EXPLORATION cánula I-EXPLORATION venosa I-EXPLORATION y I-EXPLORATION clampada I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior, I-EXPLORATION los I-EXPLORATION flujos I-EXPLORATION de I-EXPLORATION ECMO I-EXPLORATION bajaron I-EXPLORATION ligeramente I-EXPLORATION requiriendo I-EXPLORATION la I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION dos I-EXPLORATION hemoconcentrados I-EXPLORATION y I-EXPLORATION 500 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION suero I-EXPLORATION salino I-EXPLORATION 0, I-EXPLORATION 9%. I-EXPLORATION En I-EXPLORATION esta I-EXPLORATION fase I-EXPLORATION ya I-EXPLORATION estaban I-EXPLORATION separados I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION con I-EXPLORATION ligadura I-EXPLORATION previa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cava, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION la I-EXPLORATION extracción I-EXPLORATION reglada I-EXPLORATION pulmonar I-EXPLORATION mientras I-EXPLORATION se I-EXPLORATION continuaba I-EXPLORATION con I-EXPLORATION NECMO. I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION extraídos I-EXPLORATION los I-EXPLORATION pulmones I-EXPLORATION se I-EXPLORATION mantuvo I-EXPLORATION la I-EXPLORATION NECMO I-EXPLORATION 16 I-EXPLORATION minutos I-EXPLORATION más I-EXPLORATION (tiempo I-EXPLORATION total I-EXPLORATION de I-EXPLORATION NECMO I-EXPLORATION de I-EXPLORATION 84 I-EXPLORATION minutos), I-EXPLORATION se I-EXPLORATION inició I-EXPLORATION la I-EXPLORATION perfusión I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION Celsior I-EXPLORATION (solución I-EXPLORATION de I-EXPLORATION preservación I-EXPLORATION de I-EXPLORATION órganos I-EXPLORATION abdominales) I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cánula I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION ECMO I-EXPLORATION y I-EXPLORATION finalmente I-EXPLORATION se I-EXPLORATION extrajeron I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION reglada I-EXPLORATION el I-EXPLORATION hígado I-EXPLORATION y I-EXPLORATION los I-EXPLORATION riñones. I-EXPLORATION I-EXPLORATION Durante I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION proceso I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION determinaciones I-EXPLORATION seriadas I-EXPLORATION cada I-EXPLORATION 20 I-EXPLORATION minutos I-EXPLORATION del I-EXPLORATION equilibrio I-EXPLORATION ácido-base I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION iónico, I-EXPLORATION hematología I-EXPLORATION y I-EXPLORATION bioquímica I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION renal. I-EXPLORATION I-EXPLORATION PaO2: I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION (mmHg); I-EXPLORATION PaCO2: I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION dióxido I-EXPLORATION de I-EXPLORATION carbono I-EXPLORATION (mmHg); I-EXPLORATION HCO3-: I-EXPLORATION bicarbonato I-EXPLORATION (mmol/L); I-EXPLORATION Lact.: I-EXPLORATION lactato I-EXPLORATION (mg/dL); I-EXPLORATION Bil.: I-EXPLORATION bilirrubina I-EXPLORATION (mg/dL); I-EXPLORATION Hto.: I-EXPLORATION hematocrito I-EXPLORATION (%); I-EXPLORATION Hb.: I-EXPLORATION hemoglobina I-EXPLORATION (g/dL); I-EXPLORATION Gluc.: I-EXPLORATION glucemia I-EXPLORATION (mg/dL); I-EXPLORATION Na+: I-EXPLORATION ión I-EXPLORATION sodio I-EXPLORATION (mmol/L); I-EXPLORATION K+: I-EXPLORATION ión I-EXPLORATION potasio I-EXPLORATION (mmol/L); I-EXPLORATION min: I-EXPLORATION minutos I-EXPLORATION I-EXPLORATION En B-EVOLUTION cuanto I-EVOLUTION a I-EVOLUTION los I-EVOLUTION receptores I-EVOLUTION de I-EVOLUTION los I-EVOLUTION injertos I-EVOLUTION extraídos, I-EVOLUTION todos I-EVOLUTION han I-EVOLUTION presentado I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable I-EVOLUTION postrasplante. I-EVOLUTION El I-EVOLUTION receptor I-EVOLUTION pulmonar I-EVOLUTION recibió I-EVOLUTION un I-EVOLUTION trasplante I-EVOLUTION bipulmonar I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION durante I-EVOLUTION su I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION en I-EVOLUTION UCI I-EVOLUTION y I-EVOLUTION posterior I-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION planta I-EVOLUTION de I-EVOLUTION hospitalización. I-EVOLUTION I-EVOLUTION Paciente, B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS atendida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Postgrado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Rehabilitación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Prótesis I-PRESENT_ILLNESS Maxilofacial I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Universidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Barcelona, I-PRESENT_ILLNESS para I-PRESENT_ILLNESS sustituir I-PRESENT_ILLNESS la I-PRESENT_ILLNESS prótesis I-PRESENT_ILLNESS óculo-palpebral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS que I-PRESENT_ILLNESS era I-PRESENT_ILLNESS portadora. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Tras B-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION minucioso I-EXPLORATION del I-EXPLORATION defecto I-EXPLORATION facial, I-EXPLORATION se I-EXPLORATION evaluaron I-EXPLORATION las I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION soporte I-EXPLORATION para I-EXPLORATION ver I-EXPLORATION las I-EXPLORATION posibilidades I-EXPLORATION de I-EXPLORATION obtención I-EXPLORATION de I-EXPLORATION estabilidad, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION retención I-EXPLORATION de I-EXPLORATION la I-EXPLORATION prótesis4.. I-EXPLORATION Éste I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION superficie I-EXPLORATION cubierta I-EXPLORATION totalmente I-EXPLORATION de I-EXPLORATION piel, I-EXPLORATION firme, I-EXPLORATION estable, I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION una I-EXPLORATION concavidad I-EXPLORATION comunicada I-EXPLORATION con I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION temporal I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION un I-EXPLORATION agujero I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION resultado I-EXPLORATION del I-EXPLORATION fracaso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION osteointegración I-EXPLORATION de I-EXPLORATION un I-EXPLORATION implante. I-EXPLORATION I-EXPLORATION Para B-TREATMENT la I-TREATMENT elaboración I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT óculo-palpebral I-TREATMENT flexible I-TREATMENT se I-TREATMENT debe I-TREATMENT obtener I-TREATMENT una I-TREATMENT impresión I-TREATMENT que I-TREATMENT reproduzca I-TREATMENT fielmente I-TREATMENT los I-TREATMENT tejidos I-TREATMENT remanentes. I-TREATMENT Para I-TREATMENT ello I-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT delimitación I-TREATMENT de I-TREATMENT la I-TREATMENT extensión I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT sus I-TREATMENT márgenes I-TREATMENT deben I-TREATMENT estar I-TREATMENT apoyados I-TREATMENT en I-TREATMENT superficies I-TREATMENT estables. I-TREATMENT La I-TREATMENT finalidad I-TREATMENT es I-TREATMENT obtener I-TREATMENT un I-TREATMENT modelo I-TREATMENT de I-TREATMENT trabajo I-TREATMENT y I-TREATMENT de I-TREATMENT estudio I-TREATMENT en I-TREATMENT yeso I-TREATMENT piedra I-TREATMENT o I-TREATMENT yeso I-TREATMENT extraduro. I-TREATMENT Se I-TREATMENT individualizaron I-TREATMENT las I-TREATMENT zonas I-TREATMENT facial I-TREATMENT y I-TREATMENT temporal I-TREATMENT a I-TREATMENT impresionar I-TREATMENT tapando I-TREATMENT el I-TREATMENT orificio I-TREATMENT creado I-TREATMENT por I-TREATMENT la I-TREATMENT perdida I-TREATMENT del I-TREATMENT implante I-TREATMENT con I-TREATMENT cera I-TREATMENT «Utility», I-TREATMENT para I-TREATMENT que I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT de I-TREATMENT la I-TREATMENT impresión I-TREATMENT éste I-TREATMENT no I-TREATMENT bloquease I-TREATMENT su I-TREATMENT retirada. I-TREATMENT Se I-TREATMENT aplicó I-TREATMENT vaselina I-TREATMENT en I-TREATMENT las I-TREATMENT regiones I-TREATMENT que I-TREATMENT puedan I-TREATMENT retener I-TREATMENT el I-TREATMENT material I-TREATMENT de I-TREATMENT impresión I-TREATMENT como I-TREATMENT las I-TREATMENT cejas I-TREATMENT o I-TREATMENT cabello, I-TREATMENT además I-TREATMENT también I-TREATMENT se I-TREATMENT puede I-TREATMENT utilizar I-TREATMENT como I-TREATMENT material I-TREATMENT de I-TREATMENT impresión I-TREATMENT siliconas I-TREATMENT fluidas, I-TREATMENT agár, I-TREATMENT materiales I-TREATMENT de I-TREATMENT poliéter I-TREATMENT o I-TREATMENT alginato2, I-TREATMENT 5*, I-TREATMENT 6, I-TREATMENT 8*. I-TREATMENT En I-TREATMENT este I-TREATMENT caso I-TREATMENT se I-TREATMENT utilizó I-TREATMENT alginato, I-TREATMENT el I-TREATMENT cual I-TREATMENT debe I-TREATMENT ser I-TREATMENT muy I-TREATMENT fluido I-TREATMENT para I-TREATMENT no I-TREATMENT deformar I-TREATMENT los I-TREATMENT tegumentos I-TREATMENT y I-TREATMENT se I-TREATMENT comienza I-TREATMENT a I-TREATMENT colocar I-TREATMENT en I-TREATMENT las I-TREATMENT zonas I-TREATMENT más I-TREATMENT profundas I-TREATMENT del I-TREATMENT defecto, I-TREATMENT para I-TREATMENT evitar I-TREATMENT la I-TREATMENT formación I-TREATMENT de I-TREATMENT burbujas. I-TREATMENT I-TREATMENT Después I-TREATMENT se I-TREATMENT colocó I-TREATMENT una I-TREATMENT gasa I-TREATMENT sobre I-TREATMENT el I-TREATMENT alginato I-TREATMENT para I-TREATMENT evitar I-TREATMENT su I-TREATMENT escurrimiento I-TREATMENT y I-TREATMENT que I-TREATMENT además I-TREATMENT sirvió I-TREATMENT de I-TREATMENT unión I-TREATMENT a I-TREATMENT la I-TREATMENT capa I-TREATMENT de I-TREATMENT yeso I-TREATMENT de I-TREATMENT fraguado I-TREATMENT rápido I-TREATMENT que I-TREATMENT se I-TREATMENT coloca I-TREATMENT sobre I-TREATMENT el I-TREATMENT material I-TREATMENT de I-TREATMENT impresión2, I-TREATMENT 6. I-TREATMENT I-TREATMENT Es I-TREATMENT importante I-TREATMENT mantener I-TREATMENT libres I-TREATMENT las I-TREATMENT vías I-TREATMENT respiratorias I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT diciéndole I-TREATMENT que I-TREATMENT respire I-TREATMENT por I-TREATMENT la I-TREATMENT boca I-TREATMENT y I-TREATMENT conversando I-TREATMENT con I-TREATMENT ella I-TREATMENT durante I-TREATMENT el I-TREATMENT procedimiento, I-TREATMENT para I-TREATMENT tranquilizarla I-TREATMENT e I-TREATMENT informarla2. I-TREATMENT I-TREATMENT La I-TREATMENT confección I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT ocular I-TREATMENT se I-TREATMENT realizó I-TREATMENT a I-TREATMENT continuación, I-TREATMENT imitando I-TREATMENT el I-TREATMENT ojo I-TREATMENT remanente. I-TREATMENT Por I-TREATMENT las I-TREATMENT características I-TREATMENT individuales I-TREATMENT de I-TREATMENT la I-TREATMENT misma I-TREATMENT algunos I-TREATMENT autores I-TREATMENT la I-TREATMENT denominan I-TREATMENT «almendra»3*. I-TREATMENT Su I-TREATMENT tamaño I-TREATMENT corresponderá I-TREATMENT al I-TREATMENT ancho I-TREATMENT entre I-TREATMENT el I-TREATMENT canto I-TREATMENT interno I-TREATMENT y I-TREATMENT externo I-TREATMENT del I-TREATMENT ojo I-TREATMENT sano. I-TREATMENT La I-TREATMENT cara I-TREATMENT externa I-TREATMENT es I-TREATMENT totalmente I-TREATMENT convexa I-TREATMENT y I-TREATMENT recubierta I-TREATMENT de I-TREATMENT acrílico I-TREATMENT transparente I-TREATMENT para I-TREATMENT obtener I-TREATMENT mejor I-TREATMENT resultado I-TREATMENT estético. I-TREATMENT Su I-TREATMENT cara I-TREATMENT interna I-TREATMENT será I-TREATMENT plana I-TREATMENT y I-TREATMENT se I-TREATMENT apoyará I-TREATMENT en I-TREATMENT la I-TREATMENT pared I-TREATMENT posterior I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT óculo-palpebral3*. I-TREATMENT I-TREATMENT Para I-TREATMENT esta I-TREATMENT paciente I-TREATMENT se I-TREATMENT utilizó I-TREATMENT un I-TREATMENT molde I-TREATMENT de I-TREATMENT silicona, I-TREATMENT que I-TREATMENT había I-TREATMENT sido I-TREATMENT confeccionado I-TREATMENT de I-TREATMENT unas I-TREATMENT impresiones I-TREATMENT de I-TREATMENT otra I-TREATMENT paciente. I-TREATMENT Se I-TREATMENT pueden I-TREATMENT utilizar I-TREATMENT numerosas I-TREATMENT ceras, I-TREATMENT que I-TREATMENT sean I-TREATMENT duras I-TREATMENT y I-TREATMENT que I-TREATMENT pesen I-TREATMENT poco. I-TREATMENT Aquí I-TREATMENT que I-TREATMENT se I-TREATMENT utilizó I-TREATMENT cera I-TREATMENT color I-TREATMENT marfil I-TREATMENT de I-TREATMENT una I-TREATMENT consistencia I-TREATMENT dura. I-TREATMENT I-TREATMENT El I-TREATMENT iris I-TREATMENT debe I-TREATMENT ser I-TREATMENT caracterizado I-TREATMENT previamente, I-TREATMENT para I-TREATMENT esto I-TREATMENT se I-TREATMENT han I-TREATMENT descrito I-TREATMENT muchas I-TREATMENT técnicas4. I-TREATMENT En I-TREATMENT este I-TREATMENT caso I-TREATMENT se I-TREATMENT utilizaron I-TREATMENT discos I-TREATMENT de I-TREATMENT grafito I-TREATMENT por I-TREATMENT ser I-TREATMENT muy I-TREATMENT resistentes, I-TREATMENT retienen I-TREATMENT mejor I-TREATMENT la I-TREATMENT pintura I-TREATMENT y I-TREATMENT los I-TREATMENT hay I-TREATMENT de I-TREATMENT varios I-TREATMENT tamaños. I-TREATMENT El I-TREATMENT disco I-TREATMENT de I-TREATMENT grafito I-TREATMENT se I-TREATMENT selecciona I-TREATMENT según I-TREATMENT el I-TREATMENT tamaño I-TREATMENT del I-TREATMENT iris I-TREATMENT del I-TREATMENT paciente. I-TREATMENT El I-TREATMENT diámetro I-TREATMENT del I-TREATMENT iris I-TREATMENT varía I-TREATMENT entre I-TREATMENT 11, I-TREATMENT 5-12 I-TREATMENT mm, I-TREATMENT y I-TREATMENT el I-TREATMENT diámetro I-TREATMENT de I-TREATMENT la I-TREATMENT pupila I-TREATMENT varia I-TREATMENT entre I-TREATMENT 2, I-TREATMENT 5-3 I-TREATMENT mm5. I-TREATMENT Dicha I-TREATMENT caracterización I-TREATMENT precisa I-TREATMENT de I-TREATMENT una I-TREATMENT mezcla I-TREATMENT de I-TREATMENT monómero I-TREATMENT (líquido) I-TREATMENT con I-TREATMENT polímero I-TREATMENT (polvo I-TREATMENT de I-TREATMENT acrílico) I-TREATMENT y I-TREATMENT óleo, I-TREATMENT haciéndola I-TREATMENT lo I-TREATMENT más I-TREATMENT suave I-TREATMENT posible5*. I-TREATMENT Se I-TREATMENT colocaron I-TREATMENT los I-TREATMENT colores I-TREATMENT base I-TREATMENT en I-TREATMENT una I-TREATMENT paleta7. I-TREATMENT La I-TREATMENT fijación I-TREATMENT del I-TREATMENT disco I-TREATMENT a I-TREATMENT un I-TREATMENT puntero I-TREATMENT facilita I-TREATMENT su I-TREATMENT pintura I-TREATMENT de I-TREATMENT una I-TREATMENT forma I-TREATMENT radial4, I-TREATMENT 5*. I-TREATMENT Existen I-TREATMENT varias I-TREATMENT técnicas I-TREATMENT para I-TREATMENT la I-TREATMENT mejor I-TREATMENT disposición I-TREATMENT de I-TREATMENT colores. I-TREATMENT La I-TREATMENT que I-TREATMENT se I-TREATMENT utilizó I-TREATMENT fue I-TREATMENT la I-TREATMENT que I-TREATMENT empieza I-TREATMENT con I-TREATMENT colores I-TREATMENT más I-TREATMENT claros I-TREATMENT y I-TREATMENT sigue I-TREATMENT subiendo I-TREATMENT las I-TREATMENT tonalidades, I-TREATMENT pintando I-TREATMENT desde I-TREATMENT el I-TREATMENT centro I-TREATMENT hacia I-TREATMENT la I-TREATMENT periferia. I-TREATMENT Se I-TREATMENT consigue I-TREATMENT así I-TREATMENT una I-TREATMENT mejor I-TREATMENT perspectiva I-TREATMENT de I-TREATMENT profundidad. I-TREATMENT Este I-TREATMENT paso I-TREATMENT depende I-TREATMENT un I-TREATMENT 50% I-TREATMENT de I-TREATMENT la I-TREATMENT técnica I-TREATMENT y I-TREATMENT otro I-TREATMENT 50% I-TREATMENT del I-TREATMENT arte3*, I-TREATMENT 5*, I-TREATMENT 8. I-TREATMENT I-TREATMENT El I-TREATMENT color I-TREATMENT de I-TREATMENT un I-TREATMENT objeto, I-TREATMENT no I-TREATMENT es I-TREATMENT otra I-TREATMENT cosa I-TREATMENT que I-TREATMENT la I-TREATMENT propiedad I-TREATMENT que I-TREATMENT él I-TREATMENT mismo I-TREATMENT tiene I-TREATMENT de I-TREATMENT absorber I-TREATMENT una I-TREATMENT determinada I-TREATMENT cantidad I-TREATMENT de I-TREATMENT radiación I-TREATMENT de I-TREATMENT luz I-TREATMENT y I-TREATMENT emitir I-TREATMENT otras. I-TREATMENT Por I-TREATMENT eso I-TREATMENT es I-TREATMENT importante I-TREATMENT utilizar I-TREATMENT el I-TREATMENT mismo I-TREATMENT tipo I-TREATMENT de I-TREATMENT luz I-TREATMENT a I-TREATMENT la I-TREATMENT hora I-TREATMENT de I-TREATMENT examinar I-TREATMENT el I-TREATMENT color I-TREATMENT del I-TREATMENT iris. I-TREATMENT Es I-TREATMENT aconsejable I-TREATMENT la I-TREATMENT presencia I-TREATMENT del I-TREATMENT paciente I-TREATMENT para I-TREATMENT una I-TREATMENT mejor I-TREATMENT reproducción I-TREATMENT de I-TREATMENT los I-TREATMENT colores I-TREATMENT del I-TREATMENT ojo I-TREATMENT sano3*, I-TREATMENT 5*, I-TREATMENT 8. I-TREATMENT I-TREATMENT Existen I-TREATMENT varias I-TREATMENT maneras I-TREATMENT de I-TREATMENT hacer I-TREATMENT la I-TREATMENT pupila. I-TREATMENT También I-TREATMENT se I-TREATMENT pueden I-TREATMENT adquirir I-TREATMENT conformadores I-TREATMENT de I-TREATMENT córnea I-TREATMENT preformados I-TREATMENT que I-TREATMENT la I-TREATMENT incorporan, I-TREATMENT para I-TREATMENT ser I-TREATMENT adheridos I-TREATMENT al I-TREATMENT disco I-TREATMENT donde I-TREATMENT está I-TREATMENT pintado I-TREATMENT el I-TREATMENT iris4. I-TREATMENT Estos I-TREATMENT conformadores I-TREATMENT permiten I-TREATMENT comprobar I-TREATMENT en I-TREATMENT cera I-TREATMENT el I-TREATMENT centrado I-TREATMENT del I-TREATMENT ojo I-TREATMENT sobre I-TREATMENT el I-TREATMENT paciente. I-TREATMENT I-TREATMENT Tras I-TREATMENT adaptar I-TREATMENT el I-TREATMENT conjunto I-TREATMENT iris-pupila I-TREATMENT al I-TREATMENT modelo I-TREATMENT en I-TREATMENT cera, I-TREATMENT se I-TREATMENT construyó I-TREATMENT una I-TREATMENT mufla I-TREATMENT para I-TREATMENT obtener I-TREATMENT el I-TREATMENT ojo I-TREATMENT protésico I-TREATMENT en I-TREATMENT acrílico. I-TREATMENT Se I-TREATMENT cargó I-TREATMENT la I-TREATMENT mufla I-TREATMENT con I-TREATMENT resina I-TREATMENT blanca, I-TREATMENT incluyendo I-TREATMENT pigmentos I-TREATMENT que I-TREATMENT se I-TREATMENT asemejen I-TREATMENT lo I-TREATMENT más I-TREATMENT posible I-TREATMENT a I-TREATMENT la I-TREATMENT esclerótica I-TREATMENT y I-TREATMENT se I-TREATMENT polimerizó I-TREATMENT en I-TREATMENT agua I-TREATMENT hirviendo I-TREATMENT durante I-TREATMENT 30 I-TREATMENT minutos. I-TREATMENT Tras I-TREATMENT el I-TREATMENT enfriamiento I-TREATMENT se I-TREATMENT desgastó I-TREATMENT el I-TREATMENT exceso I-TREATMENT de I-TREATMENT resina I-TREATMENT existente I-TREATMENT en I-TREATMENT la I-TREATMENT superficie I-TREATMENT del I-TREATMENT iris, I-TREATMENT dejándola I-TREATMENT inclusive I-TREATMENT cóncava, I-TREATMENT para I-TREATMENT dar I-TREATMENT una I-TREATMENT mayor I-TREATMENT apariencia I-TREATMENT de I-TREATMENT profundidad; I-TREATMENT lo I-TREATMENT mismo I-TREATMENT se I-TREATMENT hizo I-TREATMENT con I-TREATMENT el I-TREATMENT espacio I-TREATMENT correspondiente I-TREATMENT a I-TREATMENT la I-TREATMENT esclerótica. I-TREATMENT I-TREATMENT La I-TREATMENT caracterización I-TREATMENT de I-TREATMENT la I-TREATMENT esclerótica I-TREATMENT se I-TREATMENT realizó I-TREATMENT imitando I-TREATMENT los I-TREATMENT vasos I-TREATMENT sanguíneos I-TREATMENT con I-TREATMENT hilos I-TREATMENT de I-TREATMENT lana I-TREATMENT o I-TREATMENT seda I-TREATMENT cortados I-TREATMENT y I-TREATMENT pegados I-TREATMENT en I-TREATMENT la I-TREATMENT esclerótica I-TREATMENT en I-TREATMENT sentido I-TREATMENT longitudinal, I-TREATMENT partiendo I-TREATMENT de I-TREATMENT los I-TREATMENT ángulos I-TREATMENT donde I-TREATMENT hay I-TREATMENT mas I-TREATMENT concentración I-TREATMENT y I-TREATMENT disminuyendo I-TREATMENT de I-TREATMENT intensidad I-TREATMENT cuando I-TREATMENT se I-TREATMENT aproximan I-TREATMENT al I-TREATMENT iris3*, I-TREATMENT 5*, I-TREATMENT 8*, I-TREATMENT 9. I-TREATMENT Se I-TREATMENT utilizan I-TREATMENT las I-TREATMENT mismas I-TREATMENT pinturas I-TREATMENT usadas I-TREATMENT para I-TREATMENT el I-TREATMENT iris. I-TREATMENT I-TREATMENT Terminada I-TREATMENT la I-TREATMENT pigmentación I-TREATMENT externa I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT esta I-TREATMENT se I-TREATMENT reubicó I-TREATMENT en I-TREATMENT la I-TREATMENT mufla I-TREATMENT y I-TREATMENT se I-TREATMENT carga I-TREATMENT con I-TREATMENT una I-TREATMENT capa I-TREATMENT de I-TREATMENT acrílico I-TREATMENT transparente I-TREATMENT que I-TREATMENT tiene I-TREATMENT la I-TREATMENT función I-TREATMENT de I-TREATMENT proteger I-TREATMENT y I-TREATMENT dar I-TREATMENT translucidez I-TREATMENT a I-TREATMENT la I-TREATMENT prótesis4, I-TREATMENT 5. I-TREATMENT I-TREATMENT Tras I-TREATMENT el I-TREATMENT pulido I-TREATMENT las I-TREATMENT dos I-TREATMENT resinas I-TREATMENT tienen I-TREATMENT que I-TREATMENT quedar I-TREATMENT perfectamente I-TREATMENT unidas, I-TREATMENT sin I-TREATMENT irregularidades. I-TREATMENT Para I-TREATMENT eso, I-TREATMENT se I-TREATMENT puede I-TREATMENT utilizar I-TREATMENT fresas I-TREATMENT de I-TREATMENT diamante, I-TREATMENT conos I-TREATMENT de I-TREATMENT silicona, I-TREATMENT papel I-TREATMENT de I-TREATMENT lija, I-TREATMENT y I-TREATMENT siempre I-TREATMENT a I-TREATMENT baja I-TREATMENT velocidad. I-TREATMENT El I-TREATMENT pulido I-TREATMENT se I-TREATMENT hizo I-TREATMENT con I-TREATMENT agua, I-TREATMENT polvo I-TREATMENT de I-TREATMENT piedra-pómez I-TREATMENT y I-TREATMENT algodón5, I-TREATMENT 10. I-TREATMENT I-TREATMENT El I-TREATMENT encerado I-TREATMENT del I-TREATMENT globo I-TREATMENT ocular I-TREATMENT empieza I-TREATMENT a I-TREATMENT partir I-TREATMENT de I-TREATMENT una I-TREATMENT hoja I-TREATMENT de I-TREATMENT cera I-TREATMENT rosa I-TREATMENT bien I-TREATMENT adaptada I-TREATMENT al I-TREATMENT modelo I-TREATMENT de I-TREATMENT trabajo, I-TREATMENT rellenando I-TREATMENT los I-TREATMENT espacios I-TREATMENT y I-TREATMENT esculpiendo I-TREATMENT los I-TREATMENT límites I-TREATMENT y I-TREATMENT los I-TREATMENT salientes I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis, I-TREATMENT los I-TREATMENT cuales I-TREATMENT tienen I-TREATMENT que I-TREATMENT estar I-TREATMENT perfectamente I-TREATMENT definidos I-TREATMENT y I-TREATMENT adaptados2, I-TREATMENT 6, I-TREATMENT 10, I-TREATMENT 11. I-TREATMENT I-TREATMENT La I-TREATMENT ubicación I-TREATMENT del I-TREATMENT ojo I-TREATMENT protésico I-TREATMENT constituye I-TREATMENT un I-TREATMENT paso I-TREATMENT extremadamente I-TREATMENT crítico I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT recomienda I-TREATMENT la I-TREATMENT presencia I-TREATMENT del I-TREATMENT paciente8*, I-TREATMENT 11. I-TREATMENT Se I-TREATMENT debe I-TREATMENT conseguir I-TREATMENT que I-TREATMENT la I-TREATMENT «almendra» I-TREATMENT ocupe I-TREATMENT la I-TREATMENT posición I-TREATMENT correcta I-TREATMENT en I-TREATMENT los I-TREATMENT tres I-TREATMENT planos I-TREATMENT del I-TREATMENT espacio12. I-TREATMENT Se I-TREATMENT usan I-TREATMENT diferentes I-TREATMENT técnicas I-TREATMENT de I-TREATMENT alineación; I-TREATMENT todas I-TREATMENT ellas I-TREATMENT tienen I-TREATMENT la I-TREATMENT finalidad I-TREATMENT de I-TREATMENT lograr I-TREATMENT la I-TREATMENT posición I-TREATMENT correcta I-TREATMENT en I-TREATMENT la I-TREATMENT lámina I-TREATMENT de I-TREATMENT cera. I-TREATMENT Aparatos I-TREATMENT como I-TREATMENT la I-TREATMENT regla I-TREATMENT de I-TREATMENT Vernier I-TREATMENT y I-TREATMENT pupilómetros, I-TREATMENT se I-TREATMENT usan I-TREATMENT para I-TREATMENT ayudar I-TREATMENT a I-TREATMENT conseguir I-TREATMENT la I-TREATMENT ubicación I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT ocular I-TREATMENT dentro I-TREATMENT de I-TREATMENT la I-TREATMENT órbita. I-TREATMENT La I-TREATMENT regla I-TREATMENT de I-TREATMENT Vernier I-TREATMENT mide I-TREATMENT la I-TREATMENT distancia I-TREATMENT interpupilar I-TREATMENT que I-TREATMENT normalmente I-TREATMENT es I-TREATMENT de I-TREATMENT 60 I-TREATMENT mm, I-TREATMENT aproximadamente2, I-TREATMENT 3*, I-TREATMENT 10. I-TREATMENT Una I-TREATMENT vez I-TREATMENT ubicada I-TREATMENT la I-TREATMENT «almendra» I-TREATMENT se I-TREATMENT comienza I-TREATMENT la I-TREATMENT escultura., I-TREATMENT confeccionando I-TREATMENT un I-TREATMENT ojo I-TREATMENT con I-TREATMENT un I-TREATMENT tamaño I-TREATMENT mayor I-TREATMENT que I-TREATMENT permite I-TREATMENT una I-TREATMENT mayor I-TREATMENT adaptación I-TREATMENT a I-TREATMENT la I-TREATMENT cavidad. I-TREATMENT I-TREATMENT La I-TREATMENT escultura I-TREATMENT intenta I-TREATMENT copiar I-TREATMENT todas I-TREATMENT las I-TREATMENT líneas I-TREATMENT de I-TREATMENT expresión I-TREATMENT e I-TREATMENT irregularidades I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT en I-TREATMENT la I-TREATMENT cera. I-TREATMENT Se I-TREATMENT crean I-TREATMENT los I-TREATMENT párpados I-TREATMENT y I-TREATMENT la I-TREATMENT abertura I-TREATMENT palpebral, I-TREATMENT siempre I-TREATMENT comparándolos I-TREATMENT con I-TREATMENT el I-TREATMENT ojo I-TREATMENT sano I-TREATMENT del I-TREATMENT paciente. I-TREATMENT Las I-TREATMENT marcas I-TREATMENT en I-TREATMENT el I-TREATMENT yeso I-TREATMENT que I-TREATMENT se I-TREATMENT aprecian I-TREATMENT en I-TREATMENT la I-TREATMENT foto, I-TREATMENT corresponden I-TREATMENT a I-TREATMENT la I-TREATMENT línea I-TREATMENT media I-TREATMENT de I-TREATMENT la I-TREATMENT cara I-TREATMENT y I-TREATMENT a I-TREATMENT la I-TREATMENT línea I-TREATMENT bipupilar. I-TREATMENT Los I-TREATMENT límites I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT deben I-TREATMENT quedar I-TREATMENT disimulados I-TREATMENT con I-TREATMENT las I-TREATMENT arrugas I-TREATMENT y I-TREATMENT salientes I-TREATMENT naturales I-TREATMENT de I-TREATMENT la I-TREATMENT piel, I-TREATMENT con I-TREATMENT la I-TREATMENT intención I-TREATMENT de I-TREATMENT conseguir I-TREATMENT la I-TREATMENT correcta I-TREATMENT expresión I-TREATMENT de I-TREATMENT la I-TREATMENT cara I-TREATMENT del I-TREATMENT paciente8. I-TREATMENT La I-TREATMENT prueba I-TREATMENT de I-TREATMENT la I-TREATMENT épitesis I-TREATMENT sobre I-TREATMENT la I-TREATMENT paciente I-TREATMENT permite I-TREATMENT verificar I-TREATMENT la I-TREATMENT alineación I-TREATMENT de I-TREATMENT los I-TREATMENT dos I-TREATMENT ojos. I-TREATMENT Se I-TREATMENT pide I-TREATMENT al I-TREATMENT paciente I-TREATMENT que I-TREATMENT imite I-TREATMENT la I-TREATMENT acción I-TREATMENT de I-TREATMENT leer I-TREATMENT un I-TREATMENT periódico. I-TREATMENT I-TREATMENT Cuando I-TREATMENT todo I-TREATMENT es I-TREATMENT correcto I-TREATMENT se I-TREATMENT incluye I-TREATMENT el I-TREATMENT encerado I-TREATMENT de I-TREATMENT la I-TREATMENT épitesis I-TREATMENT en I-TREATMENT la I-TREATMENT mufla, I-TREATMENT donde I-TREATMENT la I-TREATMENT cara I-TREATMENT interna I-TREATMENT de I-TREATMENT la I-TREATMENT escultura I-TREATMENT corresponde I-TREATMENT a I-TREATMENT la I-TREATMENT cavidad I-TREATMENT del I-TREATMENT defecto. I-TREATMENT Este I-TREATMENT tipo I-TREATMENT de I-TREATMENT prótesis I-TREATMENT es I-TREATMENT la I-TREATMENT única I-TREATMENT que I-TREATMENT permite I-TREATMENT reproducir I-TREATMENT las I-TREATMENT zonas I-TREATMENT retentivas I-TREATMENT del I-TREATMENT fondo I-TREATMENT cavitario. I-TREATMENT Las I-TREATMENT muflas I-TREATMENT deben I-TREATMENT tener I-TREATMENT guías I-TREATMENT que I-TREATMENT nos I-TREATMENT aseguren I-TREATMENT la I-TREATMENT correcta I-TREATMENT colocación I-TREATMENT y I-TREATMENT por I-TREATMENT ello I-TREATMENT se I-TREATMENT realiza I-TREATMENT una I-TREATMENT retención I-TREATMENT en I-TREATMENT el I-TREATMENT ojo I-TREATMENT que I-TREATMENT permite I-TREATMENT su I-TREATMENT ubicación I-TREATMENT en I-TREATMENT la I-TREATMENT mufla. I-TREATMENT Es I-TREATMENT muy I-TREATMENT importante I-TREATMENT que I-TREATMENT los I-TREATMENT márgenes I-TREATMENT de I-TREATMENT la I-TREATMENT cera I-TREATMENT estén I-TREATMENT en I-TREATMENT una I-TREATMENT base I-TREATMENT pulida I-TREATMENT de I-TREATMENT yeso I-TREATMENT para I-TREATMENT que I-TREATMENT queden I-TREATMENT bien I-TREATMENT definidos. I-TREATMENT La I-TREATMENT silicona I-TREATMENT fue I-TREATMENT el I-TREATMENT material I-TREATMENT de I-TREATMENT elección I-TREATMENT para I-TREATMENT confeccionar I-TREATMENT la I-TREATMENT épitesis. I-TREATMENT Viene I-TREATMENT con I-TREATMENT una I-TREATMENT presentación I-TREATMENT de I-TREATMENT un I-TREATMENT endurecedor I-TREATMENT o I-TREATMENT «crosslinker», I-TREATMENT un I-TREATMENT catalizador I-TREATMENT y I-TREATMENT una I-TREATMENT base I-TREATMENT de I-TREATMENT coloración I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT en I-TREATMENT diferentes I-TREATMENT tonalidades, I-TREATMENT para I-TREATMENT facilitar I-TREATMENT la I-TREATMENT mezcla I-TREATMENT y I-TREATMENT poder I-TREATMENT encontrar I-TREATMENT los I-TREATMENT colores I-TREATMENT adecuados I-TREATMENT en I-TREATMENT cada I-TREATMENT caso. I-TREATMENT En I-TREATMENT éste I-TREATMENT se I-TREATMENT utilizó I-TREATMENT una I-TREATMENT silicona I-TREATMENT catalizada I-TREATMENT con I-TREATMENT platina I-TREATMENT (Episyl, I-TREATMENT de I-TREATMENT la I-TREATMENT casa I-TREATMENT Dreve), I-TREATMENT que I-TREATMENT ya I-TREATMENT viene I-TREATMENT pre-coloreada. I-TREATMENT Algunos I-TREATMENT profesionales I-TREATMENT prefieren I-TREATMENT siliconas I-TREATMENT transparentes I-TREATMENT de I-TREATMENT otras I-TREATMENT casas I-TREATMENT comerciales. I-TREATMENT Si I-TREATMENT se I-TREATMENT utiliza I-TREATMENT una I-TREATMENT u I-TREATMENT otra I-TREATMENT silicona, I-TREATMENT es I-TREATMENT necesario I-TREATMENT añadir I-TREATMENT pigmentos, I-TREATMENT que I-TREATMENT pueden I-TREATMENT ser I-TREATMENT minerales I-TREATMENT u I-TREATMENT orgánicos13. I-TREATMENT Aquí I-TREATMENT se I-TREATMENT utilizaron I-TREATMENT pigmentos I-TREATMENT orgánicos, I-TREATMENT que I-TREATMENT ya I-TREATMENT vienen I-TREATMENT mezclados I-TREATMENT con I-TREATMENT aceite I-TREATMENT de I-TREATMENT silicona. I-TREATMENT I-TREATMENT Por I-TREATMENT otro I-TREATMENT lado I-TREATMENT la I-TREATMENT iluminación I-TREATMENT del I-TREATMENT local I-TREATMENT debe I-TREATMENT ser I-TREATMENT natural, I-TREATMENT para I-TREATMENT evitar I-TREATMENT errores. I-TREATMENT El I-TREATMENT paciente I-TREATMENT debe I-TREATMENT estar I-TREATMENT presente I-TREATMENT en I-TREATMENT el I-TREATMENT momento I-TREATMENT de I-TREATMENT la I-TREATMENT caracterización I-TREATMENT de I-TREATMENT la I-TREATMENT silicona. I-TREATMENT Primero I-TREATMENT se I-TREATMENT determina I-TREATMENT el I-TREATMENT color I-TREATMENT base I-TREATMENT de I-TREATMENT la I-TREATMENT piel I-TREATMENT mezclando I-TREATMENT las I-TREATMENT siliconas I-TREATMENT de I-TREATMENT vulcanización I-TREATMENT a I-TREATMENT frío I-TREATMENT y I-TREATMENT haciendo I-TREATMENT presión. I-TREATMENT Después I-TREATMENT de I-TREATMENT presionar I-TREATMENT con I-TREATMENT el I-TREATMENT dedo I-TREATMENT durante I-TREATMENT unos I-TREATMENT segundos I-TREATMENT la I-TREATMENT piel I-TREATMENT del I-TREATMENT paciente, I-TREATMENT ésta I-TREATMENT presenta I-TREATMENT un I-TREATMENT color I-TREATMENT sin I-TREATMENT afluencia I-TREATMENT sanguínea. I-TREATMENT Es I-TREATMENT este I-TREATMENT el I-TREATMENT momento I-TREATMENT en I-TREATMENT que I-TREATMENT se I-TREATMENT debe I-TREATMENT comparar I-TREATMENT el I-TREATMENT color. I-TREATMENT En I-TREATMENT seguida I-TREATMENT se I-TREATMENT intenta I-TREATMENT llegar I-TREATMENT al I-TREATMENT color I-TREATMENT exterior I-TREATMENT de I-TREATMENT la I-TREATMENT piel. I-TREATMENT Se I-TREATMENT separa I-TREATMENT los I-TREATMENT diferentes I-TREATMENT colores I-TREATMENT y I-TREATMENT se I-TREATMENT van I-TREATMENT mezclando I-TREATMENT los I-TREATMENT pigmentos I-TREATMENT hasta I-TREATMENT conseguir I-TREATMENT imitar I-TREATMENT las I-TREATMENT regiones I-TREATMENT de I-TREATMENT los I-TREATMENT párpados I-TREATMENT superior I-TREATMENT e I-TREATMENT inferior I-TREATMENT y I-TREATMENT de I-TREATMENT las I-TREATMENT zonas I-TREATMENT aledañas5. I-TREATMENT Se I-TREATMENT pueden I-TREATMENT ir I-TREATMENT agregando I-TREATMENT con I-TREATMENT un I-TREATMENT pincel I-TREATMENT diferentes I-TREATMENT colores I-TREATMENT directamente I-TREATMENT en I-TREATMENT las I-TREATMENT distintas I-TREATMENT áreas I-TREATMENT de I-TREATMENT la I-TREATMENT mufla. I-TREATMENT Una I-TREATMENT vez I-TREATMENT colocado I-TREATMENT el I-TREATMENT ojo I-TREATMENT en I-TREATMENT la I-TREATMENT mufla, I-TREATMENT se I-TREATMENT cargó I-TREATMENT con I-TREATMENT la I-TREATMENT silicona I-TREATMENT correspondiente I-TREATMENT al I-TREATMENT color I-TREATMENT base I-TREATMENT de I-TREATMENT la I-TREATMENT piel. I-TREATMENT Cargada I-TREATMENT la I-TREATMENT mufla, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT su I-TREATMENT prensado, I-TREATMENT hasta I-TREATMENT que I-TREATMENT los I-TREATMENT bordes I-TREATMENT metálicos I-TREATMENT de I-TREATMENT la I-TREATMENT mufla I-TREATMENT contactaron. I-TREATMENT Hecho I-TREATMENT esto, I-TREATMENT se I-TREATMENT coloca I-TREATMENT en I-TREATMENT agua I-TREATMENT y I-TREATMENT se I-TREATMENT hace I-TREATMENT hervir I-TREATMENT durante I-TREATMENT dos I-TREATMENT horas I-TREATMENT hasta I-TREATMENT que I-TREATMENT el I-TREATMENT material I-TREATMENT polimerice I-TREATMENT o I-TREATMENT se I-TREATMENT sigue I-TREATMENT las I-TREATMENT instrucciones I-TREATMENT del I-TREATMENT fabricante. I-TREATMENT Luego I-TREATMENT que I-TREATMENT se I-TREATMENT comprueba I-TREATMENT la I-TREATMENT vulcanización I-TREATMENT de I-TREATMENT la I-TREATMENT silicona, I-TREATMENT se I-TREATMENT abre I-TREATMENT la I-TREATMENT mufla I-TREATMENT con I-TREATMENT cuidado I-TREATMENT ya I-TREATMENT que I-TREATMENT la I-TREATMENT silicona I-TREATMENT puede I-TREATMENT rasgarse I-TREATMENT en I-TREATMENT los I-TREATMENT bordes I-TREATMENT y I-TREATMENT estropear I-TREATMENT el I-TREATMENT trabajo. I-TREATMENT I-TREATMENT Con I-TREATMENT la I-TREATMENT epítesis I-TREATMENT en I-TREATMENT mano, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT recortar I-TREATMENT los I-TREATMENT márgenes. I-TREATMENT Se I-TREATMENT limpian I-TREATMENT los I-TREATMENT restos I-TREATMENT de I-TREATMENT yeso I-TREATMENT que I-TREATMENT pueden I-TREATMENT haber I-TREATMENT quedado. I-TREATMENT También I-TREATMENT se I-TREATMENT retira I-TREATMENT el I-TREATMENT ojo I-TREATMENT para I-TREATMENT un I-TREATMENT nuevo I-TREATMENT pulido I-TREATMENT y I-TREATMENT se I-TREATMENT rellena I-TREATMENT el I-TREATMENT agujero I-TREATMENT efectuado, I-TREATMENT para I-TREATMENT colocar I-TREATMENT el I-TREATMENT ojo. I-TREATMENT Con I-TREATMENT una I-TREATMENT aguja I-TREATMENT hipodérmica, I-TREATMENT se I-TREATMENT cose I-TREATMENT con I-TREATMENT cabello I-TREATMENT las I-TREATMENT cejas I-TREATMENT y I-TREATMENT las I-TREATMENT pestañas. I-TREATMENT El I-TREATMENT color I-TREATMENT debe I-TREATMENT ser I-TREATMENT lo I-TREATMENT más I-TREATMENT parecido I-TREATMENT posible I-TREATMENT a I-TREATMENT las I-TREATMENT del I-TREATMENT paciente, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT es I-TREATMENT ideal I-TREATMENT utilizar I-TREATMENT los I-TREATMENT propios I-TREATMENT cabellos I-TREATMENT del I-TREATMENT paciente3*. I-TREATMENT I-TREATMENT Se I-TREATMENT coloca I-TREATMENT la I-TREATMENT prótesis I-TREATMENT y I-TREATMENT se I-TREATMENT verifican I-TREATMENT los I-TREATMENT márgenes. I-TREATMENT La I-TREATMENT utilización I-TREATMENT de I-TREATMENT gafas I-TREATMENT es I-TREATMENT recomendable I-TREATMENT porque I-TREATMENT ayuda I-TREATMENT a I-TREATMENT la I-TREATMENT protección I-TREATMENT del I-TREATMENT ojo I-TREATMENT natural I-TREATMENT y I-TREATMENT disimula I-TREATMENT la I-TREATMENT prótesis14. I-TREATMENT I-TREATMENT Es I-TREATMENT imprescindible I-TREATMENT explicar I-TREATMENT a I-TREATMENT cada I-TREATMENT paciente I-TREATMENT la I-TREATMENT adecuada I-TREATMENT manipulación I-TREATMENT de I-TREATMENT su I-TREATMENT epítesis I-TREATMENT óculo-palpebral, I-TREATMENT su I-TREATMENT colocación, I-TREATMENT limpieza I-TREATMENT y I-TREATMENT adhesivo I-TREATMENT médico I-TREATMENT más I-TREATMENT adecuado8*. I-TREATMENT Los I-TREATMENT adhesivos I-TREATMENT utilizados I-TREATMENT son I-TREATMENT a I-TREATMENT base I-TREATMENT de I-TREATMENT silicona I-TREATMENT médica I-TREATMENT (siliconas I-TREATMENT externas I-TREATMENT sin I-TREATMENT plomo). I-TREATMENT Normalmente I-TREATMENT el I-TREATMENT tiempo I-TREATMENT de I-TREATMENT efectividad I-TREATMENT de I-TREATMENT los I-TREATMENT adhesivos I-TREATMENT cutáneos I-TREATMENT es I-TREATMENT de I-TREATMENT 48 I-TREATMENT horas, I-TREATMENT pero I-TREATMENT depende I-TREATMENT del I-TREATMENT clima. I-TREATMENT Pasado I-TREATMENT ese I-TREATMENT tiempo, I-TREATMENT el I-TREATMENT paciente I-TREATMENT deberá I-TREATMENT retirar I-TREATMENT la I-TREATMENT prótesis, I-TREATMENT limpiarla I-TREATMENT correctamente, I-TREATMENT limpiando I-TREATMENT también I-TREATMENT la I-TREATMENT zona I-TREATMENT donde I-TREATMENT ésta I-TREATMENT se I-TREATMENT asienta. I-TREATMENT Esta I-TREATMENT tarea I-TREATMENT casi I-TREATMENT diaria I-TREATMENT debe I-TREATMENT ser I-TREATMENT muy I-TREATMENT cuidadosa I-TREATMENT ya I-TREATMENT que I-TREATMENT los I-TREATMENT bordes I-TREATMENT finos I-TREATMENT de I-TREATMENT la I-TREATMENT prótesis I-TREATMENT no I-TREATMENT deben I-TREATMENT recibir I-TREATMENT el I-TREATMENT adhesivo, I-TREATMENT evitando I-TREATMENT así I-TREATMENT el I-TREATMENT deterioro I-TREATMENT de I-TREATMENT los I-TREATMENT mismos3*. I-TREATMENT También I-TREATMENT se I-TREATMENT debe I-TREATMENT advertir I-TREATMENT al I-TREATMENT paciente I-TREATMENT para I-TREATMENT proteger I-TREATMENT su I-TREATMENT prótesis I-TREATMENT de I-TREATMENT los I-TREATMENT limpiadores I-TREATMENT abrasivos, I-TREATMENT solventes I-TREATMENT o I-TREATMENT volátiles, I-TREATMENT perfumes, I-TREATMENT colonias I-TREATMENT y I-TREATMENT sprays. I-TREATMENT Solamente I-TREATMENT se I-TREATMENT deberá I-TREATMENT usar I-TREATMENT agua I-TREATMENT tibia, I-TREATMENT jabón I-TREATMENT suave I-TREATMENT o I-TREATMENT detergente I-TREATMENT para I-TREATMENT limpiar I-TREATMENT la I-TREATMENT prótesis. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS gingival I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tiene I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS la I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS infancia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sangrado I-PRESENT_ILLNESS ocasional I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS dolor. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION intraoral I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION encía I-EXPLORATION vestibular I-EXPLORATION superior, I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION interincisal I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION rojiza, I-EXPLORATION blanda I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión, I-EXPLORATION similar I-EXPLORATION a I-EXPLORATION un I-EXPLORATION granuloma I-EXPLORATION telangiectásico, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION algunas I-EXPLORATION pequeñas I-EXPLORATION vesículas I-EXPLORATION rojizas I-EXPLORATION en I-EXPLORATION su I-EXPLORATION superficie. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION papila I-EXPLORATION que I-EXPLORATION separa I-EXPLORATION el I-EXPLORATION 12 I-EXPLORATION del I-EXPLORATION 13 I-EXPLORATION se I-EXPLORATION manifiesta I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION rojiza I-EXPLORATION con I-EXPLORATION pequeñas I-EXPLORATION proyecciones I-EXPLORATION papilares I-EXPLORATION sobreelevadas, I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION una I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION alfiler I-EXPLORATION y I-EXPLORATION entre I-EXPLORATION ambas I-EXPLORATION lesiones I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION pequeñas I-EXPLORATION zonas I-EXPLORATION puntiformes I-EXPLORATION de I-EXPLORATION coloración I-EXPLORATION rojiza. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION de I-EXPLORATION encía I-EXPLORATION insertada I-EXPLORATION en I-EXPLORATION palatino, I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION 12 I-EXPLORATION y I-EXPLORATION el I-EXPLORATION 13 I-EXPLORATION también I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION rojiza I-EXPLORATION con I-EXPLORATION elevaciones I-EXPLORATION papilares I-EXPLORATION similares I-EXPLORATION a I-EXPLORATION las I-EXPLORATION descritas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION vestibular. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION toma I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION vestibular I-EXPLORATION del I-EXPLORATION 12 I-EXPLORATION al I-EXPLORATION 13 I-EXPLORATION que I-EXPLORATION es I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION hemolinfangioma. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 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 médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY estar I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY fase I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY hormonal I-PAST_MEDICAL_HISTORY sustitutiva, I-PAST_MEDICAL_HISTORY que B-DERIVED_FROM/TO fue I-DERIVED_FROM/TO referida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO odontología I-DERIVED_FROM/TO general I-DERIVED_FROM/TO a I-DERIVED_FROM/TO una I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO periodoncia I-DERIVED_FROM/TO para I-DERIVED_FROM/TO iniciar I-DERIVED_FROM/TO un I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO multidisciplinario. I-DERIVED_FROM/TO El B-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS corregir I-PRESENT_ILLNESS el I-PRESENT_ILLNESS frente I-PRESENT_ILLNESS estético, I-PRESENT_ILLNESS solucionar I-PRESENT_ILLNESS la I-PRESENT_ILLNESS movilidad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS reposición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS molares I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY anamnesis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY dental I-PAST_MEDICAL_HISTORY constaba I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY fumadora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY diarios I-PAST_MEDICAL_HISTORY y B-FAMILY_HISTORY tenía I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY maternos I-FAMILY_HISTORY de I-FAMILY_HISTORY enfermedad I-FAMILY_HISTORY periodontal. I-FAMILY_HISTORY I-FAMILY_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION dental, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presentaba: I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION 18/28/35/ I-EXPLORATION 36/38/45/46 I-EXPLORATION y I-EXPLORATION obturaciones I-EXPLORATION en I-EXPLORATION diversas I-EXPLORATION piezas. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION periodontal I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION placa I-EXPLORATION bacteriana I-EXPLORATION y I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION gingival, I-EXPLORATION profundidad I-EXPLORATION de I-EXPLORATION sondaje I-EXPLORATION entre I-EXPLORATION 4 I-EXPLORATION y I-EXPLORATION 7 I-EXPLORATION mm, I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION soporte I-EXPLORATION generalizado; I-EXPLORATION furca I-EXPLORATION vestibular I-EXPLORATION grado I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION lingual I-EXPLORATION grado I-EXPLORATION 2 I-EXPLORATION en I-EXPLORATION 37; I-EXPLORATION furca I-EXPLORATION vestibular I-EXPLORATION grado I-EXPLORATION 2 I-EXPLORATION en I-EXPLORATION 47; I-EXPLORATION abundantes I-EXPLORATION recesiones; I-EXPLORATION movilidad I-EXPLORATION +1 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION sextante I-EXPLORATION anterosuperior I-EXPLORATION y I-EXPLORATION +2 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION grupo I-EXPLORATION anteroinferior; I-EXPLORATION mesialización I-EXPLORATION de I-EXPLORATION 37, I-EXPLORATION 47 I-EXPLORATION y I-EXPLORATION 48, I-EXPLORATION y I-EXPLORATION diastemas I-EXPLORATION en I-EXPLORATION frente I-EXPLORATION anterosuperior. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION ortodóncica I-EXPLORATION mostró I-EXPLORATION clase I-EXPLORATION III I-EXPLORATION esquelética I-EXPLORATION y I-EXPLORATION dentaria, I-EXPLORATION mordida I-EXPLORATION cruzada I-EXPLORATION anterior I-EXPLORATION y, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION céntrica, I-EXPLORATION un I-EXPLORATION contacto I-EXPLORATION prematuro, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION sobrecarga I-EXPLORATION funcional I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dientes I-EXPLORATION anteriores. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ortopantomografía I-EXPLORATION se I-EXPLORATION comprobó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION dientes, I-EXPLORATION buena I-EXPLORATION relación I-EXPLORATION corono I-EXPLORATION radicular, I-EXPLORATION pérdida I-EXPLORATION ósea I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION horizontal I-EXPLORATION de I-EXPLORATION más I-EXPLORATION del I-EXPLORATION 50%, I-EXPLORATION espacio I-EXPLORATION periodontal I-EXPLORATION ensanchado I-EXPLORATION en I-EXPLORATION 12, I-EXPLORATION defecto I-EXPLORATION angular I-EXPLORATION en I-EXPLORATION 22 I-EXPLORATION y I-EXPLORATION 37, I-EXPLORATION defecto I-EXPLORATION en I-EXPLORATION furca I-EXPLORATION de I-EXPLORATION 37 I-EXPLORATION y I-EXPLORATION 47 I-EXPLORATION y I-EXPLORATION cortical I-EXPLORATION ósea I-EXPLORATION reforzada I-EXPLORATION en I-EXPLORATION grupo I-EXPLORATION anteroinferior. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION cefalométrico I-EXPLORATION reveló I-EXPLORATION clase I-EXPLORATION III I-EXPLORATION esquelética, I-EXPLORATION protrusión I-EXPLORATION de I-EXPLORATION los I-EXPLORATION incisivos I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION altura I-EXPLORATION facial I-EXPLORATION aumentada. I-EXPLORATION Exploración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION temporo-mandibular: I-EXPLORATION sin I-EXPLORATION interés. I-EXPLORATION A I-EXPLORATION partir I-EXPLORATION de I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION previamente I-EXPLORATION expuestos, I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION diagnóstico: I-EXPLORATION enfermedad I-EXPLORATION periodontal I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION avanzada; I-EXPLORATION clase I-EXPLORATION III I-EXPLORATION esquelética I-EXPLORATION y I-EXPLORATION dentaria. I-EXPLORATION I-EXPLORATION Exposición B-TREATMENT del I-TREATMENT tratamiento I-TREATMENT I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT planificó I-TREATMENT en I-TREATMENT cuatro I-TREATMENT fases: I-TREATMENT regeneración I-TREATMENT periodontal, I-TREATMENT nivelación I-TREATMENT de I-TREATMENT arcadas I-TREATMENT mediante I-TREATMENT ortodoncia, I-TREATMENT reposición I-TREATMENT de I-TREATMENT dientes I-TREATMENT mediante I-TREATMENT prótesis I-TREATMENT implantosoportada I-TREATMENT y I-TREATMENT terapia I-TREATMENT periodontal I-TREATMENT de I-TREATMENT soporte. I-TREATMENT I-TREATMENT Primera I-TREATMENT fase: I-TREATMENT comenzamos I-TREATMENT por I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT periodontal. I-TREATMENT La I-TREATMENT paciente I-TREATMENT había I-TREATMENT sido I-TREATMENT ya I-TREATMENT motivada I-TREATMENT e I-TREATMENT instruida I-TREATMENT en I-TREATMENT normas I-TREATMENT y I-TREATMENT hábitos I-TREATMENT de I-TREATMENT higiene I-TREATMENT oral I-TREATMENT por I-TREATMENT su I-TREATMENT dentista, I-TREATMENT lo I-TREATMENT que I-TREATMENT permitió I-TREATMENT pasar I-TREATMENT directamente I-TREATMENT al I-TREATMENT debridamiento I-TREATMENT de I-TREATMENT las I-TREATMENT superficies I-TREATMENT radiculares, I-TREATMENT efectuando I-TREATMENT raspajes, I-TREATMENT alisados I-TREATMENT y I-TREATMENT pulido I-TREATMENT de I-TREATMENT superficies I-TREATMENT contaminadas. I-TREATMENT Dado I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT era I-TREATMENT muy I-TREATMENT fumadora, I-TREATMENT esta I-TREATMENT fase I-TREATMENT resultó I-TREATMENT algo I-TREATMENT laboriosa. I-TREATMENT Completamos I-TREATMENT esta I-TREATMENT fase I-TREATMENT con I-TREATMENT cirugía I-TREATMENT periodontal I-TREATMENT de I-TREATMENT bolsas I-TREATMENT residuales, I-TREATMENT es I-TREATMENT decir, I-TREATMENT las I-TREATMENT que I-TREATMENT presentaban I-TREATMENT hemorragia I-TREATMENT al I-TREATMENT sondaje I-TREATMENT cuatro I-TREATMENT semanas I-TREATMENT después I-TREATMENT de I-TREATMENT concluida I-TREATMENT la I-TREATMENT fase I-TREATMENT básica. I-TREATMENT A I-TREATMENT la I-TREATMENT vez, I-TREATMENT procedimos I-TREATMENT a I-TREATMENT tratar I-TREATMENT los I-TREATMENT defectos I-TREATMENT óseos I-TREATMENT angulares I-TREATMENT y I-TREATMENT de I-TREATMENT furcas I-TREATMENT de I-TREATMENT 12, I-TREATMENT 22, I-TREATMENT 37 I-TREATMENT y I-TREATMENT 47 I-TREATMENT y I-TREATMENT efectuamos I-TREATMENT en I-TREATMENT cada I-TREATMENT uno I-TREATMENT de I-TREATMENT ellos I-TREATMENT un I-TREATMENT pequeño I-TREATMENT colgajo I-TREATMENT para I-TREATMENT regenerar I-TREATMENT los I-TREATMENT tejidos I-TREATMENT periodontales I-TREATMENT con I-TREATMENT Emdogain®. I-TREATMENT El I-TREATMENT plazo I-TREATMENT de I-TREATMENT tiempo I-TREATMENT transcurrido I-TREATMENT en I-TREATMENT los I-TREATMENT pasos I-TREATMENT previos I-TREATMENT sirvió I-TREATMENT para I-TREATMENT reforzar I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT en I-TREATMENT hábitos I-TREATMENT de I-TREATMENT higiene I-TREATMENT interdental I-TREATMENT y I-TREATMENT para I-TREATMENT animarle I-TREATMENT a I-TREATMENT que I-TREATMENT suprimiera I-TREATMENT el I-TREATMENT hábito I-TREATMENT del I-TREATMENT tabaquismo, I-TREATMENT lo I-TREATMENT cual I-TREATMENT consiguió. I-TREATMENT Hubo I-TREATMENT que I-TREATMENT preparar I-TREATMENT una I-TREATMENT férula I-TREATMENT de I-TREATMENT relajación I-TREATMENT porque I-TREATMENT la I-TREATMENT supresión I-TREATMENT del I-TREATMENT tabaco I-TREATMENT le I-TREATMENT provocaba I-TREATMENT mucha I-TREATMENT ansiedad, I-TREATMENT sensibilidad I-TREATMENT y I-TREATMENT dolor I-TREATMENT dental. I-TREATMENT Además I-TREATMENT se I-TREATMENT le I-TREATMENT propuso I-TREATMENT revisión I-TREATMENT de I-TREATMENT mantenimiento I-TREATMENT cada I-TREATMENT cuatro I-TREATMENT meses I-TREATMENT una I-TREATMENT vez I-TREATMENT finalizadas I-TREATMENT las I-TREATMENT restantes I-TREATMENT fases I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT si I-TREATMENT la I-TREATMENT situación I-TREATMENT periodontal I-TREATMENT y I-TREATMENT de I-TREATMENT los I-TREATMENT implantes I-TREATMENT no I-TREATMENT variaba. I-TREATMENT I-TREATMENT Segunda B-DERIVED_FROM/TO fase. I-DERIVED_FROM/TO Doce I-DERIVED_FROM/TO meses I-DERIVED_FROM/TO después I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO regeneración I-DERIVED_FROM/TO periodontal I-DERIVED_FROM/TO guiada, I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO referida I-DERIVED_FROM/TO al I-DERIVED_FROM/TO ortodoncista I-DERIVED_FROM/TO para I-DERIVED_FROM/TO continuar I-DERIVED_FROM/TO el I-DERIVED_FROM/TO tratamiento. I-DERIVED_FROM/TO Esta B-TREATMENT fase I-TREATMENT se I-TREATMENT inició I-TREATMENT con I-TREATMENT ortodoncia I-TREATMENT fija, I-TREATMENT nivelando I-TREATMENT la I-TREATMENT arcada I-TREATMENT maxilar I-TREATMENT con I-TREATMENT un I-TREATMENT levante I-TREATMENT de I-TREATMENT mordida I-TREATMENT mandibular. I-TREATMENT Una I-TREATMENT vez I-TREATMENT resuelta I-TREATMENT la I-TREATMENT mordida I-TREATMENT anterior, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT nivelar I-TREATMENT la I-TREATMENT arcada I-TREATMENT mandibular, I-TREATMENT preparando I-TREATMENT los I-TREATMENT espacios I-TREATMENT que I-TREATMENT más I-TREATMENT adelante I-TREATMENT servirían I-TREATMENT para I-TREATMENT colocar I-TREATMENT implantes, I-TREATMENT si I-TREATMENT el I-TREATMENT ancho I-TREATMENT de I-TREATMENT hueso I-TREATMENT lo I-TREATMENT permitía. I-TREATMENT Para I-TREATMENT conseguir I-TREATMENT esos I-TREATMENT espacios I-TREATMENT se I-TREATMENT nivelaron I-TREATMENT los I-TREATMENT molares I-TREATMENT posteriores I-TREATMENT mandibulares, I-TREATMENT empleando I-TREATMENT arcos I-TREATMENT con I-TREATMENT escalones I-TREATMENT para I-TREATMENT no I-TREATMENT interferir I-TREATMENT la I-TREATMENT masticación. I-TREATMENT Aunque I-TREATMENT se I-TREATMENT trataba I-TREATMENT de I-TREATMENT una I-TREATMENT clase I-TREATMENT III, I-TREATMENT fue I-TREATMENT preciso I-TREATMENT empujar I-TREATMENT hacia I-TREATMENT mesial I-TREATMENT el I-TREATMENT tercer I-TREATMENT cuadrante I-TREATMENT que I-TREATMENT estaba I-TREATMENT en I-TREATMENT clase I-TREATMENT II I-TREATMENT dentaria I-TREATMENT sin I-TREATMENT sobrecargar I-TREATMENT los I-TREATMENT incisivos I-TREATMENT superiores, I-TREATMENT por I-TREATMENT eso I-TREATMENT evitamos I-TREATMENT el I-TREATMENT uso I-TREATMENT de I-TREATMENT elásticos I-TREATMENT para I-TREATMENT corregir I-TREATMENT la I-TREATMENT Clase I-TREATMENT II I-TREATMENT en I-TREATMENT el I-TREATMENT lado I-TREATMENT izquierdo I-TREATMENT desde I-TREATMENT el I-TREATMENT 22 I-TREATMENT hasta I-TREATMENT el I-TREATMENT 34. I-TREATMENT Para I-TREATMENT mesializar I-TREATMENT el I-TREATMENT tercer I-TREATMENT cuadrante I-TREATMENT se I-TREATMENT recurrió I-TREATMENT a I-TREATMENT un I-TREATMENT anclaje I-TREATMENT óseo I-TREATMENT mediante I-TREATMENT un I-TREATMENT microtornillo I-TREATMENT y I-TREATMENT un I-TREATMENT resorte I-TREATMENT de I-TREATMENT 19 I-TREATMENT x I-TREATMENT 25 I-TREATMENT de I-TREATMENT TMA®, I-TREATMENT donde I-TREATMENT podemos I-TREATMENT observar I-TREATMENT el I-TREATMENT canino I-TREATMENT en I-TREATMENT clase I-TREATMENT I I-TREATMENT de I-TREATMENT Angle. I-TREATMENT Los I-TREATMENT registros I-TREATMENT finales I-TREATMENT pueden I-TREATMENT verse I-TREATMENT en I-TREATMENT la I-TREATMENT figura I-TREATMENT 9. I-TREATMENT Para I-TREATMENT finalizar, I-TREATMENT el I-TREATMENT ortodoncista I-TREATMENT hizo I-TREATMENT una I-TREATMENT retención I-TREATMENT intracoronaria, I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT deberá I-TREATMENT llevar I-TREATMENT de I-TREATMENT por I-TREATMENT vida. I-TREATMENT I-TREATMENT La B-EXPLORATION tercera I-EXPLORATION fase, I-EXPLORATION o I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION reposición I-EXPLORATION de I-EXPLORATION los I-EXPLORATION molares I-EXPLORATION ausentes, I-EXPLORATION requirió I-EXPLORATION inicialmente I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION zonas I-EXPLORATION desdentadas I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION colocar I-EXPLORATION implantes. I-EXPLORATION Gracias I-EXPLORATION a I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION obtenidas I-EXPLORATION en I-EXPLORATION diversos I-EXPLORATION cortes, I-EXPLORATION posteriormente I-EXPLORATION manipuladas I-EXPLORATION con I-EXPLORATION programas I-EXPLORATION de I-EXPLORATION simulación I-EXPLORATION para I-EXPLORATION implantes, I-EXPLORATION se I-EXPLORATION concluyó I-EXPLORATION que I-EXPLORATION era I-EXPLORATION viable I-EXPLORATION colocar I-EXPLORATION fijaciones I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION x I-EXPLORATION 9 I-EXPLORATION mm I-EXPLORATION (Astra®) I-EXPLORATION a I-EXPLORATION cada I-EXPLORATION lado I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tramos I-EXPLORATION desdentados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mandíbula. I-EXPLORATION Estas B-TREATMENT fijaciones I-TREATMENT fueron I-TREATMENT guiadas I-TREATMENT e I-TREATMENT instaladas I-TREATMENT por I-TREATMENT una I-TREATMENT férula I-TREATMENT diagnóstico-quirúrgica, I-TREATMENT previamente I-TREATMENT confeccionada I-TREATMENT por I-TREATMENT el I-TREATMENT prostodoncista, I-TREATMENT en I-TREATMENT los I-TREATMENT lugares I-TREATMENT correspondientes I-TREATMENT a I-TREATMENT los I-TREATMENT dientes I-TREATMENT 35, I-TREATMENT 36, I-TREATMENT 45, I-TREATMENT 46. I-TREATMENT I-TREATMENT Como I-TREATMENT es I-TREATMENT habitual I-TREATMENT en I-TREATMENT estos I-TREATMENT tratamientos I-TREATMENT quirúrgicos, I-TREATMENT se I-TREATMENT le I-TREATMENT presentó I-TREATMENT a I-TREATMENT la I-TREATMENT paciente, I-TREATMENT días I-TREATMENT antes I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT junto I-TREATMENT con I-TREATMENT el I-TREATMENT presupuesto I-TREATMENT y I-TREATMENT plan I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT el I-TREATMENT formulario I-TREATMENT del I-TREATMENT Colegio I-TREATMENT de I-TREATMENT Odontólogos I-TREATMENT y I-TREATMENT Estomatólogos I-TREATMENT de I-TREATMENT Aragón I-TREATMENT para I-TREATMENT informarle I-TREATMENT de I-TREATMENT los I-TREATMENT posibles I-TREATMENT riesgos I-TREATMENT que I-TREATMENT pudieran I-TREATMENT surgir I-TREATMENT a I-TREATMENT consecuencia I-TREATMENT de I-TREATMENT la I-TREATMENT intervención. I-TREATMENT Tras I-TREATMENT meditada I-TREATMENT lectura, I-TREATMENT la I-TREATMENT paciente I-TREATMENT procedió I-TREATMENT a I-TREATMENT firmar I-TREATMENT el I-TREATMENT preceptivo I-TREATMENT consentimiento I-TREATMENT informado. I-TREATMENT Por I-TREATMENT otra I-TREATMENT parte, I-TREATMENT la I-TREATMENT paciente I-TREATMENT siguió I-TREATMENT llevando I-TREATMENT la I-TREATMENT férula I-TREATMENT de I-TREATMENT relajación I-TREATMENT durante I-TREATMENT el I-TREATMENT periodo I-TREATMENT de I-TREATMENT la I-TREATMENT integración, I-TREATMENT debido I-TREATMENT a I-TREATMENT la I-TREATMENT comodidad I-TREATMENT que I-TREATMENT le I-TREATMENT proporcionaba. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT cuarta I-TREATMENT fase, I-TREATMENT el I-TREATMENT prostodoncista I-TREATMENT realizó I-TREATMENT la I-TREATMENT prótesis I-TREATMENT implanto-soportada I-TREATMENT en I-TREATMENT metal I-TREATMENT cerámica I-TREATMENT y I-TREATMENT la I-TREATMENT cementó I-TREATMENT ya I-TREATMENT que I-TREATMENT el I-TREATMENT generalista I-TREATMENT en I-TREATMENT aquel I-TREATMENT momento I-TREATMENT no I-TREATMENT colocaba I-TREATMENT implantes I-TREATMENT ni I-TREATMENT hacía I-TREATMENT prótesis I-TREATMENT implanto-soportadas. I-TREATMENT En I-TREATMENT la I-TREATMENT figura I-TREATMENT 11 I-TREATMENT vemos I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT un I-TREATMENT año I-TREATMENT después I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT ortodóncico I-TREATMENT con I-TREATMENT la I-TREATMENT boca I-TREATMENT rehabilitada. I-TREATMENT En B-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION control I-EVOLUTION radiológico I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION colocación I-EVOLUTION de I-EVOLUTION las I-EVOLUTION fijaciones I-EVOLUTION se I-EVOLUTION apreció I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION hueso I-EVOLUTION en I-EVOLUTION varias I-EVOLUTION espiras I-EVOLUTION de I-EVOLUTION las I-EVOLUTION fijaciones I-EVOLUTION correspondientes I-EVOLUTION al I-EVOLUTION 35' I-EVOLUTION y I-EVOLUTION 45'. I-EVOLUTION Se B-TREATMENT decidió I-TREATMENT mantener I-TREATMENT esa I-TREATMENT mucosa I-TREATMENT bajo I-TREATMENT un I-TREATMENT régimen I-TREATMENT de I-TREATMENT higiene I-TREATMENT oral I-TREATMENT muy I-TREATMENT estricto, I-TREATMENT efectuando I-TREATMENT controles I-TREATMENT quincenales I-TREATMENT de I-TREATMENT placa, I-TREATMENT pulido I-TREATMENT de I-TREATMENT la I-TREATMENT superficie I-TREATMENT de I-TREATMENT piezas I-TREATMENT e I-TREATMENT implantes I-TREATMENT con I-TREATMENT taza I-TREATMENT de I-TREATMENT goma I-TREATMENT y I-TREATMENT enjuagues I-TREATMENT con I-TREATMENT clorhexidina I-TREATMENT al I-TREATMENT 0, I-TREATMENT 20% I-TREATMENT cada I-TREATMENT doce I-TREATMENT horas, I-TREATMENT hasta I-TREATMENT conseguir I-TREATMENT que I-TREATMENT los I-TREATMENT tejidos I-TREATMENT periimplantarios I-TREATMENT no I-TREATMENT presentaran I-TREATMENT hemorragia I-TREATMENT al I-TREATMENT sondaje. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION continua I-EVOLUTION en I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION en I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION mantenimiento I-EVOLUTION periodontal, I-EVOLUTION con I-EVOLUTION revisiones I-EVOLUTION trimestrales I-EVOLUTION para I-EVOLUTION comprobar I-EVOLUTION la I-EVOLUTION estabilidad I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION piezas, I-EVOLUTION implantes I-EVOLUTION y I-EVOLUTION prótesis. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS al B-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY DP I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY sustitutivo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY IRCT I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY consecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY severa I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hiperuricemia. I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY siguiente I-PAST_MEDICAL_HISTORY perfil I-PAST_MEDICAL_HISTORY respeto I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY situación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY acidosis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Dado I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY general I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY bueno I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY mantenía I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY diuresis I-PAST_MEDICAL_HISTORY residual I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY (2000 I-PAST_MEDICAL_HISTORY ml/d, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY decidió I-PAST_MEDICAL_HISTORY iniciar I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY depurador I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY intercambios I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2l, I-PAST_MEDICAL_HISTORY (4 I-PAST_MEDICAL_HISTORY l I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY 1’26% I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY l I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Icodextrina I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY recambio I-PAST_MEDICAL_HISTORY nocturno). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS iniciada I-PRESENT_ILLNESS la I-PRESENT_ILLNESS DP I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS es I-PRESENT_ILLNESS incluido I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS multicéntrico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS evaluaba I-PRESENT_ILLNESS el I-PRESENT_ILLNESS líquido I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diálisis I-PRESENT_ILLNESS con I-PRESENT_ILLNESS bicarbonato, I-PRESENT_ILLNESS Physioneal®. I-PRESENT_ILLNESS Las B-EXPLORATION características I-EXPLORATION dialíticas I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION este I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION reflejan I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION 2. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION poco I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION utilizar I-EXPLORATION esta I-EXPLORATION solución I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION refiere I-EXPLORATION algunas I-EXPLORATION molestias I-EXPLORATION como: I-EXPLORATION I-EXPLORATION • I-EXPLORATION Aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sensación I-EXPLORATION de I-EXPLORATION sed I-EXPLORATION y I-EXPLORATION discreta I-EXPLORATION distensión I-EXPLORATION abdominal I-EXPLORATION los I-EXPLORATION primeros I-EXPLORATION días. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Manifiesta I-EXPLORATION que I-EXPLORATION ocasionalmente I-EXPLORATION y I-EXPLORATION al I-EXPLORATION finalizar I-EXPLORATION los I-EXPLORATION drenajes I-EXPLORATION siente I-EXPLORATION dolor, I-EXPLORATION que I-EXPLORATION atribuye I-EXPLORATION a I-EXPLORATION la I-EXPLORATION posición I-EXPLORATION del I-EXPLORATION catéter. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Aparición I-EXPLORATION de I-EXPLORATION coágulos I-EXPLORATION de I-EXPLORATION fibrina I-EXPLORATION en I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION drenado. I-EXPLORATION I-EXPLORATION No I-EXPLORATION se I-EXPLORATION da I-EXPLORATION importancia I-EXPLORATION a I-EXPLORATION estas I-EXPLORATION manifestaciones I-EXPLORATION que I-EXPLORATION se I-EXPLORATION atribuyen, I-EXPLORATION por I-EXPLORATION una I-EXPLORATION parte I-EXPLORATION al I-EXPLORATION incumplimiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION dieta I-EXPLORATION por I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION paciente, I-EXPLORATION ya I-EXPLORATION que I-EXPLORATION tenía I-EXPLORATION un I-EXPLORATION sodio I-EXPLORATION alto I-EXPLORATION (141mEq/L), I-EXPLORATION y I-EXPLORATION por I-EXPLORATION otra, I-EXPLORATION a I-EXPLORATION la I-EXPLORATION incomodidad I-EXPLORATION que I-EXPLORATION ocasionalmente I-EXPLORATION provoca I-EXPLORATION el I-EXPLORATION líquido I-EXPLORATION IP I-EXPLORATION y I-EXPLORATION a I-EXPLORATION la I-EXPLORATION adaptación I-EXPLORATION al I-EXPLORATION tratamiento. I-EXPLORATION Para B-TREATMENT evitar I-TREATMENT la I-TREATMENT formación I-TREATMENT de I-TREATMENT coágulos I-TREATMENT se I-TREATMENT administraron I-TREATMENT 15 I-TREATMENT mg I-TREATMENT de I-TREATMENT heparina I-TREATMENT sódica I-TREATMENT en I-TREATMENT el I-TREATMENT líquido I-TREATMENT de I-TREATMENT diálisis. I-TREATMENT Esta B-EVOLUTION sintomatología I-EVOLUTION remitió I-EVOLUTION y I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION era I-EVOLUTION satisfactorio. I-EVOLUTION El I-EVOLUTION estudio I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION duración I-EVOLUTION de I-EVOLUTION tres I-EVOLUTION meses; I-EVOLUTION al I-EVOLUTION final I-EVOLUTION del I-EVOLUTION mismo I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION analíticos I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION características I-EVOLUTION dialíticas I-EVOLUTION se I-EVOLUTION reflejan I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tabla I-EVOLUTION 3. I-EVOLUTION I-EVOLUTION Se B-TREATMENT reinicia I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT habitual I-TREATMENT con I-TREATMENT 4 I-TREATMENT l I-TREATMENT de I-TREATMENT con I-TREATMENT glucosa I-TREATMENT al I-TREATMENT 1’5%, I-TREATMENT Ca I-TREATMENT normal I-TREATMENT y I-TREATMENT 2 I-TREATMENT l I-TREATMENT de I-TREATMENT solución I-TREATMENT con I-TREATMENT Icodextrina I-TREATMENT para I-TREATMENT el I-TREATMENT recambio I-TREATMENT nocturno. I-TREATMENT Tras B-EVOLUTION estos I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION con I-EVOLUTION la I-EVOLUTION solución I-EVOLUTION de I-EVOLUTION bicarbonato, I-EVOLUTION la I-EVOLUTION situación I-EVOLUTION clínica I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION era I-EVOLUTION buena I-EVOLUTION (aunque I-EVOLUTION había I-EVOLUTION manifestado I-EVOLUTION alguna I-EVOLUTION molestia) I-EVOLUTION y I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION analíticos I-EVOLUTION aceptables, I-EVOLUTION pero I-EVOLUTION se I-EVOLUTION hade I-EVOLUTION destacar I-EVOLUTION que I-EVOLUTION en I-EVOLUTION un I-EVOLUTION periodo I-EVOLUTION corto I-EVOLUTION de I-EVOLUTION tiempo, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION había I-EVOLUTION pasado I-EVOLUTION de I-EVOLUTION ser I-EVOLUTION "Medio I-EVOLUTION alto I-EVOLUTION transportador" I-EVOLUTION a I-EVOLUTION "Alto I-EVOLUTION transportador", I-EVOLUTION disminuyendo I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION de I-EVOLUTION Kt/V. I-EVOLUTION I-EVOLUTION Cinco B-TREATMENT meses I-TREATMENT más I-TREATMENT tarde, I-TREATMENT se I-TREATMENT decide I-TREATMENT reiniciar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT bicarbonato. I-TREATMENT El I-TREATMENT paciente I-TREATMENT desea I-TREATMENT volver I-TREATMENT a I-TREATMENT utilizar I-TREATMENT la I-TREATMENT nueva I-TREATMENT solución I-TREATMENT ya I-TREATMENT que I-TREATMENT le I-TREATMENT parecía I-TREATMENT que I-TREATMENT con I-TREATMENT ella"se I-TREATMENT encontraba I-TREATMENT mejor" I-TREATMENT (menos I-TREATMENT astenia I-TREATMENT y I-TREATMENT mejor I-TREATMENT estado I-TREATMENT de I-TREATMENT ánimo). I-TREATMENT Aunque I-TREATMENT el I-TREATMENT Kt/V I-TREATMENT era I-TREATMENT ligeramente I-TREATMENT inferior I-TREATMENT a I-TREATMENT los I-TREATMENT valores I-TREATMENT recomendados, I-TREATMENT al I-TREATMENT mantener I-TREATMENT diuresis, I-TREATMENT buen I-TREATMENT aclaramiento I-TREATMENT de I-TREATMENT creatinina I-TREATMENT y I-TREATMENT buen I-TREATMENT estado I-TREATMENT general, I-TREATMENT se I-TREATMENT decidió I-TREATMENT no I-TREATMENT aumentar I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT diálisis. I-TREATMENT No I-TREATMENT se I-TREATMENT considero I-TREATMENT importante I-TREATMENT el I-TREATMENT que I-TREATMENT hubieran I-TREATMENT aumentado I-TREATMENT ligeramente I-TREATMENT los I-TREATMENT valores I-TREATMENT del I-TREATMENT HCO3. I-TREATMENT I-TREATMENT En B-EVOLUTION el I-EVOLUTION control I-EVOLUTION realizado I-EVOLUTION a I-EVOLUTION los I-EVOLUTION tres I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION reiniciar I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION solución I-EVOLUTION de I-EVOLUTION bicarbonato I-EVOLUTION se I-EVOLUTION obtuvieron I-EVOLUTION los I-EVOLUTION resultados I-EVOLUTION que I-EVOLUTION se I-EVOLUTION observan I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tabla I-EVOLUTION 5. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION presentaba I-EVOLUTION muy I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION incluso I-EVOLUTION deseaba I-EVOLUTION irse I-EVOLUTION de I-EVOLUTION vacaciones I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION continuar I-EVOLUTION con I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION pauta I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION I-EVOLUTION Tres I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION y I-EVOLUTION coincidiendo I-EVOLUTION con I-EVOLUTION el I-EVOLUTION siguiente I-EVOLUTION control, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION sintiéndose I-EVOLUTION bien I-EVOLUTION y I-EVOLUTION ha I-EVOLUTION decidido I-EVOLUTION irse I-EVOLUTION de I-EVOLUTION vacaciones. I-EVOLUTION No I-EVOLUTION obstante, I-EVOLUTION su I-EVOLUTION diuresis I-EVOLUTION y I-EVOLUTION Kt/V I-EVOLUTION han I-EVOLUTION disminuido I-EVOLUTION y I-EVOLUTION está I-EVOLUTION hipertenso. I-EVOLUTION Se B-TREATMENT le I-TREATMENT prescribe I-TREATMENT mayor I-TREATMENT dosis I-TREATMENT de I-TREATMENT hipotensores I-TREATMENT y I-TREATMENT se I-TREATMENT decide I-TREATMENT aumentar I-TREATMENT el I-TREATMENT flujo I-TREATMENT peritoneal I-TREATMENT a I-TREATMENT cuatro I-TREATMENT recambios I-TREATMENT /día: I-TREATMENT 6 I-TREATMENT l I-TREATMENT al I-TREATMENT 1.36% I-TREATMENT y I-TREATMENT Icodextrina I-TREATMENT 2 I-TREATMENT l, I-TREATMENT en I-TREATMENT el I-TREATMENT recambio I-TREATMENT nocturno. I-TREATMENT I-TREATMENT Un B-EVOLUTION mes I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION hospital I-EVOLUTION con I-EVOLUTION carácter I-EVOLUTION urgente, I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION turbio I-EVOLUTION con I-EVOLUTION cultivo I-EVOLUTION negativo I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION abdominal, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION cree I-EVOLUTION es I-EVOLUTION consecuencia I-EVOLUTION de I-EVOLUTION una I-EVOLUTION irritación I-EVOLUTION peritoneal I-EVOLUTION producida I-EVOLUTION por I-EVOLUTION la I-EVOLUTION excesiva I-EVOLUTION UF I-EVOLUTION de I-EVOLUTION la I-EVOLUTION Icodextrina, I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION con I-EVOLUTION la I-EVOLUTION infusión I-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION l I-EVOLUTION drena I-EVOLUTION (3'8 I-EVOLUTION l. I-EVOLUTION Se B-TREATMENT le I-TREATMENT administran I-TREATMENT antibióticos I-TREATMENT y I-TREATMENT se I-TREATMENT reduce I-TREATMENT el I-TREATMENT volumen I-TREATMENT de I-TREATMENT la I-TREATMENT infusión I-TREATMENT de I-TREATMENT Icodextrina I-TREATMENT a I-TREATMENT 1’5 I-TREATMENT l. I-TREATMENT El B-EVOLUTION cuadro I-EVOLUTION se I-EVOLUTION soluciona I-EVOLUTION favorablemente. I-EVOLUTION I-EVOLUTION Quince I-EVOLUTION días I-EVOLUTION más I-EVOLUTION tarde, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION hospital I-EVOLUTION presentando I-EVOLUTION una I-EVOLUTION alteración I-EVOLUTION importante I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION infección, I-EVOLUTION destacando: B-EXPLORATION I-EXPLORATION • I-EXPLORATION Descenso I-EXPLORATION brusco I-EXPLORATION del I-EXPLORATION Hto I-EXPLORATION I-EXPLORATION • I-EXPLORATION Hipertensión I-EXPLORATION I-EXPLORATION • I-EXPLORATION Hiperhidratación I-EXPLORATION (aumento I-EXPLORATION de I-EXPLORATION peso I-EXPLORATION con I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION edemas I-EXPLORATION maleolares) I-EXPLORATION I-EXPLORATION • I-EXPLORATION Disnea I-EXPLORATION I-EXPLORATION • I-EXPLORATION Desorientación I-EXPLORATION importante I-EXPLORATION en I-EXPLORATION espacio-tiempo I-EXPLORATION I-EXPLORATION • I-EXPLORATION Elevación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION diafragmas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION RX I-EXPLORATION tórax, I-EXPLORATION con I-EXPLORATION reducción I-EXPLORATION de I-EXPLORATION los I-EXPLORATION campos I-EXPLORATION pulmonares I-EXPLORATION I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION analíticos I-EXPLORATION que I-EXPLORATION se I-EXPLORATION reflejan I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION 6 I-EXPLORATION demuestran I-EXPLORATION una I-EXPLORATION ALCALOSIS I-EXPLORATION METABÓLICA. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT esta I-TREATMENT situación, I-TREATMENT se I-TREATMENT suspende I-TREATMENT la I-TREATMENT infusión I-TREATMENT del I-TREATMENT líquido I-TREATMENT con I-TREATMENT bicarbonato I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT la I-TREATMENT DP I-TREATMENT con I-TREATMENT líquido I-TREATMENT con I-TREATMENT lactato I-TREATMENT PD1, I-TREATMENT aumentando I-TREATMENT la I-TREATMENT frecuencia I-TREATMENT de I-TREATMENT los I-TREATMENT recambios I-TREATMENT a10 I-TREATMENT l/día. I-TREATMENT Para I-TREATMENT optimizar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT se I-TREATMENT decide I-TREATMENT utiliza I-TREATMENT runa I-TREATMENT cicladora, I-TREATMENT para I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT instruye I-TREATMENT a I-TREATMENT la I-TREATMENT esposa I-TREATMENT del I-TREATMENT paciente I-TREATMENT ya I-TREATMENT que I-TREATMENT el I-TREATMENT estado I-TREATMENT de I-TREATMENT conciencia I-TREATMENT de I-TREATMENT éste I-TREATMENT no I-TREATMENT permite I-TREATMENT entrenarlo. I-TREATMENT A B-EVOLUTION la I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION iniciar I-EVOLUTION del I-EVOLUTION nuevo I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION cicladora I-EVOLUTION hospitalaria, I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION mejorado, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION la I-EVOLUTION situación I-EVOLUTION de I-EVOLUTION acidosis. I-EVOLUTION Es I-EVOLUTION capaz, I-EVOLUTION con I-EVOLUTION el I-EVOLUTION apoyo I-EVOLUTION de I-EVOLUTION su I-EVOLUTION esposa, I-EVOLUTION de I-EVOLUTION iniciar I-EVOLUTION la I-EVOLUTION diálisis I-EVOLUTION peritoneal I-EVOLUTION automatizada I-EVOLUTION (DPA) I-EVOLUTION en I-EVOLUTION su I-EVOLUTION casa. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION iniciada I-EVOLUTION la I-EVOLUTION diálisis I-EVOLUTION peritoneal I-EVOLUTION con I-EVOLUTION cicladora I-EVOLUTION se I-EVOLUTION normalizaron I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION analíticos I-EVOLUTION y I-EVOLUTION las I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION tensión I-EVOLUTION arterial, I-EVOLUTION siendo I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION bueno. I-EVOLUTION Los I-EVOLUTION parámetros I-EVOLUTION más I-EVOLUTION destacables I-EVOLUTION se I-EVOLUTION reflejan I-EVOLUTION en I-EVOLUTION la I-EVOLUTION tabla I-EVOLUTION 8. I-EVOLUTION I-EVOLUTION En I-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION (30 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION DP), I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION ninguna I-EVOLUTION complicación, I-EVOLUTION ningún I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION líquido I-EVOLUTION turbio I-EVOLUTION y I-EVOLUTION su I-EVOLUTION estado I-EVOLUTION general I-EVOLUTION es I-EVOLUTION correcto, I-EVOLUTION con I-EVOLUTION tendencia I-EVOLUTION al I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION peso I-EVOLUTION sin I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION edemas. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY obesidad, I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY controlada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dieta I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tabaquismo, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS fue I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS glomerulonefritis I-PRESENT_ILLNESS rápidamente I-PRESENT_ILLNESS progresiva, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS anticuerpos I-PRESENT_ILLNESS antimembrana I-PRESENT_ILLNESS basal I-PRESENT_ILLNESS glomerular. I-PRESENT_ILLNESS Por B-TREATMENT este I-TREATMENT motivo, I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT inmunosupresor I-TREATMENT con I-TREATMENT esteroides, I-TREATMENT ciclofosfamida I-TREATMENT y I-TREATMENT también I-TREATMENT plasmaféresis, I-TREATMENT todo I-TREATMENT ello, I-TREATMENT sin I-TREATMENT resultado I-TREATMENT satisfactorio I-TREATMENT para I-TREATMENT su I-TREATMENT función I-TREATMENT renal. I-TREATMENT I-TREATMENT Inicialmente I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT renal I-TREATMENT sustitutivo I-TREATMENT mediante I-TREATMENT HD I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT pasó I-TREATMENT a I-TREATMENT DP. I-TREATMENT Durante B-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION años I-EVOLUTION en I-EVOLUTION esta I-EVOLUTION técnica, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION desarrolló I-EVOLUTION 10 I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION peritonitis, I-EVOLUTION 9 I-EVOLUTION de I-EVOLUTION ellos I-EVOLUTION por I-EVOLUTION Staphilococcus I-EVOLUTION (8 I-EVOLUTION epidermidis I-EVOLUTION y I-EVOLUTION 1 I-EVOLUTION capitis). I-EVOLUTION El I-EVOLUTION último I-EVOLUTION de I-EVOLUTION ellos I-EVOLUTION por I-EVOLUTION Candida I-EVOLUTION albicans, I-EVOLUTION que I-EVOLUTION motivó I-EVOLUTION la I-EVOLUTION retirada I-EVOLUTION del I-EVOLUTION catéter I-EVOLUTION de I-EVOLUTION DP I-EVOLUTION y I-EVOLUTION su I-EVOLUTION transferencia I-EVOLUTION a I-EVOLUTION HD. I-EVOLUTION Durante I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION DP I-EVOLUTION se I-EVOLUTION transformó I-EVOLUTION en I-EVOLUTION un I-EVOLUTION "alto I-EVOLUTION transportador". I-EVOLUTION I-EVOLUTION Seis I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION del I-EVOLUTION cambio I-EVOLUTION de I-EVOLUTION modalidad I-EVOLUTION terapéutica, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION sufre I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION con I-EVOLUTION vómitos, I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION peso, I-EVOLUTION distensión I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION efecto I-EVOLUTION masa I-EVOLUTION en I-EVOLUTION hipogastrio. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION apreciándose I-EXPLORATION marcada I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION estómago I-EXPLORATION y I-EXPLORATION asa I-EXPLORATION proximal I-EXPLORATION del I-EXPLORATION intestino I-EXPLORATION delgado, I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION pared I-EXPLORATION moderadamente I-EXPLORATION engrosada; I-EXPLORATION colección I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION septos I-EXPLORATION en I-EXPLORATION hipogastrio. I-EXPLORATION I-EXPLORATION También I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computorizada I-EXPLORATION (TAC) I-EXPLORATION abdominal, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION perihepático I-EXPLORATION además I-EXPLORATION de I-EXPLORATION periesplénico, I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION peritoneal, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION colección I-EXPLORATION líquida I-EXPLORATION pélvica I-EXPLORATION con I-EXPLORATION septos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION que I-EXPLORATION engloba I-EXPLORATION asas I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION delgado, I-EXPLORATION condicionando I-EXPLORATION gran I-EXPLORATION dilatación I-EXPLORATION gástrica, I-EXPLORATION duodenal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION yeyuno, I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION hidroaéreos, I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION condujo I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION esclerosis I-EXPLORATION peritoneal. I-EXPLORATION I-EXPLORATION Por B-TREATMENT otra I-TREATMENT parte, I-TREATMENT al I-TREATMENT paciente I-TREATMENT se I-TREATMENT le I-TREATMENT propuso I-TREATMENT tratamiento I-TREATMENT quirúrgico, I-TREATMENT que I-TREATMENT desestimó. I-TREATMENT I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION tórpida, I-EVOLUTION con I-EVOLUTION varios I-EVOLUTION ingresos I-EVOLUTION por I-EVOLUTION cuadros I-EVOLUTION de I-EVOLUTION oclusión I-EVOLUTION intestinal, I-EVOLUTION precisando I-EVOLUTION alimentación I-EVOLUTION parenteral, I-EVOLUTION administración I-EVOLUTION sin I-EVOLUTION éxito I-EVOLUTION de I-EVOLUTION esteroides I-EVOLUTION y I-EVOLUTION progresivo I-EVOLUTION deterioro I-EVOLUTION de I-EVOLUTION su I-EVOLUTION estado, I-EVOLUTION con I-EVOLUTION ascitis I-EVOLUTION y I-EVOLUTION desnutrición I-EVOLUTION que I-EVOLUTION motivaron I-EVOLUTION su I-EVOLUTION fallecimiento I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico. I-EVOLUTION I-EVOLUTION Resultados B-EXPLORATION y I-EXPLORATION descripción I-EXPLORATION I-EXPLORATION Tenemos I-EXPLORATION una I-EXPLORATION serie I-EXPLORATION de I-EXPLORATION marcadores I-EXPLORATION predictivos I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION entidad, I-EXPLORATION como I-EXPLORATION son I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION en I-EXPLORATION DP, I-EXPLORATION el I-EXPLORATION que I-EXPLORATION sea I-EXPLORATION alto I-EXPLORATION transportador, I-EXPLORATION y I-EXPLORATION factores I-EXPLORATION predisponentes I-EXPLORATION como I-EXPLORATION son, I-EXPLORATION el I-EXPLORATION hiperparatiroidismo I-EXPLORATION grave I-EXPLORATION (primer I-EXPLORATION caso) I-EXPLORATION o I-EXPLORATION los I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION de I-EXPLORATION repetición I-EXPLORATION (en I-EXPLORATION el I-EXPLORATION segundo). I-EXPLORATION Hay I-EXPLORATION que I-EXPLORATION tener I-EXPLORATION en I-EXPLORATION cuenta, I-EXPLORATION que I-EXPLORATION más I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mitad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION casos, I-EXPLORATION se I-EXPLORATION producen I-EXPLORATION tras I-EXPLORATION el I-EXPLORATION abandono I-EXPLORATION de I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION DP. I-EXPLORATION I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION se I-EXPLORATION efectúa I-EXPLORATION mediante I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION imagen: I-EXPLORATION Rx I-EXPLORATION simple, I-EXPLORATION ecografía I-EXPLORATION o I-EXPLORATION TAC I-EXPLORATION abdominal, I-EXPLORATION aunque I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION obtener I-EXPLORATION mediante I-EXPLORATION biopsia I-EXPLORATION peritoneal, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION apreciar, I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION tamaño I-EXPLORATION de I-EXPLORATION los I-EXPLORATION fibroblastos, I-EXPLORATION depósito I-EXPLORATION de I-EXPLORATION fibrina, I-EXPLORATION angiogénesis I-EXPLORATION capilar, I-EXPLORATION sangrado I-EXPLORATION perivascular I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION mononucleares. I-EXPLORATION I-EXPLORATION El I-EXPLORATION tratamiento I-EXPLORATION de I-EXPLORATION este I-EXPLORATION grave I-EXPLORATION cuadro, I-EXPLORATION dependerá I-EXPLORATION del I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION peritoneal. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION estadios I-EXPLORATION iniciales I-EXPLORATION podría I-EXPLORATION ser I-EXPLORATION suficiente I-EXPLORATION el I-EXPLORATION reposo I-EXPLORATION peritoneal; I-EXPLORATION con I-EXPLORATION lavados I-EXPLORATION peritoneales I-EXPLORATION y I-EXPLORATION esteroides. I-EXPLORATION En I-EXPLORATION casos I-EXPLORATION más I-EXPLORATION avanzados I-EXPLORATION se I-EXPLORATION necesitará I-EXPLORATION tratamiento I-EXPLORATION inmunosupresor I-EXPLORATION (ciclofosfamida, I-EXPLORATION azatioprina, I-EXPLORATION ciclosporina) I-EXPLORATION e I-EXPLORATION incluso I-EXPLORATION tamoxifeno. I-EXPLORATION En I-EXPLORATION casos I-EXPLORATION extremos I-EXPLORATION con I-EXPLORATION compromiso I-EXPLORATION visceral, I-EXPLORATION puede I-EXPLORATION ser I-EXPLORATION necesario I-EXPLORATION recurrir I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cirugía, I-EXPLORATION realizando I-EXPLORATION enterolisis, I-EXPLORATION técnica I-EXPLORATION que I-EXPLORATION tiene I-EXPLORATION una I-EXPLORATION mortalidad I-EXPLORATION entre I-EXPLORATION 40-80%. I-EXPLORATION I-EXPLORATION Entre I-EXPLORATION las I-EXPLORATION medidas I-EXPLORATION de I-EXPLORATION prevención I-EXPLORATION del I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION peritonitis I-EXPLORATION esclerosante, I-EXPLORATION cabe I-EXPLORATION destacar I-EXPLORATION la I-EXPLORATION importancia I-EXPLORATION del I-EXPLORATION papel I-EXPLORATION de I-EXPLORATION enfermería I-EXPLORATION en I-EXPLORATION el I-EXPLORATION entrenamiento I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION para I-EXPLORATION reducir I-EXPLORATION al I-EXPLORATION máximo I-EXPLORATION los I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION peritonitis I-EXPLORATION y I-EXPLORATION tratarlos I-EXPLORATION adecuadamente I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION precoz; I-EXPLORATION además I-EXPLORATION debemos I-EXPLORATION utilizar I-EXPLORATION soluciones I-EXPLORATION lo I-EXPLORATION más I-EXPLORATION biocompatibles I-EXPLORATION posible, I-EXPLORATION evitando I-EXPLORATION de I-EXPLORATION ese I-EXPLORATION modo I-EXPLORATION altas I-EXPLORATION concentraciones I-EXPLORATION de I-EXPLORATION glucosa. I-EXPLORATION Así I-EXPLORATION mismo, I-EXPLORATION es I-EXPLORATION muy I-EXPLORATION importante I-EXPLORATION el I-EXPLORATION control I-EXPLORATION del I-EXPLORATION hiperparatiroidismo I-EXPLORATION secundario I-EXPLORATION en I-EXPLORATION los I-EXPLORATION pacientes I-EXPLORATION urémicos. I-EXPLORATION I-EXPLORATION Finalmente, I-EXPLORATION debemos I-EXPLORATION estar I-EXPLORATION alerta I-EXPLORATION en I-EXPLORATION aquellos I-EXPLORATION pacientes I-EXPLORATION que I-EXPLORATION se I-EXPLORATION convierten I-EXPLORATION en I-EXPLORATION altos I-EXPLORATION transportadores I-EXPLORATION con I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION del I-EXPLORATION tiempo I-EXPLORATION en I-EXPLORATION DP. I-EXPLORATION Por I-EXPLORATION tanto, I-EXPLORATION es I-EXPLORATION conveniente I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION PET I-EXPLORATION (test I-EXPLORATION de I-EXPLORATION equilibrio I-EXPLORATION peritoneal), I-EXPLORATION al I-EXPLORATION menos I-EXPLORATION una I-EXPLORATION vez I-EXPLORATION al I-EXPLORATION año I-EXPLORATION y I-EXPLORATION tras I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION peritonitis. I-EXPLORATION I-EXPLORATION Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS fruto B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY embarazo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY término, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY adecuado I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional. I-PAST_MEDICAL_HISTORY Embarazo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY controlado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY antecedente B-FAMILY_HISTORY de I-FAMILY_HISTORY lupus I-FAMILY_HISTORY eritematoso I-FAMILY_HISTORY sistémico I-FAMILY_HISTORY (LES) I-FAMILY_HISTORY materno I-FAMILY_HISTORY en I-FAMILY_HISTORY tratamiento I-FAMILY_HISTORY con I-FAMILY_HISTORY cloroquina, I-FAMILY_HISTORY siendo I-FAMILY_HISTORY negativos I-FAMILY_HISTORY los I-FAMILY_HISTORY marcadores I-FAMILY_HISTORY maternos I-FAMILY_HISTORY para I-FAMILY_HISTORY LES I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY momento I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY concepción; I-FAMILY_HISTORY exámenes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rutina I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS lactante I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS por I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS ocasiones, I-PRESENT_ILLNESS mientras I-PRESENT_ILLNESS estaba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lactancia I-PRESENT_ILLNESS mixta, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS 41.º I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuevo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS este I-PRESENT_ILLNESS motivo, I-PRESENT_ILLNESS realizándose B-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION presentó I-EXPLORATION 9.220 I-EXPLORATION leucocitos I-EXPLORATION con I-EXPLORATION 11, I-EXPLORATION 9% I-EXPLORATION de I-EXPLORATION eosinófilos, I-EXPLORATION hemograma, I-EXPLORATION sedimento I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION urocultivo I-EXPLORATION negativos. I-EXPLORATION Ante B-DERIVED_FROM/TO la I-DERIVED_FROM/TO presencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO eosinofilia I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO analítica I-DERIVED_FROM/TO y I-DERIVED_FROM/TO con I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vómitos I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO diagnostica I-DERIVED_FROM/TO intolerancia I-DERIVED_FROM/TO a I-DERIVED_FROM/TO proteínas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO leche I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vaca, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO se I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO especialista I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Alergología. I-DERIVED_FROM/TO Con B-EVOLUTION 46 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION consulta I-EVOLUTION con I-EVOLUTION máculas I-EVOLUTION anulares, I-EVOLUTION policíclicas, I-EVOLUTION localizadas I-EVOLUTION en I-EVOLUTION cabeza I-EVOLUTION y I-EVOLUTION zona I-EVOLUTION anterior I-EVOLUTION del I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION pubis. I-EVOLUTION Ante B-DERIVED_FROM/TO la I-DERIVED_FROM/TO duda I-DERIVED_FROM/TO diagnóstica I-DERIVED_FROM/TO de I-DERIVED_FROM/TO afectación I-DERIVED_FROM/TO lúpica I-DERIVED_FROM/TO o I-DERIVED_FROM/TO bien I-DERIVED_FROM/TO posible I-DERIVED_FROM/TO reacción I-DERIVED_FROM/TO adversa I-DERIVED_FROM/TO medicamentosa I-DERIVED_FROM/TO por I-DERIVED_FROM/TO cloroquina, I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO para I-DERIVED_FROM/TO el I-DERIVED_FROM/TO LES I-DERIVED_FROM/TO materno, I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO al I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO referencia I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO cita I-DERIVED_FROM/TO para I-DERIVED_FROM/TO biopsia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO las I-DERIVED_FROM/TO lesiones I-DERIVED_FROM/TO y I-DERIVED_FROM/TO analítica. I-DERIVED_FROM/TO I-DERIVED_FROM/TO La B-EXPLORATION biopsia I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION región I-EXPLORATION suprapúbica, I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION analíticos I-EXPLORATION de I-EXPLORATION anticuerpos I-EXPLORATION anti-La I-EXPLORATION y I-EXPLORATION anti-Ro I-EXPLORATION positivos I-EXPLORATION confirman I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION en I-EXPLORATION nuestro I-EXPLORATION caso. I-EXPLORATION I-EXPLORATION El I-EXPLORATION ECG I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION descartándose I-EXPLORATION la I-EXPLORATION afectación I-EXPLORATION cardíaca. I-EXPLORATION I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION anemia I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION ferropénica, I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fórmula I-EXPLORATION leucocitaria I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION neutropenia. I-EXPLORATION I-EXPLORATION Al B-TREATMENT momento I-TREATMENT del I-TREATMENT diagnóstico I-TREATMENT se I-TREATMENT le I-TREATMENT indicó I-TREATMENT al I-TREATMENT paciente I-TREATMENT fotoprotección; I-TREATMENT metilprednisolona I-TREATMENT oral, I-TREATMENT con I-TREATMENT protección I-TREATMENT gástrica I-TREATMENT por I-TREATMENT el I-TREATMENT antecedente I-TREATMENT de I-TREATMENT vómitos; I-TREATMENT y I-TREATMENT sulfato I-TREATMENT ferroso I-TREATMENT para I-TREATMENT corregir I-TREATMENT su I-TREATMENT anemia. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION habían I-EVOLUTION remitido, I-EVOLUTION suspendiéndose B-TREATMENT el I-TREATMENT tratamiento I-TREATMENT corticoideo I-TREATMENT a I-TREATMENT los I-TREATMENT 3 I-TREATMENT meses I-TREATMENT y I-TREATMENT medio. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION se I-EVOLUTION habían I-EVOLUTION negativizado I-EVOLUTION los I-EVOLUTION anticuerpos I-EVOLUTION lúpicos I-EVOLUTION maternos I-EVOLUTION en I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION y I-EVOLUTION había I-EVOLUTION desaparecido I-EVOLUTION la I-EVOLUTION neutropenia, I-EVOLUTION persistiendo I-EVOLUTION la I-EVOLUTION anemia. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Desde B-PRESENT_ILLNESS hace I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS recurrentes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS elevada I-PRESENT_ILLNESS (cada I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS semanas), I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS laterocervicales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS faringitis. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS cursan I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS (39-40 I-PRESENT_ILLNESS oC) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3-4 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS con I-PRESENT_ILLNESS escasa I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS antitérmicos. I-PRESENT_ILLNESS La B-EXPLORATION niña I-EXPLORATION está I-EXPLORATION asintomática I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION episodios I-EXPLORATION y I-EXPLORATION tiene I-EXPLORATION un I-EXPLORATION desarrollo I-EXPLORATION normal I-EXPLORATION para I-EXPLORATION su I-EXPLORATION edad. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION aparecen I-EXPLORATION leucocitosis I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION moderada, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR). I-EXPLORATION En I-EXPLORATION varias I-EXPLORATION ocasiones I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION frotis I-EXPLORATION faríngeos I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Los B-TREATMENT primeros I-TREATMENT episodios I-TREATMENT se I-TREATMENT trataron I-TREATMENT con I-TREATMENT antibiótico. I-TREATMENT No B-EVOLUTION presentó I-EVOLUTION mejoría I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION 3.o-5.o I-EVOLUTION día. I-EVOLUTION I-EVOLUTION Ante I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION descritos, I-EVOLUTION su I-EVOLUTION recurrencia I-EVOLUTION y I-EVOLUTION los I-EVOLUTION cultivos I-EVOLUTION faríngeos I-EVOLUTION negativos, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION producían I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION repetida, I-EVOLUTION se I-EVOLUTION pensó I-EVOLUTION en I-EVOLUTION la I-EVOLUTION posibilidad I-EVOLUTION de I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Marshall. I-EVOLUTION Coincidiendo B-TREATMENT con I-TREATMENT un I-TREATMENT nuevo I-TREATMENT pico I-TREATMENT febril, I-TREATMENT se I-TREATMENT inició I-TREATMENT corticoterapia I-TREATMENT oral. I-TREATMENT La B-EVOLUTION duración I-EVOLUTION del I-EVOLUTION episodio I-EVOLUTION se I-EVOLUTION acortó I-EVOLUTION a I-EVOLUTION menos I-EVOLUTION de I-EVOLUTION 6 I-EVOLUTION horas I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION toma I-EVOLUTION de I-EVOLUTION prednisona. I-EVOLUTION Dicha I-EVOLUTION respuesta I-EVOLUTION fue I-EVOLUTION comprobada I-EVOLUTION en I-EVOLUTION episodios I-EVOLUTION posteriores, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION sugiere I-EVOLUTION un I-EVOLUTION síndrome I-EVOLUTION PFAPA. I-EVOLUTION I-EVOLUTION Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Programa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Salud I-PRESENT_ILLNESS Infantil I-PRESENT_ILLNESS un I-PRESENT_ILLNESS lactante I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY fetal I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tercer I-PAST_MEDICAL_HISTORY trimestre I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY dilatación I-PAST_MEDICAL_HISTORY pielocalicial I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY (derecha: I-PAST_MEDICAL_HISTORY 4, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mm; I-PAST_MEDICAL_HISTORY izquierda: I-PAST_MEDICAL_HISTORY 4, I-PAST_MEDICAL_HISTORY 1 I-PAST_MEDICAL_HISTORY mm). I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY semana I-PAST_MEDICAL_HISTORY 41+4 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY fallo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inducción. I-PAST_MEDICAL_HISTORY Su I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 5/9 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY precisó I-PAST_MEDICAL_HISTORY reanimación I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY III; I-PAST_MEDICAL_HISTORY permaneció I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY transición I-PAST_MEDICAL_HISTORY menos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 24 I-PAST_MEDICAL_HISTORY horas. I-PAST_MEDICAL_HISTORY Antecedentes B-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés: I-FAMILY_HISTORY prima I-FAMILY_HISTORY hermana I-FAMILY_HISTORY paterna I-FAMILY_HISTORY con I-FAMILY_HISTORY escoliosis I-FAMILY_HISTORY congénita. I-FAMILY_HISTORY Exploración: B-EXPLORATION Peso: I-EXPLORATION 3, I-EXPLORATION 960 I-EXPLORATION kg I-EXPLORATION (percentil I-EXPLORATION 25); I-EXPLORATION talla: I-EXPLORATION 53 I-EXPLORATION cm I-EXPLORATION (percentil I-EXPLORATION 50); I-EXPLORATION y I-EXPLORATION perímetro I-EXPLORATION cefálico: I-EXPLORATION 37 I-EXPLORATION cm I-EXPLORATION (percentil I-EXPLORATION 25). I-EXPLORATION Se I-EXPLORATION aprecian I-EXPLORATION un I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION cráneo I-EXPLORATION con I-EXPLORATION fontanela I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION x I-EXPLORATION 1 I-EXPLORATION cm, I-EXPLORATION plagiocefalia I-EXPLORATION leve, I-EXPLORATION cuello I-EXPLORATION corto I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION al I-EXPLORATION lado I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION ligera I-EXPLORATION limitación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION movilidad, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION escoliosis I-EXPLORATION congénita I-EXPLORATION cervical. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION asimetría I-EXPLORATION en I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION tórax I-EXPLORATION posterior, I-EXPLORATION con I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION escápula I-EXPLORATION izquierda: I-EXPLORATION en I-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION hoyuelo I-EXPLORATION cutáneo I-EXPLORATION en I-EXPLORATION esa I-EXPLORATION escápula, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION tamaño I-EXPLORATION inferior I-EXPLORATION y I-EXPLORATION parece I-EXPLORATION más I-EXPLORATION horizontalizada I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION contralateral. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION y I-EXPLORATION neurológica I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Ante B-DERIVED_FROM/TO los I-DERIVED_FROM/TO hallazgos I-DERIVED_FROM/TO de I-DERIVED_FROM/TO escápula I-DERIVED_FROM/TO elevada, I-DERIVED_FROM/TO escoliosis, I-DERIVED_FROM/TO tortícolis I-DERIVED_FROM/TO y I-DERIVED_FROM/TO plagiocefalia I-DERIVED_FROM/TO se I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO su I-DERIVED_FROM/TO derivación I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO traumatología I-DERIVED_FROM/TO del I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO referencia. I-DERIVED_FROM/TO Debido B-EXPLORATION a I-EXPLORATION sus I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION dilatación I-EXPLORATION pielocalicial I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominorrenal I-EXPLORATION de I-EXPLORATION control. I-EXPLORATION I-EXPLORATION En B-EVOLUTION la I-EVOLUTION revisión I-EVOLUTION del I-EVOLUTION cuarto I-EVOLUTION mes I-EVOLUTION la I-EVOLUTION asimetría I-EVOLUTION escapular I-EVOLUTION es I-EVOLUTION más I-EVOLUTION manifiesta, I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION una I-EVOLUTION mayor I-EVOLUTION discrepancia I-EVOLUTION entre I-EVOLUTION el I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION ambas I-EVOLUTION escápulas I-EVOLUTION (la I-EVOLUTION derecha I-EVOLUTION mide I-EVOLUTION 7 I-EVOLUTION cm, I-EVOLUTION frente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 4, I-EVOLUTION 5 I-EVOLUTION cm I-EVOLUTION de I-EVOLUTION la I-EVOLUTION izquierda), I-EVOLUTION y I-EVOLUTION la I-EVOLUTION altura I-EVOLUTION del I-EVOLUTION ángulo I-EVOLUTION inferior I-EVOLUTION de I-EVOLUTION ambas I-EVOLUTION dista I-EVOLUTION 2, I-EVOLUTION 5 I-EVOLUTION cm. I-EVOLUTION La B-EXPLORATION movilidad I-EXPLORATION del I-EXPLORATION brazo I-EXPLORATION está I-EXPLORATION conservada, I-EXPLORATION aunque I-EXPLORATION existe I-EXPLORATION una I-EXPLORATION limitación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION abducción I-EXPLORATION del I-EXPLORATION hombro I-EXPLORATION izquierdo I-EXPLORATION (activa: I-EXPLORATION 85o; I-EXPLORATION pasiva: I-EXPLORATION 115o). I-EXPLORATION La I-EXPLORATION plagiocefalia I-EXPLORATION ahora I-EXPLORATION es I-EXPLORATION moderada, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION derivar I-EXPLORATION al I-EXPLORATION servicio I-EXPLORATION de I-EXPLORATION neurocirugía I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION ortesis I-EXPLORATION craneal. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION fin I-EXPLORATION de I-EXPLORATION confirmar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION y I-EXPLORATION descartar I-EXPLORATION otras I-EXPLORATION alteraciones I-EXPLORATION asociadas I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizan I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION pruebas I-EXPLORATION complementarias: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Ecografía I-EXPLORATION renal I-EXPLORATION (mayo I-EXPLORATION de I-EXPLORATION 2009): I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION una I-EXPLORATION dilatación I-EXPLORATION pielocalicial I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION grado I-EXPLORATION II/IV, I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION derecha I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION mm I-EXPLORATION e I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Ecografía I-EXPLORATION de I-EXPLORATION caderas I-EXPLORATION (mayo I-EXPLORATION de I-EXPLORATION 2009) I-EXPLORATION por I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION displasia I-EXPLORATION de I-EXPLORATION caderas: I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION completa I-EXPLORATION y I-EXPLORATION escápula I-EXPLORATION (mayo I-EXPLORATION de I-EXPLORATION 2009): I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fusión I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION dorsal I-EXPLORATION alta I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cervical I-EXPLORATION baja. I-EXPLORATION Primera I-EXPLORATION costilla I-EXPLORATION izquierda I-EXPLORATION hipoplásica. I-EXPLORATION Costillas I-EXPLORATION 2.a I-EXPLORATION a I-EXPLORATION 5.a I-EXPLORATION izquierdas I-EXPLORATION con I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION intercostal. I-EXPLORATION Elevación I-EXPLORATION de I-EXPLORATION escápula I-EXPLORATION izquierda I-EXPLORATION ("escápula I-EXPLORATION alada"). I-EXPLORATION I-EXPLORATION - I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION lateral I-EXPLORATION (junio I-EXPLORATION de I-EXPLORATION 2009): I-EXPLORATION se I-EXPLORATION objetivan I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION segmentación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuerpos I-EXPLORATION vertebrales I-EXPLORATION de I-EXPLORATION la I-EXPLORATION columna I-EXPLORATION vertebral I-EXPLORATION dorsal I-EXPLORATION alta I-EXPLORATION y I-EXPLORATION cervical I-EXPLORATION baja, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION escápula I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Ecocardiograma I-EXPLORATION y I-EXPLORATION electrocardiograma: I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS viene I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS una I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS odontológica. I-PRESENT_ILLNESS A B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY tuvo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY acudir I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY exfoliarse I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY segundo I-PAST_MEDICAL_HISTORY molar I-PAST_MEDICAL_HISTORY temporal I-PAST_MEDICAL_HISTORY izquierdo. I-PAST_MEDICAL_HISTORY Le I-PAST_MEDICAL_HISTORY realizaron I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ortopantomografía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY observaron I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY agenesia I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY segundo I-PAST_MEDICAL_HISTORY premolar I-PAST_MEDICAL_HISTORY inferior I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY mesiodens I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY arcada I-PAST_MEDICAL_HISTORY superior. I-PAST_MEDICAL_HISTORY Le I-PAST_MEDICAL_HISTORY recomendaron I-PAST_MEDICAL_HISTORY realizarse I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY periódicos. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY exploración I-PAST_MEDICAL_HISTORY bucodental I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 13 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY observa I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY persistencia I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY molar I-PAST_MEDICAL_HISTORY temporal. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY sector I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY está I-PAST_MEDICAL_HISTORY erupcionado I-PAST_MEDICAL_HISTORY correctamente. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY mesiodens I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY provocado I-PAST_MEDICAL_HISTORY ninguna I-PAST_MEDICAL_HISTORY anomalía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY posición I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY incisivos I-PAST_MEDICAL_HISTORY superiores. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY ortopantomografía I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY aprecia I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY mesiodens I-PAST_MEDICAL_HISTORY incluido I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ligera I-PAST_MEDICAL_HISTORY distoversión, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cúspide I-PAST_MEDICAL_HISTORY localizada I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY raíces I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY incisivo I-PAST_MEDICAL_HISTORY central I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY incisivo I-PAST_MEDICAL_HISTORY lateral I-PAST_MEDICAL_HISTORY superior I-PAST_MEDICAL_HISTORY izquierdo, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY 1/3 I-PAST_MEDICAL_HISTORY medio I-PAST_MEDICAL_HISTORY radicular, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY ápice I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY línea I-PAST_MEDICAL_HISTORY media. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS caries I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS molar I-PRESENT_ILLNESS temporal. I-PRESENT_ILLNESS Solicitamos B-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION radiografía I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION si I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION obturar I-EXPLORATION el I-EXPLORATION molar, I-EXPLORATION controlar I-EXPLORATION el I-EXPLORATION supernumerario I-EXPLORATION y I-EXPLORATION valorar I-EXPLORATION los I-EXPLORATION cordales. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ortopantomografía I-EXPLORATION observamos I-EXPLORATION el I-EXPLORATION mesiodens I-EXPLORATION en I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media, I-EXPLORATION ligeramente I-EXPLORATION más I-EXPLORATION verticalizado, I-EXPLORATION pero I-EXPLORATION sin I-EXPLORATION cambios I-EXPLORATION significativos I-EXPLORATION en I-EXPLORATION su I-EXPLORATION posición I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION las I-EXPLORATION radiografías I-EXPLORATION anteriores. I-EXPLORATION Decidimos B-TREATMENT seguir I-TREATMENT realizando I-TREATMENT controles I-TREATMENT periódicos I-TREATMENT del I-TREATMENT supernumerario I-TREATMENT y I-TREATMENT lo B-DERIVED_FROM/TO remitimos I-DERIVED_FROM/TO a I-DERIVED_FROM/TO cirugía I-DERIVED_FROM/TO maxilofacial I-DERIVED_FROM/TO para I-DERIVED_FROM/TO la I-DERIVED_FROM/TO exodoncia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO los I-DERIVED_FROM/TO cordales I-DERIVED_FROM/TO inferiores I-DERIVED_FROM/TO por I-DERIVED_FROM/TO presentar I-DERIVED_FROM/TO falta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO espacio I-DERIVED_FROM/TO para I-DERIVED_FROM/TO su I-DERIVED_FROM/TO erupción. I-DERIVED_FROM/TO Recomendamos B-TREATMENT la I-TREATMENT obturación I-TREATMENT del I-TREATMENT molar I-TREATMENT temporal. I-TREATMENT I-TREATMENT Un B-PRESENT_ILLNESS niño I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Atención I-PRESENT_ILLNESS Primaria I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS febrícula, I-PRESENT_ILLNESS hiporexia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS blandas I-PRESENT_ILLNESS frecuentes. I-PRESENT_ILLNESS Fue B-EXPLORATION diagnosticado I-EXPLORATION de I-EXPLORATION gastroenteritis I-EXPLORATION aguda. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION cardíaca, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION tonos I-EXPLORATION rítmicos I-EXPLORATION sin I-EXPLORATION soplos I-EXPLORATION ni I-EXPLORATION anomalías I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION tono, I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION dato I-EXPLORATION que I-EXPLORATION llamó I-EXPLORATION la I-EXPLORATION atención. I-EXPLORATION Se I-EXPLORATION interrogó I-EXPLORATION al I-EXPLORATION niño I-EXPLORATION sobre I-EXPLORATION antecedentes I-EXPLORATION de I-EXPLORATION precordalgias, I-EXPLORATION presíncopes, I-EXPLORATION síncopes, I-EXPLORATION síntomas I-EXPLORATION relacionados I-EXPLORATION con I-EXPLORATION el I-EXPLORATION ejercicio I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION tolerancia I-EXPLORATION a I-EXPLORATION éste, I-EXPLORATION palpitaciones I-EXPLORATION y I-EXPLORATION sensación I-EXPLORATION de I-EXPLORATION disritmia I-EXPLORATION cardíaca, I-EXPLORATION sin I-EXPLORATION respuestas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION patología. I-EXPLORATION Tras I-EXPLORATION realizar I-EXPLORATION un I-EXPLORATION electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION vez I-EXPLORATION que I-EXPLORATION el I-EXPLORATION pediatra I-EXPLORATION confirma I-EXPLORATION su I-EXPLORATION sospecha, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION remitido I-EXPLORATION a I-EXPLORATION cardiología I-EXPLORATION infantil I-EXPLORATION para I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio. I-EXPLORATION I-EXPLORATION ¿Cuál I-EXPLORATION es I-EXPLORATION la I-EXPLORATION interpretación I-EXPLORATION del I-EXPLORATION ECG?, I-EXPLORATION ¿y I-EXPLORATION el I-EXPLORATION hallazgo I-EXPLORATION auscultatorio I-EXPLORATION que I-EXPLORATION llamó I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION al I-EXPLORATION pediatra?, I-EXPLORATION ¿y I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION diagnóstica? I-EXPLORATION Es I-EXPLORATION necesario I-EXPLORATION revisar I-EXPLORATION el I-EXPLORATION ECG I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION seguir I-EXPLORATION leyendo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION ECG I-EXPLORATION muestra, I-EXPLORATION siguiendo I-EXPLORATION la I-EXPLORATION lectura I-EXPLORATION sistemática, I-EXPLORATION un I-EXPLORATION ritmo I-EXPLORATION auricular I-EXPLORATION ectópico I-EXPLORATION procedente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION parte I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION izquierda I-EXPLORATION (onda I-EXPLORATION P I-EXPLORATION negativa I-EXPLORATION en I-EXPLORATION I, I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION aVF). I-EXPLORATION Sin I-EXPLORATION embargo, I-EXPLORATION observamos I-EXPLORATION un I-EXPLORATION eje I-EXPLORATION anómalo I-EXPLORATION (derecho) I-EXPLORATION de I-EXPLORATION QRS I-EXPLORATION y I-EXPLORATION T I-EXPLORATION (aproximadamente I-EXPLORATION 180o I-EXPLORATION en I-EXPLORATION ambos), I-EXPLORATION pues I-EXPLORATION tanto I-EXPLORATION los I-EXPLORATION complejos I-EXPLORATION QRS I-EXPLORATION como I-EXPLORATION las I-EXPLORATION ondas I-EXPLORATION T I-EXPLORATION son I-EXPLORATION negativas I-EXPLORATION donde I-EXPLORATION habitualmente I-EXPLORATION son I-EXPLORATION positivas I-EXPLORATION (I, I-EXPLORATION II, I-EXPLORATION aVL, I-EXPLORATION aVF), I-EXPLORATION y I-EXPLORATION viceversa. I-EXPLORATION I-EXPLORATION Estos I-EXPLORATION hallazgos I-EXPLORATION electrocardiográficos I-EXPLORATION sólo I-EXPLORATION pueden I-EXPLORATION deberse I-EXPLORATION a I-EXPLORATION una I-EXPLORATION incorrecta I-EXPLORATION colocación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION totalidad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION electrodos I-EXPLORATION (en I-EXPLORATION el I-EXPLORATION hemitórax I-EXPLORATION equivocado) I-EXPLORATION o I-EXPLORATION a I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION dextrocardia I-EXPLORATION (ubicación I-EXPLORATION del I-EXPLORATION corazón I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemitórax I-EXPLORATION derecho). I-EXPLORATION El I-EXPLORATION dato I-EXPLORATION auscultatorio I-EXPLORATION fue I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tonos I-EXPLORATION cardíacos I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemitórax I-EXPLORATION derecho; I-EXPLORATION asimismo, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION dextrocardia, I-EXPLORATION hígado I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION burbuja I-EXPLORATION gástrica I-EXPLORATION en I-EXPLORATION hemiabdomen I-EXPLORATION derecho. I-EXPLORATION Con B-DERIVED_FROM/TO la I-DERIVED_FROM/TO confirmación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO situs I-DERIVED_FROM/TO inversus I-DERIVED_FROM/TO totalis, I-DERIVED_FROM/TO el I-DERIVED_FROM/TO niño I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO cardiología I-DERIVED_FROM/TO infantil I-DERIVED_FROM/TO para I-DERIVED_FROM/TO descartar I-DERIVED_FROM/TO la I-DERIVED_FROM/TO presencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO una I-DERIVED_FROM/TO cardiopatía I-DERIVED_FROM/TO congénita. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocho I-PRESENT_ILLNESS años I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY África I-PAST_MEDICAL_HISTORY subsahariana, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS para I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hematuria I-PRESENT_ILLNESS macroscópica I-PRESENT_ILLNESS al I-PRESENT_ILLNESS final I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS micción I-PRESENT_ILLNESS y I-PRESENT_ILLNESS proteinuria I-PRESENT_ILLNESS de I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Lleva B-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY viviendo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestra I-PAST_MEDICAL_HISTORY comunidad. I-PAST_MEDICAL_HISTORY Refiere I-PAST_MEDICAL_HISTORY baños I-PAST_MEDICAL_HISTORY anteriores I-PAST_MEDICAL_HISTORY frecuentes I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY río. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY ni B-FAMILY_HISTORY familiares I-FAMILY_HISTORY a I-FAMILY_HISTORY destacar. I-FAMILY_HISTORY La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION muestran I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION anemia I-EXPLORATION microcítica, I-EXPLORATION con I-EXPLORATION Hb I-EXPLORATION 10, I-EXPLORATION 9 I-EXPLORATION g/dL, I-EXPLORATION Hto I-EXPLORATION 32, I-EXPLORATION 8%, I-EXPLORATION VCM I-EXPLORATION 74, I-EXPLORATION 9 I-EXPLORATION fL I-EXPLORATION y I-EXPLORATION eosinofilia I-EXPLORATION con I-EXPLORATION 767 I-EXPLORATION eosinófilos/µL; I-EXPLORATION VSG I-EXPLORATION 40 I-EXPLORATION mm/h. I-EXPLORATION La I-EXPLORATION bioquímica I-EXPLORATION muestra I-EXPLORATION urea I-EXPLORATION y I-EXPLORATION creatinina I-EXPLORATION e I-EXPLORATION iones I-EXPLORATION normales. I-EXPLORATION Estudio I-EXPLORATION inmunológico I-EXPLORATION con I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION y I-EXPLORATION complemento I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION El I-EXPLORATION sistemático I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION muestra I-EXPLORATION hematuria I-EXPLORATION microscópica I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION cristales I-EXPLORATION de I-EXPLORATION oxalato I-EXPLORATION cálcico. I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION fue I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION hidronefrosis I-EXPLORATION grado I-EXPLORATION II I-EXPLORATION de I-EXPLORATION pelvis I-EXPLORATION renal I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION La I-EXPLORATION investigación I-EXPLORATION de I-EXPLORATION Schistosoma I-EXPLORATION sp. I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION visualizándose I-EXPLORATION huevos I-EXPLORATION de I-EXPLORATION S. I-EXPLORATION haematobium. I-EXPLORATION El I-EXPLORATION coprocultivo I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION Plasmodium I-EXPLORATION falciparum, I-EXPLORATION Entamoeba I-EXPLORATION histolytica, I-EXPLORATION Schistosoma I-EXPLORATION sp., I-EXPLORATION y I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION las I-EXPLORATION hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT se I-TREATMENT realizó I-TREATMENT mediante I-TREATMENT dos I-TREATMENT dosis I-TREATMENT de I-TREATMENT praziquantel I-TREATMENT a I-TREATMENT 20 I-TREATMENT mg/kg/dosis I-TREATMENT separadas I-TREATMENT por I-TREATMENT 12 I-TREATMENT horas. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION posteriores I-EVOLUTION revisiones. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY chino, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS tónico-clónicos I-PRESENT_ILLNESS generalizados, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia I-PRESENT_ILLNESS e I-PRESENT_ILLNESS incontinencia I-PRESENT_ILLNESS esfinteriana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS que I-PRESENT_ILLNESS cedió I-PRESENT_ILLNESS espontáneamente. I-PRESENT_ILLNESS Desde I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS previas I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS líquidas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Estaba I-PRESENT_ILLNESS afebril. I-PRESENT_ILLNESS Antecedentes B-FAMILY_HISTORY familiares I-FAMILY_HISTORY y B-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION únicamente I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION leve I-EXPLORATION sequedad I-EXPLORATION de I-EXPLORATION mucosas. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION hemograma, I-EXPLORATION bioquímica I-EXPLORATION y I-EXPLORATION gasometría I-EXPLORATION venosa, I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION En B-EVOLUTION las I-EVOLUTION siguientes I-EVOLUTION ocho I-EVOLUTION horas, I-EVOLUTION presenta I-EVOLUTION tres I-EVOLUTION nuevas I-EVOLUTION crisis I-EVOLUTION de I-EVOLUTION similares I-EVOLUTION características I-EVOLUTION a I-EVOLUTION la I-EVOLUTION inicial, I-EVOLUTION que B-TREATMENT ceden I-TREATMENT con I-TREATMENT diazepam I-TREATMENT intravenoso I-TREATMENT (IV) I-TREATMENT y/o I-TREATMENT ácido I-TREATMENT valproico I-TREATMENT IV I-TREATMENT en I-TREATMENT cinco I-TREATMENT minutos. I-TREATMENT Se B-EXPLORATION realizaron I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION y I-EXPLORATION un I-EXPLORATION electroencefalograma, I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Permaneció B-EVOLUTION hospitalizada I-EVOLUTION durante I-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION nuevas I-EVOLUTION crisis. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION coprocultivo I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION rotavirus. I-EXPLORATION Su B-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION favorable, I-EVOLUTION sin I-EVOLUTION crisis I-EVOLUTION y I-EVOLUTION con I-EVOLUTION desarrollo I-EVOLUTION psicomotor I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mucosidad I-PRESENT_ILLNESS nasal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS habiéndose I-PRESENT_ILLNESS hecho I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS más I-PRESENT_ILLNESS persistente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS accesos I-PRESENT_ILLNESS repetidos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS han I-PRESENT_ILLNESS observado I-PRESENT_ILLNESS cianosis I-PRESENT_ILLNESS perioral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ocasionalmente I-PRESENT_ILLNESS terminan I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS vómito; I-PRESENT_ILLNESS se I-PRESENT_ILLNESS encuentra I-PRESENT_ILLNESS afebril I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS reducción I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ingesta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS leche I-PRESENT_ILLNESS materna. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION un I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION coloración I-EXPLORATION y I-EXPLORATION perfusión I-EXPLORATION periférica, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION dificultad I-EXPLORATION respiratoria I-EXPLORATION y I-EXPLORATION auscultación I-EXPLORATION cardiopulmonar I-EXPLORATION normal; I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION dejar I-EXPLORATION en I-EXPLORATION observación, I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION episodios I-EXPLORATION en I-EXPLORATION los I-EXPLORATION que I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION acceso I-EXPLORATION con I-EXPLORATION varios I-EXPLORATION golpes I-EXPLORATION de I-EXPLORATION tos I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION espiración I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION inspiración I-EXPLORATION ruidosa I-EXPLORATION en I-EXPLORATION forma I-EXPLORATION de I-EXPLORATION gallo I-EXPLORATION al I-EXPLORATION finalizar I-EXPLORATION el I-EXPLORATION acceso, I-EXPLORATION acompañado I-EXPLORATION de I-EXPLORATION cianosis I-EXPLORATION facial. I-EXPLORATION I-EXPLORATION Se B-TREATMENT decide I-TREATMENT ingresarlo I-TREATMENT bajo I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT síndrome I-TREATMENT pertusoide, I-TREATMENT con I-TREATMENT monitorización I-TREATMENT continua I-TREATMENT de I-TREATMENT saturación I-TREATMENT de I-TREATMENT oxígeno, I-TREATMENT frecuencia I-TREATMENT cardiaca I-TREATMENT y I-TREATMENT respiratoria. I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION aumenta I-EVOLUTION la I-EVOLUTION frecuencia I-EVOLUTION de I-EVOLUTION los I-EVOLUTION accesos I-EVOLUTION de I-EVOLUTION tos I-EVOLUTION de I-EVOLUTION tipo I-EVOLUTION pertusoide, I-EVOLUTION se I-EVOLUTION objetiva I-EVOLUTION repercusión I-EVOLUTION en I-EVOLUTION la I-EVOLUTION frecuencia I-EVOLUTION cardiaca I-EVOLUTION y I-EVOLUTION la I-EVOLUTION saturación I-EVOLUTION de I-EVOLUTION oxígeno I-EVOLUTION durante I-EVOLUTION dichos I-EVOLUTION accesos I-EVOLUTION e, I-EVOLUTION incluso, I-EVOLUTION en I-EVOLUTION los I-EVOLUTION periodos I-EVOLUTION intercríticos I-EVOLUTION presenta I-EVOLUTION pausas I-EVOLUTION de I-EVOLUTION apnea I-EVOLUTION que I-EVOLUTION se I-EVOLUTION recuperan I-EVOLUTION con I-EVOLUTION estimulación, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT le I-TREATMENT administra I-TREATMENT oxigenoterapia I-TREATMENT con I-TREATMENT gafas I-TREATMENT nasales I-TREATMENT y I-TREATMENT también I-TREATMENT sueroterapia I-TREATMENT intravenosa I-TREATMENT hasta I-TREATMENT que I-TREATMENT recupera I-TREATMENT una I-TREATMENT alimentación I-TREATMENT enteral I-TREATMENT suficiente; I-TREATMENT se I-TREATMENT trata I-TREATMENT con I-TREATMENT azitromicina I-TREATMENT al I-TREATMENT paciente I-TREATMENT y I-TREATMENT a I-TREATMENT los I-TREATMENT contactos I-TREATMENT cercanos. I-TREATMENT I-TREATMENT Durante B-EXPLORATION su I-EXPLORATION ingreso I-EXPLORATION hospitalario, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION serológico I-EXPLORATION para I-EXPLORATION Bordetella I-EXPLORATION pertussis I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION negativo I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION la I-EXPLORATION determinación I-EXPLORATION inicial I-EXPLORATION como I-EXPLORATION en I-EXPLORATION la I-EXPLORATION siguiente, I-EXPLORATION un I-EXPLORATION mes I-EXPLORATION después. I-EXPLORATION I-EXPLORATION Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS días, I-PRESENT_ILLNESS hijo B-PAST_MEDICAL_HISTORY único, 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 Atención I-PRESENT_ILLNESS Primaria I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS secreción I-PRESENT_ILLNESS blanquecina I-PRESENT_ILLNESS en I-PRESENT_ILLNESS conducto I-PRESENT_ILLNESS auditivo I-PRESENT_ILLNESS externo I-PRESENT_ILLNESS (CAE). I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se B-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION dicha I-EXPLORATION secreción, I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION SAMR. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION familiar, I-EXPLORATION obteniéndose I-EXPLORATION cultivo I-EXPLORATION nasal I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION padres, I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Al B-FAMILY_HISTORY analizar I-FAMILY_HISTORY la I-FAMILY_HISTORY historia I-FAMILY_HISTORY familiar, I-FAMILY_HISTORY tenemos I-FAMILY_HISTORY conocimiento I-FAMILY_HISTORY de I-FAMILY_HISTORY que I-FAMILY_HISTORY la I-FAMILY_HISTORY madre I-FAMILY_HISTORY había I-FAMILY_HISTORY presentado I-FAMILY_HISTORY una I-FAMILY_HISTORY herida I-FAMILY_HISTORY quirúrgica I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY momento I-FAMILY_HISTORY del I-FAMILY_HISTORY parto, I-FAMILY_HISTORY cuyo I-FAMILY_HISTORY cultivo I-FAMILY_HISTORY fue I-FAMILY_HISTORY positivo I-FAMILY_HISTORY para I-FAMILY_HISTORY SARM I-FAMILY_HISTORY con I-FAMILY_HISTORY el I-FAMILY_HISTORY mismo I-FAMILY_HISTORY antibiograma I-FAMILY_HISTORY que I-FAMILY_HISTORY el I-FAMILY_HISTORY hallado I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY niño I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY CAE, I-FAMILY_HISTORY por I-FAMILY_HISTORY lo I-FAMILY_HISTORY que I-FAMILY_HISTORY suponemos I-FAMILY_HISTORY que I-FAMILY_HISTORY se I-FAMILY_HISTORY ha I-FAMILY_HISTORY producido I-FAMILY_HISTORY una I-FAMILY_HISTORY transmisión I-FAMILY_HISTORY vertical I-FAMILY_HISTORY de I-FAMILY_HISTORY dicho I-FAMILY_HISTORY germen. I-FAMILY_HISTORY Tras B-EXPLORATION realizar I-EXPLORATION estas I-EXPLORATION investigaciones, I-EXPLORATION se I-EXPLORATION vuelve I-EXPLORATION a I-EXPLORATION tomar I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION del I-EXPLORATION CAE I-EXPLORATION del I-EXPLORATION niño, I-EXPLORATION siendo I-EXPLORATION de I-EXPLORATION nuevo I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION SARM, I-EXPLORATION cuyo I-EXPLORATION antibiograma I-EXPLORATION se I-EXPLORATION muestra I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION 1. I-EXPLORATION I-EXPLORATION Dado B-TREATMENT que I-TREATMENT este I-TREATMENT segundo I-TREATMENT cultivo I-TREATMENT es I-TREATMENT sensible I-TREATMENT a I-TREATMENT ciprofloxacino, I-TREATMENT se I-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT local I-TREATMENT con I-TREATMENT esa I-TREATMENT quinolona I-TREATMENT siendo I-TREATMENT el I-TREATMENT cultivo I-TREATMENT de I-TREATMENT control I-TREATMENT negativo. I-TREATMENT I-TREATMENT S. B-PRESENT_ILLNESS Piris I-PRESENT_ILLNESS Borregasa, I-PRESENT_ILLNESS M.R. I-PRESENT_ILLNESS Acuña I-PRESENT_ILLNESS Allerb I-PRESENT_ILLNESS I-PRESENT_ILLNESS aMIR-Pediatría. I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Universitario I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Octubre. I-PRESENT_ILLNESS Madrid. I-PRESENT_ILLNESS España. I-PRESENT_ILLNESS bPediatra. I-PRESENT_ILLNESS CS I-PRESENT_ILLNESS Martín I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Vargas. I-PRESENT_ILLNESS Madrid. I-PRESENT_ILLNESS España. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS una I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cabecera I-PRESENT_ILLNESS descubre I-PRESENT_ILLNESS una I-PRESENT_ILLNESS marcha I-PRESENT_ILLNESS torpe: I-PRESENT_ILLNESS sabe I-PRESENT_ILLNESS ponerse I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS ayuda, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS sabe I-PRESENT_ILLNESS correr, I-PRESENT_ILLNESS chuta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS balón I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS pies I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sube I-PRESENT_ILLNESS y I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS escaleras I-PRESENT_ILLNESS agarrada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS manos. I-PRESENT_ILLNESS No B-FAMILY_HISTORY se I-FAMILY_HISTORY describen I-FAMILY_HISTORY alteraciones I-FAMILY_HISTORY neurológicas I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY I-FAMILY_HISTORY Antecedentes B-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Nacida I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY mediante I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentación I-PAST_MEDICAL_HISTORY podálica. I-PAST_MEDICAL_HISTORY Peso I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacer, I-PAST_MEDICAL_HISTORY 2780 I-PAST_MEDICAL_HISTORY g; I-PAST_MEDICAL_HISTORY test I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Apgar, I-PAST_MEDICAL_HISTORY 8/9; I-PAST_MEDICAL_HISTORY reanimación I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY II. I-PAST_MEDICAL_HISTORY Pruebas I-PAST_MEDICAL_HISTORY endocrinometabólicas I-PAST_MEDICAL_HISTORY normales. I-PAST_MEDICAL_HISTORY Vacunación I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día. I-PAST_MEDICAL_HISTORY Desarrollo I-PAST_MEDICAL_HISTORY psicomotor: I-PAST_MEDICAL_HISTORY sonrisa I-PAST_MEDICAL_HISTORY social I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY sostén I-PAST_MEDICAL_HISTORY cefálico I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY sedestación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY siete I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY gateo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY ocho I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY marcha I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY apoyo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 17 I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY motricidad I-PAST_MEDICAL_HISTORY fina I-PAST_MEDICAL_HISTORY normal. I-PAST_MEDICAL_HISTORY Bisílabos I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY referenciales I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY ocho I-PAST_MEDICAL_HISTORY meses, I-PAST_MEDICAL_HISTORY bisílabos I-PAST_MEDICAL_HISTORY referenciales I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Exploración B-EXPLORATION física I-EXPLORATION I-EXPLORATION Talla, I-EXPLORATION 92 I-EXPLORATION cm I-EXPLORATION (percentil I-EXPLORATION 97 I-EXPLORATION [P97]); I-EXPLORATION peso, I-EXPLORATION 11, I-EXPLORATION 8 I-EXPLORATION kg I-EXPLORATION (P25-50); I-EXPLORATION perímetro I-EXPLORATION craneal. I-EXPLORATION 53, I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION (P97). I-EXPLORATION Buen I-EXPLORATION estado I-EXPLORATION general. I-EXPLORATION Bien I-EXPLORATION nutrida. I-EXPLORATION Sin I-EXPLORATION dismorfias I-EXPLORATION ni I-EXPLORATION discromías. I-EXPLORATION Cráneo I-EXPLORATION normoconfigurado. I-EXPLORATION Auscultación I-EXPLORATION cardiopulmonar I-EXPLORATION normal. I-EXPLORATION Abdomen I-EXPLORATION depresible I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION organomegalias. I-EXPLORATION Genitales I-EXPLORATION externos I-EXPLORATION femeninos I-EXPLORATION y I-EXPLORATION normales. I-EXPLORATION Exploración I-EXPLORATION neurológica: I-EXPLORATION hábito I-EXPLORATION longilíneo I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION alineación I-EXPLORATION del I-EXPLORATION raquis I-EXPLORATION y I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades; I-EXPLORATION pares I-EXPLORATION craneales I-EXPLORATION normales; I-EXPLORATION tono I-EXPLORATION activo I-EXPLORATION normal; I-EXPLORATION leve I-EXPLORATION hipotonía I-EXPLORATION pasiva I-EXPLORATION con I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bufanda I-EXPLORATION que I-EXPLORATION sobrepasa I-EXPLORATION la I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION y I-EXPLORATION dedo I-EXPLORATION al I-EXPLORATION antebrazo; I-EXPLORATION en I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION inferiores, I-EXPLORATION el I-EXPLORATION ángulo I-EXPLORATION poplíteo I-EXPLORATION supera I-EXPLORATION los I-EXPLORATION 90o I-EXPLORATION y I-EXPLORATION hace I-EXPLORATION abducción I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION caderas; I-EXPLORATION reflejos I-EXPLORATION osteotendinosos I-EXPLORATION presentes I-EXPLORATION y I-EXPLORATION simétricos; I-EXPLORATION llama I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION la I-EXPLORATION marcha I-EXPLORATION ligeramente I-EXPLORATION oscilante, I-EXPLORATION no I-EXPLORATION claudicante; I-EXPLORATION no I-EXPLORATION dismetría, I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Romberg I-EXPLORATION negativo; I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION disdiadococinesia; I-EXPLORATION pinza I-EXPLORATION digital I-EXPLORATION normal; I-EXPLORATION maniobra I-EXPLORATION de I-EXPLORATION Gowers I-EXPLORATION negativa; I-EXPLORATION sin I-EXPLORATION hipertrofia I-EXPLORATION gemelar. I-EXPLORATION I-EXPLORATION Evolución B-DERIVED_FROM/TO posterior I-DERIVED_FROM/TO I-DERIVED_FROM/TO El I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO es I-DERIVED_FROM/TO remitido I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Neurología I-DERIVED_FROM/TO con I-DERIVED_FROM/TO control I-DERIVED_FROM/TO clínico I-DERIVED_FROM/TO cada I-DERIVED_FROM/TO tres I-DERIVED_FROM/TO meses. I-DERIVED_FROM/TO Se B-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION hemograma, I-EXPLORATION una I-EXPLORATION bioquímica I-EXPLORATION general, I-EXPLORATION pruebas I-EXPLORATION tiroideas I-EXPLORATION y I-EXPLORATION creatinfosfocinasa, I-EXPLORATION con I-EXPLORATION resultados I-EXPLORATION normales. I-EXPLORATION Durante B-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION la I-EVOLUTION niña I-EVOLUTION desarrolló I-EVOLUTION una I-EVOLUTION macrocefalia I-EVOLUTION de I-EVOLUTION +3, I-EVOLUTION 6 I-EVOLUTION desviaciones I-EVOLUTION estándar I-EVOLUTION (DS) I-EVOLUTION y I-EVOLUTION un I-EVOLUTION discreto I-EVOLUTION temblor I-EVOLUTION intencional, I-EVOLUTION sin I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION torpeza I-EVOLUTION motora I-EVOLUTION en I-EVOLUTION la I-EVOLUTION deambulación, I-EVOLUTION por B-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION cerebral, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION descubrió I-EXPLORATION una I-EXPLORATION llamativa I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION cuatro I-EXPLORATION ventrículos I-EXPLORATION cerebrales I-EXPLORATION con I-EXPLORATION quiste I-EXPLORATION retrocerebeloso I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION malformaciones I-EXPLORATION asociadas, I-EXPLORATION sugerente I-EXPLORATION todo I-EXPLORATION ello I-EXPLORATION de I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION posterior I-EXPLORATION en I-EXPLORATION el I-EXPLORATION contexto I-EXPLORATION del I-EXPLORATION complejo I-EXPLORATION de I-EXPLORATION Dandy-Walker. I-EXPLORATION I-EXPLORATION Se B-TREATMENT recomendó, I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT Neurología, I-TREATMENT fisioterapia I-TREATMENT mediante I-TREATMENT el I-TREATMENT método I-TREATMENT Bobath, I-TREATMENT con I-TREATMENT la I-TREATMENT que I-TREATMENT se I-TREATMENT ha I-TREATMENT detenido, I-TREATMENT por I-TREATMENT el I-TREATMENT momento, I-TREATMENT el I-TREATMENT deterioro I-TREATMENT neurológico. I-TREATMENT I-TREATMENT Dirección I-TREATMENT para I-TREATMENT correspondencia: I-TREATMENT Salvador I-TREATMENT Piris I-TREATMENT Borregas I-TREATMENT dockbps@hotmail.com I-TREATMENT I-TREATMENT Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sano I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY correctamente I-PAST_MEDICAL_HISTORY vacunado, I-PAST_MEDICAL_HISTORY excepto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY varicela. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tuvo B-PRESENT_ILLNESS escarlatina I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS del I-PRESENT_ILLNESS exantema. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS quinto I-PRESENT_ILLNESS día I-PRESENT_ILLNESS persiste I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS alta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS y I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS izquierdos. I-PRESENT_ILLNESS Es I-PRESENT_ILLNESS diagnosticado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS celulitis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tratado I-PRESENT_ILLNESS ambulatoriamente I-PRESENT_ILLNESS con I-PRESENT_ILLNESS amoxicilina-clavulánico I-PRESENT_ILLNESS oral I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dosis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS mg/kg/día I-PRESENT_ILLNESS (de I-PRESENT_ILLNESS amoxicilina). I-PRESENT_ILLNESS A I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS aumenta I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tumefacción, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS decide I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presenta I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION varicela I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION pustuloso, I-EXPLORATION dolor, I-EXPLORATION tumefacción, I-EXPLORATION edema I-EXPLORATION importante I-EXPLORATION en I-EXPLORATION el I-EXPLORATION pie I-EXPLORATION y I-EXPLORATION el I-EXPLORATION tobillo I-EXPLORATION izquierdos I-EXPLORATION y I-EXPLORATION placa I-EXPLORATION eritematosa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION planta I-EXPLORATION del I-EXPLORATION pie. I-EXPLORATION No I-EXPLORATION realiza I-EXPLORATION deambulación I-EXPLORATION autónoma. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION está I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION I-EXPLORATION El I-EXPLORATION control I-EXPLORATION analítico I-EXPLORATION muestra I-EXPLORATION 13 I-EXPLORATION 600 I-EXPLORATION leucocitos/mm3 I-EXPLORATION (68, I-EXPLORATION 3% I-EXPLORATION neutrófilos); I-EXPLORATION hemoglobina, I-EXPLORATION 10, I-EXPLORATION 7 I-EXPLORATION g/dl; I-EXPLORATION hematocrito, I-EXPLORATION 31, I-EXPLORATION 1%; I-EXPLORATION plaquetas, I-EXPLORATION 374 I-EXPLORATION 000/mm3, I-EXPLORATION y I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION (VSG), I-EXPLORATION 116. I-EXPLORATION Hemocultivo I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Se B-TREATMENT trata I-TREATMENT con I-TREATMENT amoxicilina/clavulánico I-TREATMENT intravenoso I-TREATMENT (IV), I-TREATMENT pero I-TREATMENT al I-TREATMENT cuarto I-TREATMENT día I-TREATMENT presenta I-TREATMENT un I-TREATMENT empeoramiento I-TREATMENT de I-TREATMENT la I-TREATMENT tumefacción. I-TREATMENT Se B-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION del I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION músculo I-EXPLORATION gemelo I-EXPLORATION interno I-EXPLORATION con I-EXPLORATION hipoecogenicidad I-EXPLORATION y I-EXPLORATION tumefacción I-EXPLORATION con I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION patrón I-EXPLORATION fibroadiposo, I-EXPLORATION que I-EXPLORATION refleja I-EXPLORATION edema I-EXPLORATION e I-EXPLORATION infiltración I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION graso I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION piomiositis. I-EXPLORATION No I-EXPLORATION hay I-EXPLORATION constancia I-EXPLORATION de I-EXPLORATION absceso I-EXPLORATION susceptible I-EXPLORATION de I-EXPLORATION drenaje. I-EXPLORATION I-EXPLORATION Se B-TREATMENT instaura I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT cefotaxima I-TREATMENT y I-TREATMENT cloxacilina, I-TREATMENT pero I-TREATMENT al I-TREATMENT ser I-TREATMENT la I-TREATMENT evolución I-TREATMENT clínica, I-TREATMENT analítica I-TREATMENT y I-TREATMENT ecográfica I-TREATMENT desfavorable, I-TREATMENT se I-TREATMENT decide I-TREATMENT un I-TREATMENT cambio I-TREATMENT de I-TREATMENT pauta I-TREATMENT por I-TREATMENT clindamicina I-TREATMENT y I-TREATMENT vancomicina I-TREATMENT IV I-TREATMENT con I-TREATMENT posterior I-TREATMENT disminución I-TREATMENT de I-TREATMENT la I-TREATMENT VSG I-TREATMENT y I-TREATMENT ecografía I-TREATMENT sin I-TREATMENT alteraciones I-TREATMENT significativas. I-TREATMENT Al B-EVOLUTION alta I-EVOLUTION realizaba I-EVOLUTION deambulación I-EVOLUTION autónoma I-EVOLUTION y I-EVOLUTION no I-EVOLUTION presentaba I-EVOLUTION secuelas I-EVOLUTION funcionales. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS con I-PRESENT_ILLNESS odinofagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS palpebral I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS llamativo, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS edemas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS otras I-PRESENT_ILLNESS localizaciones. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION hipertrofia I-EXPLORATION amigdalar I-EXPLORATION con I-EXPLORATION exudado I-EXPLORATION bilateral, I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION laterocervicales I-EXPLORATION de I-EXPLORATION pequeño I-EXPLORATION tamaño, I-EXPLORATION además I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION descrito. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION sedimento I-EXPLORATION urinario I-EXPLORATION y I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION cifras I-EXPLORATION de I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION siendo I-EXPLORATION normales. I-EXPLORATION Ante B-TREATMENT dichos I-TREATMENT hallazgos, I-TREATMENT se I-TREATMENT toma I-TREATMENT frotis I-TREATMENT faríngeo I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT amoxicilina I-TREATMENT oral I-TREATMENT durante I-TREATMENT una I-TREATMENT semana. I-TREATMENT Al B-EVOLUTION concluir I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION vuelve I-EVOLUTION a I-EVOLUTION consultar, I-EVOLUTION manifestando I-EVOLUTION haber I-EVOLUTION padecido I-EVOLUTION fiebre I-EVOLUTION durante I-EVOLUTION 12 I-EVOLUTION días I-EVOLUTION junto I-EVOLUTION con I-EVOLUTION astenia. I-EVOLUTION No I-EVOLUTION apareció I-EVOLUTION exantema I-EVOLUTION tras I-EVOLUTION la I-EVOLUTION toma I-EVOLUTION de I-EVOLUTION antibiótico. I-EVOLUTION El B-EXPLORATION cultivo I-EXPLORATION del I-EXPLORATION exudado I-EXPLORATION faríngeo I-EXPLORATION resultó I-EXPLORATION negativo I-EXPLORATION para I-EXPLORATION S. I-EXPLORATION pyogenes. I-EXPLORATION Al I-EXPLORATION explorarlo I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION menor I-EXPLORATION edema I-EXPLORATION palpebral, I-EXPLORATION y I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION mínima I-EXPLORATION hepatoesplenomegalia I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION mononuclésico I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION control I-EXPLORATION analítico I-EXPLORATION con I-EXPLORATION hemograma, I-EXPLORATION perfil I-EXPLORATION hepático I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION VEB I-EXPLORATION y I-EXPLORATION citomegalovirus. I-EXPLORATION Se I-EXPLORATION encuentra I-EXPLORATION linfocitosis I-EXPLORATION relativa I-EXPLORATION (leucocitos I-EXPLORATION 7480/µl I-EXPLORATION con I-EXPLORATION un I-EXPLORATION 68% I-EXPLORATION de I-EXPLORATION linfocitos), I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION transaminasas I-EXPLORATION (GOT I-EXPLORATION 125 I-EXPLORATION UI/l, I-EXPLORATION GPT I-EXPLORATION 171 I-EXPLORATION UI/l) I-EXPLORATION y I-EXPLORATION serología I-EXPLORATION con I-EXPLORATION IgM I-EXPLORATION positiva I-EXPLORATION frente I-EXPLORATION a I-EXPLORATION VEB. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 17 I-EVOLUTION días I-EVOLUTION del I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION cuadro I-EVOLUTION encontramos I-EVOLUTION remisión I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION edema I-EVOLUTION palpebral I-EVOLUTION bilateral, I-EVOLUTION mejoría I-EVOLUTION del I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION hepatoesplenomegalia I-EVOLUTION y I-EVOLUTION normalización I-EVOLUTION del I-EVOLUTION control I-EVOLUTION analítico. I-EVOLUTION I-EVOLUTION Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 34 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS revisión. I-PRESENT_ILLNESS Primer I-PRESENT_ILLNESS hijo, I-PRESENT_ILLNESS fruto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS embarazo I-PRESENT_ILLNESS controlado. I-PRESENT_ILLNESS Varicela I-PRESENT_ILLNESS materna I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS gestación. I-PRESENT_ILLNESS Parto B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY semana I-PAST_MEDICAL_HISTORY 35 I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY 6, I-PAST_MEDICAL_HISTORY vaginal, I-PAST_MEDICAL_HISTORY instrumentado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ventosa. I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY 9/10. I-PAST_MEDICAL_HISTORY Somatometría I-PAST_MEDICAL_HISTORY adecuada I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY (perímetro I-PAST_MEDICAL_HISTORY cefálico: I-PAST_MEDICAL_HISTORY 33 I-PAST_MEDICAL_HISTORY cm, I-PAST_MEDICAL_HISTORY percentil I-PAST_MEDICAL_HISTORY 50-75 I-PAST_MEDICAL_HISTORY [P50-75]). I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY refieren I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION escafocefalia I-EXPLORATION y I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION una I-EXPLORATION cresta I-EXPLORATION ósea I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sutura I-EXPLORATION sagital. I-EXPLORATION Este I-EXPLORATION hallazgo I-EXPLORATION se I-EXPLORATION interpreta I-EXPLORATION como I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION acabalgamiento I-EXPLORATION de I-EXPLORATION suturas. I-EXPLORATION La I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION era I-EXPLORATION adecuada I-EXPLORATION a I-EXPLORATION su I-EXPLORATION edad. I-EXPLORATION A I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION meses I-EXPLORATION presenta I-EXPLORATION deformidad I-EXPLORATION craneal I-EXPLORATION más I-EXPLORATION manifiesta, I-EXPLORATION con I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION prominencia I-EXPLORATION ósea I-EXPLORATION sagital. I-EXPLORATION Se I-EXPLORATION palpa I-EXPLORATION fontanela I-EXPLORATION anterior I-EXPLORATION a I-EXPLORATION punta I-EXPLORATION de I-EXPLORATION dedo. I-EXPLORATION Mantiene I-EXPLORATION desarrollo I-EXPLORATION neurológico I-EXPLORATION adecuado I-EXPLORATION y I-EXPLORATION crecimiento I-EXPLORATION del I-EXPLORATION perímetro I-EXPLORATION cefálico I-EXPLORATION (perímetro I-EXPLORATION cefálico: I-EXPLORATION 40 I-EXPLORATION cm, I-EXPLORATION P75). I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION craneosinostosis I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION Rx I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION informada I-EXPLORATION como I-EXPLORATION probable I-EXPLORATION cierre I-EXPLORATION precoz I-EXPLORATION de I-EXPLORATION sutura I-EXPLORATION sagital I-EXPLORATION y I-EXPLORATION se I-EXPLORATION deriva I-EXPLORATION a I-EXPLORATION Cirugía I-EXPLORATION Pediátrica. I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION probable I-EXPLORATION de I-EXPLORATION craneosinostosis I-EXPLORATION sagital I-EXPLORATION y I-EXPLORATION lambdoidea, I-EXPLORATION solicitaron I-EXPLORATION una I-EXPLORATION TC I-EXPLORATION craneal I-EXPLORATION tridimensional I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION cierre I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sutura I-EXPLORATION sagital. I-EXPLORATION Se B-EVOLUTION derivó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Neurocirugía I-EVOLUTION de I-EVOLUTION referencia I-EVOLUTION a I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION edad. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS oC I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS tos, I-PRESENT_ILLNESS mocos, I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS líquidas I-PRESENT_ILLNESS más I-PRESENT_ILLNESS frecuentes, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inapetencia I-PRESENT_ILLNESS parcial. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION destaca I-EXPLORATION eritema I-EXPLORATION amigdalar I-EXPLORATION con I-EXPLORATION exudado I-EXPLORATION escaso, I-EXPLORATION moco I-EXPLORATION en I-EXPLORATION cavum, I-EXPLORATION eritema I-EXPLORATION timpánico I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION signos I-EXPLORATION y I-EXPLORATION eritema I-EXPLORATION conjuntival I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones. I-EXPLORATION Se B-TREATMENT diagnostica I-TREATMENT de I-TREATMENT viriasis I-TREATMENT y I-TREATMENT se I-TREATMENT recomienda I-TREATMENT tratamiento I-TREATMENT sintomático. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION tres I-EVOLUTION días, I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION hospital I-EVOLUTION por I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION purpúricas I-EVOLUTION en I-EVOLUTION los I-EVOLUTION miembros I-EVOLUTION inferiores I-EVOLUTION y I-EVOLUTION los I-EVOLUTION pabellones I-EVOLUTION auriculares, I-EVOLUTION y I-EVOLUTION edema I-EVOLUTION en I-EVOLUTION el I-EVOLUTION dorso I-EVOLUTION de I-EVOLUTION manos I-EVOLUTION y I-EVOLUTION pies. I-EVOLUTION Se B-EXPLORATION ingresa I-EXPLORATION durante I-EXPLORATION cinco I-EXPLORATION días I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION púrpura I-EXPLORATION de I-EXPLORATION Schönlein-Henoch I-EXPLORATION con I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION sanguíneo I-EXPLORATION con I-EXPLORATION coagulación I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION (tanto I-EXPLORATION en I-EXPLORATION fase I-EXPLORATION aguda I-EXPLORATION como I-EXPLORATION en I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION meses I-EXPLORATION posteriores) I-EXPLORATION sin I-EXPLORATION proteinuria I-EXPLORATION ni I-EXPLORATION hematuria. I-EXPLORATION Recibe B-TREATMENT penicilina I-TREATMENT oral I-TREATMENT por I-TREATMENT sospecha I-TREATMENT de I-TREATMENT etiología I-TREATMENT estreptocócica, I-TREATMENT encontrándose I-TREATMENT en I-TREATMENT el I-TREATMENT cultivo I-TREATMENT del I-TREATMENT frotis I-TREATMENT faríngeo I-TREATMENT un I-TREATMENT S. I-TREATMENT pyogenes I-TREATMENT del I-TREATMENT grupo I-TREATMENT A. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION nueve I-EVOLUTION días I-EVOLUTION del I-EVOLUTION ingreso, I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION centro I-EVOLUTION de I-EVOLUTION salud, I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION objetivan I-EVOLUTION lesiones I-EVOLUTION residuales I-EVOLUTION de I-EVOLUTION púrpura, I-EVOLUTION sin I-EVOLUTION edema I-EVOLUTION articular. I-EVOLUTION Se B-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION frotis I-EXPLORATION faríngeo, I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pediatra I-PRESENT_ILLNESS para I-PRESENT_ILLNESS una I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS rutinaria. I-PRESENT_ILLNESS El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY niño I-PAST_MEDICAL_HISTORY sano I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Durante B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física, I-EXPLORATION el I-EXPLORATION pediatra I-EXPLORATION detecta I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION cardiaco I-EXPLORATION sistólico I-EXPLORATION vibratorio I-EXPLORATION 2/6 I-EXPLORATION en I-EXPLORATION borde I-EXPLORATION esternal I-EXPLORATION izquierdo I-EXPLORATION bajo, I-EXPLORATION no I-EXPLORATION irradiado I-EXPLORATION y I-EXPLORATION que I-EXPLORATION se I-EXPLORATION modifica I-EXPLORATION con I-EXPLORATION la I-EXPLORATION postura, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION segundo I-EXPLORATION tono I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION tonos I-EXPLORATION arrítmicos I-EXPLORATION sin I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION respiratoria. I-EXPLORATION Los I-EXPLORATION pulsos I-EXPLORATION periféricos I-EXPLORATION son I-EXPLORATION palpables I-EXPLORATION y I-EXPLORATION simétricos. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION percentiles I-EXPLORATION para I-EXPLORATION su I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION talla. I-EXPLORATION I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION está I-EXPLORATION asintomático; I-EXPLORATION no I-EXPLORATION refiere I-EXPLORATION haber I-EXPLORATION presentado I-EXPLORATION palpitaciones, I-EXPLORATION precordalgia I-EXPLORATION ni I-EXPLORATION síncopes I-EXPLORATION y I-EXPLORATION tiene I-EXPLORATION una I-EXPLORATION buena I-EXPLORATION tolerancia I-EXPLORATION al I-EXPLORATION ejercicio I-EXPLORATION físico. I-EXPLORATION I-EXPLORATION En B-FAMILY_HISTORY la I-FAMILY_HISTORY familia I-FAMILY_HISTORY no I-FAMILY_HISTORY refieren I-FAMILY_HISTORY enfermedades I-FAMILY_HISTORY cardiovasculares I-FAMILY_HISTORY ni I-FAMILY_HISTORY hay I-FAMILY_HISTORY antecedente I-FAMILY_HISTORY de I-FAMILY_HISTORY muerte I-FAMILY_HISTORY súbita. I-FAMILY_HISTORY I-FAMILY_HISTORY Ante B-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION tonos I-EXPLORATION arrítmicos I-EXPLORATION a I-EXPLORATION la I-EXPLORATION auscultación, I-EXPLORATION el I-EXPLORATION pediatra I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION en I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION que I-EXPLORATION se I-EXPLORATION muestra I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Fig. I-EXPLORATION 1. I-EXPLORATION I-EXPLORATION ¿Cuál I-EXPLORATION es I-EXPLORATION la I-EXPLORATION lectura I-EXPLORATION e I-EXPLORATION interpretación I-EXPLORATION del I-EXPLORATION electrocardiograma? I-EXPLORATION 1 I-EXPLORATION I-EXPLORATION Aunque I-EXPLORATION lo I-EXPLORATION primero I-EXPLORATION que I-EXPLORATION nos I-EXPLORATION llama I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION es I-EXPLORATION la I-EXPLORATION irregularidad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ritmo, I-EXPLORATION empezamos I-EXPLORATION nuestra I-EXPLORATION lectura I-EXPLORATION sistemática I-EXPLORATION comprobando I-EXPLORATION que I-EXPLORATION es I-EXPLORATION un I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION (onda I-EXPLORATION P I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION I I-EXPLORATION y I-EXPLORATION aVF) I-EXPLORATION a I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION de I-EXPLORATION 55 I-EXPLORATION lpm. I-EXPLORATION I-EXPLORATION Seguidamente I-EXPLORATION analizamos I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION del I-EXPLORATION QRS I-EXPLORATION siguiendo I-EXPLORATION tres I-EXPLORATION pasos: I-EXPLORATION 1) I-EXPLORATION localizar I-EXPLORATION el I-EXPLORATION cuadrante I-EXPLORATION utilizando I-EXPLORATION las I-EXPLORATION derivaciones I-EXPLORATION I I-EXPLORATION y I-EXPLORATION aVF; I-EXPLORATION 2) I-EXPLORATION encontrar I-EXPLORATION la I-EXPLORATION derivación I-EXPLORATION con I-EXPLORATION complejo I-EXPLORATION QRS I-EXPLORATION equifásico I-EXPLORATION (altura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION R I-EXPLORATION similar I-EXPLORATION a I-EXPLORATION la I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION S) I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION derivaciones I-EXPLORATION de I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION (I, I-EXPLORATION II, I-EXPLORATION III, I-EXPLORATION aVR, I-EXPLORATION aVL, I-EXPLORATION aVF), I-EXPLORATION y I-EXPLORATION 3) I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION QRS I-EXPLORATION será I-EXPLORATION perpendicular I-EXPLORATION a I-EXPLORATION esta I-EXPLORATION derivación I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION cuadrante I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION paso I-EXPLORATION 1. I-EXPLORATION En I-EXPLORATION nuestro I-EXPLORATION caso: I-EXPLORATION 1) I-EXPLORATION el I-EXPLORATION QRS I-EXPLORATION es I-EXPLORATION positivo I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION derivaciones I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION se I-EXPLORATION encontrará I-EXPLORATION entre I-EXPLORATION 0 I-EXPLORATION y I-EXPLORATION 90o; I-EXPLORATION 2) I-EXPLORATION la I-EXPLORATION derivación I-EXPLORATION con I-EXPLORATION complejo I-EXPLORATION más I-EXPLORATION equifásico I-EXPLORATION sería I-EXPLORATION la I-EXPLORATION derivación I-EXPLORATION I, I-EXPLORATION cuya I-EXPLORATION perpendicular I-EXPLORATION es I-EXPLORATION 90o, I-EXPLORATION por I-EXPLORATION tanto I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION QRS I-EXPLORATION está I-EXPLORATION a I-EXPLORATION 90o. I-EXPLORATION I-EXPLORATION El I-EXPLORATION eje I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION T I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION también I-EXPLORATION pues I-EXPLORATION está I-EXPLORATION entre I-EXPLORATION 0 I-EXPLORATION y I-EXPLORATION 90o. I-EXPLORATION I-EXPLORATION La I-EXPLORATION duración I-EXPLORATION del I-EXPLORATION complejo I-EXPLORATION QRS I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION (0, I-EXPLORATION 04 I-EXPLORATION seg). I-EXPLORATION No I-EXPLORATION observamos I-EXPLORATION morfología I-EXPLORATION de I-EXPLORATION QRS I-EXPLORATION que I-EXPLORATION sugiera I-EXPLORATION alteración I-EXPLORATION en I-EXPLORATION la I-EXPLORATION conducción I-EXPLORATION intraventricular I-EXPLORATION (por I-EXPLORATION ejemplo, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION rR´ I-EXPLORATION en I-EXPLORATION V1) I-EXPLORATION ni I-EXPLORATION hallazgos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION hipertrofia I-EXPLORATION ventricular. I-EXPLORATION I-EXPLORATION La I-EXPLORATION onda I-EXPLORATION T I-EXPLORATION y I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION son I-EXPLORATION normales; I-EXPLORATION no I-EXPLORATION hay I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION la I-EXPLORATION repolarización. I-EXPLORATION I-EXPLORATION A I-EXPLORATION continuación I-EXPLORATION analizamos I-EXPLORATION los I-EXPLORATION intervalos I-EXPLORATION PR2: I-EXPLORATION llama I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION que I-EXPLORATION el I-EXPLORATION intervalo I-EXPLORATION PR I-EXPLORATION (desde I-EXPLORATION el I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION onda I-EXPLORATION P I-EXPLORATION hasta I-EXPLORATION el I-EXPLORATION inicio I-EXPLORATION del I-EXPLORATION QRS) I-EXPLORATION va I-EXPLORATION variando I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION del I-EXPLORATION registro, I-EXPLORATION no I-EXPLORATION es I-EXPLORATION constante. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Fig. I-EXPLORATION 2 I-EXPLORATION se I-EXPLORATION muestra I-EXPLORATION el I-EXPLORATION trazado I-EXPLORATION en I-EXPLORATION DII I-EXPLORATION a I-EXPLORATION partir I-EXPLORATION del I-EXPLORATION quinto I-EXPLORATION latido I-EXPLORATION del I-EXPLORATION ECG I-EXPLORATION basal: I-EXPLORATION el I-EXPLORATION intervalo I-EXPLORATION PR I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION latido I-EXPLORATION mide I-EXPLORATION 4, I-EXPLORATION 5 I-EXPLORATION cuadritos I-EXPLORATION o I-EXPLORATION milímetros I-EXPLORATION (0, I-EXPLORATION 04 I-EXPLORATION x I-EXPLORATION 4, I-EXPLORATION 5=0, I-EXPLORATION 18 I-EXPLORATION seg), I-EXPLORATION que I-EXPLORATION está I-EXPLORATION en I-EXPLORATION el I-EXPLORATION límite I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad, I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION latido I-EXPLORATION tiene I-EXPLORATION un I-EXPLORATION intervalo I-EXPLORATION PR I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION (0, I-EXPLORATION 22 I-EXPLORATION seg), I-EXPLORATION el I-EXPLORATION tercero I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm I-EXPLORATION (0, I-EXPLORATION 24 I-EXPLORATION seg), I-EXPLORATION el I-EXPLORATION cuarto I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION mm I-EXPLORATION (0, I-EXPLORATION 32 I-EXPLORATION seg), I-EXPLORATION todos I-EXPLORATION ellos I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION límite I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION normalidad. I-EXPLORATION Vemos I-EXPLORATION también I-EXPLORATION que I-EXPLORATION después I-EXPLORATION del I-EXPLORATION cuarto I-EXPLORATION latido I-EXPLORATION hay I-EXPLORATION una I-EXPLORATION onda I-EXPLORATION P I-EXPLORATION (marcada I-EXPLORATION con I-EXPLORATION una I-EXPLORATION flecha) I-EXPLORATION que I-EXPLORATION no I-EXPLORATION va I-EXPLORATION seguida I-EXPLORATION de I-EXPLORATION complejo I-EXPLORATION QRS. I-EXPLORATION Este I-EXPLORATION registro I-EXPLORATION electrocardiográfico I-EXPLORATION (intervalo I-EXPLORATION PR I-EXPLORATION que I-EXPLORATION se I-EXPLORATION alarga I-EXPLORATION progresivamente I-EXPLORATION hasta I-EXPLORATION que I-EXPLORATION una I-EXPLORATION onda I-EXPLORATION P I-EXPLORATION no I-EXPLORATION conduce) I-EXPLORATION refleja I-EXPLORATION un I-EXPLORATION bloqueo I-EXPLORATION auriculoventricular I-EXPLORATION (BAV) I-EXPLORATION de I-EXPLORATION segundo I-EXPLORATION grado I-EXPLORATION tipo I-EXPLORATION Mobitz I-EXPLORATION I. I-EXPLORATION El I-EXPLORATION intervalo I-EXPLORATION QTc I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION (0, I-EXPLORATION 38 I-EXPLORATION seg). I-EXPLORATION I-EXPLORATION Ante B-DERIVED_FROM/TO los I-DERIVED_FROM/TO hallazgos I-DERIVED_FROM/TO electrocardiográficos, I-DERIVED_FROM/TO el I-DERIVED_FROM/TO pediatra I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO remitir I-DERIVED_FROM/TO al I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO al I-DERIVED_FROM/TO hospital, I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO consulta I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cardiología I-DERIVED_FROM/TO Pediátrica, I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO de I-DERIVED_FROM/TO esta I-DERIVED_FROM/TO arritmia. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION de I-EXPLORATION Cardiología I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION ecocardiograma I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION descartando I-EXPLORATION patología I-EXPLORATION estructural. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION nuevo I-EXPLORATION electrocardiograma I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION a I-EXPLORATION 60 I-EXPLORATION lpm I-EXPLORATION con I-EXPLORATION un I-EXPLORATION PR I-EXPLORATION alargado I-EXPLORATION (BAV I-EXPLORATION de I-EXPLORATION primer I-EXPLORATION grado), I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lectura I-EXPLORATION sistemática I-EXPLORATION normal. I-EXPLORATION Tras I-EXPLORATION realizar I-EXPLORATION ejercicio I-EXPLORATION leve, I-EXPLORATION con I-EXPLORATION la I-EXPLORATION finalidad I-EXPLORATION de I-EXPLORATION aumentar I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION cardiaca, I-EXPLORATION se I-EXPLORATION repitió I-EXPLORATION el I-EXPLORATION ECG, I-EXPLORATION con I-EXPLORATION normalización I-EXPLORATION (acortamiento) I-EXPLORATION del I-EXPLORATION intervalo I-EXPLORATION PR. I-EXPLORATION I-EXPLORATION En I-EXPLORATION resumen, I-EXPLORATION estamos I-EXPLORATION ante I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION asintomático I-EXPLORATION desde I-EXPLORATION el I-EXPLORATION punto I-EXPLORATION de I-EXPLORATION vista I-EXPLORATION cardiovascular, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION soplo I-EXPLORATION cardiaco I-EXPLORATION de I-EXPLORATION características I-EXPLORATION funcionales, I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION un I-EXPLORATION hallazgo I-EXPLORATION casual I-EXPLORATION de I-EXPLORATION BAV I-EXPLORATION de I-EXPLORATION primer I-EXPLORATION grado I-EXPLORATION y I-EXPLORATION de I-EXPLORATION segundo I-EXPLORATION grado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ECG. I-EXPLORATION I-EXPLORATION Para I-EXPLORATION ampliar I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION un I-EXPLORATION Holter-ECG I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION que I-EXPLORATION constató I-EXPLORATION un I-EXPLORATION BAV I-EXPLORATION de I-EXPLORATION primer I-EXPLORATION grado I-EXPLORATION con I-EXPLORATION dos I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION BAV I-EXPLORATION de I-EXPLORATION segundo I-EXPLORATION grado I-EXPLORATION tipo I-EXPLORATION Mobitz I-EXPLORATION I I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION descanso I-EXPLORATION nocturno. I-EXPLORATION I-EXPLORATION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS y I-PRESENT_ILLNESS medio, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY asiático, 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 Atención I-PRESENT_ILLNESS Primaria I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día I-PRESENT_ILLNESS siguiente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS llegar I-PRESENT_ILLNESS del I-PRESENT_ILLNESS orfanato I-PRESENT_ILLNESS de I-PRESENT_ILLNESS China I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS viviendo, I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS adoptada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS española I-PRESENT_ILLNESS compuesta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS padre, I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS hijos I-PRESENT_ILLNESS biológicos I-PRESENT_ILLNESS adolescentes. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS acompaña I-PRESENT_ILLNESS su I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS adoptiva, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS solicita I-PRESENT_ILLNESS una I-PRESENT_ILLNESS valoración I-PRESENT_ILLNESS general I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS espera I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS atendida I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS referencia I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Comunidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Madrid I-PRESENT_ILLNESS establece I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS Protocolo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Adopción I-PRESENT_ILLNESS Internacional. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION destaca I-EXPLORATION su I-EXPLORATION fenotipo I-EXPLORATION mongoloide I-EXPLORATION racial, I-EXPLORATION un I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION nutricional I-EXPLORATION y I-EXPLORATION un I-EXPLORATION comportamiento I-EXPLORATION tranquilo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION descubre I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION periné I-EXPLORATION hay I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION lineal I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION horquilla I-EXPLORATION vulvar I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ano, I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION herida I-EXPLORATION incisa, I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION eritematoso, I-EXPLORATION recubierta I-EXPLORATION de I-EXPLORATION mucosa I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sangrado. I-EXPLORATION La I-EXPLORATION uretra, I-EXPLORATION la I-EXPLORATION vagina, I-EXPLORATION la I-EXPLORATION vulva I-EXPLORATION y I-EXPLORATION el I-EXPLORATION ano I-EXPLORATION tienen I-EXPLORATION un I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION La I-EXPLORATION primera I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION fue I-EXPLORATION la I-EXPLORATION de I-EXPLORATION una I-EXPLORATION agresión I-EXPLORATION sexual, I-EXPLORATION pero I-EXPLORATION se I-EXPLORATION optó I-EXPLORATION por I-EXPLORATION una I-EXPLORATION actitud I-EXPLORATION expectante, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION sangrado I-EXPLORATION activo I-EXPLORATION y I-EXPLORATION de I-EXPLORATION dolor, I-EXPLORATION al I-EXPLORATION aspecto I-EXPLORATION normal I-EXPLORATION del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION los I-EXPLORATION genitales I-EXPLORATION externos I-EXPLORATION y I-EXPLORATION al I-EXPLORATION comportamiento I-EXPLORATION tranquilo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION niña I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION exploración. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION de I-EXPLORATION vías I-EXPLORATION urinarias, I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Tras B-EVOLUTION los I-EVOLUTION primeros I-EVOLUTION controles I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION de I-EVOLUTION referencia I-EVOLUTION antes I-EVOLUTION mencionado, I-EVOLUTION la I-EVOLUTION madre I-EVOLUTION acude I-EVOLUTION angustiada I-EVOLUTION al I-EVOLUTION centro I-EVOLUTION de I-EVOLUTION salud, I-EVOLUTION porque I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION sospechan I-EVOLUTION que I-EVOLUTION en I-EVOLUTION la I-EVOLUTION familia I-EVOLUTION se I-EVOLUTION está I-EVOLUTION abusando I-EVOLUTION sexualmente I-EVOLUTION de I-EVOLUTION la I-EVOLUTION niña, I-EVOLUTION e I-EVOLUTION incluso I-EVOLUTION se I-EVOLUTION les I-EVOLUTION ha I-EVOLUTION amenazado I-EVOLUTION con I-EVOLUTION denunciarlo I-EVOLUTION así I-EVOLUTION ante I-EVOLUTION las I-EVOLUTION autoridades. I-EVOLUTION En I-EVOLUTION este I-EVOLUTION intervalo, I-EVOLUTION la I-EVOLUTION oportuna I-EVOLUTION lectura I-EVOLUTION de I-EVOLUTION un I-EVOLUTION artículo I-EVOLUTION relacionado I-EVOLUTION con I-EVOLUTION el I-EVOLUTION surco I-EVOLUTION perineal3 I-EVOLUTION proporciona I-EVOLUTION la I-EVOLUTION clave I-EVOLUTION para I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION definitivo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION malformación, I-EVOLUTION con I-EVOLUTION el I-EVOLUTION consiguiente I-EVOLUTION alivio I-EVOLUTION de I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION implicados. I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION microbiológico I-EXPLORATION solicitado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION hospital I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION enfermedades I-EXPLORATION de I-EXPLORATION transmisión I-EXPLORATION sexual I-EXPLORATION fue I-EXPLORATION negativo I-EXPLORATION (lúes, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION y I-EXPLORATION de I-EXPLORATION las I-EXPLORATION hepatitis I-EXPLORATION B, I-EXPLORATION C I-EXPLORATION y I-EXPLORATION A, I-EXPLORATION herpes I-EXPLORATION y I-EXPLORATION gonococo). I-EXPLORATION La B-EVOLUTION niña I-EVOLUTION refiere, I-EVOLUTION de I-EVOLUTION modo I-EVOLUTION ocasional, I-EVOLUTION dolor I-EVOLUTION leve I-EVOLUTION en I-EVOLUTION la I-EVOLUTION vulva I-EVOLUTION y I-EVOLUTION tiene I-EVOLUTION cierta I-EVOLUTION tendencia I-EVOLUTION al I-EVOLUTION estreñimiento, I-EVOLUTION aunque I-EVOLUTION estas I-EVOLUTION molestias I-EVOLUTION no I-EVOLUTION interfieren I-EVOLUTION con I-EVOLUTION su I-EVOLUTION actividad I-EVOLUTION habitual I-EVOLUTION y I-EVOLUTION no I-EVOLUTION hay I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION irritación I-EVOLUTION local. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS octubre I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39, I-PRESENT_ILLNESS 7 I-PRESENT_ILLNESS oC, I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS ocular I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION leve I-EXPLORATION eritema I-EXPLORATION palpebral, I-EXPLORATION sin I-EXPLORATION oftalmoplejia I-EXPLORATION ni I-EXPLORATION proptosis, I-EXPLORATION y I-EXPLORATION con I-EXPLORATION agudeza I-EXPLORATION visual I-EXPLORATION normal. I-EXPLORATION Se B-TREATMENT pauta I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amoxicilina/clavulánico I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT 80 I-TREATMENT mg/kg/día I-TREATMENT por I-TREATMENT vía I-TREATMENT oral I-TREATMENT y I-TREATMENT se I-TREATMENT informa I-TREATMENT sobre I-TREATMENT las I-TREATMENT posibles I-TREATMENT complicaciones. I-TREATMENT A B-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION iniciar I-EVOLUTION el I-EVOLUTION tratamiento, I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION la I-EVOLUTION urgencia I-EVOLUTION hospitalaria I-EVOLUTION por I-EVOLUTION no I-EVOLUTION tolerar I-EVOLUTION el I-EVOLUTION antibiótico I-EVOLUTION oral I-EVOLUTION y I-EVOLUTION persistir I-EVOLUTION el I-EVOLUTION dolor I-EVOLUTION ocular I-EVOLUTION y I-EVOLUTION la I-EVOLUTION fiebre. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION hospital, I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION ocular I-EXPLORATION detectó I-EXPLORATION ptosis I-EXPLORATION palpebral I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION movilidad I-EXPLORATION ocular, I-EXPLORATION discreto I-EXPLORATION eritema I-EXPLORATION palpebral, I-EXPLORATION pupilas I-EXPLORATION isocóricas I-EXPLORATION y I-EXPLORATION normorreactivas, I-EXPLORATION motilidad I-EXPLORATION ocular I-EXPLORATION conservada I-EXPLORATION y I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION normal. I-EXPLORATION Entre I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias, I-EXPLORATION destaca: I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION leucocitos, I-EXPLORATION 14 I-EXPLORATION 720/μl I-EXPLORATION (N: I-EXPLORATION 76, I-EXPLORATION 7%; I-EXPLORATION L: I-EXPLORATION 15, I-EXPLORATION 5%; I-EXPLORATION M: I-EXPLORATION 7, I-EXPLORATION 7%); I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR), I-EXPLORATION 227, I-EXPLORATION 1 I-EXPLORATION mg/l; I-EXPLORATION hemocultivo, I-EXPLORATION negativo; I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION normal; I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION orbital, I-EXPLORATION informada I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION inflamatorios I-EXPLORATION en I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION intraorbitaria I-EXPLORATION extraconal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION cambios I-EXPLORATION inflamatorios I-EXPLORATION en I-EXPLORATION los I-EXPLORATION senos I-EXPLORATION paranasales. I-EXPLORATION Es B-TREATMENT ingresado I-TREATMENT y I-TREATMENT se I-TREATMENT pauta I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amoxicilina/clavulánico I-TREATMENT intravenoso, I-TREATMENT que I-TREATMENT se I-TREATMENT mantiene I-TREATMENT durante I-TREATMENT seis I-TREATMENT días, I-TREATMENT y I-TREATMENT es I-TREATMENT dado I-TREATMENT de I-TREATMENT alta I-TREATMENT con I-TREATMENT el I-TREATMENT mismo I-TREATMENT antibiótico I-TREATMENT oral I-TREATMENT hasta I-TREATMENT completar I-TREATMENT 15 I-TREATMENT días. I-TREATMENT Su B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS previamente B-PAST_MEDICAL_HISTORY sana, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS inicia, I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso, I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo, I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS nariz, I-PRESENT_ILLNESS luego I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS y I-PRESENT_ILLNESS después I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS boca. I-PRESENT_ILLNESS Es B-TREATMENT valorada I-TREATMENT por I-TREATMENT el I-TREATMENT dermatólogo, I-TREATMENT el I-TREATMENT odontólogo I-TREATMENT y I-TREATMENT el I-TREATMENT otorrinolaringólogo; I-TREATMENT se I-TREATMENT realiza I-TREATMENT tratamiento I-TREATMENT por I-TREATMENT sospecha I-TREATMENT de I-TREATMENT impétigo. I-TREATMENT No B-EVOLUTION se I-EVOLUTION observa I-EVOLUTION mejoría; I-EVOLUTION en I-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas I-EVOLUTION siguientes, I-EVOLUTION presenta I-EVOLUTION lesiones I-EVOLUTION eritematosas I-EVOLUTION en I-EVOLUTION los I-EVOLUTION dedos I-EVOLUTION de I-EVOLUTION las I-EVOLUTION manos I-EVOLUTION y I-EVOLUTION se I-EVOLUTION diagnostica I-EVOLUTION de I-EVOLUTION viriasis. I-EVOLUTION Sigue I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION mejoría, I-EVOLUTION se I-EVOLUTION observan I-EVOLUTION también I-EVOLUTION dichas I-EVOLUTION lesiones I-EVOLUTION en I-EVOLUTION los I-EVOLUTION dedos I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION pies, I-EVOLUTION asociando I-EVOLUTION abdominalgias I-EVOLUTION y I-EVOLUTION vómitos I-EVOLUTION ocasionales. I-EVOLUTION Siempre I-EVOLUTION afebril, I-EVOLUTION la I-EVOLUTION madre I-EVOLUTION refiere I-EVOLUTION observar I-EVOLUTION "caída I-EVOLUTION del I-EVOLUTION cabello", I-EVOLUTION sin I-EVOLUTION otros I-EVOLUTION signos I-EVOLUTION clínicos I-EVOLUTION asociados. I-EVOLUTION Antecedentes B-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Antecedentes B-FAMILY_HISTORY familiares: I-FAMILY_HISTORY padre I-FAMILY_HISTORY diagnosticado I-FAMILY_HISTORY de I-FAMILY_HISTORY colon I-FAMILY_HISTORY irritable, I-FAMILY_HISTORY sin I-FAMILY_HISTORY casos I-FAMILY_HISTORY reumatológicos I-FAMILY_HISTORY ni I-FAMILY_HISTORY clínica I-FAMILY_HISTORY similar I-FAMILY_HISTORY a I-FAMILY_HISTORY la I-FAMILY_HISTORY de I-FAMILY_HISTORY la I-FAMILY_HISTORY niña; I-FAMILY_HISTORY una I-FAMILY_HISTORY prima I-FAMILY_HISTORY hermana I-FAMILY_HISTORY materna I-FAMILY_HISTORY diagnosticada I-FAMILY_HISTORY hace I-FAMILY_HISTORY un I-FAMILY_HISTORY año I-FAMILY_HISTORY de I-FAMILY_HISTORY púrpura I-FAMILY_HISTORY de I-FAMILY_HISTORY Schonlein-Henoch. I-FAMILY_HISTORY I-FAMILY_HISTORY Cuando B-EXPLORATION ingresa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hospital I-EXPLORATION está I-EXPLORATION febril I-EXPLORATION (38 I-EXPLORATION oC), I-EXPLORATION con I-EXPLORATION buen I-EXPLORATION aspecto I-EXPLORATION general. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION eritema I-EXPLORATION malar I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION respeta I-EXPLORATION el I-EXPLORATION pliegue I-EXPLORATION nasolabial; I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION tumefacción I-EXPLORATION en I-EXPLORATION el I-EXPLORATION área I-EXPLORATION del I-EXPLORATION lacrimal I-EXPLORATION izquierdo. I-EXPLORATION Lesiones I-EXPLORATION purpúricas I-EXPLORATION en I-EXPLORATION los I-EXPLORATION pulpejos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION manos, I-EXPLORATION en I-EXPLORATION los I-EXPLORATION pies I-EXPLORATION y I-EXPLORATION en I-EXPLORATION los I-EXPLORATION talones. I-EXPLORATION Presenta I-EXPLORATION en I-EXPLORATION la I-EXPLORATION orofaringe I-EXPLORATION aftas, I-EXPLORATION estomatitis I-EXPLORATION y I-EXPLORATION enantema. I-EXPLORATION No I-EXPLORATION tiene I-EXPLORATION adenopatías. I-EXPLORATION Las I-EXPLORATION exploraciones I-EXPLORATION osteoarticular I-EXPLORATION y I-EXPLORATION neurológica, I-EXPLORATION y I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION cardiopulmonar, I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Estudios I-EXPLORATION complementarios I-EXPLORATION solicitados: I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hemograma, I-EXPLORATION Hb I-EXPLORATION 10, I-EXPLORATION 6 I-EXPLORATION g/dl, I-EXPLORATION leucocitos I-EXPLORATION 3500/μl I-EXPLORATION con I-EXPLORATION fórmula I-EXPLORATION normal, I-EXPLORATION plaquetas I-EXPLORATION 126 I-EXPLORATION 000/ I-EXPLORATION μl I-EXPLORATION (un I-EXPLORATION mes I-EXPLORATION antes I-EXPLORATION solo I-EXPLORATION destacar I-EXPLORATION 4400 I-EXPLORATION leucocitos/ I-EXPLORATION μl). I-EXPLORATION Frotis I-EXPLORATION sanguíneo I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION morfológicas. I-EXPLORATION Velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION 44 I-EXPLORATION mm/hora. I-EXPLORATION Reactantes I-EXPLORATION fase I-EXPLORATION aguda: I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 0, I-EXPLORATION 18 I-EXPLORATION mg/dl, I-EXPLORATION procalcitonina I-EXPLORATION 0, I-EXPLORATION 06 I-EXPLORATION ng/ml. I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION coagulación, I-EXPLORATION pruebas I-EXPLORATION reumáticas I-EXPLORATION y I-EXPLORATION proteinograma I-EXPLORATION normales. I-EXPLORATION Inmunoglobulinas I-EXPLORATION con I-EXPLORATION IgG I-EXPLORATION 1830 I-EXPLORATION mg/dl I-EXPLORATION e I-EXPLORATION IgA I-EXPLORATION 271 I-EXPLORATION mg/dl. I-EXPLORATION Complementos I-EXPLORATION C3 I-EXPLORATION 23, I-EXPLORATION 7 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION C4 I-EXPLORATION 4, I-EXPLORATION 2 I-EXPLORATION mg/dl. I-EXPLORATION Autoinmunidad: I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (ANA) I-EXPLORATION + I-EXPLORATION 1/1280, I-EXPLORATION anti-SM I-EXPLORATION positivo, I-EXPLORATION anti-ADN I-EXPLORATION fuertemente I-EXPLORATION positivo. I-EXPLORATION Sistemático I-EXPLORATION de I-EXPLORATION orina I-EXPLORATION 150-250 I-EXPLORATION eritrocitos/campo. I-EXPLORATION Serologías I-EXPLORATION bacteriana I-EXPLORATION a I-EXPLORATION Mycoplasma, I-EXPLORATION parasitaria I-EXPLORATION a I-EXPLORATION toxoplasma I-EXPLORATION y I-EXPLORATION vírica I-EXPLORATION a I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein-Barr, I-EXPLORATION parvovirus I-EXPLORATION B19, I-EXPLORATION adenovirus, I-EXPLORATION echovirus I-EXPLORATION y I-EXPLORATION coxsakie I-EXPLORATION negativas. I-EXPLORATION Destacar I-EXPLORATION una I-EXPLORATION IgM I-EXPLORATION a I-EXPLORATION citomegalovirus I-EXPLORATION positiva. I-EXPLORATION Hemocultivo I-EXPLORATION y I-EXPLORATION frotis I-EXPLORATION faríngeo, I-EXPLORATION bucal, I-EXPLORATION conjuntiva I-EXPLORATION y I-EXPLORATION punción I-EXPLORATION púrpura, I-EXPLORATION negativos. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION clínica I-EXPLORATION y I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION complementarios I-EXPLORATION referidos, I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION lupus I-EXPLORATION eritematoso I-EXPLORATION sistémico I-EXPLORATION (LES), I-EXPLORATION se I-EXPLORATION solicitan I-EXPLORATION anticuerpos I-EXPLORATION antifosfolípidos I-EXPLORATION (AAF), I-EXPLORATION antilúpicos I-EXPLORATION positivos I-EXPLORATION y I-EXPLORATION anticardiolipina I-EXPLORATION positiva I-EXPLORATION (IgG, I-EXPLORATION IgM), I-EXPLORATION una I-EXPLORATION ecocardiografía I-EXPLORATION (función I-EXPLORATION y I-EXPLORATION estructura I-EXPLORATION cardiacas I-EXPLORATION normales) I-EXPLORATION y I-EXPLORATION opinión I-EXPLORATION dermatológica. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION cumplir I-EXPLORATION más I-EXPLORATION de I-EXPLORATION cuatro I-EXPLORATION de I-EXPLORATION los I-EXPLORATION criterios I-EXPLORATION de I-EXPLORATION la I-EXPLORATION Asociación I-EXPLORATION Americana I-EXPLORATION de I-EXPLORATION Reumatología, I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION LES I-EXPLORATION y I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION nefrológica I-EXPLORATION y I-EXPLORATION reumatológica. I-EXPLORATION Se B-TREATMENT pauta I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT medidas I-TREATMENT generales, I-TREATMENT antipalúdicos I-TREATMENT (hidroxicloroquina) I-TREATMENT y I-TREATMENT corticoides I-TREATMENT (prednisona) I-TREATMENT orales, I-TREATMENT manteniéndose I-TREATMENT revisiones I-TREATMENT correspondientes I-TREATMENT en I-TREATMENT su I-TREATMENT seguimiento I-TREATMENT multidisciplinar. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS contusión I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS parte I-PRESENT_ILLNESS lateral I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS Durante B-EXPLORATION la I-EXPLORATION exploración, I-EXPLORATION presenta I-EXPLORATION cierta I-EXPLORATION tumefacción I-EXPLORATION sin I-EXPLORATION hematoma I-EXPLORATION y I-EXPLORATION escaso I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION lateral I-EXPLORATION del I-EXPLORATION pie, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION tobillo I-EXPLORATION normal. I-EXPLORATION Al B-TREATMENT no I-TREATMENT sospechar I-TREATMENT fractura, I-TREATMENT se I-TREATMENT recomienda I-TREATMENT inmovilización I-TREATMENT y I-TREATMENT reposo I-TREATMENT físico I-TREATMENT relativo, I-TREATMENT además I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT analgésico, I-TREATMENT indicando I-TREATMENT control I-TREATMENT en I-TREATMENT una I-TREATMENT semana I-TREATMENT según I-TREATMENT la I-TREATMENT evolución I-TREATMENT clínica. I-TREATMENT Transcurrido B-EVOLUTION el I-EVOLUTION periodo I-EVOLUTION de I-EVOLUTION inmovilización, I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION consulta, I-EVOLUTION se I-EVOLUTION retira I-EVOLUTION la I-EVOLUTION inmovilización I-EVOLUTION y, I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION sintomatología, I-EVOLUTION se I-EVOLUTION da I-EVOLUTION de I-EVOLUTION alta, I-EVOLUTION retomando I-EVOLUTION su I-EVOLUTION actividad I-EVOLUTION física I-EVOLUTION habitual I-EVOLUTION como I-EVOLUTION portero I-EVOLUTION de I-EVOLUTION waterpolo. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION dos I-EVOLUTION semanas, I-EVOLUTION acude I-EVOLUTION a I-EVOLUTION Urgencias I-EVOLUTION del I-EVOLUTION centro I-EVOLUTION de I-EVOLUTION salud I-EVOLUTION por I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION lateral I-EVOLUTION del I-EVOLUTION pie I-EVOLUTION derecho. I-EVOLUTION Ha I-EVOLUTION estado I-EVOLUTION practicando I-EVOLUTION waterpolo I-EVOLUTION y I-EVOLUTION niega I-EVOLUTION antecedente I-EVOLUTION traumático I-EVOLUTION en I-EVOLUTION este I-EVOLUTION periodo I-EVOLUTION de I-EVOLUTION tiempo. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION exploración I-EVOLUTION destaca I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION tumefacción I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION proximal I-EVOLUTION del I-EVOLUTION quinto I-EVOLUTION metatarsiano I-EVOLUTION del I-EVOLUTION pie I-EVOLUTION derecho, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION realizan I-EVOLUTION una I-EVOLUTION radiología I-EVOLUTION frontal I-EVOLUTION y I-EVOLUTION otra I-EVOLUTION lateral I-EVOLUTION de I-EVOLUTION dicho I-EVOLUTION pie, I-EVOLUTION informándose I-EVOLUTION como I-EVOLUTION posible I-EVOLUTION fractura I-EVOLUTION de I-EVOLUTION Jones. I-EVOLUTION Posteriormente, I-EVOLUTION es I-EVOLUTION valorado I-EVOLUTION por I-EVOLUTION su I-EVOLUTION pediatra, I-EVOLUTION que I-EVOLUTION observa I-EVOLUTION tumefacción I-EVOLUTION no I-EVOLUTION dolorosa I-EVOLUTION también I-EVOLUTION en I-EVOLUTION el I-EVOLUTION pie I-EVOLUTION izquierdo; I-EVOLUTION al I-EVOLUTION tratarse I-EVOLUTION de I-EVOLUTION un I-EVOLUTION preadolescente I-EVOLUTION que I-EVOLUTION realiza I-EVOLUTION deporte I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION habitual, I-EVOLUTION sin I-EVOLUTION un I-EVOLUTION antecedente I-EVOLUTION traumático I-EVOLUTION conocido, I-EVOLUTION y I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION sospecha I-EVOLUTION de I-EVOLUTION posible I-EVOLUTION apofisitis, I-EVOLUTION decide I-EVOLUTION realizar I-EVOLUTION una I-EVOLUTION radiología I-EVOLUTION bilateral I-EVOLUTION oblicua, I-EVOLUTION que I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION imagen I-EVOLUTION de I-EVOLUTION fragmentación I-EVOLUTION en I-EVOLUTION la I-EVOLUTION base I-EVOLUTION del I-EVOLUTION quinto I-EVOLUTION metatarsiano I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION pies. I-EVOLUTION Se B-TREATMENT diagnostica I-TREATMENT de I-TREATMENT apofisitis I-TREATMENT del I-TREATMENT quinto I-TREATMENT metatarsiano, I-TREATMENT también I-TREATMENT conocida I-TREATMENT como I-TREATMENT enfermedad I-TREATMENT de I-TREATMENT Iselin, I-TREATMENT recibiendo I-TREATMENT tratamiento I-TREATMENT analgésico I-TREATMENT y I-TREATMENT antiinflamatorio, I-TREATMENT junto I-TREATMENT con I-TREATMENT reposo I-TREATMENT deportivo I-TREATMENT hasta I-TREATMENT la I-TREATMENT desaparición I-TREATMENT del I-TREATMENT dolor. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION vuelto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION práctica I-EVOLUTION de I-EVOLUTION su I-EVOLUTION actividad I-EVOLUTION deportiva I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION molestias I-EVOLUTION de I-EVOLUTION nuevo. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY medicamentosas I-PAST_MEDICAL_HISTORY conocidas. I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY bronquiolitis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY brotes I-PAST_MEDICAL_HISTORY recurrentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dermatitis I-PAST_MEDICAL_HISTORY atópica. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY seguimiento I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY consultas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Alergología I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY episódica I-PAST_MEDICAL_HISTORY estacional I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sensibilización I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY pólenes I-PAST_MEDICAL_HISTORY (gramíneas, I-PAST_MEDICAL_HISTORY olivos, I-PAST_MEDICAL_HISTORY malezas), I-PAST_MEDICAL_HISTORY ácaros I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY queso, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY asocia I-PAST_MEDICAL_HISTORY rinoconjuntivitis. I-PAST_MEDICAL_HISTORY Precisa I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY inmunoterapia I-PAST_MEDICAL_HISTORY específica I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY pólenes I-PAST_MEDICAL_HISTORY (gramíneas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY olivo) I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY sublingual, I-PAST_MEDICAL_HISTORY fluticasona I-PAST_MEDICAL_HISTORY tópica I-PAST_MEDICAL_HISTORY nasal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antihistamínicos I-PAST_MEDICAL_HISTORY orales, I-PAST_MEDICAL_HISTORY asociando I-PAST_MEDICAL_HISTORY budesonida I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY salbutamol I-PAST_MEDICAL_HISTORY inhalados I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY periodos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY crisis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Durante B-PRESENT_ILLNESS un I-PRESENT_ILLNESS brote I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dermatitis I-PRESENT_ILLNESS atópica, I-PRESENT_ILLNESS le I-PRESENT_ILLNESS administran I-PRESENT_ILLNESS el I-PRESENT_ILLNESS jugo I-PRESENT_ILLNESS directo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS planta I-PRESENT_ILLNESS Aloe I-PRESENT_ILLNESS vera I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS uno I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS hombros, I-PRESENT_ILLNESS desarrollando I-PRESENT_ILLNESS en I-PRESENT_ILLNESS pocos I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS habonosas I-PRESENT_ILLNESS confluentes I-PRESENT_ILLNESS e I-PRESENT_ILLNESS intensamente I-PRESENT_ILLNESS pruriginosas I-PRESENT_ILLNESS por I-PRESENT_ILLNESS toda I-PRESENT_ILLNESS la I-PRESENT_ILLNESS superficie I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS espalda, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS asociar I-PRESENT_ILLNESS afectación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vía I-PRESENT_ILLNESS aérea. I-PRESENT_ILLNESS Se B-TREATMENT pauta I-TREATMENT dexclorfeniramina I-TREATMENT con I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT clínica I-TREATMENT en I-TREATMENT las I-TREATMENT siguientes I-TREATMENT horas. I-TREATMENT Tras B-EVOLUTION tres I-EVOLUTION días I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION en I-EVOLUTION dosis I-EVOLUTION habituales, I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION desaparecieron I-EVOLUTION por I-EVOLUTION completo I-EVOLUTION sin I-EVOLUTION dejar I-EVOLUTION cicatrices. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro 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 médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS hipopigmentadas I-PRESENT_ILLNESS posinflamatorias I-PRESENT_ILLNESS residuales I-PRESENT_ILLNESS que I-PRESENT_ILLNESS dibujan I-PRESENT_ILLNESS el I-PRESENT_ILLNESS contorno I-PRESENT_ILLNESS de I-PRESENT_ILLNESS uno I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estos I-PRESENT_ILLNESS tatuajes I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS realización, I-PRESENT_ILLNESS afectando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS superficie I-PRESENT_ILLNESS de I-PRESENT_ILLNESS extensión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS antebrazos. I-PRESENT_ILLNESS Las I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS representan I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Ash® I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Pikachu®, I-PRESENT_ILLNESS los I-PRESENT_ILLNESS personajes I-PRESENT_ILLNESS protagonistas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS serie I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dibujos I-PRESENT_ILLNESS animados I-PRESENT_ILLNESS Pokemon®. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS las I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS previas I-PRESENT_ILLNESS había I-PRESENT_ILLNESS consultado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS localidad I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS que I-PRESENT_ILLNESS veraneaba I-PRESENT_ILLNESS porque I-PRESENT_ILLNESS presentaba, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tatuaje, I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS vesiculoampollosas I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS una I-PRESENT_ILLNESS base I-PRESENT_ILLNESS eritematosa, I-PRESENT_ILLNESS pruriginosas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sobreinfección I-PRESENT_ILLNESS secundaria. I-PRESENT_ILLNESS Pasado B-EVOLUTION un I-EVOLUTION año, I-EVOLUTION aún I-EVOLUTION se I-EVOLUTION aprecian I-EVOLUTION lesiones I-EVOLUTION residuales I-EVOLUTION con I-EVOLUTION prurito I-EVOLUTION ocasional. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS afebril, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS amigdalitis I-PRESENT_ILLNESS pultácea, I-PRESENT_ILLNESS frotis I-PRESENT_ILLNESS faríngeo I-PRESENT_ILLNESS negativo I-PRESENT_ILLNESS a I-PRESENT_ILLNESS estreptococo, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS resto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS exploración I-PRESENT_ILLNESS física I-PRESENT_ILLNESS normal. I-PRESENT_ILLNESS Dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS tuvo I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS y I-PRESENT_ILLNESS diarrea. I-PRESENT_ILLNESS Por B-TREATMENT todo I-TREATMENT ello I-TREATMENT se I-TREATMENT orienta I-TREATMENT como I-TREATMENT un I-TREATMENT cuadro I-TREATMENT vírico, I-TREATMENT realizando I-TREATMENT tratamiento I-TREATMENT sintomático. I-TREATMENT A B-EXPLORATION los I-EXPLORATION dos I-EXPLORATION días, I-EXPLORATION por I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION deposiciones I-EXPLORATION líquidas, I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION coprocultivo I-EXPLORATION que I-EXPLORATION es I-EXPLORATION positivo I-EXPLORATION a I-EXPLORATION Salmonella I-EXPLORATION typhimurium. I-EXPLORATION A B-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION cuadro, I-EVOLUTION el I-EVOLUTION niño I-EVOLUTION presenta I-EVOLUTION unas I-EVOLUTION lesiones I-EVOLUTION eritematosas I-EVOLUTION y I-EVOLUTION algunos I-EVOLUTION nódulos I-EVOLUTION pretibiales, I-EVOLUTION dolorosas, I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION extremidades I-EVOLUTION inferiores, I-EVOLUTION en I-EVOLUTION número I-EVOLUTION de I-EVOLUTION 8-9, I-EVOLUTION de I-EVOLUTION tamaño I-EVOLUTION de I-EVOLUTION 2-3 I-EVOLUTION cm I-EVOLUTION de I-EVOLUTION diámetro, I-EVOLUTION sin I-EVOLUTION otros I-EVOLUTION signos I-EVOLUTION ni I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Ante B-EXPLORATION la I-EXPLORATION clínica, I-EXPLORATION orientamos I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION como I-EXPLORATION EN I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION S. I-EXPLORATION typhimurium. I-EXPLORATION Solicitamos I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION hemograma, I-EXPLORATION bioquímica, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION globular I-EXPLORATION (VSG), I-EXPLORATION factor I-EXPLORATION reumatoide, I-EXPLORATION antiestreptolisinas I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (ANA), I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION otras I-EXPLORATION posibles I-EXPLORATION etiologías1. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION objetiva I-EXPLORATION alteraciones I-EXPLORATION radiológicas I-EXPLORATION y I-EXPLORATION las I-EXPLORATION determinaciones I-EXPLORATION analíticas I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION A B-EVOLUTION la I-EVOLUTION semana I-EVOLUTION desaparecen I-EVOLUTION los I-EVOLUTION nódulos, I-EVOLUTION con I-EVOLUTION curación I-EVOLUTION completa. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS llevada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS frontal, I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS máxima I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS °C I-PRESENT_ILLNESS y I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS Presentaba B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY corrección I-PAST_MEDICAL_HISTORY quirúrgica I-PAST_MEDICAL_HISTORY endoscópica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trigonocefalia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION ingreso, I-EXPLORATION presentaba I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION de I-EXPLORATION 137 I-EXPLORATION lpm, I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION de I-EXPLORATION 25 I-EXPLORATION rpm, I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 102/60 I-EXPLORATION mm I-EXPLORATION Hg I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 36, I-EXPLORATION 8 I-EXPLORATION °C. I-EXPLORATION Neurológicamente I-EXPLORATION estaba I-EXPLORATION consciente, I-EXPLORATION orientada I-EXPLORATION y I-EXPLORATION colaboradora, I-EXPLORATION con I-EXPLORATION Glasgow I-EXPLORATION 15/15. I-EXPLORATION Rigidez I-EXPLORATION de I-EXPLORATION nuca I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION Kernig I-EXPLORATION y I-EXPLORATION Brudzinski I-EXPLORATION positivos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION región I-EXPLORATION periorbitaria I-EXPLORATION derecha I-EXPLORATION presentaba I-EXPLORATION tumefacción I-EXPLORATION con I-EXPLORATION eritema, I-EXPLORATION calor I-EXPLORATION local I-EXPLORATION y I-EXPLORATION movimientos I-EXPLORATION oculares I-EXPLORATION conservados. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION analítica I-EXPLORATION con I-EXPLORATION leucocitosis I-EXPLORATION 14 I-EXPLORATION 500/mm3, I-EXPLORATION neutrofilia I-EXPLORATION 13 I-EXPLORATION 900/mm3, I-EXPLORATION linfopenia I-EXPLORATION 390/mm3 I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda: I-EXPLORATION fibrinógeno I-EXPLORATION 881 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 241 I-EXPLORATION mg/l. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION punción I-EXPLORATION lumbar, I-EXPLORATION tras I-EXPLORATION confirmar I-EXPLORATION normalidad I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo, I-EXPLORATION obteniéndose I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION turbio, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION citoquímico I-EXPLORATION mostraba I-EXPLORATION 380 I-EXPLORATION leucocitos/mm3 I-EXPLORATION con I-EXPLORATION un I-EXPLORATION 38% I-EXPLORATION de I-EXPLORATION polimorfonucleares, I-EXPLORATION hipoglucorraquia I-EXPLORATION 41 I-EXPLORATION mg/dl I-EXPLORATION e I-EXPLORATION hiperproteinorraquia I-EXPLORATION 240 I-EXPLORATION mg/dl; I-EXPLORATION en I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Gram I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION bacterias. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION hemocultivo I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION S. I-EXPLORATION pyogenes. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION craneal I-EXPLORATION evidenciaba I-EXPLORATION ocupación I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION celdillas I-EXPLORATION etmoidales I-EXPLORATION izquierdas I-EXPLORATION y I-EXPLORATION frontales I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION tumefacción I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION periorbitaria I-EXPLORATION derecha. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT cefotaxima I-TREATMENT y I-TREATMENT vancomicina, I-TREATMENT suspendiendo I-TREATMENT este I-TREATMENT último I-TREATMENT al I-TREATMENT aislarse I-TREATMENT S. I-TREATMENT pyogenes, I-TREATMENT y I-TREATMENT se I-TREATMENT asoció I-TREATMENT clindamicina I-TREATMENT por I-TREATMENT presentar I-TREATMENT exantema I-TREATMENT escarlatiniforme. I-TREATMENT I-TREATMENT Al B-EVOLUTION séptimo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION tuvo I-EVOLUTION un I-EVOLUTION episodio I-EVOLUTION convulsivo I-EVOLUTION tónico-clónico I-EVOLUTION focalizado I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hemicuerpo I-EVOLUTION izquierdo I-EVOLUTION que I-EVOLUTION posteriormente I-EVOLUTION se I-EVOLUTION generalizó. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION craneal, I-EXPLORATION encontrando I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION sugestiva I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION oftálmica I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION ocupación I-EXPLORATION parcial I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION cavernoso I-EXPLORATION derecho, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION realce I-EXPLORATION meníngeo. I-EXPLORATION Fue B-TREATMENT tratada I-TREATMENT con I-TREATMENT ácido I-TREATMENT valpróico I-TREATMENT y I-TREATMENT dexametasona, I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT anticoagulación. I-TREATMENT Posteriormente, B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION satisfactoriamente I-EVOLUTION manteniéndose B-TREATMENT 21 I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT intravenoso, I-TREATMENT con B-EVOLUTION controles I-EVOLUTION clínicos, I-EVOLUTION neurológico, I-EVOLUTION electrocardiográfico I-EVOLUTION y I-EVOLUTION mediante I-EVOLUTION resonancia I-EVOLUTION magnética I-EVOLUTION normales I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION secuelas I-EVOLUTION neurológicas. I-EVOLUTION I-EVOLUTION Adolescente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 16 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS constante I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS fosa I-PRESENT_ILLNESS iliaca I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS junto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS vómito I-PRESENT_ILLNESS aislado. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS los I-PRESENT_ILLNESS días I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS tenido I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS inespecíficas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS apreciar I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS o I-PRESENT_ILLNESS calor. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS fecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS última I-PRESENT_ILLNESS regla I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS visita I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS acné, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ciproterona I-PRESENT_ILLNESS 50 I-PRESENT_ILLNESS mg I-PRESENT_ILLNESS y I-PRESENT_ILLNESS asociación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS acetato I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ciproterona, I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS mg, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS etinilestradiol, I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS µg. I-PRESENT_ILLNESS Sin B-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION únicamente I-EXPLORATION destaca I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION profunda I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION derecha, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION irritación I-EXPLORATION peritoneal. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION patología I-EXPLORATION apendicular, I-EXPLORATION se I-EXPLORATION realiza, I-EXPLORATION una I-EXPLORATION analítica, I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION normal I-EXPLORATION excepto I-EXPLORATION por I-EXPLORATION el I-EXPLORATION dímero I-EXPLORATION D I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION sensibilidad, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION 9958 I-EXPLORATION ng/ml, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ecogenicidad I-EXPLORATION del I-EXPLORATION contenido I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION iliaca I-EXPLORATION común I-EXPLORATION derecha I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION trombo I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION sin I-EXPLORATION ocupación I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION luz I-EXPLORATION y I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION porción I-EXPLORATION distal I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION iliaca I-EXPLORATION superficial I-EXPLORATION ipsilateral, I-EXPLORATION estando I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION femoral I-EXPLORATION común I-EXPLORATION permeable. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior, I-EXPLORATION se I-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION con I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION helicoidal I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION cuyos I-EXPLORATION hallazgos I-EXPLORATION son I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION defectos I-EXPLORATION de I-EXPLORATION repleción I-EXPLORATION en I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION pulmonares I-EXPLORATION lobares I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION lóbulos I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION arterias I-EXPLORATION pulmonares I-EXPLORATION principales, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION ni I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION dilatación I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION derecho. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION radiológicos I-EXPLORATION resultan I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tromboembolismo I-EXPLORATION pulmonar I-EXPLORATION (TEP) I-EXPLORATION masivo. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION TC I-EXPLORATION abdominal I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION la I-EXPLORATION extensión I-EXPLORATION caudal I-EXPLORATION del I-EXPLORATION trombo I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT recibe I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT heparina I-TREATMENT de I-TREATMENT bajo I-TREATMENT peso I-TREATMENT molecular I-TREATMENT subcutánea I-TREATMENT y I-TREATMENT presenta I-TREATMENT una I-TREATMENT evolución I-TREATMENT clínica I-TREATMENT favorable. I-TREATMENT Se B-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION trombofilia I-EXPLORATION encontrando I-EXPLORATION como I-EXPLORATION única I-EXPLORATION alteración I-EXPLORATION un I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION S I-EXPLORATION libre I-EXPLORATION antigénica I-EXPLORATION del I-EXPLORATION 19% I-EXPLORATION (valor I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION normal I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION 54%). I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS embarazo I-PRESENT_ILLNESS no I-PRESENT_ILLNESS controlado, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS una I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (G4A0V3), I-PRESENT_ILLNESS inmune I-PRESENT_ILLNESS a I-PRESENT_ILLNESS rubeola I-PRESENT_ILLNESS y I-PRESENT_ILLNESS toxoplasma. I-PRESENT_ILLNESS Exudado I-PRESENT_ILLNESS rectovaginal I-PRESENT_ILLNESS estreptocócico I-PRESENT_ILLNESS no I-PRESENT_ILLNESS recogido. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS gestacional I-PRESENT_ILLNESS estimada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS biometría I-PRESENT_ILLNESS es I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33-34 I-PRESENT_ILLNESS semanas. I-PRESENT_ILLNESS Recibe B-TREATMENT un I-TREATMENT ciclo I-TREATMENT de I-TREATMENT corticoides I-TREATMENT completo I-TREATMENT y I-TREATMENT precisa I-TREATMENT tratamiento I-TREATMENT por I-TREATMENT preeclampsia I-TREATMENT y I-TREATMENT edema I-TREATMENT agudo I-TREATMENT de I-TREATMENT pulmón. I-TREATMENT Se I-TREATMENT realiza I-TREATMENT una I-TREATMENT cesárea I-TREATMENT urgente I-TREATMENT por I-TREATMENT causa I-TREATMENT materna, I-TREATMENT con I-TREATMENT bolsa I-TREATMENT rota I-TREATMENT intraoperatoria I-TREATMENT y I-TREATMENT líquido I-TREATMENT amniótico I-TREATMENT claro. I-TREATMENT Test B-EVOLUTION de I-EVOLUTION Apgar I-EVOLUTION 7/9, I-EVOLUTION REA I-EVOLUTION III. I-EVOLUTION Peso I-EVOLUTION del I-EVOLUTION recién I-EVOLUTION nacido I-EVOLUTION (RN) I-EVOLUTION de I-EVOLUTION 1600 I-EVOLUTION g. I-EVOLUTION No I-EVOLUTION fue I-EVOLUTION tallado I-EVOLUTION por I-EVOLUTION inestabilidad I-EVOLUTION clínica. I-EVOLUTION Precisa B-DERIVED_FROM/TO traslado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO una I-DERIVED_FROM/TO Unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cuidados I-DERIVED_FROM/TO Intensivos I-DERIVED_FROM/TO Neonatales I-DERIVED_FROM/TO (UCIN) I-DERIVED_FROM/TO tipo I-DERIVED_FROM/TO IIIC I-DERIVED_FROM/TO a I-DERIVED_FROM/TO las I-DERIVED_FROM/TO 12 I-DERIVED_FROM/TO horas I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vida I-DERIVED_FROM/TO por I-DERIVED_FROM/TO un I-DERIVED_FROM/TO cuadro I-DERIVED_FROM/TO de I-DERIVED_FROM/TO enfermedad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO membrana I-DERIVED_FROM/TO hialina, I-DERIVED_FROM/TO hipertensión I-DERIVED_FROM/TO pulmonar I-DERIVED_FROM/TO grave I-DERIVED_FROM/TO e I-DERIVED_FROM/TO inestabilidad I-DERIVED_FROM/TO hemodinámica. I-DERIVED_FROM/TO En B-TREATMENT este I-TREATMENT centro I-TREATMENT precisa I-TREATMENT varios I-TREATMENT ciclos I-TREATMENT de I-TREATMENT antibioterapia I-TREATMENT por I-TREATMENT sepsis I-TREATMENT nosocomial I-TREATMENT y I-TREATMENT por I-TREATMENT sospecha I-TREATMENT de I-TREATMENT enterocolitis I-TREATMENT necrotizante I-TREATMENT no I-TREATMENT confirmada, I-TREATMENT y I-TREATMENT recibe I-TREATMENT una I-TREATMENT transfusión I-TREATMENT de I-TREATMENT concentrado I-TREATMENT de I-TREATMENT hematíes. I-TREATMENT Se B-EVOLUTION realiza I-EVOLUTION seguimiento I-EVOLUTION con I-EVOLUTION ecografías I-EVOLUTION cerebrales I-EVOLUTION seriadas, I-EVOLUTION sin I-EVOLUTION hallazgos I-EVOLUTION significativos. I-EVOLUTION Electroencefalografía I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION A B-DERIVED_FROM/TO los I-DERIVED_FROM/TO 26 I-DERIVED_FROM/TO días I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vida, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO una I-DERIVED_FROM/TO edad I-DERIVED_FROM/TO gestacional I-DERIVED_FROM/TO corregida I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 36+4 I-DERIVED_FROM/TO semanas, I-DERIVED_FROM/TO es I-DERIVED_FROM/TO trasladado I-DERIVED_FROM/TO de I-DERIVED_FROM/TO vuelta I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO centro. I-DERIVED_FROM/TO A B-EVOLUTION los I-EVOLUTION 38 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida, I-EVOLUTION se I-EVOLUTION objetiva I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION movimiento I-EVOLUTION espontáneo I-EVOLUTION del I-EVOLUTION brazo I-EVOLUTION derecho, I-EVOLUTION con I-EVOLUTION un I-EVOLUTION reflejo I-EVOLUTION de I-EVOLUTION Moro I-EVOLUTION asimétrico I-EVOLUTION y I-EVOLUTION escasa I-EVOLUTION prensión I-EVOLUTION palmar, I-EVOLUTION junto I-EVOLUTION con I-EVOLUTION tumefacción I-EVOLUTION y I-EVOLUTION mínimo I-EVOLUTION eritema I-EVOLUTION del I-EVOLUTION hombro I-EVOLUTION derecho, I-EVOLUTION que I-EVOLUTION resulta I-EVOLUTION doloroso, I-EVOLUTION con I-EVOLUTION llanto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION palpación I-EVOLUTION y I-EVOLUTION a I-EVOLUTION la I-EVOLUTION movilización. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION articular I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION derrame I-EXPLORATION articular I-EXPLORATION leve-moderado, I-EXPLORATION hiperecogénico I-EXPLORATION y I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION derrame I-EXPLORATION complicado. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT punción I-TREATMENT y I-TREATMENT drenaje I-TREATMENT con I-TREATMENT aguja I-TREATMENT fina I-TREATMENT sin I-TREATMENT incidencias, I-TREATMENT obteniendo I-TREATMENT 2 I-TREATMENT ml I-TREATMENT de I-TREATMENT líquido I-TREATMENT hemopurulento I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT cefotaxima I-TREATMENT y I-TREATMENT cloxacilina I-TREATMENT intravenosa. I-TREATMENT Tras B-EVOLUTION el I-EVOLUTION drenaje I-EVOLUTION se I-EVOLUTION reduce I-EVOLUTION la I-EVOLUTION tumefacción I-EVOLUTION si I-EVOLUTION bien I-EVOLUTION persiste I-EVOLUTION una I-EVOLUTION asimetría I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tamaño I-EVOLUTION del I-EVOLUTION hombro I-EVOLUTION derecho I-EVOLUTION respecto I-EVOLUTION al I-EVOLUTION izquierdo. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 48 I-EVOLUTION horas I-EVOLUTION se I-EVOLUTION confirma I-EVOLUTION que I-EVOLUTION crece I-EVOLUTION E. I-EVOLUTION coli I-EVOLUTION sin I-EVOLUTION resistencias I-EVOLUTION en I-EVOLUTION el I-EVOLUTION antibiograma, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION suspende I-EVOLUTION la I-EVOLUTION cloxacilina, I-EVOLUTION manteniendo I-EVOLUTION la I-EVOLUTION cefotaxima I-EVOLUTION en I-EVOLUTION monoterapia. I-EVOLUTION A B-EXPLORATION los I-EXPLORATION cinco I-EXPLORATION días I-EXPLORATION de I-EXPLORATION tratamiento I-EXPLORATION intravenoso, I-EXPLORATION se I-EXPLORATION obtiene I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION que I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 14, I-EXPLORATION 6 I-EXPLORATION mg/dl, I-EXPLORATION a I-EXPLORATION pesar I-EXPLORATION de I-EXPLORATION no I-EXPLORATION presentar I-EXPLORATION empeoramiento I-EXPLORATION clínico I-EXPLORATION del I-EXPLORATION hombro. I-EXPLORATION Se I-EXPLORATION repite I-EXPLORATION de I-EXPLORATION nuevo I-EXPLORATION la I-EXPLORATION ecografía, I-EXPLORATION que I-EXPLORATION evidencia I-EXPLORATION un I-EXPLORATION mínimo I-EXPLORATION derrame I-EXPLORATION articular I-EXPLORATION y I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION abscesificada I-EXPLORATION incipiente I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION capsular. I-EXPLORATION Se B-TREATMENT realiza I-TREATMENT un I-TREATMENT nuevo I-TREATMENT drenaje I-TREATMENT guiado I-TREATMENT por I-TREATMENT ecografía. I-TREATMENT Se I-TREATMENT obtienen I-TREATMENT 0, I-TREATMENT 3 I-TREATMENT ml I-TREATMENT de I-TREATMENT muestra, I-TREATMENT en I-TREATMENT cuyo I-TREATMENT cultivo I-TREATMENT crece I-TREATMENT el I-TREATMENT mismo I-TREATMENT E. I-TREATMENT coli I-TREATMENT multisensible. I-TREATMENT A I-TREATMENT los I-TREATMENT siete I-TREATMENT días I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT se I-TREATMENT decide I-TREATMENT asociar I-TREATMENT amikacina I-TREATMENT intravenosa I-TREATMENT para I-TREATMENT potenciar I-TREATMENT el I-TREATMENT efecto I-TREATMENT antibiótico I-TREATMENT por I-TREATMENT aumento I-TREATMENT leve I-TREATMENT de I-TREATMENT la I-TREATMENT PCR. I-TREATMENT Tras B-EVOLUTION esto, I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 72 I-EVOLUTION horas I-EVOLUTION presenta I-EVOLUTION una I-EVOLUTION marcada I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION analítica. I-EVOLUTION Ante B-TREATMENT la I-TREATMENT buena I-TREATMENT evolución I-TREATMENT clínica I-TREATMENT y I-TREATMENT analítica, I-TREATMENT se I-TREATMENT decide I-TREATMENT pasar I-TREATMENT a I-TREATMENT cefuroxima-axetilo I-TREATMENT para I-TREATMENT completar I-TREATMENT tres I-TREATMENT semanas I-TREATMENT de I-TREATMENT antibiótico I-TREATMENT oral. I-TREATMENT I-TREATMENT Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS cuyos I-PRESENT_ILLNESS padres I-PRESENT_ILLNESS consultaron I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS del I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS porque I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS a I-PRESENT_ILLNESS diario I-PRESENT_ILLNESS un I-PRESENT_ILLNESS sueño I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS inquieto I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ronquido I-PRESENT_ILLNESS continuo, I-PRESENT_ILLNESS respiración I-PRESENT_ILLNESS bucal, I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS profusa I-PRESENT_ILLNESS y I-PRESENT_ILLNESS frecuentes I-PRESENT_ILLNESS despertares I-PRESENT_ILLNESS nocturnos. I-PRESENT_ILLNESS Sus I-PRESENT_ILLNESS ronquidos I-PRESENT_ILLNESS eran I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS ruidosos, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS se I-PRESENT_ILLNESS modificaban I-PRESENT_ILLNESS al I-PRESENT_ILLNESS cambiar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS postura I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acentuaban I-PRESENT_ILLNESS con I-PRESENT_ILLNESS los I-PRESENT_ILLNESS cuadros I-PRESENT_ILLNESS catarrales. I-PRESENT_ILLNESS Los I-PRESENT_ILLNESS padres I-PRESENT_ILLNESS dudaban I-PRESENT_ILLNESS de I-PRESENT_ILLNESS que I-PRESENT_ILLNESS pudiera I-PRESENT_ILLNESS tener I-PRESENT_ILLNESS apneas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS negaban I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cianosis. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS día I-PRESENT_ILLNESS el I-PRESENT_ILLNESS niño I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mostraba I-PRESENT_ILLNESS cansado, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS quejaba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS matutina I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS habitual I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tenía I-PRESENT_ILLNESS poco I-PRESENT_ILLNESS apetito. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS periodo I-PRESENT_ILLNESS escolar I-PRESENT_ILLNESS había I-PRESENT_ILLNESS padecido I-PRESENT_ILLNESS infecciones I-PRESENT_ILLNESS respiratorias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS repetida. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS el I-PRESENT_ILLNESS colegio, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS maestra I-PRESENT_ILLNESS les I-PRESENT_ILLNESS había I-PRESENT_ILLNESS comentado I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS prestaba I-PRESENT_ILLNESS atención I-PRESENT_ILLNESS y I-PRESENT_ILLNESS jugaba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS poco I-PRESENT_ILLNESS entusiasmo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS energía. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dormir I-PRESENT_ILLNESS del I-PRESENT_ILLNESS niño I-PRESENT_ILLNESS afectaba I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS calidad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS padres, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS lograban I-PRESENT_ILLNESS conseguir I-PRESENT_ILLNESS un I-PRESENT_ILLNESS sueño I-PRESENT_ILLNESS reparador I-PRESENT_ILLNESS debido I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS continuas I-PRESENT_ILLNESS interrupciones I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mostraban I-PRESENT_ILLNESS preocupados I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rendidos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION un I-EXPLORATION estancamiento I-EXPLORATION importante I-EXPLORATION y I-EXPLORATION progresivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION curva I-EXPLORATION ponderoestatural I-EXPLORATION desde I-EXPLORATION los I-EXPLORATION 18 I-EXPLORATION meses. I-EXPLORATION Presentaba I-EXPLORATION facies I-EXPLORATION adenoidea I-EXPLORATION con I-EXPLORATION hipertofia I-EXPLORATION amigdalar I-EXPLORATION grado I-EXPLORATION IV/IV I-EXPLORATION y I-EXPLORATION respiración I-EXPLORATION oral. I-EXPLORATION La I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION practicó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION polisomnográfico I-EXPLORATION nocturno I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Unidad I-EXPLORATION del I-EXPLORATION Sueño I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION SAOS I-EXPLORATION infantil I-EXPLORATION con I-EXPLORATION predominio I-EXPLORATION obstructivo. I-EXPLORATION Los I-EXPLORATION datos I-EXPLORATION registrados I-EXPLORATION pusieron I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION sueño I-EXPLORATION anómalo, I-EXPLORATION fragmentado I-EXPLORATION y I-EXPLORATION con I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION su I-EXPLORATION mantenimiento I-EXPLORATION por I-EXPLORATION eventos I-EXPLORATION respiratorios I-EXPLORATION obstructivos I-EXPLORATION en I-EXPLORATION número I-EXPLORATION patológico. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT consistente I-TREATMENT en I-TREATMENT adenoidectomía I-TREATMENT y I-TREATMENT radiofrecuencia I-TREATMENT inducida I-TREATMENT amigdalar. I-TREATMENT El B-EVOLUTION niño I-EVOLUTION mejoró, I-EVOLUTION presentando I-EVOLUTION remisión I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION nocturnos I-EVOLUTION y I-EVOLUTION diurnos I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION inmediata. I-EVOLUTION En I-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION recuperó I-EVOLUTION un I-EVOLUTION crecimiento I-EVOLUTION y I-EVOLUTION ganancia I-EVOLUTION ponderal I-EVOLUTION adecuados I-EVOLUTION y I-EVOLUTION se I-EVOLUTION vio I-EVOLUTION libre I-EVOLUTION de I-EVOLUTION los I-EVOLUTION procesos I-EVOLUTION respiratorios I-EVOLUTION de I-EVOLUTION repetición I-EVOLUTION que I-EVOLUTION venía I-EVOLUTION padeciendo I-EVOLUTION con I-EVOLUTION anterioridad. I-EVOLUTION La I-EVOLUTION familia I-EVOLUTION manifestó I-EVOLUTION estar I-EVOLUTION muy I-EVOLUTION contenta I-EVOLUTION con I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION niño I-EVOLUTION y, I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION también I-EVOLUTION es I-EVOLUTION importante, I-EVOLUTION todos I-EVOLUTION habían I-EVOLUTION vuelto I-EVOLUTION a I-EVOLUTION dormir I-EVOLUTION bien. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS alta, I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS odinofagia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS azitromicina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS genitales I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS dolorosas. I-PRESENT_ILLNESS Ausencia B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY menarquia, I-PAST_MEDICAL_HISTORY contacto I-PAST_MEDICAL_HISTORY sexual I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY traumatismos I-PAST_MEDICAL_HISTORY genitales I-PAST_MEDICAL_HISTORY previos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION genital I-EXPLORATION presenta I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION labios I-EXPLORATION mayores, I-EXPLORATION con I-EXPLORATION úlceras I-EXPLORATION profundas, I-EXPLORATION simétricas, I-EXPLORATION negruzcas, I-EXPLORATION la I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION ellas I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION longitudinal I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION labios I-EXPLORATION menores I-EXPLORATION y I-EXPLORATION varias I-EXPLORATION lesiones I-EXPLORATION satélites I-EXPLORATION menores I-EXPLORATION perivulvares, I-EXPLORATION recubiertas I-EXPLORATION algunas I-EXPLORATION de I-EXPLORATION material I-EXPLORATION fibrinoide I-EXPLORATION y I-EXPLORATION muy I-EXPLORATION dolorosa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION manipulación. I-EXPLORATION Resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION relevantes. I-EXPLORATION I-EXPLORATION En I-EXPLORATION las I-EXPLORATION pruebas I-EXPLORATION complementarias I-EXPLORATION destaca I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 22, I-EXPLORATION 38/µl I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 138, I-EXPLORATION 9 I-EXPLORATION mg/l, I-EXPLORATION con I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION sedimento I-EXPLORATION urinario I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION una I-EXPLORATION úlcera I-EXPLORATION genital I-EXPLORATION aguda, I-EXPLORATION planteamos I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION diferencial I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION infeccioso, I-EXPLORATION ya I-EXPLORATION sea I-EXPLORATION venéreo I-EXPLORATION (sífilis, I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simple, I-EXPLORATION linfogranuloma I-EXPLORATION venéreo, I-EXPLORATION chancroide) I-EXPLORATION o I-EXPLORATION no I-EXPLORATION venéreo I-EXPLORATION (virus I-EXPLORATION de I-EXPLORATION Epstein-Barr I-EXPLORATION [VEB], I-EXPLORATION citomegalovirus I-EXPLORATION [CMV], I-EXPLORATION Brucella), I-EXPLORATION y I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION no I-EXPLORATION infeccioso I-EXPLORATION (enfermedad I-EXPLORATION de I-EXPLORATION Crohn, I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Behçet, I-EXPLORATION pénfigo I-EXPLORATION vulgar, I-EXPLORATION liquen I-EXPLORATION escleroso, I-EXPLORATION aftosis I-EXPLORATION idiopática, I-EXPLORATION eritema I-EXPLORATION fijo I-EXPLORATION medicamentoso, I-EXPLORATION eritema I-EXPLORATION multiforme) I-EXPLORATION 1-3. I-EXPLORATION I-EXPLORATION Se B-TREATMENT ingresa I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT con I-TREATMENT analgesia, I-TREATMENT lubricante I-TREATMENT cicratizante I-TREATMENT y I-TREATMENT fomentos I-TREATMENT con I-TREATMENT suero I-TREATMENT fisiológico. I-TREATMENT Ante I-TREATMENT la I-TREATMENT evolución I-TREATMENT tórpida, I-TREATMENT se I-TREATMENT añaden I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT antibióticos I-TREATMENT de I-TREATMENT amplio I-TREATMENT espectro, I-TREATMENT aciclovir I-TREATMENT IV I-TREATMENT y I-TREATMENT corticoterapia I-TREATMENT oral, I-TREATMENT en I-TREATMENT espera I-TREATMENT de I-TREATMENT los I-TREATMENT resultados I-TREATMENT de I-TREATMENT los I-TREATMENT cultivos. I-TREATMENT El B-EXPLORATION urocultivo, I-EXPLORATION el I-EXPLORATION hemocultivo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION exudado I-EXPLORATION vaginal I-EXPLORATION y I-EXPLORATION cervical I-EXPLORATION (para I-EXPLORATION C. I-EXPLORATION trachomatis), I-EXPLORATION así I-EXPLORATION como I-EXPLORATION los I-EXPLORATION frotis I-EXPLORATION de I-EXPLORATION las I-EXPLORATION úlceras I-EXPLORATION genitales, I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION para I-EXPLORATION VEB, I-EXPLORATION CMV, I-EXPLORATION Brucella, I-EXPLORATION Rosa I-EXPLORATION de I-EXPLORATION Bengala, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana I-EXPLORATION y I-EXPLORATION lúes I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION solicita I-EXPLORATION determinación I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION del I-EXPLORATION virus I-EXPLORATION herpes I-EXPLORATION simple I-EXPLORATION tipos I-EXPLORATION I I-EXPLORATION y I-EXPLORATION II, I-EXPLORATION mediante I-EXPLORATION reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polimerasa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION la I-EXPLORATION úlcera I-EXPLORATION genital, I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION finalmente I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION Se B-EVOLUTION establece I-EVOLUTION el I-EVOLUTION diagnóstico, I-EVOLUTION por I-EVOLUTION exclusión, I-EVOLUTION de I-EVOLUTION úlcera I-EVOLUTION de I-EVOLUTION Lipschütz I-EVOLUTION en I-EVOLUTION su I-EVOLUTION forma I-EVOLUTION gangrenosa I-EVOLUTION y I-EVOLUTION se I-EVOLUTION decide I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION de I-EVOLUTION ingreso, I-EVOLUTION persistiendo I-EVOLUTION las I-EVOLUTION ulceraciones I-EVOLUTION múltiples I-EVOLUTION con I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION tejido, I-EVOLUTION sin I-EVOLUTION aspecto I-EVOLUTION inflamatorio I-EVOLUTION y I-EVOLUTION con I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION cicatrización, I-EVOLUTION en I-EVOLUTION las I-EVOLUTION más I-EVOLUTION externas, I-EVOLUTION sin I-EVOLUTION apreciarse I-EVOLUTION retracción I-EVOLUTION de I-EVOLUTION las I-EVOLUTION mucosas I-EVOLUTION genitales I-EVOLUTION ni I-EVOLUTION secreciones I-EVOLUTION vaginales. I-EVOLUTION I-EVOLUTION El I-EVOLUTION cuadro I-EVOLUTION estaba I-EVOLUTION casi I-EVOLUTION totalmente I-EVOLUTION resuelto I-EVOLUTION a I-EVOLUTION las I-EVOLUTION siete I-EVOLUTION semanas I-EVOLUTION del I-EVOLUTION diagnóstico. I-EVOLUTION I-EVOLUTION Presentamos B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY caso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY niña I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diez I-PAST_MEDICAL_HISTORY días I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY chino, I-PAST_MEDICAL_HISTORY con B-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS °C I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología. I-PRESENT_ILLNESS Alimentada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS lactancia I-PRESENT_ILLNESS artificial. I-PRESENT_ILLNESS Sin B-FAMILY_HISTORY ambiente I-FAMILY_HISTORY epidémico I-FAMILY_HISTORY familiar. I-FAMILY_HISTORY I-FAMILY_HISTORY Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY mantenido I-PAST_MEDICAL_HISTORY controles I-PAST_MEDICAL_HISTORY normales; I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY eutócico I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY infeccioso, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY precisó I-PAST_MEDICAL_HISTORY reanimación I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY pruebas I-PAST_MEDICAL_HISTORY metabólicas I-PAST_MEDICAL_HISTORY estaban I-PAST_MEDICAL_HISTORY pendientes I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ese I-PAST_MEDICAL_HISTORY momento. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION presentaba I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION sin I-EXPLORATION aspecto I-EXPLORATION séptico, I-EXPLORATION siendo I-EXPLORATION normal I-EXPLORATION por I-EXPLORATION aparatos. I-EXPLORATION I-EXPLORATION En B-TREATMENT Urgencias I-TREATMENT se I-TREATMENT inicia I-TREATMENT protocolo I-TREATMENT de I-TREATMENT fiebre I-TREATMENT sin I-TREATMENT foco I-TREATMENT en I-TREATMENT paciente I-TREATMENT neonatal I-TREATMENT (analítica I-TREATMENT sanguínea, I-TREATMENT urinaria I-TREATMENT y I-TREATMENT de I-TREATMENT líquido I-TREATMENT cefalorraquídeo I-TREATMENT normales) I-TREATMENT y I-TREATMENT se I-TREATMENT pauta I-TREATMENT antibioterapia I-TREATMENT empírica. I-TREATMENT I-TREATMENT Permanece B-EVOLUTION afebril I-EVOLUTION desde I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION ingreso I-EVOLUTION y I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION alta, I-EVOLUTION sin I-EVOLUTION incidencias I-EVOLUTION salvo I-EVOLUTION por I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION exantema I-EVOLUTION maculopapular I-EVOLUTION al I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION ingreso, I-EVOLUTION que I-EVOLUTION remite I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION espontánea I-EVOLUTION en I-EVOLUTION las I-EVOLUTION siguientes I-EVOLUTION 24-48 I-EVOLUTION horas. I-EVOLUTION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT viriasis, I-TREATMENT y I-TREATMENT una I-TREATMENT vez I-TREATMENT que I-TREATMENT se I-TREATMENT confirman I-TREATMENT los I-TREATMENT resultados I-TREATMENT definitivos I-TREATMENT de I-TREATMENT los I-TREATMENT cultivos I-TREATMENT (negativos), I-TREATMENT se I-TREATMENT suspende I-TREATMENT la I-TREATMENT antibioterapia. I-TREATMENT Se B-EVOLUTION decide I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION I-EVOLUTION Dos I-EVOLUTION días I-EVOLUTION después, I-EVOLUTION acude I-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Urgencias I-EVOLUTION por I-EVOLUTION un I-EVOLUTION exantema I-EVOLUTION de I-EVOLUTION un I-EVOLUTION día I-EVOLUTION de I-EVOLUTION evolución, I-EVOLUTION generalizado, I-EVOLUTION a I-EVOLUTION expensas I-EVOLUTION de I-EVOLUTION elementos I-EVOLUTION “en I-EVOLUTION diana” I-EVOLUTION con I-EVOLUTION aclaramiento I-EVOLUTION central, I-EVOLUTION sobreelevados I-EVOLUTION y I-EVOLUTION confluyentes. I-EVOLUTION Leve B-EXPLORATION coloración I-EXPLORATION amoratada, I-EXPLORATION más I-EXPLORATION intensa I-EXPLORATION en I-EXPLORATION miembros I-EXPLORATION inferiores, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION borra I-EXPLORATION parcialmente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión, I-EXPLORATION sin I-EXPLORATION petequias. I-EXPLORATION Como I-EXPLORATION única I-EXPLORATION clínica I-EXPLORATION acompañante, I-EXPLORATION presentaba I-EXPLORATION deposiciones I-EXPLORATION líquidas I-EXPLORATION escasas. I-EXPLORATION I-EXPLORATION Se B-EVOLUTION mantuvo I-EVOLUTION en I-EVOLUTION observación I-EVOLUTION durante I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION y, I-EVOLUTION ante I-EVOLUTION la I-EVOLUTION no I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION y I-EVOLUTION el I-EVOLUTION buen I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION el I-EVOLUTION alta. I-EVOLUTION I-EVOLUTION Tras I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION en I-EVOLUTION domicilio, I-EVOLUTION acude I-EVOLUTION nuevamente I-EVOLUTION por I-EVOLUTION shock I-EVOLUTION hipovolémico I-EVOLUTION secundario I-EVOLUTION a I-EVOLUTION un I-EVOLUTION cuadro I-EVOLUTION de I-EVOLUTION diarrea I-EVOLUTION abundante I-EVOLUTION desde I-EVOLUTION 18 I-EVOLUTION horas I-EVOLUTION antes, I-EVOLUTION sin I-EVOLUTION vómitos I-EVOLUTION ni I-EVOLUTION rechazo I-EVOLUTION de I-EVOLUTION tomas. I-EVOLUTION Las B-EXPLORATION lesiones I-EXPLORATION cutáneas I-EXPLORATION habían I-EXPLORATION desaparecido. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION coprocultivo I-EXPLORATION no I-EXPLORATION se I-EXPLORATION aisló I-EXPLORATION germen I-EXPLORATION y I-EXPLORATION la I-EXPLORATION virología I-EXPLORATION fecal I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION Recibió B-TREATMENT reposición I-TREATMENT con I-TREATMENT fluidoterapia I-TREATMENT intravenosa, I-TREATMENT que I-TREATMENT fue I-TREATMENT retirándose I-TREATMENT según I-TREATMENT mejoraba I-TREATMENT la I-TREATMENT tolerancia I-TREATMENT oral I-TREATMENT con I-TREATMENT leche I-TREATMENT hidrolizada I-TREATMENT y I-TREATMENT tras I-TREATMENT descartar I-TREATMENT afectación I-TREATMENT intestinal. I-TREATMENT Las B-EVOLUTION deposiciones I-EVOLUTION mejoraron I-EVOLUTION progresivamente I-EVOLUTION y I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION En I-EVOLUTION controles I-EVOLUTION sucesivos I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION adecuada I-EVOLUTION ganancia I-EVOLUTION ponderoestatural, I-EVOLUTION con I-EVOLUTION deposiciones I-EVOLUTION de I-EVOLUTION consistencia I-EVOLUTION normal. I-EVOLUTION Mantuvo I-EVOLUTION la I-EVOLUTION alimentación I-EVOLUTION con I-EVOLUTION fórmula I-EVOLUTION hidrolizada I-EVOLUTION durante I-EVOLUTION unas I-EVOLUTION semanas, I-EVOLUTION con I-EVOLUTION posterior I-EVOLUTION tolerancia I-EVOLUTION de I-EVOLUTION fórmula I-EVOLUTION artificial, I-EVOLUTION sin I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION nuevas I-EVOLUTION lesiones I-EVOLUTION cutáneas. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS del I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY de B-PRESENT_ILLNESS 21 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad. I-PRESENT_ILLNESS Refiere I-PRESENT_ILLNESS la I-PRESENT_ILLNESS madre I-PRESENT_ILLNESS que I-PRESENT_ILLNESS inicia I-PRESENT_ILLNESS su I-PRESENT_ILLNESS padecimiento I-PRESENT_ILLNESS actual I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS detectar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manera I-PRESENT_ILLNESS súbita I-PRESENT_ILLNESS alteración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS descrito I-PRESENT_ILLNESS como I-PRESENT_ILLNESS “arrastrando I-PRESENT_ILLNESS el I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS izquierdo”; I-PRESENT_ILLNESS esto I-PRESENT_ILLNESS no I-PRESENT_ILLNESS le I-PRESENT_ILLNESS causaba I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS equilibrio, I-PRESENT_ILLNESS caída I-PRESENT_ILLNESS o I-PRESENT_ILLNESS inhabilidad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS desplazarse. I-PRESENT_ILLNESS Así I-PRESENT_ILLNESS mismo, I-PRESENT_ILLNESS nota I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS del I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS ipsilateral I-PRESENT_ILLNESS con I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS discapacidad I-PRESENT_ILLNESS para I-PRESENT_ILLNESS manipular I-PRESENT_ILLNESS objetos, I-PRESENT_ILLNESS caracterizada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pasarlos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS mano, I-PRESENT_ILLNESS niega I-PRESENT_ILLNESS el I-PRESENT_ILLNESS poder I-PRESENT_ILLNESS localizar I-PRESENT_ILLNESS con I-PRESENT_ILLNESS exactitud I-PRESENT_ILLNESS si I-PRESENT_ILLNESS es I-PRESENT_ILLNESS de I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS proximal I-PRESENT_ILLNESS o I-PRESENT_ILLNESS distal; I-PRESENT_ILLNESS esto I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manera I-PRESENT_ILLNESS constante, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS ceder, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS horario I-PRESENT_ILLNESS o I-PRESENT_ILLNESS calendario, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS atenuantes, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS exacerbantes I-PRESENT_ILLNESS o I-PRESENT_ILLNESS acompañantes. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION neurológica I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION funciones I-EXPLORATION superiores I-EXPLORATION preservadas, I-EXPLORATION nervios I-EXPLORATION craneales I-EXPLORATION sin I-EXPLORATION alteraciones, I-EXPLORATION sistema I-EXPLORATION sensorial I-EXPLORATION —lo I-EXPLORATION posible I-EXPLORATION de I-EXPLORATION valorar I-EXPLORATION por I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION cooperación I-EXPLORATION del I-EXPLORATION paciente— I-EXPLORATION normal, I-EXPLORATION a I-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION muscular I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION las I-EXPLORATION cuatro I-EXPLORATION extremidades I-EXPLORATION simétricas I-EXPLORATION y I-EXPLORATION eutróficas I-EXPLORATION con I-EXPLORATION tono I-EXPLORATION muscular I-EXPLORATION sin I-EXPLORATION alteraciones, I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION activa I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION fuerza I-EXPLORATION 3/5 I-EXPLORATION en I-EXPLORATION porcion I-EXPLORATION distal I-EXPLORATION y I-EXPLORATION 4/5 I-EXPLORATION en I-EXPLORATION seccion I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION hemicuerpo I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION 5/5 I-EXPLORATION en I-EXPLORATION extremidades I-EXPLORATION de I-EXPLORATION hemicuerpo I-EXPLORATION derecho. I-EXPLORATION No I-EXPLORATION presenta I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION mantener I-EXPLORATION la I-EXPLORATION bipedestación I-EXPLORATION sin I-EXPLORATION apoyo. I-EXPLORATION La I-EXPLORATION marcha I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION sin I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION sustentación, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION contacto I-EXPLORATION simetrica I-EXPLORATION bilateral, I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION discreta I-EXPLORATION rotación I-EXPLORATION externa I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION miembro I-EXPLORATION pelvico I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION caída I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION golpeando I-EXPLORATION el I-EXPLORATION suelo I-EXPLORATION con I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION planta I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION de I-EXPLORATION oscilación, I-EXPLORATION con I-EXPLORATION movimientos I-EXPLORATION asimétricos, I-EXPLORATION acompañados I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION incompleta I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION izquierda. I-EXPLORATION Puede I-EXPLORATION realizar I-EXPLORATION la I-EXPLORATION marcha I-EXPLORATION sin I-EXPLORATION apoyo. I-EXPLORATION Reflejos I-EXPLORATION primitivos I-EXPLORATION ausentes, I-EXPLORATION Babinski I-EXPLORATION negativo, I-EXPLORATION reflejo I-EXPLORATION braquioradial I-EXPLORATION 2/4, I-EXPLORATION bicipital I-EXPLORATION 2/4, I-EXPLORATION tricipital I-EXPLORATION 2/4, I-EXPLORATION rotulaino I-EXPLORATION 2/4, I-EXPLORATION aquileo I-EXPLORATION 2/4 I-EXPLORATION bilaterales. I-EXPLORATION Rigidez I-EXPLORATION nucal, I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Brudsinski I-EXPLORATION y I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Kernig I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitan I-EXPLORATION radiografías I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION y I-EXPLORATION cadera, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION reportan I-EXPLORATION como I-EXPLORATION normales I-EXPLORATION y I-EXPLORATION se I-EXPLORATION le I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION cráneo, I-EXPLORATION sin I-EXPLORATION encontrar I-EXPLORATION datos I-EXPLORATION radiográficos I-EXPLORATION sugestivos I-EXPLORATION del I-EXPLORATION origen I-EXPLORATION de I-EXPLORATION la I-EXPLORATION causa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sintomatología, I-EXPLORATION razón I-EXPLORATION por I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION le I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION contrastada I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION y I-EXPLORATION médula I-EXPLORATION espinal, I-EXPLORATION encontrándose I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION intramedular I-EXPLORATION heterogénea I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION desde I-EXPLORATION C3 I-EXPLORATION hasta I-EXPLORATION T3 I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION hipointensas I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION zonas I-EXPLORATION hiperintensas I-EXPLORATION en I-EXPLORATION T2 I-EXPLORATION que I-EXPLORATION involucran I-EXPLORATION el I-EXPLORATION espesor I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION medular I-EXPLORATION y I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION mide I-EXPLORATION 7, I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION y I-EXPLORATION oblitera I-EXPLORATION el I-EXPLORATION espacio I-EXPLORATION subaracnoideo. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION preparó I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia, I-EXPLORATION extrayéndose I-EXPLORATION muestras I-EXPLORATION para I-EXPLORATION análisis I-EXPLORATION por I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION Servicio I-EXPLORATION de I-EXPLORATION Patología, I-EXPLORATION que I-EXPLORATION observó I-EXPLORATION neoplasia I-EXPLORATION fibrilar I-EXPLORATION compuesta I-EXPLORATION de I-EXPLORATION hipercelularidad I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION astrocítica I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION hemorragia; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION necrosis I-EXPLORATION ni I-EXPLORATION hiperplasia I-EXPLORATION vascular, I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION células I-EXPLORATION irregulares, I-EXPLORATION cromatina I-EXPLORATION grumosa I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION ninguna I-EXPLORATION mitosis, I-EXPLORATION realizándose I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION astrocitoma I-EXPLORATION fibrilar I-EXPLORATION difuso I-EXPLORATION grado I-EXPLORATION II I-EXPLORATION de I-EXPLORATION la I-EXPLORATION OMS I-EXPLORATION de I-EXPLORATION localización I-EXPLORATION intramedular. I-EXPLORATION I-EXPLORATION Posteriormente B-DERIVED_FROM/TO se I-DERIVED_FROM/TO traslada I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO a I-DERIVED_FROM/TO un I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO especializado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO patología I-DERIVED_FROM/TO en I-DERIVED_FROM/TO los I-DERIVED_FROM/TO EE. I-DERIVED_FROM/TO UU., I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realiza I-DERIVED_FROM/TO la I-DERIVED_FROM/TO extracción I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO mayor I-DERIVED_FROM/TO cantidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tumoración, I-DERIVED_FROM/TO aproximadamente I-DERIVED_FROM/TO un I-DERIVED_FROM/TO 80-90%, I-DERIVED_FROM/TO y I-DERIVED_FROM/TO se I-DERIVED_FROM/TO envía I-DERIVED_FROM/TO la I-DERIVED_FROM/TO muestra I-DERIVED_FROM/TO a I-DERIVED_FROM/TO patología I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO encuentran I-DERIVED_FROM/TO dos I-DERIVED_FROM/TO mitosis I-DERIVED_FROM/TO positivas, I-DERIVED_FROM/TO reclasificando I-DERIVED_FROM/TO la I-DERIVED_FROM/TO tumoración I-DERIVED_FROM/TO en I-DERIVED_FROM/TO un I-DERIVED_FROM/TO grado I-DERIVED_FROM/TO III I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO OMS. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Niña B-PRESENT_ILLNESS previamente I-PRESENT_ILLNESS sana, 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 está I-PAST_MEDICAL_HISTORY correctamente I-PAST_MEDICAL_HISTORY vacunada. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS tiene I-PRESENT_ILLNESS un I-PRESENT_ILLNESS primer I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS parotídea. I-PRESENT_ILLNESS Cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS parotídea I-PRESENT_ILLNESS que I-PRESENT_ILLNESS borraba I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ángulo I-PRESENT_ILLNESS mandibular, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS inflamatorios I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS supuración I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS conducto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Stenon. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION leucocitosis I-EXPLORATION (19 I-EXPLORATION 700/mm3) I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (65%), I-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 45 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION amilasa I-EXPLORATION de I-EXPLORATION 881 I-EXPLORATION U/l. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION inflamación I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION parótidas, I-EXPLORATION sin I-EXPLORATION colecciones. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT ingreso I-TREATMENT para I-TREATMENT antibioterapia I-TREATMENT intravenosa I-TREATMENT con I-TREATMENT amoxicilina-clavulánico, I-TREATMENT analgesia I-TREATMENT y I-TREATMENT antiinflamatorios. I-TREATMENT Dada B-EVOLUTION la I-EVOLUTION buena I-EVOLUTION evolución, I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION tres I-EVOLUTION días I-EVOLUTION después I-EVOLUTION para I-EVOLUTION continuar I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION ambulatoria. I-EVOLUTION I-EVOLUTION Posteriormente I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION sucesivos I-EVOLUTION episodios I-EVOLUTION (cuatro I-EVOLUTION más) I-EVOLUTION de I-EVOLUTION características I-EVOLUTION clínicas I-EVOLUTION y I-EVOLUTION analíticas I-EVOLUTION similares, I-EVOLUTION que I-EVOLUTION han I-EVOLUTION sido I-EVOLUTION tratados I-EVOLUTION con I-EVOLUTION antibioterapia I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION ambulatoria I-EVOLUTION con I-EVOLUTION buena I-EVOLUTION evolución. I-EVOLUTION Son I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION de I-EVOLUTION duración I-EVOLUTION aproximadamente, I-EVOLUTION bilaterales, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION predominio I-EVOLUTION de I-EVOLUTION afectación I-EVOLUTION en I-EVOLUTION el I-EVOLUTION lado I-EVOLUTION izquierdo. I-EVOLUTION I-EVOLUTION Es I-EVOLUTION seguida I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION de I-EVOLUTION Infectología I-EVOLUTION Pediátrica I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION completado I-EVOLUTION el I-EVOLUTION estudio. I-EVOLUTION Todas B-EXPLORATION las I-EXPLORATION serologías I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION reumatoideas I-EXPLORATION son I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION repiten I-EXPLORATION ecografías I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION el I-EXPLORATION aumento I-EXPLORATION glandular, I-EXPLORATION con I-EXPLORATION fotos I-EXPLORATION heterogéneos I-EXPLORATION hipoecogénicos. I-EXPLORATION En B-EVOLUTION la I-EVOLUTION actualidad I-EVOLUTION sin I-EVOLUTION nuevos I-EVOLUTION episodios. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS diagnostica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS neumonía I-PRESENT_ILLNESS con I-PRESENT_ILLNESS condensación I-PRESENT_ILLNESS parenquimatosa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS lóbulo I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY hay I-PAST_MEDICAL_HISTORY datos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Embarazo I-PAST_MEDICAL_HISTORY controlado I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY incidencias, I-PAST_MEDICAL_HISTORY nacida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 38 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad I-PAST_MEDICAL_HISTORY gestacional, I-PAST_MEDICAL_HISTORY cesárea I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY falta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY progresión. I-PAST_MEDICAL_HISTORY Peso I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2870 I-PAST_MEDICAL_HISTORY g. I-PAST_MEDICAL_HISTORY Vacunas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY desarrollo I-PAST_MEDICAL_HISTORY psicomotor I-PAST_MEDICAL_HISTORY normal. I-PAST_MEDICAL_HISTORY Refieren I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY primer I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY bebe I-PAST_MEDICAL_HISTORY bastantes I-PAST_MEDICAL_HISTORY líquidos, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diuresis I-PAST_MEDICAL_HISTORY abundante. I-PAST_MEDICAL_HISTORY Peso I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY talla I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY percentil I-PAST_MEDICAL_HISTORY 50. I-PAST_MEDICAL_HISTORY Refieren I-PAST_MEDICAL_HISTORY avidez I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY sal I-PAST_MEDICAL_HISTORY (se I-PAST_MEDICAL_HISTORY bebe I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY agua I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY playa I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY avidez I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY prefiere I-PAST_MEDICAL_HISTORY alimentos I-PAST_MEDICAL_HISTORY salados) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY calambres I-PAST_MEDICAL_HISTORY musculares I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ocasiones. I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY hay I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY a I-FAMILY_HISTORY destacar. I-FAMILY_HISTORY I-FAMILY_HISTORY Peso B-EXPLORATION 12, I-EXPLORATION 4 I-EXPLORATION kg I-EXPLORATION (p10-25), I-EXPLORATION talla I-EXPLORATION 95 I-EXPLORATION cm I-EXPLORATION (p50), I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION 100/60 I-EXPLORATION mmHg, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION 90 I-EXPLORATION lpm, I-EXPLORATION frecuencia I-EXPLORATION respiratoria I-EXPLORATION 28 I-EXPLORATION rpm, I-EXPLORATION temperatura I-EXPLORATION 38, I-EXPLORATION 3 I-EXPLORATION oC. I-EXPLORATION Regular I-EXPLORATION aspecto I-EXPLORATION general I-EXPLORATION por I-EXPLORATION facies I-EXPLORATION febril, I-EXPLORATION decaída I-EXPLORATION y I-EXPLORATION discreta I-EXPLORATION sequedad I-EXPLORATION de I-EXPLORATION mucosas. I-EXPLORATION Cráneo I-EXPLORATION normal. I-EXPLORATION Signos I-EXPLORATION meníngeos I-EXPLORATION negativos. I-EXPLORATION No I-EXPLORATION presenta I-EXPLORATION exantemas I-EXPLORATION ni I-EXPLORATION petequias. I-EXPLORATION Otoscopia I-EXPLORATION y I-EXPLORATION orofaringe I-EXPLORATION normal. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION entrada I-EXPLORATION de I-EXPLORATION aire I-EXPLORATION en I-EXPLORATION base I-EXPLORATION derecha. I-EXPLORATION Abdomen I-EXPLORATION blando I-EXPLORATION y I-EXPLORATION depresible, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION palpan I-EXPLORATION masas, I-EXPLORATION ni I-EXPLORATION visceromegalias. I-EXPLORATION Genitales I-EXPLORATION normales I-EXPLORATION de I-EXPLORATION niña. I-EXPLORATION Región I-EXPLORATION lumbosacra I-EXPLORATION normal. I-EXPLORATION Resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION En I-EXPLORATION los I-EXPLORATION análisis I-EXPLORATION realizados I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION infección I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION 000 I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION (neutrófilos I-EXPLORATION 87%) I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION (PCR) I-EXPLORATION de I-EXPLORATION 200 I-EXPLORATION mg/l, I-EXPLORATION pero I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION hipopotasemia I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 2 I-EXPLORATION mmol/l I-EXPLORATION con I-EXPLORATION Na I-EXPLORATION 129 I-EXPLORATION mmol/l, I-EXPLORATION Cl I-EXPLORATION 92, I-EXPLORATION 2 I-EXPLORATION mmol/l, I-EXPLORATION Ca I-EXPLORATION 9, I-EXPLORATION 5 I-EXPLORATION mg/dl, I-EXPLORATION Mg I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION mg/dl, I-EXPLORATION Cr I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION alcalosis I-EXPLORATION metabólica I-EXPLORATION (pH I-EXPLORATION 7, I-EXPLORATION 50 I-EXPLORATION y I-EXPLORATION bicarbonato I-EXPLORATION 24, I-EXPLORATION 1 I-EXPLORATION mmol/l). I-EXPLORATION Renina I-EXPLORATION y I-EXPLORATION aldosterona I-EXPLORATION elevadas. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION orina: I-EXPLORATION densidad I-EXPLORATION 1005, I-EXPLORATION PH I-EXPLORATION 8, I-EXPLORATION sedimento I-EXPLORATION normal. I-EXPLORATION Iones I-EXPLORATION en I-EXPLORATION orina: I-EXPLORATION K I-EXPLORATION 17, I-EXPLORATION 5 I-EXPLORATION mEq/l, I-EXPLORATION Cl I-EXPLORATION 10 I-EXPLORATION mEq/l, I-EXPLORATION Na I-EXPLORATION 7 I-EXPLORATION mEq/l; I-EXPLORATION Na I-EXPLORATION orina/K I-EXPLORATION orina I-EXPLORATION 0, I-EXPLORATION 4. I-EXPLORATION Excreciones I-EXPLORATION fraccionadas I-EXPLORATION de I-EXPLORATION K I-EXPLORATION elevadas I-EXPLORATION (8,32%), I-EXPLORATION de I-EXPLORATION Na I-EXPLORATION (0,06%) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION Cl I-EXPLORATION (0,11%) I-EXPLORATION en I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION normalidad. I-EXPLORATION Ca/Cr I-EXPLORATION 0, I-EXPLORATION 56 I-EXPLORATION mg/mg. I-EXPLORATION Aclaramiento I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION normal, I-EXPLORATION filtrado I-EXPLORATION glomerular I-EXPLORATION 104, I-EXPLORATION 50 I-EXPLORATION ml/min/1, I-EXPLORATION 73m2, I-EXPLORATION I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION renal I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION en I-EXPLORATION el I-EXPLORATION electrocardiograma I-EXPLORATION (ECG) I-EXPLORATION se I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION hipopotasemia I-EXPLORATION por I-EXPLORATION prolongación I-EXPLORATION del I-EXPLORATION PR I-EXPLORATION en I-EXPLORATION el I-EXPLORATION ECG. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT neumonía I-TREATMENT basal I-TREATMENT derecha, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT cefuroxima I-TREATMENT intravenosa I-TREATMENT y B-EVOLUTION de I-EVOLUTION modo I-EVOLUTION progresivo I-EVOLUTION fue I-EVOLUTION mejorando I-EVOLUTION clínica, I-EVOLUTION radiológica I-EVOLUTION y I-EVOLUTION analíticamente. I-EVOLUTION I-EVOLUTION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT tubulopatía, I-TREATMENT dada I-TREATMENT la I-TREATMENT hipopotasemia I-TREATMENT y I-TREATMENT la I-TREATMENT pérdida I-TREATMENT urinaria I-TREATMENT elevada I-TREATMENT de I-TREATMENT este I-TREATMENT electrolito, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT suplementos I-TREATMENT intravenosos I-TREATMENT de I-TREATMENT potasio I-TREATMENT y B-EVOLUTION se I-EVOLUTION corrigieron I-EVOLUTION poco I-EVOLUTION a I-EVOLUTION poco I-EVOLUTION las I-EVOLUTION cifras, I-EVOLUTION siendo I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION el I-EVOLUTION K I-EVOLUTION de I-EVOLUTION 3, I-EVOLUTION 9 I-EVOLUTION mmol/l. I-EVOLUTION I-EVOLUTION Se I-EVOLUTION controló I-EVOLUTION en I-EVOLUTION consultas I-EVOLUTION de I-EVOLUTION Nefrología I-EVOLUTION Pediátrica, I-EVOLUTION confirmándose I-EVOLUTION la I-EVOLUTION tubulopatía I-EVOLUTION genéticamente I-EVOLUTION (síndrome I-EVOLUTION de I-EVOLUTION Gitelman) I-EVOLUTION y I-EVOLUTION manteniendo I-EVOLUTION adecuados I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION K I-EVOLUTION sérico I-EVOLUTION con B-TREATMENT suplementos I-TREATMENT orales I-TREATMENT y I-TREATMENT dieta I-TREATMENT rica I-TREATMENT en I-TREATMENT este I-TREATMENT electrolito. I-TREATMENT I-TREATMENT La B-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION portadora I-EXPLORATION de I-EXPLORATION las I-EXPLORATION variaciones I-EXPLORATION p. I-EXPLORATION Gly741Arg I-EXPLORATION y I-EXPLORATION p. I-EXPLORATION Cys994Tyr, I-EXPLORATION ambas I-EXPLORATION en I-EXPLORATION heterocigosis, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION SLC12A3, I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION brazo I-EXPLORATION largo I-EXPLORATION del I-EXPLORATION cromosoma I-EXPLORATION 16. I-EXPLORATION Transmisión I-EXPLORATION autosómica I-EXPLORATION recesiva. I-EXPLORATION I-EXPLORATION Nuestra B-TREATMENT paciente, I-TREATMENT desde I-TREATMENT su I-TREATMENT diagnóstico, I-TREATMENT recibe I-TREATMENT una I-TREATMENT dieta I-TREATMENT rica I-TREATMENT en I-TREATMENT potasio I-TREATMENT y I-TREATMENT magnesio I-TREATMENT y I-TREATMENT suplementos I-TREATMENT orales I-TREATMENT de I-TREATMENT potasio. I-TREATMENT Tras I-TREATMENT varios I-TREATMENT años I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT dada I-TREATMENT las I-TREATMENT altas I-TREATMENT dosis I-TREATMENT de I-TREATMENT suplementos I-TREATMENT orales I-TREATMENT de I-TREATMENT K I-TREATMENT (4, I-TREATMENT 3 I-TREATMENT mEq/kg/día) I-TREATMENT para I-TREATMENT mantener I-TREATMENT niveles I-TREATMENT séricos I-TREATMENT de I-TREATMENT K I-TREATMENT 3, I-TREATMENT 1-3, I-TREATMENT 5 I-TREATMENT mmol/l, I-TREATMENT se I-TREATMENT decide I-TREATMENT asociar I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT diuréticos I-TREATMENT ahorradores I-TREATMENT de I-TREATMENT potasio. I-TREATMENT I-TREATMENT En I-TREATMENT ocasiones, I-TREATMENT coincidiendo I-TREATMENT con I-TREATMENT episodios I-TREATMENT de I-TREATMENT diarrea I-TREATMENT y I-TREATMENT vómitos, I-TREATMENT presenta I-TREATMENT hipopotasemia I-TREATMENT sintomática, I-TREATMENT que I-TREATMENT precisa I-TREATMENT suplementos I-TREATMENT intravenosos I-TREATMENT de I-TREATMENT potasio. I-TREATMENT I-TREATMENT No I-TREATMENT hay I-TREATMENT datos I-TREATMENT de I-TREATMENT hipomagnesemia I-TREATMENT en I-TREATMENT ningún I-TREATMENT momento, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT no I-TREATMENT recibe I-TREATMENT suplementos I-TREATMENT de I-TREATMENT magnesio I-TREATMENT orales, I-TREATMENT solo I-TREATMENT una I-TREATMENT dieta I-TREATMENT rica I-TREATMENT en I-TREATMENT magnesio. I-TREATMENT I-TREATMENT Se B-EVOLUTION trata I-EVOLUTION de I-EVOLUTION una I-EVOLUTION enfermedad I-EVOLUTION de I-EVOLUTION carácter I-EVOLUTION permanente I-EVOLUTION con I-EVOLUTION evolución I-EVOLUTION y I-EVOLUTION pronóstico I-EVOLUTION favorables I-EVOLUTION si I-EVOLUTION se I-EVOLUTION cumple I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS cutáneas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS cuyo I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS coincidió I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS faringoamigdalitis I-PRESENT_ILLNESS tratada I-PRESENT_ILLNESS con I-PRESENT_ILLNESS amoxicilina. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS las I-PRESENT_ILLNESS últimas I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS vesículo-ampollosas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS artralgias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambos I-PRESENT_ILLNESS tobillos, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS impiden I-PRESENT_ILLNESS la I-PRESENT_ILLNESS deambulación. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destaca I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION purpúricas I-EXPLORATION palpables, I-EXPLORATION localizadas I-EXPLORATION en I-EXPLORATION piernas, I-EXPLORATION glúteos, I-EXPLORATION codos I-EXPLORATION y I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION manos, I-EXPLORATION acompañadas I-EXPLORATION de I-EXPLORATION ampollas I-EXPLORATION de I-EXPLORATION contenido I-EXPLORATION serohemorrágico. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION edema I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION izquierda, I-EXPLORATION pies I-EXPLORATION y I-EXPLORATION tobillos, I-EXPLORATION e I-EXPLORATION hiperemia I-EXPLORATION amigdalar I-EXPLORATION sin I-EXPLORATION exudados. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION exploraciones I-EXPLORATION complementarias I-EXPLORATION (hemograma, I-EXPLORATION bioquímica, I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION tira I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION orina) I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT sospecha I-TREATMENT de I-TREATMENT PSH I-TREATMENT con I-TREATMENT afectación I-TREATMENT sistémica, I-TREATMENT el I-TREATMENT paciente I-TREATMENT fue I-TREATMENT hospitalizado I-TREATMENT para I-TREATMENT iniciar I-TREATMENT tratamiento I-TREATMENT esteroideo I-TREATMENT (prednisona I-TREATMENT 2 I-TREATMENT mg/kg/día). I-TREATMENT La B-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION articulares, I-EVOLUTION siendo I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION hospitalización. I-EVOLUTION I-EVOLUTION Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS indurada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS externa I-PRESENT_ILLNESS del I-PRESENT_ILLNESS muslo, I-PRESENT_ILLNESS única, I-PRESENT_ILLNESS lineal, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dudosa I-PRESENT_ILLNESS adherencia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS planos I-PRESENT_ILLNESS profundos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Dicha B-TREATMENT lesión I-TREATMENT es I-TREATMENT extirpada I-TREATMENT y B-EXPLORATION Anatomía I-EXPLORATION Patológica I-EXPLORATION aporta I-EXPLORATION el I-EXPLORATION siguiente I-EXPLORATION informe: I-EXPLORATION “Paniculitits I-EXPLORATION neutrofílica I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION lobular I-EXPLORATION con I-EXPLORATION alta I-EXPLORATION proporción I-EXPLORATION de I-EXPLORATION esclerosis I-EXPLORATION periférica. I-EXPLORATION Existe I-EXPLORATION destrucción I-EXPLORATION masiva I-EXPLORATION de I-EXPLORATION adipocitos I-EXPLORATION con I-EXPLORATION extenso I-EXPLORATION granuloma I-EXPLORATION lipofágico, I-EXPLORATION todo I-EXPLORATION delimitado I-EXPLORATION por I-EXPLORATION tejido I-EXPLORATION conjuntivo I-EXPLORATION fibroso I-EXPLORATION abundante”. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION descripción I-EXPLORATION microscópica, I-EXPLORATION refiere I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION restos I-EXPLORATION intracelulares I-EXPLORATION PAS+ I-EXPLORATION y I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION tipo I-EXPLORATION Touton I-EXPLORATION escasas. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION inflamatorias I-EXPLORATION presentan I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION habituales I-EXPLORATION descartando I-EXPLORATION naturaleza I-EXPLORATION neoplásica. I-EXPLORATION Añaden I-EXPLORATION como I-EXPLORATION posibles I-EXPLORATION causas5-8: I-EXPLORATION I-EXPLORATION • I-EXPLORATION Reacción I-EXPLORATION tipo I-EXPLORATION autoeccematización I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION infección, I-EXPLORATION predominantemente I-EXPLORATION bacteriana8. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Esclerodermia I-EXPLORATION localizada I-EXPLORATION profunda I-EXPLORATION juvenil5, I-EXPLORATION aunque I-EXPLORATION en I-EXPLORATION esta I-EXPLORATION el I-EXPLORATION infiltrado I-EXPLORATION neutrofílico I-EXPLORATION suele I-EXPLORATION ser I-EXPLORATION menos I-EXPLORATION patente. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Lesiones I-EXPLORATION evolutivas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Weber I-EXPLORATION Christian. I-EXPLORATION I-EXPLORATION • I-EXPLORATION Paniculitis I-EXPLORATION asociada I-EXPLORATION al I-EXPLORATION déficit I-EXPLORATION de I-EXPLORATION α1-antitripsina. I-EXPLORATION I-EXPLORATION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que, B-PRESENT_ILLNESS sin I-PRESENT_ILLNESS recordar I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS previo, I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS dolorosa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS advertida I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS antes. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION dolorosa I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION × I-EXPLORATION 11 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION medio-distal I-EXPLORATION del I-EXPLORATION muslo I-EXPLORATION izquierdo. I-EXPLORATION La I-EXPLORATION extremidad I-EXPLORATION está I-EXPLORATION mínimamente I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION contralateral. I-EXPLORATION La I-EXPLORATION piel I-EXPLORATION presenta I-EXPLORATION coloración I-EXPLORATION y I-EXPLORATION temperatura I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION es I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION clínicos I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION del I-EXPLORATION fémur I-EXPLORATION izquierdo I-EXPLORATION que I-EXPLORATION evidencia I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION calcificada. I-EXPLORATION Posteriormente I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION ecografía I-EXPLORATION del I-EXPLORATION muslo, I-EXPLORATION que I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION oval I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION hiperecogénicas I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior I-EXPLORATION que I-EXPLORATION provocan I-EXPLORATION sombras I-EXPLORATION acústicas I-EXPLORATION posteriores, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION sugiere I-EXPLORATION un I-EXPLORATION diagnóstico I-EXPLORATION definitivo. I-EXPLORATION Para I-EXPLORATION concretar I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC), I-EXPLORATION que I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION calcificada I-EXPLORATION que I-EXPLORATION no I-EXPLORATION engloba I-EXPLORATION estructuras I-EXPLORATION neuromusculares, I-EXPLORATION de I-EXPLORATION características I-EXPLORATION aparentemente I-EXPLORATION benignas, I-EXPLORATION pero I-EXPLORATION que I-EXPLORATION no I-EXPLORATION permite I-EXPLORATION descartar I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trate I-EXPLORATION de I-EXPLORATION un I-EXPLORATION condroma I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION patología I-EXPLORATION maligna, I-EXPLORATION se I-EXPLORATION deriva I-EXPLORATION a I-EXPLORATION un I-EXPLORATION hospital I-EXPLORATION de I-EXPLORATION tercer I-EXPLORATION nivel I-EXPLORATION para I-EXPLORATION su I-EXPLORATION valoración, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION reevalúa I-EXPLORATION el I-EXPLORATION caso. I-EXPLORATION Un I-EXPLORATION familiar I-EXPLORATION recuerda I-EXPLORATION un I-EXPLORATION traumatismo I-EXPLORATION con I-EXPLORATION el I-EXPLORATION manillar I-EXPLORATION de I-EXPLORATION la I-EXPLORATION bicicleta I-EXPLORATION unos I-EXPLORATION cuatro I-EXPLORATION meses I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION inicial, I-EXPLORATION seguido I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION e I-EXPLORATION inflamación I-EXPLORATION los I-EXPLORATION siete I-EXPLORATION días I-EXPLORATION posteriores. I-EXPLORATION El B-TREATMENT caso I-TREATMENT se I-TREATMENT orienta I-TREATMENT inicialmente I-TREATMENT como I-TREATMENT un I-TREATMENT hematoma I-TREATMENT calcificado I-TREATMENT y I-TREATMENT se I-TREATMENT sugiere I-TREATMENT un I-TREATMENT tratamiento I-TREATMENT conservador I-TREATMENT y I-TREATMENT una I-TREATMENT visita I-TREATMENT de I-TREATMENT seguimiento I-TREATMENT tres I-TREATMENT meses I-TREATMENT después. I-TREATMENT Pasado B-EVOLUTION ese I-EVOLUTION tiempo, I-EVOLUTION solicitan I-EVOLUTION una I-EVOLUTION radiografía I-EVOLUTION simple I-EVOLUTION de I-EVOLUTION control I-EVOLUTION que I-EVOLUTION no I-EVOLUTION muestra I-EVOLUTION cambios I-EVOLUTION respecto I-EVOLUTION a I-EVOLUTION la I-EVOLUTION previa. I-EVOLUTION Ante I-EVOLUTION la I-EVOLUTION evolución I-EVOLUTION clínica, I-EVOLUTION revaloran I-EVOLUTION la I-EVOLUTION TC I-EVOLUTION inicial I-EVOLUTION y I-EVOLUTION reorientan I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION como I-EVOLUTION miositis I-EVOLUTION osificante I-EVOLUTION traumática I-EVOLUTION (MOT). I-EVOLUTION Cuatro I-EVOLUTION años I-EVOLUTION después I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION apenas I-EVOLUTION ha I-EVOLUTION disminuido I-EVOLUTION su I-EVOLUTION tamaño, I-EVOLUTION pero I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION no I-EVOLUTION se I-EVOLUTION plantea I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION clínicamente I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION está I-EVOLUTION asintomática. I-EVOLUTION I-EVOLUTION Lactante B-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS visita I-PRESENT_ILLNESS de I-PRESENT_ILLNESS control I-PRESENT_ILLNESS del I-PRESENT_ILLNESS recién I-PRESENT_ILLNESS nacido. I-PRESENT_ILLNESS Varón, B-PAST_MEDICAL_HISTORY fruto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY segunda I-PAST_MEDICAL_HISTORY gestación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY término I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY parto I-PAST_MEDICAL_HISTORY eutócico I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY incidencias. I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS madre I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aproximadamente I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS vértice I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS del I-PRESENT_ILLNESS nacimiento. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION evidencia I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION limpios, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION sobreinfección. I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION aplasia I-EXPLORATION cutis I-EXPLORATION congénita I-EXPLORATION (ACC) I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION cerebral I-EXPLORATION transfontanelar, I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION genograma I-EXPLORATION no I-EXPLORATION evidenció I-EXPLORATION enfermedades I-EXPLORATION genéticas, I-EXPLORATION pero B-FAMILY_HISTORY el I-FAMILY_HISTORY padre I-FAMILY_HISTORY también I-FAMILY_HISTORY presentaba I-FAMILY_HISTORY una I-FAMILY_HISTORY zona I-FAMILY_HISTORY de I-FAMILY_HISTORY alopecia I-FAMILY_HISTORY cicatricial I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY vértice I-FAMILY_HISTORY del I-FAMILY_HISTORY cuero I-FAMILY_HISTORY cabelludo, I-FAMILY_HISTORY que I-FAMILY_HISTORY refiere I-FAMILY_HISTORY desde I-FAMILY_HISTORY la I-FAMILY_HISTORY infancia. I-FAMILY_HISTORY I-FAMILY_HISTORY Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS ocho I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS natural B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY provincia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Huesca I-PAST_MEDICAL_HISTORY (España), I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS ante I-PRESENT_ILLNESS la I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS dérmica I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS adenopatías I-PRESENT_ILLNESS de I-PRESENT_ILLNESS localización I-PRESENT_ILLNESS cérvico-occipital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION costrosa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuero I-EXPLORATION cabelludo I-EXPLORATION occipital, I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION × I-EXPLORATION 3 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION desprende I-EXPLORATION fácilmente, I-EXPLORATION sin I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION escara I-EXPLORATION ni I-EXPLORATION zona I-EXPLORATION eritematosa. I-EXPLORATION De I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION manera, I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION tres I-EXPLORATION adenopatías I-EXPLORATION retroauriculares I-EXPLORATION y I-EXPLORATION occipitales, I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION muy I-EXPLORATION dolorosas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION La B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY picadura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY garrapata I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY días, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY identificada I-PAST_MEDICAL_HISTORY dentro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY especie I-PAST_MEDICAL_HISTORY Dermacentor I-PAST_MEDICAL_HISTORY marginatus. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Se B-TREATMENT pauta I-TREATMENT eritromicina I-TREATMENT a I-TREATMENT dosis I-TREATMENT de I-TREATMENT 40 I-TREATMENT mg/kg/día I-TREATMENT durante I-TREATMENT ocho I-TREATMENT días I-TREATMENT y I-TREATMENT se I-TREATMENT solicita I-TREATMENT serología I-TREATMENT para I-TREATMENT Toxoplasma, I-TREATMENT Borrelia, I-TREATMENT citomegalovirus, I-TREATMENT virus I-TREATMENT de I-TREATMENT Epstein-Barr I-TREATMENT y I-TREATMENT Rickettsia I-TREATMENT conorii, I-TREATMENT evidenciándose I-TREATMENT una I-TREATMENT positivización I-TREATMENT de I-TREATMENT IgG I-TREATMENT para I-TREATMENT citomegalovirus I-TREATMENT y I-TREATMENT de I-TREATMENT anticuerpos I-TREATMENT para I-TREATMENT Rickettsia I-TREATMENT conorii I-TREATMENT (1/640) I-TREATMENT mediante I-TREATMENT inmonofluorescencia I-TREATMENT indirecta I-TREATMENT y I-TREATMENT posterior I-TREATMENT aumento I-TREATMENT a I-TREATMENT los I-TREATMENT 40 I-TREATMENT días. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION medicación I-EVOLUTION pautada, I-EVOLUTION presenta I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION una I-EVOLUTION de I-EVOLUTION las I-EVOLUTION tres I-EVOLUTION adenopatías I-EVOLUTION durante I-EVOLUTION un I-EVOLUTION mes, I-EVOLUTION que I-EVOLUTION sigue I-EVOLUTION siendo I-EVOLUTION dolorosa I-EVOLUTION al I-EVOLUTION tacto, I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION posterior. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION cuatro I-EVOLUTION años I-EVOLUTION y I-EVOLUTION habiéndose I-EVOLUTION encontrado I-EVOLUTION asintomática I-EVOLUTION durante I-EVOLUTION este I-EVOLUTION periodo, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION consulta I-EVOLUTION por I-EVOLUTION aparición I-EVOLUTION nuevamente I-EVOLUTION de I-EVOLUTION pequeños I-EVOLUTION nódulos I-EVOLUTION discretamente I-EVOLUTION dolorosos I-EVOLUTION a I-EVOLUTION la I-EVOLUTION palpación I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION de I-EVOLUTION la I-EVOLUTION región I-EVOLUTION cráneo-cervical I-EVOLUTION bilateral, I-EVOLUTION apreciándose I-EVOLUTION ecográficamente I-EVOLUTION cuatro I-EVOLUTION lesiones I-EVOLUTION compatibles I-EVOLUTION con I-EVOLUTION adenopatías I-EVOLUTION de I-EVOLUTION aspecto I-EVOLUTION inflamatorio I-EVOLUTION residual I-EVOLUTION sin I-EVOLUTION otros I-EVOLUTION hallazgos I-EVOLUTION valorables, I-EVOLUTION ninguna I-EVOLUTION de I-EVOLUTION ellas I-EVOLUTION de I-EVOLUTION tamaño I-EVOLUTION significativo, I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION tratadas I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION sintomática. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS diez I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sano, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS una I-PRESENT_ILLNESS celulitis I-PRESENT_ILLNESS indurada I-PRESENT_ILLNESS y I-PRESENT_ILLNESS violácea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS muslo, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS conglomerado I-PRESENT_ILLNESS adenopático I-PRESENT_ILLNESS inguinal, I-PRESENT_ILLNESS acompañados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS febrícula I-PRESENT_ILLNESS intermitente. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS puerta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS entrada I-PRESENT_ILLNESS era I-PRESENT_ILLNESS una I-PRESENT_ILLNESS herida I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS producida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS playa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Brasil I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS antes, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS había I-PRESENT_ILLNESS cicatrizado. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS con I-PRESENT_ILLNESS amoxicilina-clavulánico I-PRESENT_ILLNESS endovenoso, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS mejoró I-PRESENT_ILLNESS la I-PRESENT_ILLNESS sintomatología. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION conglomerado I-EXPLORATION adenopático. I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF) I-EXPLORATION de I-EXPLORATION las I-EXPLORATION adenopatías I-EXPLORATION mostraba I-EXPLORATION histológicamente I-EXPLORATION granulomas I-EXPLORATION epitelioides I-EXPLORATION con I-EXPLORATION necrosis. I-EXPLORATION La I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION induración I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION vesículas I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 48 I-EXPLORATION horas. I-EXPLORATION La I-EXPLORATION cuantificación I-EXPLORATION de I-EXPLORATION interferón I-EXPLORATION gamma I-EXPLORATION fue I-EXPLORATION positiva. I-EXPLORATION No I-EXPLORATION había I-EXPLORATION recibido I-EXPLORATION vacunación I-EXPLORATION con I-EXPLORATION bacilo I-EXPLORATION de I-EXPLORATION Calmette-Guérin I-EXPLORATION (BCG). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION del I-EXPLORATION pie, I-EXPLORATION siendo I-EXPLORATION positiva I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION de I-EXPLORATION la I-EXPLORATION polimerasa I-EXPLORATION para I-EXPLORATION la I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION ADN I-EXPLORATION de I-EXPLORATION Mycobacterium I-EXPLORATION tuberculosis I-EXPLORATION (PCR-TB). I-EXPLORATION Se I-EXPLORATION confirmó I-EXPLORATION microbiológicamente I-EXPLORATION aislando I-EXPLORATION Mycobacterium I-EXPLORATION tuberculosis I-EXPLORATION sensible I-EXPLORATION a I-EXPLORATION isoniazida I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION PAAF I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION cutánea. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION computarizada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION fueron I-EXPLORATION normales, I-EXPLORATION y I-EXPLORATION las I-EXPLORATION baciloscopias I-EXPLORATION y I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION jugo I-EXPLORATION gástrico, I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunitario I-EXPLORATION (con I-EXPLORATION detección I-EXPLORATION de I-EXPLORATION inmunoglobulinas, I-EXPLORATION inmunidad I-EXPLORATION celular I-EXPLORATION y I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION el I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION la I-EXPLORATION inmunodeficiencia I-EXPLORATION humana) I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT terapia I-TREATMENT antituberculosa I-TREATMENT (isoniazida, I-TREATMENT rifampicina I-TREATMENT y I-TREATMENT pirazinamida). I-TREATMENT Esta I-TREATMENT tuvo I-TREATMENT que I-TREATMENT ser I-TREATMENT sustituida I-TREATMENT por I-TREATMENT etambutol I-TREATMENT tras I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT un I-TREATMENT exantema I-TREATMENT cutáneo I-TREATMENT pruriginoso I-TREATMENT presuntamente I-TREATMENT causado I-TREATMENT por I-TREATMENT pirazinamida I-TREATMENT y I-TREATMENT que I-TREATMENT desapareció I-TREATMENT tras I-TREATMENT su I-TREATMENT retirada. I-TREATMENT Un B-EVOLUTION mes I-EVOLUTION después I-EVOLUTION aparecieron I-EVOLUTION dos I-EVOLUTION fístulas I-EVOLUTION cutáneas I-EVOLUTION profundas, I-EVOLUTION que B-TREATMENT requirieron I-TREATMENT desbridamiento I-TREATMENT quirúrgico. I-TREATMENT Tras B-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION se I-EVOLUTION resolvieron I-EVOLUTION la I-EVOLUTION escrófula I-EVOLUTION cutánea I-EVOLUTION y I-EVOLUTION las I-EVOLUTION adenopatías I-EVOLUTION inguinales. I-EVOLUTION No B-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION paciente I-EXPLORATION bacilífero I-EXPLORATION y I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION familiar I-EXPLORATION con I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nueve I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS cervical I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS fiebre. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedente, I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY directo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY misma I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY semana I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY manillar I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY patinete. I-PAST_MEDICAL_HISTORY En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm, I-EXPLORATION blanda I-EXPLORATION y I-EXPLORATION móvil, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios I-EXPLORATION adyacentes I-EXPLORATION y I-EXPLORATION dolorosa I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION Es B-TREATMENT diagnosticada I-TREATMENT de I-TREATMENT adenitis I-TREATMENT laterocervical, I-TREATMENT iniciando I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT amoxicilina-clavulánico I-TREATMENT oral. I-TREATMENT I-TREATMENT Tras B-DERIVED_FROM/TO una I-DERIVED_FROM/TO semana I-DERIVED_FROM/TO es I-DERIVED_FROM/TO revisada I-DERIVED_FROM/TO en I-DERIVED_FROM/TO consulta, I-DERIVED_FROM/TO persistiendo I-DERIVED_FROM/TO el I-DERIVED_FROM/TO dolor I-DERIVED_FROM/TO y I-DERIVED_FROM/TO la I-DERIVED_FROM/TO tumoración, I-DERIVED_FROM/TO esta I-DERIVED_FROM/TO vez I-DERIVED_FROM/TO indurada, I-DERIVED_FROM/TO sin I-DERIVED_FROM/TO otros I-DERIVED_FROM/TO síntomas I-DERIVED_FROM/TO acompañantes, I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO es I-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO Urgencias I-DERIVED_FROM/TO de I-DERIVED_FROM/TO su I-DERIVED_FROM/TO hospital I-DERIVED_FROM/TO de I-DERIVED_FROM/TO referencia, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO realiza I-DERIVED_FROM/TO una I-DERIVED_FROM/TO ecografía I-DERIVED_FROM/TO en I-DERIVED_FROM/TO la I-DERIVED_FROM/TO que I-DERIVED_FROM/TO se I-DERIVED_FROM/TO visualiza I-DERIVED_FROM/TO una I-DERIVED_FROM/TO lesión I-DERIVED_FROM/TO abscesificada I-DERIVED_FROM/TO subyacente I-DERIVED_FROM/TO al I-DERIVED_FROM/TO músculo I-DERIVED_FROM/TO esternocleidomastoideo I-DERIVED_FROM/TO (ECM), I-DERIVED_FROM/TO decidiéndose I-DERIVED_FROM/TO su I-DERIVED_FROM/TO ingreso I-DERIVED_FROM/TO para I-DERIVED_FROM/TO administrar I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO antibiótico I-DERIVED_FROM/TO intravenoso. I-DERIVED_FROM/TO Reexplorando B-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente, I-EXPLORATION se I-EXPLORATION palpa I-EXPLORATION el I-EXPLORATION músculo I-EXPLORATION ECM I-EXPLORATION izquierdo I-EXPLORATION engrosado I-EXPLORATION en I-EXPLORATION toda I-EXPLORATION su I-EXPLORATION extensión, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION repetir I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION bilateral. I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION indica I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION engrosamiento I-EXPLORATION del I-EXPLORATION músculo I-EXPLORATION ECM I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION alteración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ecogenicidad, I-EXPLORATION visualizándose I-EXPLORATION dos I-EXPLORATION focos I-EXPLORATION hipoecoicos I-EXPLORATION intramusculares I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION piomiositis, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION absceso I-EXPLORATION subyacente I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 6 I-EXPLORATION × I-EXPLORATION 2, I-EXPLORATION 7 I-EXPLORATION cm. I-EXPLORATION I-EXPLORATION La B-TREATMENT paciente I-TREATMENT permanece I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT intravenoso I-TREATMENT con I-TREATMENT cloxacilina I-TREATMENT y I-TREATMENT clindamicina I-TREATMENT durante I-TREATMENT siete I-TREATMENT días, I-TREATMENT presentando I-TREATMENT una I-TREATMENT mejoría I-TREATMENT progresiva I-TREATMENT de I-TREATMENT la I-TREATMENT clínica, I-TREATMENT y I-TREATMENT se I-TREATMENT da I-TREATMENT de I-TREATMENT alta I-TREATMENT en I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT clindamicina I-TREATMENT oral. I-TREATMENT I-TREATMENT La B-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION nuevamente I-EXPLORATION revisada I-EXPLORATION en I-EXPLORATION consulta I-EXPLORATION 15 I-EXPLORATION días I-EXPLORATION después, I-EXPLORATION presentando I-EXPLORATION a I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION cervical I-EXPLORATION izquierda, I-EXPLORATION aunque I-EXPLORATION de I-EXPLORATION menor I-EXPLORATION tamaño. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION ecografía I-EXPLORATION cervical I-EXPLORATION bilateral I-EXPLORATION donde I-EXPLORATION ya I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION datos I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION piomiositis, I-EXPLORATION pero I-EXPLORATION sí I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION del I-EXPLORATION absceso I-EXPLORATION subyacente I-EXPLORATION al I-EXPLORATION músculo, I-EXPLORATION aunque I-EXPLORATION con I-EXPLORATION una I-EXPLORATION reducción I-EXPLORATION significativa I-EXPLORATION de I-EXPLORATION su I-EXPLORATION tamaño. I-EXPLORATION Se B-EVOLUTION mantiene I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION durante I-EVOLUTION cuatro I-EVOLUTION semanas, I-EVOLUTION presentando I-EVOLUTION buena I-EVOLUTION evolución I-EVOLUTION hasta I-EVOLUTION la I-EVOLUTION total I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION cuadro. I-EVOLUTION I-EVOLUTION Niño B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial I-PAST_MEDICAL_HISTORY intermitente I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY base, 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 Pediatría I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS por I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS brusca I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS cervical, I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS esa I-PRESENT_ILLNESS mañana I-PRESENT_ILLNESS (aproximadamente I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución), I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS contexto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS asmática I-PRESENT_ILLNESS que I-PRESENT_ILLNESS el I-PRESENT_ILLNESS niño I-PRESENT_ILLNESS estaba I-PRESENT_ILLNESS tratando I-PRESENT_ILLNESS con I-PRESENT_ILLNESS salbutamol I-PRESENT_ILLNESS inhalado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS domicilio. I-PRESENT_ILLNESS A B-EXPLORATION su I-EXPLORATION llegada I-EXPLORATION presenta I-EXPLORATION un I-EXPLORATION regular I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION palidez I-EXPLORATION cutánea, I-EXPLORATION taquipnea I-EXPLORATION y I-EXPLORATION tiraje I-EXPLORATION intercostal; I-EXPLORATION con I-EXPLORATION hipoventilación I-EXPLORATION generalizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION auscultación. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION un I-EXPLORATION edema I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cervical I-EXPLORATION bilateral, I-EXPLORATION con I-EXPLORATION crepitación I-EXPLORATION en I-EXPLORATION dicha I-EXPLORATION zona. I-EXPLORATION Ante B-TREATMENT crisis I-TREATMENT asmática I-TREATMENT con I-TREATMENT score I-TREATMENT moderado I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT broncodilatador I-TREATMENT y I-TREATMENT corticoideo I-TREATMENT y B-DERIVED_FROM/TO se I-DERIVED_FROM/TO deriva I-DERIVED_FROM/TO a I-DERIVED_FROM/TO Urgencias I-DERIVED_FROM/TO hospitalarias. I-DERIVED_FROM/TO Allí B-EXPLORATION realizan I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION encontrando I-EXPLORATION neumomediastino I-EXPLORATION y I-EXPLORATION un I-EXPLORATION enfisema I-EXPLORATION subcutáneo I-EXPLORATION torácico I-EXPLORATION y I-EXPLORATION cervical, I-EXPLORATION sin I-EXPLORATION neumotórax. I-EXPLORATION Se B-TREATMENT pauta I-TREATMENT analgesia I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT oxígeno, I-TREATMENT broncodilatadores I-TREATMENT y I-TREATMENT prednisona I-TREATMENT oral; I-TREATMENT experimentó B-EVOLUTION mejoría I-EVOLUTION progresiva, I-EVOLUTION dándole I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION después. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS niña I-PRESENT_ILLNESS de I-PRESENT_ILLNESS siete I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sin B-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés, I-FAMILY_HISTORY salvo I-FAMILY_HISTORY un I-FAMILY_HISTORY caso I-FAMILY_HISTORY de I-FAMILY_HISTORY liquen I-FAMILY_HISTORY plano I-FAMILY_HISTORY cutáneo I-FAMILY_HISTORY en I-FAMILY_HISTORY el I-FAMILY_HISTORY padre I-FAMILY_HISTORY años I-FAMILY_HISTORY antes. I-FAMILY_HISTORY No B-PAST_MEDICAL_HISTORY hay I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés, I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY estreñimiento I-PAST_MEDICAL_HISTORY funcional I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dermatitis I-PAST_MEDICAL_HISTORY atópica I-PAST_MEDICAL_HISTORY leve. I-PAST_MEDICAL_HISTORY Consulta B-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS ungueales I-PRESENT_ILLNESS (piqueteado, I-PRESENT_ILLNESS líneas I-PRESENT_ILLNESS transversales, I-PRESENT_ILLNESS descamación I-PRESENT_ILLNESS y I-PRESENT_ILLNESS uñas I-PRESENT_ILLNESS quebradizas) I-PRESENT_ILLNESS en I-PRESENT_ILLNESS algunas I-PRESENT_ILLNESS uñas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pies, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Sin I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS referido. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY hábito I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY chupeteado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dedos. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY hay I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY cutáneas I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY mucosas. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY asociada. I-PAST_MEDICAL_HISTORY Refiere I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY dieta I-PAST_MEDICAL_HISTORY variada, I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY algo I-PAST_MEDICAL_HISTORY deficitaria I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY frutas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Exploración B-EXPLORATION clínica I-EXPLORATION normal, I-EXPLORATION salvo I-EXPLORATION por I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION ungueales I-EXPLORATION descritas; I-EXPLORATION peso I-EXPLORATION y I-EXPLORATION talla I-EXPLORATION en I-EXPLORATION percentil I-EXPLORATION 50-75. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT un I-TREATMENT polivitamínico I-TREATMENT ante I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT déficit I-TREATMENT vitamínico, I-TREATMENT pero I-TREATMENT tras I-TREATMENT dos I-TREATMENT meses I-TREATMENT seguían I-TREATMENT las I-TREATMENT lesiones I-TREATMENT sin I-TREATMENT cambios. I-TREATMENT I-TREATMENT El B-DERIVED_FROM/TO piqueteado I-DERIVED_FROM/TO ungueal I-DERIVED_FROM/TO nos I-DERIVED_FROM/TO hacía I-DERIVED_FROM/TO sospechar I-DERIVED_FROM/TO varias I-DERIVED_FROM/TO enfermedades I-DERIVED_FROM/TO como I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO diferencial I-DERIVED_FROM/TO (eccema, I-DERIVED_FROM/TO psoriasis I-DERIVED_FROM/TO ungueal, I-DERIVED_FROM/TO liquen I-DERIVED_FROM/TO plano I-DERIVED_FROM/TO ungueal I-DERIVED_FROM/TO y I-DERIVED_FROM/TO alopecia I-DERIVED_FROM/TO areata), I-DERIVED_FROM/TO por I-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO remitida I-DERIVED_FROM/TO a I-DERIVED_FROM/TO Dermatología I-DERIVED_FROM/TO para I-DERIVED_FROM/TO valoración. I-DERIVED_FROM/TO Fue B-EXPLORATION diagnosticada I-EXPLORATION inicialmente I-EXPLORATION de I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION dermatitis I-EXPLORATION de I-EXPLORATION contacto I-EXPLORATION o I-EXPLORATION lesiones I-EXPLORATION secundarias I-EXPLORATION a I-EXPLORATION atopia. I-EXPLORATION Se I-EXPLORATION descartaron I-EXPLORATION alergias, I-EXPLORATION inclusive I-EXPLORATION a I-EXPLORATION metales I-EXPLORATION pesados I-EXPLORATION y I-EXPLORATION níquel. I-EXPLORATION I-EXPLORATION Ante I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION materiales I-EXPLORATION o I-EXPLORATION productos I-EXPLORATION que I-EXPLORATION le I-EXPLORATION pudiesen I-EXPLORATION causar I-EXPLORATION dermatitis I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lecho I-EXPLORATION ungueal, I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION atopia I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION y I-EXPLORATION la I-EXPLORATION persistencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION analítico I-EXPLORATION para I-EXPLORATION completar I-EXPLORATION el I-EXPLORATION estudio. I-EXPLORATION Se I-EXPLORATION analizó I-EXPLORATION el I-EXPLORATION metabolismo I-EXPLORATION férrico, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION otros I-EXPLORATION posibles I-EXPLORATION déficits I-EXPLORATION nutricionales I-EXPLORATION (zinc, I-EXPLORATION 1-25 I-EXPLORATION hidroxi-colecalciferol, I-EXPLORATION vitaminas I-EXPLORATION B12 I-EXPLORATION y I-EXPLORATION B6), I-EXPLORATION tirotropina I-EXPLORATION (TSH) I-EXPLORATION y I-EXPLORATION tiroxina I-EXPLORATION (T4), I-EXPLORATION resultando I-EXPLORATION todos I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION solicitaron I-EXPLORATION también I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION autoinmunidad I-EXPLORATION ante I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION psoriasis I-EXPLORATION ungueal, I-EXPLORATION siendo I-EXPLORATION negativos I-EXPLORATION el I-EXPLORATION factor I-EXPLORATION reumatoide I-EXPLORATION y I-EXPLORATION los I-EXPLORATION anticuerpos I-EXPLORATION antinucleares. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT normalidad I-TREATMENT de I-TREATMENT los I-TREATMENT resultados I-TREATMENT analíticos I-TREATMENT y I-TREATMENT la I-TREATMENT persistencia I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones, I-TREATMENT que I-TREATMENT hacían I-TREATMENT sospechar I-TREATMENT como I-TREATMENT posibilidades I-TREATMENT diagnósticas I-TREATMENT la I-TREATMENT psoriasis I-TREATMENT ungueal, I-TREATMENT sin I-TREATMENT poder I-TREATMENT descartar I-TREATMENT un I-TREATMENT liquen I-TREATMENT plano I-TREATMENT ungueal, I-TREATMENT o I-TREATMENT lesiones I-TREATMENT de I-TREATMENT eccema I-TREATMENT ungueal, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT tazaroteno I-TREATMENT tópico I-TREATMENT (un I-TREATMENT derivado I-TREATMENT de I-TREATMENT vitamina I-TREATMENT A) I-TREATMENT sobre I-TREATMENT la I-TREATMENT lámina I-TREATMENT ungueal I-TREATMENT durante I-TREATMENT tres I-TREATMENT meses. I-TREATMENT Evolucionó B-EVOLUTION favorablemente, I-EVOLUTION normalizándose I-EVOLUTION las I-EVOLUTION lesiones I-EVOLUTION ungueales. I-EVOLUTION I-EVOLUTION Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS autolimitados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipotermia I-PRESENT_ILLNESS asociados I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS fría I-PRESENT_ILLNESS y I-PRESENT_ILLNESS palidez I-PRESENT_ILLNESS cutánea. I-PRESENT_ILLNESS Ocurren I-PRESENT_ILLNESS de I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS diaria, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS duración I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS horas, I-PRESENT_ILLNESS siendo I-PRESENT_ILLNESS más I-PRESENT_ILLNESS frecuentes I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS el I-PRESENT_ILLNESS sueño. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompañan I-PRESENT_ILLNESS de I-PRESENT_ILLNESS movimientos I-PRESENT_ILLNESS tónico-clónicos, I-PRESENT_ILLNESS desconexión I-PRESENT_ILLNESS del I-PRESENT_ILLNESS medio, I-PRESENT_ILLNESS relajación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esfínteres I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS periodo I-PRESENT_ILLNESS poscrítico. I-PRESENT_ILLNESS Así I-PRESENT_ILLNESS mismo I-PRESENT_ILLNESS no I-PRESENT_ILLNESS asocia I-PRESENT_ILLNESS tiritona. I-PRESENT_ILLNESS Entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS se I-PRESENT_ILLNESS mantiene I-PRESENT_ILLNESS asintomática. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY consta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sospecha I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY comicial I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY confirmada, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY transfontanelar I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY electroencefalograma I-PAST_MEDICAL_HISTORY (EEG) I-PAST_MEDICAL_HISTORY normal. I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY hay I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY de I-FAMILY_HISTORY epilepsia I-FAMILY_HISTORY familiar. I-FAMILY_HISTORY Un I-FAMILY_HISTORY tío I-FAMILY_HISTORY materno I-FAMILY_HISTORY está I-FAMILY_HISTORY afecto I-FAMILY_HISTORY de I-FAMILY_HISTORY migraña. I-FAMILY_HISTORY I-FAMILY_HISTORY A B-EXPLORATION su I-EXPLORATION llegada I-EXPLORATION a I-EXPLORATION Urgencias, I-EXPLORATION presenta I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION y I-EXPLORATION neurológica I-EXPLORATION normal, I-EXPLORATION con I-EXPLORATION constantes I-EXPLORATION normales, I-EXPLORATION salvo I-EXPLORATION una I-EXPLORATION discreta I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION cardiaca. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION hipotermia, I-EXPLORATION aunque I-EXPLORATION la I-EXPLORATION familia I-EXPLORATION aporta I-EXPLORATION un I-EXPLORATION registro I-EXPLORATION exhaustivo I-EXPLORATION de I-EXPLORATION los I-EXPLORATION días I-EXPLORATION previos, I-EXPLORATION con I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION temperatura I-EXPLORATION rectal I-EXPLORATION de I-EXPLORATION entre I-EXPLORATION 34 I-EXPLORATION y I-EXPLORATION 35 I-EXPLORATION °C. I-EXPLORATION I-EXPLORATION Todos I-EXPLORATION los I-EXPLORATION estudios I-EXPLORATION realizados I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION (analítica I-EXPLORATION general, I-EXPLORATION gasometría, I-EXPLORATION estudio I-EXPLORATION metabólico I-EXPLORATION y I-EXPLORATION endocrinológico, I-EXPLORATION tóxicos I-EXPLORATION en I-EXPLORATION orina, I-EXPLORATION EEG, I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION [RM], I-EXPLORATION Holter I-EXPLORATION y I-EXPLORATION ecocardiograma). I-EXPLORATION Después I-EXPLORATION de I-EXPLORATION rehistoriar I-EXPLORATION a I-EXPLORATION la I-EXPLORATION familia, I-EXPLORATION refieren I-EXPLORATION que I-EXPLORATION la I-EXPLORATION niña I-EXPLORATION padece I-EXPLORATION desde I-EXPLORATION hace I-EXPLORATION unos I-EXPLORATION meses I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION dolor I-EXPLORATION abdominal I-EXPLORATION recurrente, I-EXPLORATION autolimitados, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION añade I-EXPLORATION al I-EXPLORATION estudio I-EXPLORATION una I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION con I-EXPLORATION resultado I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT HPE I-TREATMENT y I-TREATMENT teniendo I-TREATMENT en I-TREATMENT cuenta I-TREATMENT el I-TREATMENT alto I-TREATMENT número I-TREATMENT de I-TREATMENT episodios, I-TREATMENT junto I-TREATMENT con I-TREATMENT el I-TREATMENT antecedente I-TREATMENT familiar I-TREATMENT migrañoso, I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT ciproheptadina. I-TREATMENT Sin I-TREATMENT embargo, I-TREATMENT la I-TREATMENT paciente I-TREATMENT rechaza I-TREATMENT su I-TREATMENT ingesta, I-TREATMENT a B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION los I-EVOLUTION episodios I-EVOLUTION se I-EVOLUTION autolimitan I-EVOLUTION en I-EVOLUTION el I-EVOLUTION tiempo. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION debut, I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática. 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 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hiperemia I-PRESENT_ILLNESS conjuntival I-PRESENT_ILLNESS y I-PRESENT_ILLNESS lagrimeo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ojo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY destacables I-PAST_MEDICAL_HISTORY constan I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY alergia I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ácaros, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY rinitis I-PAST_MEDICAL_HISTORY alérgica I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY crónico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY budesonida I-PAST_MEDICAL_HISTORY inhalada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY terbutalina I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY demanda. I-PAST_MEDICAL_HISTORY No B-FAMILY_HISTORY presenta I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY Se B-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT tópico, I-TREATMENT acudiendo B-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION al I-EVOLUTION cabo I-EVOLUTION de I-EVOLUTION cuatro I-EVOLUTION semanas I-EVOLUTION por I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION clínica I-EVOLUTION bilateral, I-EVOLUTION sin I-EVOLUTION secreción I-EVOLUTION purulenta. I-EVOLUTION Durante I-EVOLUTION los I-EVOLUTION siete I-EVOLUTION meses I-EVOLUTION posteriores I-EVOLUTION persiste I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION intermitente I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION tratamiento I-EVOLUTION con I-EVOLUTION antihistáminicos I-EVOLUTION orales I-EVOLUTION y I-EVOLUTION oftálmicos, I-EVOLUTION asociando I-EVOLUTION además I-EVOLUTION en I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION días I-EVOLUTION tumefacción I-EVOLUTION palpebral I-EVOLUTION con I-EVOLUTION fotofobia I-EVOLUTION e I-EVOLUTION hiperemia I-EVOLUTION conjuntival I-EVOLUTION bilateral I-EVOLUTION matutina, I-EVOLUTION sin I-EVOLUTION prurito, I-EVOLUTION estornudos, I-EVOLUTION cuadro I-EVOLUTION catarral I-EVOLUTION ni I-EVOLUTION fiebre. I-EVOLUTION Ante B-DERIVED_FROM/TO la I-DERIVED_FROM/TO escasa I-DERIVED_FROM/TO respuesta I-DERIVED_FROM/TO a I-DERIVED_FROM/TO tratamientos I-DERIVED_FROM/TO habituales, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO decide I-DERIVED_FROM/TO derivar I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Oftalmología. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oftalmológica I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION queratitis I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION posible I-EXPLORATION etiología I-EXPLORATION herpética, I-EXPLORATION pautándose B-TREATMENT terapia I-TREATMENT antiviral, I-TREATMENT ciclopléjico I-TREATMENT y I-TREATMENT antibiótico I-TREATMENT tópicos, I-TREATMENT sin I-TREATMENT apreciar I-TREATMENT mejoría. I-TREATMENT Dada B-DERIVED_FROM/TO la I-DERIVED_FROM/TO persistencia I-DERIVED_FROM/TO del I-DERIVED_FROM/TO cuadro, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO sospecha I-DERIVED_FROM/TO una I-DERIVED_FROM/TO queratitis I-DERIVED_FROM/TO por I-DERIVED_FROM/TO exposición I-DERIVED_FROM/TO nocturna I-DERIVED_FROM/TO secundaria I-DERIVED_FROM/TO a I-DERIVED_FROM/TO exoftalmos I-DERIVED_FROM/TO y I-DERIVED_FROM/TO se I-DERIVED_FROM/TO deriva I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO endocrinología I-DERIVED_FROM/TO pediátrica I-DERIVED_FROM/TO para I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO función I-DERIVED_FROM/TO tiroidea, I-DERIVED_FROM/TO alcanzando I-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO final I-DERIVED_FROM/TO de I-DERIVED_FROM/TO hipertiroidismo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO causa I-DERIVED_FROM/TO autoinmune I-DERIVED_FROM/TO o I-DERIVED_FROM/TO enfermedad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Graves I-DERIVED_FROM/TO (EG). I-DERIVED_FROM/TO I-DERIVED_FROM/TO Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY africano, I-PAST_MEDICAL_HISTORY a B-PRESENT_ILLNESS la I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS detecta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS genu I-PRESENT_ILLNESS varo I-PRESENT_ILLNESS simétrico I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS llamativo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS revisión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS puericultura. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY ni B-FAMILY_HISTORY familiares I-FAMILY_HISTORY de I-FAMILY_HISTORY interés. I-FAMILY_HISTORY Presenta B-EXPLORATION un I-EXPLORATION desarrollo I-EXPLORATION psicomotor I-EXPLORATION normal. I-EXPLORATION Es B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Traumatología, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO realiza I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO radiológico I-DERIVED_FROM/TO confirmándose I-DERIVED_FROM/TO la I-DERIVED_FROM/TO alteración I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO ángulo I-DERIVED_FROM/TO metafisodiafisario, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO un I-DERIVED_FROM/TO componente I-DERIVED_FROM/TO de I-DERIVED_FROM/TO torsión I-DERIVED_FROM/TO tibial I-DERIVED_FROM/TO interna I-DERIVED_FROM/TO marcado I-DERIVED_FROM/TO y I-DERIVED_FROM/TO una I-DERIVED_FROM/TO alteración I-DERIVED_FROM/TO del I-DERIVED_FROM/TO cartílago I-DERIVED_FROM/TO de I-DERIVED_FROM/TO crecimiento I-DERIVED_FROM/TO proximal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO tibia. I-DERIVED_FROM/TO Se B-EXPLORATION completa I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION análisis I-EXPLORATION del I-EXPLORATION metabolismo I-EXPLORATION óseo, I-EXPLORATION siendo I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION normales. I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT ortésico I-TREATMENT inicial I-TREATMENT sin I-TREATMENT observarse I-TREATMENT mejoría I-TREATMENT tras I-TREATMENT diez I-TREATMENT meses I-TREATMENT de I-TREATMENT seguimiento, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT tratamiento I-TREATMENT quirúrgico I-TREATMENT corrector I-TREATMENT (osteotomía I-TREATMENT desrotatoria I-TREATMENT tibial I-TREATMENT distal I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT osteotomía I-TREATMENT valguizante I-TREATMENT proximal) I-TREATMENT con I-TREATMENT muy I-TREATMENT buena I-TREATMENT evolución. I-TREATMENT Los B-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION son I-EVOLUTION favorables, I-EVOLUTION manteniendo I-EVOLUTION un I-EVOLUTION alineamiento I-EVOLUTION correcto I-EVOLUTION de I-EVOLUTION ambas I-EVOLUTION extremidades. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS tórax I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS × I-PRESENT_ILLNESS 0, I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS eritematosas, I-PRESENT_ILLNESS ligeramente I-PRESENT_ILLNESS descamativas, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS pruriginosas. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION brazo I-EXPLORATION presenta I-EXPLORATION otra I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION características I-EXPLORATION similares, I-EXPLORATION de I-EXPLORATION mayor I-EXPLORATION tamaño, I-EXPLORATION también I-EXPLORATION asintomática. I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT pitiriasis I-TREATMENT rosada, I-TREATMENT no I-TREATMENT se I-TREATMENT pauta I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT se I-TREATMENT espera I-TREATMENT para I-TREATMENT ver I-TREATMENT la I-TREATMENT evolución I-TREATMENT del I-TREATMENT cuadro. I-TREATMENT I-TREATMENT A B-EVOLUTION la I-EVOLUTION semana I-EVOLUTION acude I-EVOLUTION de I-EVOLUTION nuevo I-EVOLUTION a I-EVOLUTION consulta, I-EVOLUTION presentando I-EVOLUTION un I-EVOLUTION aumento I-EVOLUTION del I-EVOLUTION número I-EVOLUTION de I-EVOLUTION lesiones, I-EVOLUTION distribuidas I-EVOLUTION por I-EVOLUTION el I-EVOLUTION tronco, I-EVOLUTION el I-EVOLUTION abdomen, I-EVOLUTION el I-EVOLUTION dorso I-EVOLUTION y I-EVOLUTION la I-EVOLUTION región I-EVOLUTION cervical, I-EVOLUTION y I-EVOLUTION respetando I-EVOLUTION la I-EVOLUTION cara, I-EVOLUTION el I-EVOLUTION cuero I-EVOLUTION cabelludo I-EVOLUTION y I-EVOLUTION las I-EVOLUTION extremidades I-EVOLUTION inferiores. I-EVOLUTION Al B-EXPLORATION igual I-EXPLORATION que I-EXPLORATION la I-EXPLORATION semana I-EXPLORATION anterior, I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION son I-EXPLORATION asintomáticas. I-EXPLORATION I-EXPLORATION Dado I-EXPLORATION la I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION lesiones, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION consultar I-EXPLORATION vía I-EXPLORATION telemática I-EXPLORATION a I-EXPLORATION Dermatología, I-EXPLORATION quienes I-EXPLORATION emiten I-EXPLORATION como I-EXPLORATION diagnóstico I-EXPLORATION más I-EXPLORATION probable I-EXPLORATION una I-EXPLORATION pitiriasis I-EXPLORATION rosada, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION probable I-EXPLORATION lesión I-EXPLORATION heraldo I-EXPLORATION del I-EXPLORATION brazo, I-EXPLORATION la I-EXPLORATION descamación I-EXPLORATION periférica I-EXPLORATION en I-EXPLORATION algunas I-EXPLORATION lesiones I-EXPLORATION y I-EXPLORATION la I-EXPLORATION distribución. I-EXPLORATION I-EXPLORATION Aconsejan B-TREATMENT no I-TREATMENT tratar I-TREATMENT y I-TREATMENT nos I-TREATMENT recuerdan I-TREATMENT que I-TREATMENT el I-TREATMENT cuadro I-TREATMENT puede I-TREATMENT durar I-TREATMENT un I-TREATMENT total I-TREATMENT de I-TREATMENT 6-8 I-TREATMENT semanas. I-TREATMENT I-TREATMENT Niña B-PRESENT_ILLNESS de I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS quística I-PRESENT_ILLNESS sobreelevada I-PRESENT_ILLNESS azulada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diámetro I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS raíz I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS un I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS sucesivas I-PRESENT_ILLNESS visitas. I-PRESENT_ILLNESS Según B-EXPLORATION el I-EXPLORATION especialista, I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION sugiere I-EXPLORATION un I-EXPLORATION pilomatricoma I-EXPLORATION o I-EXPLORATION epitelioma I-EXPLORATION calcificante I-EXPLORATION de I-EXPLORATION Malherbe I-EXPLORATION (puede I-EXPLORATION ser I-EXPLORATION azulado I-EXPLORATION por I-EXPLORATION su I-EXPLORATION componente I-EXPLORATION cálcico). I-EXPLORATION Recomienda B-TREATMENT la I-TREATMENT extirpación I-TREATMENT quirúrgica I-TREATMENT como I-TREATMENT actuación I-TREATMENT diagnóstico-terapéutica. I-TREATMENT I-TREATMENT Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY argelino I-PAST_MEDICAL_HISTORY ingresado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY prisión. I-PAST_MEDICAL_HISTORY Es I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaco I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY marihuana, I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY beber I-PAST_MEDICAL_HISTORY cerveza I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY diaria I-PAST_MEDICAL_HISTORY previamente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY prisión, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY niega I-PAST_MEDICAL_HISTORY consumo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY drogas I-PAST_MEDICAL_HISTORY tanto I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY parenteral I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY otras I-PAST_MEDICAL_HISTORY vías. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Presenta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY trastorno I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY control I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY impulsos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sigue I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY benzodiacepinas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ansiolíticos. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tiene I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY conducta I-PAST_MEDICAL_HISTORY violenta I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY insultos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY sanitario I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY destrozo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mobiliario. I-PAST_MEDICAL_HISTORY También I-PAST_MEDICAL_HISTORY existen I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diversas I-PAST_MEDICAL_HISTORY autoagresiones: I-PAST_MEDICAL_HISTORY huelgas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hambre, I-PAST_MEDICAL_HISTORY autocontusiones, I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY superficiales I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY brazos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY piernas, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY ingesta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuchillas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY objetos I-PAST_MEDICAL_HISTORY extraños I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY finalmente I-PAST_MEDICAL_HISTORY fueron I-PAST_MEDICAL_HISTORY evacuados I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY natural I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY apoyo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY dieta I-PAST_MEDICAL_HISTORY rica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY fibra. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS esta I-PRESENT_ILLNESS ocasión, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS ingerido I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cortauñas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS queja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS mismo I-PRESENT_ILLNESS tiempo I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS iniciado I-PRESENT_ILLNESS una I-PRESENT_ILLNESS huelga I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hambre, I-PRESENT_ILLNESS ingiriendo I-PRESENT_ILLNESS agua I-PRESENT_ILLNESS e I-PRESENT_ILLNESS infusiones I-PRESENT_ILLNESS azucaradas. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION un I-EXPLORATION abdomen I-EXPLORATION blando, I-EXPLORATION depresible I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION se I-EXPLORATION puede I-EXPLORATION observar I-EXPLORATION una I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION cortauñas I-EXPLORATION situada I-EXPLORATION en I-EXPLORATION intestino I-EXPLORATION delgado. I-EXPLORATION A B-DERIVED_FROM/TO pesar I-DERIVED_FROM/TO de I-DERIVED_FROM/TO quedar I-DERIVED_FROM/TO descartado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO la I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO un I-DERIVED_FROM/TO abdomen I-DERIVED_FROM/TO agudo I-DERIVED_FROM/TO quirúrgico, I-DERIVED_FROM/TO dado I-DERIVED_FROM/TO que I-DERIVED_FROM/TO el I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO se I-DERIVED_FROM/TO sigue I-DERIVED_FROM/TO quejando I-DERIVED_FROM/TO de I-DERIVED_FROM/TO intenso I-DERIVED_FROM/TO dolor, I-DERIVED_FROM/TO se I-DERIVED_FROM/TO le I-DERIVED_FROM/TO deriva I-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO urgencias I-DERIVED_FROM/TO hospitalario, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO confirman I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO diagnóstico I-DERIVED_FROM/TO prescribiendo I-DERIVED_FROM/TO una I-DERIVED_FROM/TO dieta I-DERIVED_FROM/TO rica I-DERIVED_FROM/TO en I-DERIVED_FROM/TO fibra I-DERIVED_FROM/TO y I-DERIVED_FROM/TO aconsejado I-DERIVED_FROM/TO el I-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO del I-DERIVED_FROM/TO paciente. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION los I-EXPLORATION 6 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION placa, I-EXPLORATION una I-EXPLORATION nueva I-EXPLORATION radiografía I-EXPLORATION nos I-EXPLORATION muestra I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION pieza I-EXPLORATION descrita I-EXPLORATION en I-EXPLORATION colon I-EXPLORATION ascendente, I-EXPLORATION pero I-EXPLORATION vemos I-EXPLORATION la I-EXPLORATION otra I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION cortauñas I-EXPLORATION ingerido I-EXPLORATION posteriormente I-EXPLORATION en I-EXPLORATION un I-EXPLORATION tramo I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION tubo I-EXPLORATION digestivo. I-EXPLORATION Trascurridos I-EXPLORATION 9 I-EXPLORATION días I-EXPLORATION del I-EXPLORATION inicio I-EXPLORATION del I-EXPLORATION cuadro, I-EXPLORATION realizamos I-EXPLORATION otra I-EXPLORATION placa I-EXPLORATION de I-EXPLORATION control I-EXPLORATION y I-EXPLORATION apreciamos I-EXPLORATION cómo I-EXPLORATION ambas I-EXPLORATION piezas I-EXPLORATION de I-EXPLORATION ese I-EXPLORATION cortaúñas I-EXPLORATION se I-EXPLORATION han I-EXPLORATION situado I-EXPLORATION juntas I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION colon I-EXPLORATION descendente. I-EXPLORATION Nos B-TREATMENT refiere I-TREATMENT que I-TREATMENT abandona I-TREATMENT la I-TREATMENT huelga I-TREATMENT de I-TREATMENT hambre I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT instaura I-TREATMENT una I-TREATMENT dieta I-TREATMENT rica I-TREATMENT en I-TREATMENT fibra. I-TREATMENT I-TREATMENT Nuevas B-EXPLORATION radiografías I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION nos I-EXPLORATION muestran I-EXPLORATION que I-EXPLORATION el I-EXPLORATION citado I-EXPLORATION cuerpo I-EXPLORATION extraño I-EXPLORATION no I-EXPLORATION avanza I-EXPLORATION del I-EXPLORATION colon I-EXPLORATION trasverso I-EXPLORATION hasta I-EXPLORATION que I-EXPLORATION por I-EXPLORATION una I-EXPLORATION placa I-EXPLORATION realizada I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 30 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION ingesta, I-EXPLORATION revela I-EXPLORATION ambas I-EXPLORATION partes I-EXPLORATION del I-EXPLORATION cortauñas I-EXPLORATION en I-EXPLORATION últimos I-EXPLORATION tramos I-EXPLORATION del I-EXPLORATION tubo I-EXPLORATION digestivo, I-EXPLORATION siendo B-EVOLUTION expulsados I-EVOLUTION al I-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION defecación, I-EVOLUTION según I-EVOLUTION nos I-EVOLUTION informa I-EVOLUTION el I-EVOLUTION propio I-EVOLUTION paciente. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 18 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS natural I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Perú, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Centro I-PRESENT_ILLNESS en I-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2012. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY reconocimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY negó I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Dentro B-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS hábitos I-PRESENT_ILLNESS tóxicos I-PRESENT_ILLNESS refirió I-PRESENT_ILLNESS consumo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 150 I-PRESENT_ILLNESS gr. I-PRESENT_ILLNESS de I-PRESENT_ILLNESS alcohol I-PRESENT_ILLNESS los I-PRESENT_ILLNESS fines I-PRESENT_ILLNESS de I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS y I-PRESENT_ILLNESS heroína I-PRESENT_ILLNESS fumada I-PRESENT_ILLNESS ocasional. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS cuanto I-PRESENT_ILLNESS a I-PRESENT_ILLNESS prácticas I-PRESENT_ILLNESS sexuales I-PRESENT_ILLNESS manifestó I-PRESENT_ILLNESS ser I-PRESENT_ILLNESS heterosexual I-PRESENT_ILLNESS y I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS tenido I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS parejas, I-PRESENT_ILLNESS frecuentemente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS contexto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS intoxicación I-PRESENT_ILLNESS enólica I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS tomar I-PRESENT_ILLNESS medidas I-PRESENT_ILLNESS preventivas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION numerosas I-EXPLORATION lesiones I-EXPLORATION cutáneas I-EXPLORATION maculares I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION en I-EXPLORATION tórax, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION orientó I-EXPLORATION como I-EXPLORATION pitiriasis I-EXPLORATION rosada. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION analítica I-EXPLORATION dentro I-EXPLORATION del I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION ingresos: I-EXPLORATION hemograma, I-EXPLORATION bioquímica I-EXPLORATION y I-EXPLORATION serologías I-EXPLORATION VIH, I-EXPLORATION hepatitis I-EXPLORATION y I-EXPLORATION lues, I-EXPLORATION detectándose I-EXPLORATION Treponema I-EXPLORATION pallidum I-EXPLORATION anticuerpos I-EXPLORATION reagínicos I-EXPLORATION 1/8, I-EXPLORATION Treponema I-EXPLORATION pallidum I-EXPLORATION anticuerpos I-EXPLORATION treponémicos I-EXPLORATION positivos, I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION resultados I-EXPLORATION analíticos. I-EXPLORATION I-EXPLORATION Reinterrogado, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION negó I-EXPLORATION haber I-EXPLORATION presentado I-EXPLORATION ninguna I-EXPLORATION manifestación I-EXPLORATION de I-EXPLORATION sífilis I-EXPLORATION primaria, I-EXPLORATION si I-EXPLORATION bien, I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION numerosas I-EXPLORATION placas I-EXPLORATION alopécicas I-EXPLORATION en I-EXPLORATION cuero I-EXPLORATION cabelludo I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION irregular, I-EXPLORATION de I-EXPLORATION características I-EXPLORATION no I-EXPLORATION cicatriciales, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION inflamatorios I-EXPLORATION ni I-EXPLORATION descamación, I-EXPLORATION menores I-EXPLORATION de I-EXPLORATION un I-EXPLORATION centímetro I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos, I-EXPLORATION no I-EXPLORATION desprovistas I-EXPLORATION completamente I-EXPLORATION de I-EXPLORATION pelo, I-EXPLORATION y I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION en I-EXPLORATION región I-EXPLORATION temporo-occipital. I-EXPLORATION I-EXPLORATION Esta I-EXPLORATION manifestación I-EXPLORATION la I-EXPLORATION había I-EXPLORATION observado I-EXPLORATION el I-EXPLORATION propio I-EXPLORATION paciente I-EXPLORATION hacía I-EXPLORATION cinco I-EXPLORATION días, I-EXPLORATION coincidiendo I-EXPLORATION con I-EXPLORATION un I-EXPLORATION corte I-EXPLORATION de I-EXPLORATION pelo, I-EXPLORATION sin I-EXPLORATION que I-EXPLORATION se I-EXPLORATION hubiese I-EXPLORATION percatado I-EXPLORATION antes. I-EXPLORATION I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION dermatológica I-EXPLORATION descrita I-EXPLORATION es I-EXPLORATION coincidente I-EXPLORATION con I-EXPLORATION la I-EXPLORATION denominada I-EXPLORATION alopecia I-EXPLORATION apolillada, I-EXPLORATION un I-EXPLORATION signo I-EXPLORATION infrecuente I-EXPLORATION de I-EXPLORATION secundarismo I-EXPLORATION luético. I-EXPLORATION I-EXPLORATION Se B-TREATMENT trató I-TREATMENT con I-TREATMENT penicilina I-TREATMENT G I-TREATMENT benzatina I-TREATMENT 2.400.000 I-TREATMENT UI. I-TREATMENT en I-TREATMENT dosis I-TREATMENT única. I-TREATMENT Posteriormente B-EVOLUTION se I-EVOLUTION procedió I-EVOLUTION a I-EVOLUTION seguimiento I-EVOLUTION clínico I-EVOLUTION y I-EVOLUTION serológico. I-EVOLUTION I-EVOLUTION Se I-EVOLUTION considera I-EVOLUTION que I-EVOLUTION la I-EVOLUTION alopecia I-EVOLUTION se I-EVOLUTION resuelve I-EVOLUTION totalmente I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION secuelas I-EVOLUTION hacia I-EVOLUTION el I-EVOLUTION tercer I-EVOLUTION mes I-EVOLUTION después I-EVOLUTION del I-EVOLUTION tratamiento1. I-EVOLUTION I-EVOLUTION La I-EVOLUTION incidencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION infección I-EVOLUTION por I-EVOLUTION sífilis I-EVOLUTION en I-EVOLUTION el I-EVOLUTION medio I-EVOLUTION penitenciario I-EVOLUTION es I-EVOLUTION más I-EVOLUTION alta I-EVOLUTION que I-EVOLUTION en I-EVOLUTION la I-EVOLUTION población I-EVOLUTION general2. I-EVOLUTION La I-EVOLUTION alopecia I-EVOLUTION en I-EVOLUTION cuero I-EVOLUTION cabelludo I-EVOLUTION es I-EVOLUTION una I-EVOLUTION manifestación I-EVOLUTION poco I-EVOLUTION común I-EVOLUTION en I-EVOLUTION la I-EVOLUTION sífilis I-EVOLUTION secundaria3, I-EVOLUTION se I-EVOLUTION estima I-EVOLUTION que I-EVOLUTION se I-EVOLUTION presenta I-EVOLUTION entre I-EVOLUTION el I-EVOLUTION 4 I-EVOLUTION y I-EVOLUTION el I-EVOLUTION 11% I-EVOLUTION según I-EVOLUTION diversos I-EVOLUTION estudios I-EVOLUTION publicados4, I-EVOLUTION 5, I-EVOLUTION pudiendo I-EVOLUTION tratarse I-EVOLUTION tanto I-EVOLUTION de I-EVOLUTION alopecias I-EVOLUTION difusas I-EVOLUTION como I-EVOLUTION de I-EVOLUTION aspecto I-EVOLUTION apolillado6. I-EVOLUTION I-EVOLUTION Si I-EVOLUTION bien I-EVOLUTION la I-EVOLUTION sífilis I-EVOLUTION es I-EVOLUTION poco I-EVOLUTION habitual I-EVOLUTION dentro I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION diferencial I-EVOLUTION de I-EVOLUTION alopecia, I-EVOLUTION debe I-EVOLUTION ser I-EVOLUTION tenido I-EVOLUTION en I-EVOLUTION cuenta I-EVOLUTION el I-EVOLUTION secundarismo I-EVOLUTION luético, I-EVOLUTION en I-EVOLUTION un I-EVOLUTION contexto I-EVOLUTION epidemiológico I-EVOLUTION de I-EVOLUTION riesgo. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS español I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 28 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS institucionalizado B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY prisión I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY diciembre I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY 2009 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY salvo I-PAST_MEDICAL_HISTORY asma I-PAST_MEDICAL_HISTORY bronquial I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY broncodilatadores I-PAST_MEDICAL_HISTORY inhalados. I-PAST_MEDICAL_HISTORY Previo I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY ingreso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY prisión, I-PAST_MEDICAL_HISTORY residió I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY nordeste I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Brasil, I-PAST_MEDICAL_HISTORY estado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Ceará, I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY marzo I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY 2008 I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY agosto I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY 2009, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY áreas I-PAST_MEDICAL_HISTORY suburbanas I-PAST_MEDICAL_HISTORY ("favelas"). I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY estancia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Brasil I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY consumido I-PAST_MEDICAL_HISTORY agua I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY grifo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ensaladas I-PAST_MEDICAL_HISTORY frescas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY caminado I-PAST_MEDICAL_HISTORY descalzo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY barro. I-PAST_MEDICAL_HISTORY También I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sufrido I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY diarreico I-PAST_MEDICAL_HISTORY autolimitado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY origen I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY aclarado. I-PAST_MEDICAL_HISTORY Doce B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS prisión I-PRESENT_ILLNESS inicia I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS general I-PRESENT_ILLNESS marcado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS y I-PRESENT_ILLNESS adelgazamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS Kgs I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso, I-PRESENT_ILLNESS acompañado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mareos, I-PRESENT_ILLNESS cefaleas I-PRESENT_ILLNESS ocasionales I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS dispépsica. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS líquida, I-PRESENT_ILLNESS acompañados I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS presencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS productos I-PRESENT_ILLNESS patológicos. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION únicamente I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION palidez I-EXPLORATION marcada I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica, I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 9, I-EXPLORATION 4 I-EXPLORATION gr/ I-EXPLORATION dL, I-EXPLORATION un I-EXPLORATION hematocrito I-EXPLORATION de I-EXPLORATION 29, I-EXPLORATION 3%, I-EXPLORATION un I-EXPLORATION volumen I-EXPLORATION corpuscular I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION 65fL, I-EXPLORATION leucocitos I-EXPLORATION de I-EXPLORATION 10.900/mm3 I-EXPLORATION (eosinófilos I-EXPLORATION 2.800/mm3), I-EXPLORATION plaquetas I-EXPLORATION 431.000/mm3. I-EXPLORATION Las I-EXPLORATION serologías I-EXPLORATION de I-EXPLORATION VIH, I-EXPLORATION hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C I-EXPLORATION fueron I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION derivó I-EXPLORATION para I-EXPLORATION ingreso I-EXPLORATION en I-EXPLORATION su I-EXPLORATION hospital I-EXPLORATION de I-EXPLORATION referencia, I-EXPLORATION donde I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION completa, I-EXPLORATION incluidas I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION función I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION la I-EXPLORATION radiología I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION alteraciones. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION parásitos I-EXPLORATION en I-EXPLORATION heces I-EXPLORATION en I-EXPLORATION 3 I-EXPLORATION muestras I-EXPLORATION consecutivas I-EXPLORATION por I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION concentración I-EXPLORATION con I-EXPLORATION éterformol, I-EXPLORATION observándose I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION huevos I-EXPLORATION de I-EXPLORATION uncinarias. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION Strongyloides I-EXPLORATION stercoralis I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION mediante I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION ELISA I-EXPLORATION con I-EXPLORATION una I-EXPLORATION titulación I-EXPLORATION de I-EXPLORATION 0.6 I-EXPLORATION unidades I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION óptica. I-EXPLORATION Se B-TREATMENT pautó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT albendazol I-TREATMENT 400 I-TREATMENT mg/12 I-TREATMENT horas I-TREATMENT (d.u) I-TREATMENT e I-TREATMENT ivermectina I-TREATMENT 200 I-TREATMENT microgramos/Kg/día I-TREATMENT dos I-TREATMENT días I-TREATMENT consecutivos I-TREATMENT junto I-TREATMENT con I-TREATMENT sulfato I-TREATMENT férrico I-TREATMENT oral I-TREATMENT durante I-TREATMENT 3 I-TREATMENT meses. I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION una I-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION hematológicos I-EVOLUTION y I-EVOLUTION negativización I-EVOLUTION tanto I-EVOLUTION del I-EVOLUTION análisis I-EVOLUTION coproparasitológico I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parásitos I-EVOLUTION intestinales I-EVOLUTION como I-EVOLUTION de I-EVOLUTION la I-EVOLUTION serología I-EVOLUTION para I-EVOLUTION Strongiloydes I-EVOLUTION stercoralis. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS portadora I-PRESENT_ILLNESS de I-PRESENT_ILLNESS prótesis I-PRESENT_ILLNESS de I-PRESENT_ILLNESS rodilla I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colecistectomía I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY herniorrafia I-PAST_MEDICAL_HISTORY umbilical, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS en I-PRESENT_ILLNESS región I-PRESENT_ILLNESS geniana I-PRESENT_ILLNESS izquierda I-PRESENT_ILLNESS de I-PRESENT_ILLNESS unos I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS ido I-PRESENT_ILLNESS disminuyendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS muy I-PRESENT_ILLNESS lentamente. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS única I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS referida I-PRESENT_ILLNESS es I-PRESENT_ILLNESS la I-PRESENT_ILLNESS derivada I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tamaño I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tumor. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION dos I-EXPLORATION tumoraciones, I-EXPLORATION aparentemente I-EXPLORATION independientes I-EXPLORATION entre I-EXPLORATION sí I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION parótida, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 2 I-EXPLORATION ó I-EXPLORATION 3 I-EXPLORATION cm, I-EXPLORATION móviles, I-EXPLORATION bien I-EXPLORATION definidas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION elástica. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION PAAF I-EXPLORATION preoperatoria I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION frotis I-EXPLORATION con I-EXPLORATION cuadro I-EXPLORATION citológico I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION mixto I-EXPLORATION de I-EXPLORATION glándula I-EXPLORATION salival. I-EXPLORATION Dado I-EXPLORATION que I-EXPLORATION en I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION la I-EXPLORATION tumoración I-EXPLORATION se I-EXPLORATION localiza, I-EXPLORATION en I-EXPLORATION principio, I-EXPLORATION independiente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION parótida I-EXPLORATION y I-EXPLORATION en I-EXPLORATION una I-EXPLORATION localización I-EXPLORATION poco I-EXPLORATION frecuente I-EXPLORATION para I-EXPLORATION un I-EXPLORATION adenoma I-EXPLORATION pleomorfo, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION RNM. I-EXPLORATION Esta I-EXPLORATION evidencia I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION ocupante I-EXPLORATION de I-EXPLORATION espacio I-EXPLORATION en I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mejilla I-EXPLORATION izquierda, I-EXPLORATION de I-EXPLORATION señal I-EXPLORATION homogénea, I-EXPLORATION hipointensa I-EXPLORATION en I-EXPLORATION T1 I-EXPLORATION y I-EXPLORATION marcadamente I-EXPLORATION hiperintensa I-EXPLORATION en I-EXPLORATION T2. I-EXPLORATION Esta I-EXPLORATION imagen I-EXPLORATION es I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION linfangioma, I-EXPLORATION que I-EXPLORATION en I-EXPLORATION su I-EXPLORATION parte I-EXPLORATION craneal I-EXPLORATION se I-EXPLORATION extiende I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION del I-EXPLORATION límite I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION y I-EXPLORATION desciende I-EXPLORATION en I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION el I-EXPLORATION borde I-EXPLORATION externo I-EXPLORATION del I-EXPLORATION masetero I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION bucal I-EXPLORATION donde I-EXPLORATION lo I-EXPLORATION bordea I-EXPLORATION anteriormente I-EXPLORATION y I-EXPLORATION se I-EXPLORATION introduce I-EXPLORATION medialmente I-EXPLORATION contactando I-EXPLORATION con I-EXPLORATION el I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION y I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION externa I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT realizar I-TREATMENT preoperatorio, I-TREATMENT se I-TREATMENT practica I-TREATMENT la I-TREATMENT intervención I-TREATMENT mediante I-TREATMENT un I-TREATMENT abordaje I-TREATMENT intraoral. I-TREATMENT Al B-EXPLORATION incidir I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION que I-EXPLORATION se I-EXPLORATION hernia, I-EXPLORATION y I-EXPLORATION que I-EXPLORATION resulta I-EXPLORATION fácil I-EXPLORATION de I-EXPLORATION separar I-EXPLORATION de I-EXPLORATION los I-EXPLORATION tejidos I-EXPLORATION circundantes I-EXPLORATION mediante I-EXPLORATION disección I-EXPLORATION roma. I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION final I-EXPLORATION nos I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION cm, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION quístico I-EXPLORATION y I-EXPLORATION forma I-EXPLORATION tubular I-EXPLORATION arrosariada. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION extirpada I-EXPLORATION muestra I-EXPLORATION macroscópicamente I-EXPLORATION una I-EXPLORATION formación I-EXPLORATION elongada, I-EXPLORATION cilíndrica, I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 11 I-EXPLORATION x I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION cm I-EXPLORATION cubierta I-EXPLORATION por I-EXPLORATION una I-EXPLORATION cápsula I-EXPLORATION con I-EXPLORATION vasos I-EXPLORATION prominentes I-EXPLORATION en I-EXPLORATION superficie I-EXPLORATION y I-EXPLORATION estructuras I-EXPLORATION cilíndricas I-EXPLORATION adheridas I-EXPLORATION a I-EXPLORATION la I-EXPLORATION formación I-EXPLORATION principal. I-EXPLORATION Al I-EXPLORATION corte I-EXPLORATION presenta I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fibroso I-EXPLORATION denso, I-EXPLORATION hialinizado, I-EXPLORATION alternando I-EXPLORATION con I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION más I-EXPLORATION laxo. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION microscópico I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION de I-EXPLORATION células I-EXPLORATION con I-EXPLORATION citoplasma I-EXPLORATION eosinófilo, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION mal I-EXPLORATION definidos, I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION fusiformes I-EXPLORATION con I-EXPLORATION sus I-EXPLORATION extremos I-EXPLORATION elongados, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION disponen I-EXPLORATION en I-EXPLORATION haces I-EXPLORATION adquiriendo I-EXPLORATION a I-EXPLORATION veces I-EXPLORATION un I-EXPLORATION aspecto I-EXPLORATION serpenteante I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION figuras I-EXPLORATION de I-EXPLORATION mitosis. I-EXPLORATION La I-EXPLORATION tumoración I-EXPLORATION presenta I-EXPLORATION zonas I-EXPLORATION más I-EXPLORATION densas I-EXPLORATION que I-EXPLORATION alternan I-EXPLORATION con I-EXPLORATION otras I-EXPLORATION mucho I-EXPLORATION más I-EXPLORATION laxas, I-EXPLORATION contiene I-EXPLORATION vasos I-EXPLORATION de I-EXPLORATION paredes I-EXPLORATION a I-EXPLORATION veces I-EXPLORATION hialinizadas, I-EXPLORATION en I-EXPLORATION general I-EXPLORATION finas I-EXPLORATION y I-EXPLORATION algunas I-EXPLORATION dilatadas I-EXPLORATION quísticamente. I-EXPLORATION La I-EXPLORATION tumoración I-EXPLORATION aparece I-EXPLORATION bien I-EXPLORATION delimitada I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION se I-EXPLORATION observan I-EXPLORATION fascículos I-EXPLORATION nerviosos, I-EXPLORATION algunos I-EXPLORATION con I-EXPLORATION comienzo I-EXPLORATION de I-EXPLORATION proliferación. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION el I-EXPLORATION de I-EXPLORATION neurofibroma I-EXPLORATION plexiforme. I-EXPLORATION I-EXPLORATION En I-EXPLORATION nuestro I-EXPLORATION caso I-EXPLORATION no I-EXPLORATION encontramos I-EXPLORATION ningún I-EXPLORATION hallazgo I-EXPLORATION clínico I-EXPLORATION ni I-EXPLORATION antecedente I-EXPLORATION personal I-EXPLORATION ó I-EXPLORATION familiar I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION neurofibromatosis I-EXPLORATION tipo I-EXPLORATION I I-EXPLORATION ó I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION poliglandular I-EXPLORATION MEN I-EXPLORATION III I-EXPLORATION (MEN I-EXPLORATION IIb) I-EXPLORATION y I-EXPLORATION parece I-EXPLORATION confirmar I-EXPLORATION que I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION aisladas I-EXPLORATION son I-EXPLORATION independientes I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION síndromes. I-EXPLORATION I-EXPLORATION En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION intervención, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION ningún I-EVOLUTION signo I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION tumoral I-EVOLUTION en I-EVOLUTION las I-EVOLUTION sucesivas I-EVOLUTION revisiones. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-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 una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS no I-PRESENT_ILLNESS dolorosa, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS lento I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS seis I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS maxilar I-PRESENT_ILLNESS superior, I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS los I-PRESENT_ILLNESS premolares I-PRESENT_ILLNESS 14 I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 15, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS permanecen I-PRESENT_ILLNESS vitales, I-PRESENT_ILLNESS desplazando I-PRESENT_ILLNESS ligeramente I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS raíces. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS hay I-PRESENT_ILLNESS dolor, I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS tróficas I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inflamación. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION expansión I-EXPLORATION en I-EXPLORATION la I-EXPLORATION corteza I-EXPLORATION vestibular, I-EXPLORATION con I-EXPLORATION integridad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION existía I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION radiolúcida I-EXPLORATION entre I-EXPLORATION las I-EXPLORATION raíces I-EXPLORATION de I-EXPLORATION los I-EXPLORATION premolares I-EXPLORATION superiores. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION nos I-EXPLORATION dio I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION OKC I-EXPLORATION con I-EXPLORATION aisladas I-EXPLORATION microinclusiones I-EXPLORATION córneas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION quística I-EXPLORATION que I-EXPLORATION ofrece I-EXPLORATION aislado I-EXPLORATION componente I-EXPLORATION cartilaginoso; I-EXPLORATION no I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION proliferación I-EXPLORATION celular I-EXPLORATION ameloblástica. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS raza I-PRESENT_ILLNESS blanca, I-PRESENT_ILLNESS 80 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 acudió I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION induración I-EXPLORATION eritematosa, I-EXPLORATION parcialmente I-EXPLORATION ulcerada, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua I-EXPLORATION dolorosa I-EXPLORATION al I-EXPLORATION tacto. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION objetivó, I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación, I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION adenomegalias, I-EXPLORATION ni I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION masas I-EXPLORATION cervicales. I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION cuyo I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION evidenció I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION uniforme I-EXPLORATION de I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION linfoma. I-EXPLORATION La I-EXPLORATION analítica I-EXPLORATION preoperatoria I-EXPLORATION (hemograma, I-EXPLORATION bioquímica) I-EXPLORATION y I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION no I-EXPLORATION mostraron I-EXPLORATION alteraciones I-EXPLORATION significativas. I-EXPLORATION Bajo B-TREATMENT anestesia I-TREATMENT local I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT tumoración I-TREATMENT con I-TREATMENT amplios I-TREATMENT márgenes I-TREATMENT de I-TREATMENT seguridad. I-TREATMENT I-TREATMENT Microscópicamente, B-EXPLORATION el I-EXPLORATION infiltrado I-EXPLORATION linfoide I-EXPLORATION ulceraba I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION epitelial I-EXPLORATION infiltrando, I-EXPLORATION en I-EXPLORATION profundidad, I-EXPLORATION la I-EXPLORATION musculatura I-EXPLORATION lingual. I-EXPLORATION Alrededor I-EXPLORATION de I-EXPLORATION este I-EXPLORATION infiltrado I-EXPLORATION se I-EXPLORATION podían I-EXPLORATION reconocer I-EXPLORATION múltiples I-EXPLORATION folículos I-EXPLORATION linfoides; I-EXPLORATION algunos I-EXPLORATION mostraban I-EXPLORATION centros I-EXPLORATION germinales I-EXPLORATION reactivos I-EXPLORATION con I-EXPLORATION histiocitos I-EXPLORATION tipo I-EXPLORATION cielo I-EXPLORATION estrellado I-EXPLORATION (starry-sky); I-EXPLORATION otros I-EXPLORATION mostraron I-EXPLORATION cambios I-EXPLORATION regresivos I-EXPLORATION en I-EXPLORATION los I-EXPLORATION centros I-EXPLORATION germinales I-EXPLORATION con I-EXPLORATION depósitos I-EXPLORATION de I-EXPLORATION sustancia I-EXPLORATION eosinófila I-EXPLORATION homogénea. I-EXPLORATION Todos I-EXPLORATION estaban I-EXPLORATION rodeados I-EXPLORATION por I-EXPLORATION un I-EXPLORATION importante I-EXPLORATION infiltrado I-EXPLORATION perifolicular I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION pequeñas I-EXPLORATION células I-EXPLORATION linfoides I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION ligeramente I-EXPLORATION irregulares I-EXPLORATION y I-EXPLORATION acúmulos I-EXPLORATION de I-EXPLORATION cromatina I-EXPLORATION moderadamente I-EXPLORATION densos I-EXPLORATION similares I-EXPLORATION a I-EXPLORATION los I-EXPLORATION centrocitos I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION marginal. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION reconocer I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION numerosos I-EXPLORATION histiocitos I-EXPLORATION y I-EXPLORATION eosinófilos. I-EXPLORATION Ocasionalmente I-EXPLORATION algunas I-EXPLORATION células I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION varios I-EXPLORATION nucleolos I-EXPLORATION prominentes, I-EXPLORATION se I-EXPLORATION entremezclaban I-EXPLORATION con I-EXPLORATION las I-EXPLORATION células I-EXPLORATION pequeñas I-EXPLORATION formando I-EXPLORATION columnas I-EXPLORATION de I-EXPLORATION centroblastos I-EXPLORATION e I-EXPLORATION inmunoblastos. I-EXPLORATION También I-EXPLORATION podía I-EXPLORATION reconocerse I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION diferenciación I-EXPLORATION plasmocitoide, I-EXPLORATION predominante I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION paraseptal I-EXPLORATION y I-EXPLORATION subepitelial. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tumoración, I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION lóbulos, I-EXPLORATION parcialmente I-EXPLORATION conservados, I-EXPLORATION de I-EXPLORATION glándulas I-EXPLORATION salivales I-EXPLORATION menores I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION mucoso, I-EXPLORATION mostrando I-EXPLORATION una I-EXPLORATION destacada I-EXPLORATION infiltración I-EXPLORATION linfoidea. I-EXPLORATION Los I-EXPLORATION conductos I-EXPLORATION salivales I-EXPLORATION estaban I-EXPLORATION dilatados I-EXPLORATION e I-EXPLORATION infiltrados I-EXPLORATION por I-EXPLORATION células I-EXPLORATION B I-EXPLORATION con I-EXPLORATION formación I-EXPLORATION ocasional I-EXPLORATION de I-EXPLORATION islas I-EXPLORATION epimioepiteliales. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION podían I-EXPLORATION reconocer, I-EXPLORATION abundantes I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION los I-EXPLORATION conductos I-EXPLORATION glandulares. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION sobre I-EXPLORATION secciones I-EXPLORATION congeladas I-EXPLORATION y I-EXPLORATION fijadas I-EXPLORATION en I-EXPLORATION formalina I-EXPLORATION y I-EXPLORATION parafina, I-EXPLORATION utilizando I-EXPLORATION el I-EXPLORATION método I-EXPLORATION estreptavidina-biotina. I-EXPLORATION Se I-EXPLORATION emplearon I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION anticuerpos: I-EXPLORATION CD20, I-EXPLORATION CD3, I-EXPLORATION CD5, I-EXPLORATION CD10, I-EXPLORATION CD23, I-EXPLORATION CD43, I-EXPLORATION DBA44, I-EXPLORATION CD68, I-EXPLORATION inmunoglobulinas I-EXPLORATION α, I-EXPLORATION γ, I-EXPLORATION µ I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION pesada I-EXPLORATION y I-EXPLORATION κ, I-EXPLORATION λ I-EXPLORATION de I-EXPLORATION cadena I-EXPLORATION ligera. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION centrocíticas, I-EXPLORATION mostraron I-EXPLORATION un I-EXPLORATION fenotipo I-EXPLORATION B, I-EXPLORATION con I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION CD20, I-EXPLORATION CD5 I-EXPLORATION y I-EXPLORATION CD43. I-EXPLORATION CD10, I-EXPLORATION CD23 I-EXPLORATION y I-EXPLORATION DBA44 I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION pequeña I-EXPLORATION proporción I-EXPLORATION de I-EXPLORATION células I-EXPLORATION T, I-EXPLORATION con I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION el I-EXPLORATION CD3. I-EXPLORATION Las I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION en I-EXPLORATION las I-EXPLORATION bandas I-EXPLORATION paraseptales I-EXPLORATION y I-EXPLORATION subepiteliales I-EXPLORATION y I-EXPLORATION también I-EXPLORATION las I-EXPLORATION de I-EXPLORATION los I-EXPLORATION conductos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas I-EXPLORATION mucosas, I-EXPLORATION mostraron I-EXPLORATION producción I-EXPLORATION de I-EXPLORATION inmunoglobulina I-EXPLORATION IgG/κ. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION linfoma I-EXPLORATION MALT. I-EXPLORATION Las I-EXPLORATION alteraciones I-EXPLORATION morfológicas I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas I-EXPLORATION salivales I-EXPLORATION menores I-EXPLORATION próximas I-EXPLORATION al I-EXPLORATION tumor, I-EXPLORATION se I-EXPLORATION interpretaron I-EXPLORATION como I-EXPLORATION sialoadenitis I-EXPLORATION mioepitelial. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION sufrió I-EVOLUTION otras I-EVOLUTION manifestaciones I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION como I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION Sjögren, I-EVOLUTION artritis I-EVOLUTION reumatoide I-EVOLUTION diseminada, I-EVOLUTION lupus I-EVOLUTION eritematoso, I-EVOLUTION o I-EVOLUTION tiroiditis I-EVOLUTION de I-EVOLUTION Hashimoto. I-EVOLUTION El I-EVOLUTION linfoma I-EVOLUTION se I-EVOLUTION consideró I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION tanto I-EVOLUTION en I-EVOLUTION un I-EVOLUTION estadio I-EVOLUTION IE. I-EVOLUTION La B-TREATMENT paciente I-TREATMENT no I-TREATMENT ha I-TREATMENT recibido I-TREATMENT ningún I-TREATMENT tratamiento I-TREATMENT salvo I-TREATMENT el I-TREATMENT quirúrgico, I-TREATMENT sin I-TREATMENT presentar I-TREATMENT signos I-TREATMENT de I-TREATMENT enfermedad I-TREATMENT al I-TREATMENT año I-TREATMENT del I-TREATMENT diagnóstico. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS úlcera I-PRESENT_ILLNESS en I-PRESENT_ILLNESS encía I-PRESENT_ILLNESS adherida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS región I-PRESENT_ILLNESS molar I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS había I-PRESENT_ILLNESS cedido I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS conservador. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION oral I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION úlcera I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION zona I-EXPLORATION molar I-EXPLORATION superior I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION fondo I-EXPLORATION necrótico I-EXPLORATION y I-EXPLORATION bordes I-EXPLORATION sobreelevados I-EXPLORATION y I-EXPLORATION eritematosos I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION junto I-EXPLORATION a I-EXPLORATION un I-EXPLORATION abombamiento I-EXPLORATION en I-EXPLORATION fondo I-EXPLORATION vestibular I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION en I-EXPLORATION paladar I-EXPLORATION duro I-EXPLORATION (lado I-EXPLORATION izquierdo). I-EXPLORATION Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY bebedor I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY refería I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esófago I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 1/3 I-PAST_MEDICAL_HISTORY distal I-PAST_MEDICAL_HISTORY hacía I-PAST_MEDICAL_HISTORY cuatro I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY trataba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esófago I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY enteroide, I-PAST_MEDICAL_HISTORY pobremente I-PAST_MEDICAL_HISTORY diferenciado, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY infiltración I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tejido I-PAST_MEDICAL_HISTORY adiposo I-PAST_MEDICAL_HISTORY periesofágico, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY escasa I-PAST_MEDICAL_HISTORY reacción I-PAST_MEDICAL_HISTORY fibroblastica I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY linfoide I-PAST_MEDICAL_HISTORY peritumoral, I-PAST_MEDICAL_HISTORY así I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY metástasis I-PAST_MEDICAL_HISTORY ganglionar, I-PAST_MEDICAL_HISTORY presentando I-PAST_MEDICAL_HISTORY extensión I-PAST_MEDICAL_HISTORY extracapsular, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY atipias I-PAST_MEDICAL_HISTORY intensas, I-PAST_MEDICAL_HISTORY índice I-PAST_MEDICAL_HISTORY mitótico I-PAST_MEDICAL_HISTORY elevado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY necrosis I-PAST_MEDICAL_HISTORY moderada. I-PAST_MEDICAL_HISTORY El B-TREATMENT paciente I-TREATMENT no I-TREATMENT recibió I-TREATMENT tratamiento I-TREATMENT complementario I-TREATMENT con I-TREATMENT quimioterapia I-TREATMENT ni I-TREATMENT radioterapia I-TREATMENT postoperatoria I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT en I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT sufrió I-TREATMENT dehiscencia I-TREATMENT de I-TREATMENT la I-TREATMENT sutura I-TREATMENT gastroesofágica I-TREATMENT y I-TREATMENT fistula I-TREATMENT gastrocutánea I-TREATMENT que I-TREATMENT cedió I-TREATMENT tras I-TREATMENT nutricion I-TREATMENT parenteral. I-TREATMENT I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION simple I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION ortopantomografía I-EXPLORATION y I-EXPLORATION Waters I-EXPLORATION apreciando I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION osteolisis I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION hueso I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION e I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION ocupación I-EXPLORATION en I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION izquierdo. I-EXPLORATION Se I-EXPLORATION procedió I-EXPLORATION a I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION intraoral, I-EXPLORATION informando I-EXPLORATION el I-EXPLORATION anatomopatólogo I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION esófago. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION ingresado I-EVOLUTION para I-EVOLUTION descartar I-EVOLUTION que I-EVOLUTION presentase I-EVOLUTION más I-EVOLUTION metástasis I-EVOLUTION y I-EVOLUTION delimitar I-EVOLUTION la I-EVOLUTION extensión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION metástasis I-EVOLUTION de I-EVOLUTION hueso I-EVOLUTION maxilar. I-EVOLUTION La B-EXPLORATION exploración I-EXPLORATION cervical I-EXPLORATION para I-EXPLORATION valorar I-EXPLORATION el I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cadenas I-EXPLORATION ganglionares I-EXPLORATION fue I-EXPLORATION negativo. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION TAC I-EXPLORATION orofacial, I-EXPLORATION apreciando I-EXPLORATION destrucción I-EXPLORATION de I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION izquierdo I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION paladar I-EXPLORATION duro, I-EXPLORATION apófisis I-EXPLORATION pterigoides, I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION rotura I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION de I-EXPLORATION pared I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION izquierdo, I-EXPLORATION existiendo I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION espacio I-EXPLORATION masticador I-EXPLORATION izquierdo, I-EXPLORATION y I-EXPLORATION estando I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION muy I-EXPLORATION próximo I-EXPLORATION al I-EXPLORATION suelo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION órbita I-EXPLORATION izquierda. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION siendo I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION completó I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION gammagrafía I-EXPLORATION ósea, I-EXPLORATION apreciando I-EXPLORATION lesiones I-EXPLORATION óseas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION malignidad I-EXPLORATION en I-EXPLORATION hueso I-EXPLORATION maxilar I-EXPLORATION superior I-EXPLORATION izquierdo, I-EXPLORATION pelvis I-EXPLORATION derecha, I-EXPLORATION séptima I-EXPLORATION vértebra I-EXPLORATION dorsal I-EXPLORATION y I-EXPLORATION parrilla I-EXPLORATION costal I-EXPLORATION derecha. I-EXPLORATION Cuando B-EVOLUTION se I-EVOLUTION terminó I-EVOLUTION de I-EVOLUTION completar I-EVOLUTION el I-EVOLUTION estudio I-EVOLUTION (dos I-EVOLUTION semanas I-EVOLUTION de I-EVOLUTION duración I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION consulta I-EVOLUTION y I-EVOLUTION toma I-EVOLUTION de I-EVOLUTION biopsia I-EVOLUTION intraoral), I-EVOLUTION la I-EVOLUTION lesión I-EVOLUTION intraoral I-EVOLUTION había I-EVOLUTION crecido I-EVOLUTION enormemente, I-EVOLUTION presentando I-EVOLUTION áreas I-EVOLUTION necróticas I-EVOLUTION y I-EVOLUTION afectando I-EVOLUTION a I-EVOLUTION todo I-EVOLUTION el I-EVOLUTION fondo I-EVOLUTION vestibular I-EVOLUTION superior I-EVOLUTION izquierdo, I-EVOLUTION encía I-EVOLUTION y I-EVOLUTION paladar I-EVOLUTION duro I-EVOLUTION izquierdo, I-EVOLUTION presentando I-EVOLUTION así I-EVOLUTION mismo I-EVOLUTION impotencia I-EVOLUTION funcional I-EVOLUTION en I-EVOLUTION pierna I-EVOLUTION derecha I-EVOLUTION que I-EVOLUTION le I-EVOLUTION impedía I-EVOLUTION una I-EVOLUTION correcta I-EVOLUTION deambulación. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION murió I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION repentina I-EVOLUTION tras I-EVOLUTION presentar I-EVOLUTION hemorragia I-EVOLUTION masiva I-EVOLUTION por I-EVOLUTION cavidad I-EVOLUTION oral. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY células I-PAST_MEDICAL_HISTORY basales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY piel I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY región I-PAST_MEDICAL_HISTORY paranasal I-PAST_MEDICAL_HISTORY izquierda, I-PAST_MEDICAL_HISTORY acudió B-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tumoración I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ángulo I-PRESENT_ILLNESS mandibular 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 Aportaba B-EXPLORATION un I-EXPLORATION informe I-EXPLORATION citopatológico I-EXPLORATION procedente I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION punciones-aspiración I-EXPLORATION con I-EXPLORATION aguja I-EXPLORATION fina I-EXPLORATION (PAAF) I-EXPLORATION efectuada I-EXPLORATION en I-EXPLORATION otro I-EXPLORATION centro, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION resultado I-EXPLORATION de I-EXPLORATION frotis I-EXPLORATION sugestivos I-EXPLORATION de I-EXPLORATION proliferación I-EXPLORATION epitelial I-EXPLORATION de I-EXPLORATION baja I-EXPLORATION agresividad I-EXPLORATION citológica. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION observados I-EXPLORATION eran I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION un I-EXPLORATION adenoma I-EXPLORATION pleomorfo I-EXPLORATION de I-EXPLORATION glándula I-EXPLORATION salivar, I-EXPLORATION sin I-EXPLORATION embargo I-EXPLORATION la I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION estroma I-EXPLORATION era I-EXPLORATION mínima, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION patrón I-EXPLORATION se I-EXPLORATION desviaba I-EXPLORATION de I-EXPLORATION lo I-EXPLORATION habitual I-EXPLORATION en I-EXPLORATION estos I-EXPLORATION casos, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION pudieron I-EXPLORATION descartar I-EXPLORATION otros I-EXPLORATION tumores, I-EXPLORATION incluído I-EXPLORATION el I-EXPLORATION carcinoma. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION región I-EXPLORATION yugulodigástrica I-EXPLORATION derecha, I-EXPLORATION desplazable I-EXPLORATION sobre I-EXPLORATION planos I-EXPLORATION profundos I-EXPLORATION y I-EXPLORATION no I-EXPLORATION adherida I-EXPLORATION a I-EXPLORATION la I-EXPLORATION piel. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION otras I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION tumoraciones I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cervicofacial. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION la I-EXPLORATION sospecha I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION tumor I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION cola I-EXPLORATION parotídea I-EXPLORATION derecha, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION (TC) I-EXPLORATION cervicofacial I-EXPLORATION con I-EXPLORATION contraste, I-EXPLORATION practicándose I-EXPLORATION ventana I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION y I-EXPLORATION ventana I-EXPLORATION de I-EXPLORATION hueso. I-EXPLORATION I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION superficial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION parotídea I-EXPLORATION derecha, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cola I-EXPLORATION de I-EXPLORATION la I-EXPLORATION parótida, I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION nodular, I-EXPLORATION hipercaptante, I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION definidos I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION que, I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION las I-EXPLORATION características I-EXPLORATION radiológicas I-EXPLORATION y I-EXPLORATION la I-EXPLORATION lenta I-EXPLORATION evolución I-EXPLORATION en I-EXPLORATION tres I-EXPLORATION años, I-EXPLORATION se I-EXPLORATION interpretó I-EXPLORATION como I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION benigna, I-EXPLORATION a I-EXPLORATION considerar I-EXPLORATION las I-EXPLORATION etiologías I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION pleomorfo, I-EXPLORATION tumor I-EXPLORATION de I-EXPLORATION Warthin I-EXPLORATION u I-EXPLORATION otros I-EXPLORATION tumores I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION salivar I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION benigna. I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION adenopatías I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION no I-EXPLORATION significativo I-EXPLORATION en I-EXPLORATION sendas I-EXPLORATION cadenas I-EXPLORATION submandibulares, I-EXPLORATION yugulodigástricas I-EXPLORATION y I-EXPLORATION en I-EXPLORATION triángulos I-EXPLORATION posteriores. I-EXPLORATION I-EXPLORATION Con B-TREATMENT la I-TREATMENT sospecha I-TREATMENT clínico-radiológica I-TREATMENT de I-TREATMENT tumor I-TREATMENT benigno I-TREATMENT de I-TREATMENT glándula I-TREATMENT parótida I-TREATMENT derecha, I-TREATMENT se I-TREATMENT intervino I-TREATMENT quirúrgicamente I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general I-TREATMENT e I-TREATMENT intubación I-TREATMENT orotraqueal, I-TREATMENT realizándose I-TREATMENT parotidectomía I-TREATMENT suprafacial I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT un I-TREATMENT abordaje I-TREATMENT de I-TREATMENT ritidectomía, I-TREATMENT con I-TREATMENT resección I-TREATMENT del I-TREATMENT lóbulo I-TREATMENT parotídeo I-TREATMENT superficial I-TREATMENT de I-TREATMENT 5 I-TREATMENT x I-TREATMENT 3 I-TREATMENT cm I-TREATMENT y I-TREATMENT aplicación I-TREATMENT de I-TREATMENT cierre I-TREATMENT con I-TREATMENT colgajo I-TREATMENT de I-TREATMENT SMAS. I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION bien I-EXPLORATION delimitada I-EXPLORATION de I-EXPLORATION 18 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION de I-EXPLORATION color I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION superficie I-EXPLORATION homogénea, I-EXPLORATION en I-EXPLORATION un I-EXPLORATION extremo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza. I-EXPLORATION Al I-EXPLORATION corte, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION de I-EXPLORATION textura I-EXPLORATION homogénea, I-EXPLORATION y I-EXPLORATION características I-EXPLORATION macroscópicas I-EXPLORATION de I-EXPLORATION normalidad I-EXPLORATION para I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula. I-EXPLORATION Asimismo, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biosia-exéresis I-EXPLORATION de I-EXPLORATION adenopatía I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION la I-EXPLORATION proximidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glándula I-EXPLORATION parótida, I-EXPLORATION que I-EXPLORATION al I-EXPLORATION corte I-EXPLORATION presentó I-EXPLORATION una I-EXPLORATION textura I-EXPLORATION homogénea, I-EXPLORATION color I-EXPLORATION blanquecino I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION elástica. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION microscópico I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION encapsulada I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION nidos I-EXPLORATION o I-EXPLORATION trabéculas I-EXPLORATION separadas I-EXPLORATION por I-EXPLORATION una I-EXPLORATION membrana I-EXPLORATION basal I-EXPLORATION eosinófila I-EXPLORATION y I-EXPLORATION constituidas I-EXPLORATION por I-EXPLORATION células I-EXPLORATION basalioides I-EXPLORATION que I-EXPLORATION se I-EXPLORATION disponían I-EXPLORATION a I-EXPLORATION modo I-EXPLORATION de I-EXPLORATION empalizada I-EXPLORATION periférica. I-EXPLORATION La I-EXPLORATION celularidad I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION inmunohistoquímico I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION citoqueratina I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION peso I-EXPLORATION molecular I-EXPLORATION y I-EXPLORATION focalmente I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION S-100. I-EXPLORATION El I-EXPLORATION diagnóstico I-EXPLORATION anatomopatológico I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION basales I-EXPLORATION de I-EXPLORATION glándula I-EXPLORATION parótida I-EXPLORATION y I-EXPLORATION ganglios I-EXPLORATION linfáticos I-EXPLORATION con I-EXPLORATION hiperplasia I-EXPLORATION folicular. I-EXPLORATION I-EXPLORATION El B-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION complicaciones I-EVOLUTION importantes, I-EVOLUTION salvo I-EVOLUTION ligera I-EVOLUTION paresia I-EVOLUTION a I-EVOLUTION nivel I-EVOLUTION de I-EVOLUTION las I-EVOLUTION ramas I-EVOLUTION frontal I-EVOLUTION y I-EVOLUTION bucal I-EVOLUTION del I-EVOLUTION nervio I-EVOLUTION facial, I-EVOLUTION que I-EVOLUTION experimentó I-EVOLUTION mejoría I-EVOLUTION progresiva I-EVOLUTION en I-EVOLUTION los I-EVOLUTION días I-EVOLUTION subsiguientes I-EVOLUTION a I-EVOLUTION la I-EVOLUTION intervención. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS otica I-PRESENT_ILLNESS y I-PRESENT_ILLNESS craneofacial I-PRESENT_ILLNESS referida I-PRESENT_ILLNESS con I-PRESENT_ILLNESS otalgia I-PRESENT_ILLNESS izquierda, I-PRESENT_ILLNESS tinitus I-PRESENT_ILLNESS bilateral, I-PRESENT_ILLNESS vértigo, I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS oído I-PRESENT_ILLNESS tapado I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuello I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuero I-PRESENT_ILLNESS cabelludo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS zona I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION otorrinolaringologico I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION patología I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION oído, I-EXPLORATION nariz I-EXPLORATION o I-EXPLORATION garganta. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION compromiso I-EXPLORATION músculo-esquelético I-EXPLORATION con I-EXPLORATION resentimiento I-EXPLORATION muscular I-EXPLORATION local I-EXPLORATION en I-EXPLORATION zonas I-EXPLORATION de: I-EXPLORATION pterigoideo I-EXPLORATION externo I-EXPLORATION bilateral, I-EXPLORATION temporal I-EXPLORATION bilateral, I-EXPLORATION digastrico I-EXPLORATION vientre I-EXPLORATION posterior, I-EXPLORATION esternocleidomastoideo I-EXPLORATION bilateral, I-EXPLORATION esplenio I-EXPLORATION bilateral, I-EXPLORATION occipitofrontal I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION izquierda. I-EXPLORATION Se I-EXPLORATION encuentran I-EXPLORATION puntos I-EXPLORATION gatillo I-EXPLORATION en I-EXPLORATION músculo I-EXPLORATION trapecio I-EXPLORATION bilateralmente. I-EXPLORATION La I-EXPLORATION paciente I-EXPLORATION reporta I-EXPLORATION dolor I-EXPLORATION al I-EXPLORATION masticar I-EXPLORATION y I-EXPLORATION dolor I-EXPLORATION al I-EXPLORATION tragar I-EXPLORATION alimentos I-EXPLORATION duros. I-EXPLORATION También I-EXPLORATION relata I-EXPLORATION odontalgias I-EXPLORATION fantasmas I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION molares I-EXPLORATION mandibulares I-EXPLORATION izquierdos I-EXPLORATION sin I-EXPLORATION patología I-EXPLORATION dental I-EXPLORATION evidente I-EXPLORATION al I-EXPLORATION examen, I-EXPLORATION igualmente I-EXPLORATION describe I-EXPLORATION dolor I-EXPLORATION tipo I-EXPLORATION hiperalgesia I-EXPLORATION secundaria I-EXPLORATION en I-EXPLORATION cuero I-EXPLORATION cabelludo I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION hace I-EXPLORATION pensar I-EXPLORATION en I-EXPLORATION un I-EXPLORATION posible I-EXPLORATION componente I-EXPLORATION neuropatico I-EXPLORATION de I-EXPLORATION su I-EXPLORATION queja. I-EXPLORATION Reporta I-EXPLORATION sabores I-EXPLORATION agrio-amargos I-EXPLORATION periódicamente I-EXPLORATION con I-EXPLORATION sensación I-EXPLORATION de I-EXPLORATION quemadura I-EXPLORATION en I-EXPLORATION paladar. I-EXPLORATION Se I-EXPLORATION palpan I-EXPLORATION los I-EXPLORATION procesos I-EXPLORATION hamulares, I-EXPLORATION encontrando I-EXPLORATION dolor I-EXPLORATION intenso I-EXPLORATION local I-EXPLORATION del I-EXPLORATION lado I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION referido I-EXPLORATION a I-EXPLORATION oído I-EXPLORATION y I-EXPLORATION zona I-EXPLORATION mandibular I-EXPLORATION izquierda I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación. I-EXPLORATION Se B-TREATMENT programa I-TREATMENT la I-TREATMENT infiltración I-TREATMENT de I-TREATMENT la I-TREATMENT zona I-TREATMENT hamular I-TREATMENT izquierda I-TREATMENT con I-TREATMENT corticoide I-TREATMENT sintético I-TREATMENT (Betametasona I-TREATMENT - I-TREATMENT suspensión I-TREATMENT de I-TREATMENT 4 I-TREATMENT mg) I-TREATMENT previa I-TREATMENT anestesia I-TREATMENT local. I-TREATMENT La I-TREATMENT paciente I-TREATMENT también I-TREATMENT fue I-TREATMENT manejada I-TREATMENT con I-TREATMENT dispositivo I-TREATMENT intraoral I-TREATMENT para I-TREATMENT la I-TREATMENT supresión I-TREATMENT de I-TREATMENT la I-TREATMENT actividad I-TREATMENT muscular I-TREATMENT como I-TREATMENT tratamiento I-TREATMENT del I-TREATMENT DTM I-TREATMENT y I-TREATMENT la I-TREATMENT sintomatología I-TREATMENT otica I-TREATMENT referida I-TREATMENT 1 I-TREATMENT mes I-TREATMENT posterior I-TREATMENT a I-TREATMENT la I-TREATMENT sintomatología I-TREATMENT de I-TREATMENT la I-TREATMENT Bursitis I-TREATMENT Hamular. I-TREATMENT Se B-EVOLUTION ha I-EVOLUTION controlado I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION durante I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION sin I-EVOLUTION recurrencia I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología. I-EVOLUTION La I-EVOLUTION presentacion I-EVOLUTION clinica I-EVOLUTION del I-EVOLUTION compromiso I-EVOLUTION músculo-esqueletico I-EVOLUTION y I-EVOLUTION otico, I-EVOLUTION adicional I-EVOLUTION al I-EVOLUTION dolor I-EVOLUTION en I-EVOLUTION zona I-EVOLUTION del I-EVOLUTION proceso I-EVOLUTION hamular I-EVOLUTION y I-EVOLUTION posible I-EVOLUTION relacion I-EVOLUTION concomitante I-EVOLUTION pueden I-EVOLUTION tener I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION base I-EVOLUTION fisiopatologica I-EVOLUTION del I-EVOLUTION caso I-EVOLUTION clínico I-EVOLUTION anterior. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS solicitando I-PRESENT_ILLNESS una I-PRESENT_ILLNESS solución I-PRESENT_ILLNESS estética I-PRESENT_ILLNESS para I-PRESENT_ILLNESS su I-PRESENT_ILLNESS frente I-PRESENT_ILLNESS anterior. I-PRESENT_ILLNESS Durante B-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY primeros I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY sometido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY intervenciones I-PAST_MEDICAL_HISTORY quirúrgicas I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY conseguir I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY cierre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tejidos I-PAST_MEDICAL_HISTORY blandos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY labio I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY paladar. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION extraoral I-EXPLORATION se I-EXPLORATION podía I-EXPLORATION observar I-EXPLORATION una I-EXPLORATION asimetría I-EXPLORATION del I-EXPLORATION labio I-EXPLORATION superior I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION las I-EXPLORATION diversas I-EXPLORATION operaciones I-EXPLORATION a I-EXPLORATION las I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION sometido I-EXPLORATION en I-EXPLORATION la I-EXPLORATION infancia. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION intraoral I-EXPLORATION se I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION una I-EXPLORATION evidente I-EXPLORATION malposición I-EXPLORATION y I-EXPLORATION maloclusión I-EXPLORATION dentaria I-EXPLORATION así I-EXPLORATION como I-EXPLORATION distintas I-EXPLORATION agenesias I-EXPLORATION dentales I-EXPLORATION (15, I-EXPLORATION 12, I-EXPLORATION 11, I-EXPLORATION 25, I-EXPLORATION 34, I-EXPLORATION 33 I-EXPLORATION y I-EXPLORATION 44) I-EXPLORATION y I-EXPLORATION discrepancia I-EXPLORATION maxilo-mandibular. I-EXPLORATION Apreciándose I-EXPLORATION también I-EXPLORATION una I-EXPLORATION gingivitis I-EXPLORATION moderada I-EXPLORATION por I-EXPLORATION falta I-EXPLORATION de I-EXPLORATION control I-EXPLORATION de I-EXPLORATION placa. I-EXPLORATION I-EXPLORATION Vemos I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION grave I-EXPLORATION dismorfosis I-EXPLORATION maxilo-mandibular I-EXPLORATION que I-EXPLORATION aconsejaba I-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION un I-EXPLORATION tratamiento I-EXPLORATION ortodóncico I-EXPLORATION previo I-EXPLORATION a I-EXPLORATION cualquier I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION decisión I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION prostodóncico. I-EXPLORATION El I-EXPLORATION caso I-EXPLORATION fue I-EXPLORATION consultado I-EXPLORATION al I-EXPLORATION especialista I-EXPLORATION en I-EXPLORATION ortodoncia I-EXPLORATION y I-EXPLORATION este I-EXPLORATION planteo I-EXPLORATION la I-EXPLORATION necesidad I-EXPLORATION de I-EXPLORATION una I-EXPLORATION cirugía I-EXPLORATION ortognática I-EXPLORATION previa I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION protético. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION explicó I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION y I-EXPLORATION este I-EXPLORATION se I-EXPLORATION opuso I-EXPLORATION a I-EXPLORATION someterse I-EXPLORATION al I-EXPLORATION tratamiento I-EXPLORATION quirúrgico. I-EXPLORATION I-EXPLORATION Analizado B-TREATMENT los I-TREATMENT hábitos I-TREATMENT higiénicos I-TREATMENT del I-TREATMENT paciente I-TREATMENT y I-TREATMENT observando I-TREATMENT una I-TREATMENT clara I-TREATMENT deficiencia I-TREATMENT en I-TREATMENT su I-TREATMENT control I-TREATMENT de I-TREATMENT placa, I-TREATMENT se I-TREATMENT opta I-TREATMENT por I-TREATMENT realizar I-TREATMENT una I-TREATMENT prótesis I-TREATMENT fija I-TREATMENT sobre I-TREATMENT coronas I-TREATMENT telescópicas, I-TREATMENT facultativamente I-TREATMENT removible, I-TREATMENT lo I-TREATMENT cual, I-TREATMENT por I-TREATMENT un I-TREATMENT lado I-TREATMENT mejorará I-TREATMENT el I-TREATMENT control I-TREATMENT de I-TREATMENT placa I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT paciente, I-TREATMENT cuestión I-TREATMENT fundamental I-TREATMENT para I-TREATMENT el I-TREATMENT pronóstico I-TREATMENT del I-TREATMENT tratamiento, I-TREATMENT y I-TREATMENT por I-TREATMENT otro I-TREATMENT lado I-TREATMENT se I-TREATMENT cumple I-TREATMENT la I-TREATMENT necesidad I-TREATMENT de I-TREATMENT ferulización I-TREATMENT de I-TREATMENT la I-TREATMENT arcada I-TREATMENT a I-TREATMENT ambos I-TREATMENT lados I-TREATMENT de I-TREATMENT la I-TREATMENT fisura I-TREATMENT palatina. I-TREATMENT I-TREATMENT Las I-TREATMENT coronas I-TREATMENT telescópicas I-TREATMENT como I-TREATMENT sistema I-TREATMENT prostodóncico I-TREATMENT de I-TREATMENT doble I-TREATMENT corona I-TREATMENT permite I-TREATMENT realizar I-TREATMENT una I-TREATMENT ferulización I-TREATMENT cruzada I-TREATMENT de I-TREATMENT la I-TREATMENT arcada I-TREATMENT dentaria I-TREATMENT (en I-TREATMENT nuestro I-TREATMENT paciente I-TREATMENT se I-TREATMENT limita I-TREATMENT a I-TREATMENT la I-TREATMENT zona I-TREATMENT anterior I-TREATMENT del I-TREATMENT maxilar), I-TREATMENT lo I-TREATMENT cual I-TREATMENT va I-TREATMENT a I-TREATMENT permitir I-TREATMENT una I-TREATMENT estabilización I-TREATMENT de I-TREATMENT los I-TREATMENT dientes I-TREATMENT a I-TREATMENT largo I-TREATMENT plazo. I-TREATMENT El I-TREATMENT concepto I-TREATMENT de I-TREATMENT doble I-TREATMENT corona I-TREATMENT y I-TREATMENT el I-TREATMENT diseño I-TREATMENT intrínseco I-TREATMENT de I-TREATMENT las I-TREATMENT mismas I-TREATMENT hace I-TREATMENT que I-TREATMENT la I-TREATMENT transmisión I-TREATMENT de I-TREATMENT las I-TREATMENT fuerzas I-TREATMENT masticatorias I-TREATMENT sean I-TREATMENT lo I-TREATMENT más I-TREATMENT favorable I-TREATMENT al I-TREATMENT diente I-TREATMENT ya I-TREATMENT que I-TREATMENT estas I-TREATMENT se I-TREATMENT van I-TREATMENT a I-TREATMENT producir I-TREATMENT siempre I-TREATMENT en I-TREATMENT sentido I-TREATMENT axial I-TREATMENT al I-TREATMENT eje I-TREATMENT del I-TREATMENT diente. I-TREATMENT La I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT pueda I-TREATMENT retirar I-TREATMENT la I-TREATMENT estructura I-TREATMENT secundaria I-TREATMENT hace I-TREATMENT más I-TREATMENT fácil I-TREATMENT la I-TREATMENT higiene I-TREATMENT de I-TREATMENT los I-TREATMENT dientes I-TREATMENT pilares I-TREATMENT sobre I-TREATMENT todo I-TREATMENT si I-TREATMENT se I-TREATMENT compara I-TREATMENT con I-TREATMENT la I-TREATMENT dificultad I-TREATMENT de I-TREATMENT limpieza I-TREATMENT de I-TREATMENT un I-TREATMENT puente I-TREATMENT fijo I-TREATMENT convencional, I-TREATMENT esta I-TREATMENT circunstancia I-TREATMENT fue I-TREATMENT uno I-TREATMENT de I-TREATMENT los I-TREATMENT principales I-TREATMENT motivos I-TREATMENT por I-TREATMENT el I-TREATMENT que I-TREATMENT optamos I-TREATMENT en I-TREATMENT nuestro I-TREATMENT paciente I-TREATMENT para I-TREATMENT realizar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT coronas I-TREATMENT telescópicas, I-TREATMENT ya I-TREATMENT que I-TREATMENT la I-TREATMENT higiene I-TREATMENT del I-TREATMENT paciente I-TREATMENT no I-TREATMENT era I-TREATMENT del I-TREATMENT todo I-TREATMENT satisfactoria, I-TREATMENT tal I-TREATMENT y I-TREATMENT como I-TREATMENT hemos I-TREATMENT mencionado I-TREATMENT anteriormente. I-TREATMENT I-TREATMENT Desde B-EVOLUTION el I-EVOLUTION primer I-EVOLUTION momento I-EVOLUTION se I-EVOLUTION informa I-EVOLUTION al I-EVOLUTION paciente I-EVOLUTION que I-EVOLUTION el I-EVOLUTION resultado I-EVOLUTION estético I-EVOLUTION y I-EVOLUTION funcional I-EVOLUTION no I-EVOLUTION va I-EVOLUTION a I-EVOLUTION ser I-EVOLUTION el I-EVOLUTION idóneo, I-EVOLUTION cuestión I-EVOLUTION que I-EVOLUTION en I-EVOLUTION todo I-EVOLUTION momento I-EVOLUTION entiende I-EVOLUTION y I-EVOLUTION acepta. I-EVOLUTION Previo B-TREATMENT al I-TREATMENT tratamiento I-TREATMENT prostodóncico I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exodoncia I-TREATMENT del I-TREATMENT resto I-TREATMENT radicular I-TREATMENT del I-TREATMENT diente I-TREATMENT 13 I-TREATMENT y I-TREATMENT una I-TREATMENT vez I-TREATMENT cicatrizada I-TREATMENT la I-TREATMENT herida I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT realizar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT definitivo. I-TREATMENT Este I-TREATMENT consistió I-TREATMENT en I-TREATMENT la I-TREATMENT preparación I-TREATMENT de I-TREATMENT los I-TREATMENT dientes I-TREATMENT pilares I-TREATMENT 15, I-TREATMENT 21, I-TREATMENT 22, I-TREATMENT 23 I-TREATMENT y I-TREATMENT 24, I-TREATMENT realizando I-TREATMENT tallados I-TREATMENT convencionales I-TREATMENT para I-TREATMENT coronas I-TREATMENT telescópicas. I-TREATMENT Cabe I-TREATMENT resaltar I-TREATMENT el I-TREATMENT importante I-TREATMENT tallado I-TREATMENT que I-TREATMENT hubo I-TREATMENT que I-TREATMENT realizar I-TREATMENT a I-TREATMENT la I-TREATMENT corona I-TREATMENT del I-TREATMENT diente I-TREATMENT 21, I-TREATMENT para I-TREATMENT poder I-TREATMENT conseguir I-TREATMENT el I-TREATMENT paralelismo I-TREATMENT entre I-TREATMENT pilares, I-TREATMENT cuestión I-TREATMENT ésta I-TREATMENT que I-TREATMENT es I-TREATMENT de I-TREATMENT crucial I-TREATMENT importancia I-TREATMENT en I-TREATMENT todos I-TREATMENT los I-TREATMENT trabajos I-TREATMENT con I-TREATMENT coronas I-TREATMENT telescópicas. I-TREATMENT I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT toma I-TREATMENT de I-TREATMENT impresiones I-TREATMENT y I-TREATMENT registros I-TREATMENT intermaxilares I-TREATMENT para I-TREATMENT que I-TREATMENT con I-TREATMENT los I-TREATMENT modelos I-TREATMENT obtenidos I-TREATMENT se I-TREATMENT confeccionen I-TREATMENT en I-TREATMENT el I-TREATMENT laboratorio I-TREATMENT las I-TREATMENT cofias I-TREATMENT primarias. I-TREATMENT Estas I-TREATMENT son I-TREATMENT probadas I-TREATMENT en I-TREATMENT la I-TREATMENT boca I-TREATMENT del I-TREATMENT paciente I-TREATMENT en I-TREATMENT donde I-TREATMENT se I-TREATMENT verifica I-TREATMENT su I-TREATMENT correcto I-TREATMENT ajuste I-TREATMENT para I-TREATMENT a I-TREATMENT continuación I-TREATMENT tomar I-TREATMENT una I-TREATMENT segunda I-TREATMENT impresión I-TREATMENT "de I-TREATMENT arrastre" I-TREATMENT que I-TREATMENT nos I-TREATMENT posiciona I-TREATMENT las I-TREATMENT cofias I-TREATMENT primarias I-TREATMENT con I-TREATMENT respecto I-TREATMENT al I-TREATMENT resto I-TREATMENT de I-TREATMENT estructuras I-TREATMENT de I-TREATMENT la I-TREATMENT boca I-TREATMENT del I-TREATMENT paciente. I-TREATMENT Obteniéndose I-TREATMENT un I-TREATMENT nuevo I-TREATMENT modelo I-TREATMENT donde I-TREATMENT van I-TREATMENT a I-TREATMENT ser I-TREATMENT confeccionadas I-TREATMENT las I-TREATMENT coronas I-TREATMENT secundarias I-TREATMENT que I-TREATMENT conforman I-TREATMENT la I-TREATMENT prótesis I-TREATMENT fija I-TREATMENT facultativamente I-TREATMENT removible. I-TREATMENT Esta I-TREATMENT estructura I-TREATMENT secundaria I-TREATMENT es I-TREATMENT probada I-TREATMENT en I-TREATMENT la I-TREATMENT boca I-TREATMENT del I-TREATMENT paciente I-TREATMENT en I-TREATMENT donde I-TREATMENT se I-TREATMENT comprueba I-TREATMENT tanto I-TREATMENT el I-TREATMENT ajuste I-TREATMENT como I-TREATMENT la I-TREATMENT relación I-TREATMENT oclusal. I-TREATMENT I-TREATMENT Una I-TREATMENT vez I-TREATMENT seleccionado I-TREATMENT el I-TREATMENT color I-TREATMENT se I-TREATMENT procede I-TREATMENT a I-TREATMENT su I-TREATMENT terminación I-TREATMENT y I-TREATMENT colocación. I-TREATMENT El B-EVOLUTION resultado I-EVOLUTION final, I-EVOLUTION que I-EVOLUTION se I-EVOLUTION aprecia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION imagen, I-EVOLUTION podemos I-EVOLUTION ver I-EVOLUTION un I-EVOLUTION resultado I-EVOLUTION que I-EVOLUTION desde I-EVOLUTION nuestro I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION es I-EVOLUTION simplemente I-EVOLUTION aceptable, I-EVOLUTION pero I-EVOLUTION que I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION valoró I-EVOLUTION como I-EVOLUTION muy I-EVOLUTION satisfactorio, I-EVOLUTION quizás I-EVOLUTION debido I-EVOLUTION a, I-EVOLUTION lógicamente, I-EVOLUTION al I-EVOLUTION estado I-EVOLUTION inicial I-EVOLUTION que I-EVOLUTION presentaba I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION que I-EVOLUTION el I-EVOLUTION creía I-EVOLUTION imposible I-EVOLUTION de I-EVOLUTION mejorar, I-EVOLUTION y I-EVOLUTION a I-EVOLUTION la I-EVOLUTION predisposición I-EVOLUTION favorable I-EVOLUTION que I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION en I-EVOLUTION todo I-EVOLUTION momento. I-EVOLUTION I-EVOLUTION El I-EVOLUTION caso I-EVOLUTION ha I-EVOLUTION sido I-EVOLUTION revisado I-EVOLUTION a I-EVOLUTION lo I-EVOLUTION largo I-EVOLUTION de I-EVOLUTION cinco I-EVOLUTION años I-EVOLUTION consecutivos I-EVOLUTION y I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION del I-EVOLUTION mal I-EVOLUTION control I-EVOLUTION de I-EVOLUTION placa I-EVOLUTION por I-EVOLUTION parte I-EVOLUTION del I-EVOLUTION paciente, I-EVOLUTION que I-EVOLUTION no I-EVOLUTION hemos I-EVOLUTION conseguido I-EVOLUTION que I-EVOLUTION adquiera I-EVOLUTION unos I-EVOLUTION hábitos I-EVOLUTION adecuados I-EVOLUTION de I-EVOLUTION higiene, I-EVOLUTION los I-EVOLUTION pilares I-EVOLUTION de I-EVOLUTION la I-EVOLUTION prótesis I-EVOLUTION están I-EVOLUTION en I-EVOLUTION perfecto I-EVOLUTION estado I-EVOLUTION y I-EVOLUTION tanto I-EVOLUTION el I-EVOLUTION confort I-EVOLUTION y I-EVOLUTION la I-EVOLUTION estética I-EVOLUTION para I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION siguen I-EVOLUTION siendo I-EVOLUTION satisfactorias. I-EVOLUTION De I-EVOLUTION esta I-EVOLUTION manera I-EVOLUTION se I-EVOLUTION pone I-EVOLUTION de I-EVOLUTION manifiesto I-EVOLUTION el I-EVOLUTION correcto I-EVOLUTION funcionamiento I-EVOLUTION de I-EVOLUTION los I-EVOLUTION tratamientos I-EVOLUTION con I-EVOLUTION coronas I-EVOLUTION telescópicas I-EVOLUTION a I-EVOLUTION medio I-EVOLUTION y I-EVOLUTION largo I-EVOLUTION plazo I-EVOLUTION siendo I-EVOLUTION una I-EVOLUTION posibilidad I-EVOLUTION que I-EVOLUTION siempre I-EVOLUTION debemos I-EVOLUTION tener I-EVOLUTION en I-EVOLUTION cuenta I-EVOLUTION a I-EVOLUTION la I-EVOLUTION hora I-EVOLUTION de I-EVOLUTION planificar I-EVOLUTION nuestros I-EVOLUTION tratamientos, I-EVOLUTION sobre I-EVOLUTION todo I-EVOLUTION en I-EVOLUTION pacientes I-EVOLUTION con I-EVOLUTION un I-EVOLUTION mal I-EVOLUTION pronóstico I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION dientes I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION el I-EVOLUTION comportamiento I-EVOLUTION biomecánico I-EVOLUTION de I-EVOLUTION las I-EVOLUTION coronas I-EVOLUTION telescópicas I-EVOLUTION hace I-EVOLUTION que I-EVOLUTION la I-EVOLUTION supervivencia I-EVOLUTION a I-EVOLUTION largo I-EVOLUTION plazo I-EVOLUTION de I-EVOLUTION estos I-EVOLUTION dientes I-EVOLUTION sea I-EVOLUTION prolongada. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS refiere B-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY acudido I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY dentista I-PAST_MEDICAL_HISTORY particular I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY medio I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY presentar I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY nódulo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY dorso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY lengua, I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY mismo I-PAST_MEDICAL_HISTORY color I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mucosa I-PAST_MEDICAL_HISTORY adyacente, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY consistencia I-PAST_MEDICAL_HISTORY firme, I-PAST_MEDICAL_HISTORY asintomático, I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY cm. I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diámetro, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY realiza I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY excisional I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY histopatológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY adenoma I-PAST_MEDICAL_HISTORY monomorfo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY canalicular; I-PAST_MEDICAL_HISTORY tres B-PRESENT_ILLNESS años I-PRESENT_ILLNESS después, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS nuevamente I-PRESENT_ILLNESS con I-PRESENT_ILLNESS su I-PRESENT_ILLNESS dentista I-PRESENT_ILLNESS por I-PRESENT_ILLNESS recidiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión, I-PRESENT_ILLNESS a B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION intraoral I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION en I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lengua I-EXPLORATION en I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION localización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION lesión, I-EXPLORATION con I-EXPLORATION dolor I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión, I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION linfadenopatía I-EXPLORATION cervical, I-EXPLORATION se I-EXPLORATION solicita I-EXPLORATION estudios I-EXPLORATION de I-EXPLORATION laboratorio, I-EXPLORATION biometría I-EXPLORATION hemática I-EXPLORATION y I-EXPLORATION química I-EXPLORATION sanguínea, I-EXPLORATION con I-EXPLORATION resultados I-EXPLORATION normales, I-EXPLORATION decidiendo I-EXPLORATION realizar I-EXPLORATION segunda I-EXPLORATION biopsia I-EXPLORATION excisional. I-EXPLORATION I-EXPLORATION La I-EXPLORATION pieza I-EXPLORATION macroscópica I-EXPLORATION presenta I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION forma I-EXPLORATION y I-EXPLORATION superficie I-EXPLORATION irregular, I-EXPLORATION color I-EXPLORATION marrón I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION mm.. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION se I-EXPLORATION podía I-EXPLORATION observar I-EXPLORATION múltiples I-EXPLORATION cavidades I-EXPLORATION pseudoquísticas I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION variable I-EXPLORATION compuestos I-EXPLORATION por I-EXPLORATION células I-EXPLORATION cúbicas I-EXPLORATION de I-EXPLORATION citoplasma I-EXPLORATION escaso, I-EXPLORATION núcleos I-EXPLORATION ovales I-EXPLORATION con I-EXPLORATION contenido I-EXPLORATION eosinófilo, I-EXPLORATION rodeado I-EXPLORATION por I-EXPLORATION una I-EXPLORATION banda I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION conjuntivo I-EXPLORATION fibroso I-EXPLORATION denso, I-EXPLORATION bien I-EXPLORATION vascularizado, I-EXPLORATION e I-EXPLORATION infiltrado I-EXPLORATION inflamatorio I-EXPLORATION crónico I-EXPLORATION moderado I-EXPLORATION y I-EXPLORATION difuso, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION fibroso I-EXPLORATION que I-EXPLORATION rodea I-EXPLORATION a I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION principal I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION cordones I-EXPLORATION alineados I-EXPLORATION de I-EXPLORATION células I-EXPLORATION cúbicas I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION hipercromáticos, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION periferia I-EXPLORATION presenta I-EXPLORATION infiltración I-EXPLORATION perineural I-EXPLORATION con I-EXPLORATION tejido I-EXPLORATION muscular I-EXPLORATION estriado.. I-EXPLORATION I-EXPLORATION Con I-EXPLORATION estas I-EXPLORATION características I-EXPLORATION se I-EXPLORATION da I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION adenoideo I-EXPLORATION quístico I-EXPLORATION siendo I-EXPLORATION diferente I-EXPLORATION al I-EXPLORATION diagnóstico I-EXPLORATION previo I-EXPLORATION de I-EXPLORATION adenoma I-EXPLORATION canalicular, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION solicitar I-EXPLORATION el I-EXPLORATION corte I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION biopsia, I-EXPLORATION observándose I-EXPLORATION las I-EXPLORATION características I-EXPLORATION de I-EXPLORATION un I-EXPLORATION CAQ I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION tomados. I-EXPLORATION Se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION panel I-EXPLORATION de I-EXPLORATION inmunohistoquímica I-EXPLORATION recomendado, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION es I-EXPLORATION el I-EXPLORATION siguiente: I-EXPLORATION proteína I-EXPLORATION S-100, I-EXPLORATION Actina I-EXPLORATION para I-EXPLORATION músculo I-EXPLORATION liso I-EXPLORATION específica, I-EXPLORATION CALPONINA, I-EXPLORATION CEA, I-EXPLORATION Antígeno I-EXPLORATION Epitelial I-EXPLORATION de I-EXPLORATION Membrana, I-EXPLORATION PAGF, I-EXPLORATION Ki67. I-EXPLORATION (7-8) I-EXPLORATION I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION marcadores I-EXPLORATION fueron: I-EXPLORATION CEA I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION el I-EXPLORATION citoplasma I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION de I-EXPLORATION células I-EXPLORATION luminares I-EXPLORATION (normalmente I-EXPLORATION encontrado I-EXPLORATION en I-EXPLORATION conductos I-EXPLORATION estriados I-EXPLORATION de I-EXPLORATION las I-EXPLORATION glándulas I-EXPLORATION salivales I-EXPLORATION menores), I-EXPLORATION EMA I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION citoplasma I-EXPLORATION de I-EXPLORATION conductos I-EXPLORATION intercalados I-EXPLORATION y I-EXPLORATION estriados I-EXPLORATION (abundante I-EXPLORATION en I-EXPLORATION células I-EXPLORATION mioepiteliales I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION los I-EXPLORATION acinos), I-EXPLORATION S-100 I-EXPLORATION positiva I-EXPLORATION en I-EXPLORATION las I-EXPLORATION células I-EXPLORATION mioepiteliales, I-EXPLORATION conductos I-EXPLORATION intercalados I-EXPLORATION y I-EXPLORATION estriados. I-EXPLORATION La I-EXPLORATION CALP I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION células I-EXPLORATION mioepiteliales, I-EXPLORATION también I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION Ki-67 I-EXPLORATION demostró I-EXPLORATION áreas I-EXPLORATION focales I-EXPLORATION escasas I-EXPLORATION con I-EXPLORATION aproximadamente I-EXPLORATION el I-EXPLORATION 15 I-EXPLORATION al I-EXPLORATION 20% I-EXPLORATION de I-EXPLORATION tinción I-EXPLORATION nuclear, I-EXPLORATION que I-EXPLORATION al I-EXPLORATION correlacionar I-EXPLORATION con I-EXPLORATION la I-EXPLORATION clínica I-EXPLORATION nos I-EXPLORATION indica I-EXPLORATION que I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION es I-EXPLORATION de I-EXPLORATION bajo I-EXPLORATION grado, I-EXPLORATION corroborado B-DERIVED_FROM/TO el I-DERIVED_FROM/TO diagnostico I-DERIVED_FROM/TO se I-DERIVED_FROM/TO envía I-DERIVED_FROM/TO al I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO a I-DERIVED_FROM/TO centro I-DERIVED_FROM/TO oncológico I-DERIVED_FROM/TO para I-DERIVED_FROM/TO su I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO y I-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO a I-DERIVED_FROM/TO largo I-DERIVED_FROM/TO plazo, I-DERIVED_FROM/TO después B-EVOLUTION de I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION presenta I-EVOLUTION recurrencia I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION le I-EVOLUTION realiza I-EVOLUTION glosectomia I-EVOLUTION parcial, I-EVOLUTION con I-EVOLUTION seguimiento I-EVOLUTION a I-EVOLUTION largo I-EVOLUTION plazo. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 56 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS para I-PRESENT_ILLNESS extracción I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS resto I-PRESENT_ILLNESS radicular. I-PRESENT_ILLNESS Durante B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION clínica I-EXPLORATION se I-EXPLORATION descubren I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION papulares I-EXPLORATION en I-EXPLORATION encías, I-EXPLORATION con I-EXPLORATION tendencia I-EXPLORATION a I-EXPLORATION confluir, I-EXPLORATION que I-EXPLORATION adquieren I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION empedrado. I-EXPLORATION La I-EXPLORATION mucosa I-EXPLORATION labial I-EXPLORATION inferior I-EXPLORATION tiene I-EXPLORATION una I-EXPLORATION disposición I-EXPLORATION coarrugada I-EXPLORATION y I-EXPLORATION en I-EXPLORATION la I-EXPLORATION lengua I-EXPLORATION aparecen I-EXPLORATION gran I-EXPLORATION número I-EXPLORATION de I-EXPLORATION pápulas I-EXPLORATION que I-EXPLORATION confieren I-EXPLORATION a I-EXPLORATION ésta, I-EXPLORATION aspecto I-EXPLORATION moriforme. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION yugal I-EXPLORATION aparece I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION polipoide I-EXPLORATION que I-EXPLORATION extirpamos I-EXPLORATION a I-EXPLORATION la I-EXPLORATION vez I-EXPLORATION que I-EXPLORATION realizamos I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION la I-EXPLORATION encía I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION es I-EXPLORATION hiperplasia I-EXPLORATION inflamatoria I-EXPLORATION y I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION yugal, I-EXPLORATION pólipo I-EXPLORATION fibroepitelial. I-EXPLORATION I-EXPLORATION En B-PRESENT_ILLNESS la I-PRESENT_ILLNESS anamnesis I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS sido I-PRESENT_ILLNESS operada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bocio I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS ocasiones, I-PRESENT_ILLNESS así I-PRESENT_ILLNESS como I-PRESENT_ILLNESS de I-PRESENT_ILLNESS quistes I-PRESENT_ILLNESS mamarios I-PRESENT_ILLNESS bilaterales. I-PRESENT_ILLNESS Padece I-PRESENT_ILLNESS ulcera I-PRESENT_ILLNESS gástrica, I-PRESENT_ILLNESS esofagitis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pólipos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS colon. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS le I-PRESENT_ILLNESS han I-PRESENT_ILLNESS extirpado I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS cutáneas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS brazos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS plantas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS pies. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Ante B-PAST_MEDICAL_HISTORY esta I-PAST_MEDICAL_HISTORY patología I-PAST_MEDICAL_HISTORY tan I-PAST_MEDICAL_HISTORY florida I-PAST_MEDICAL_HISTORY solicitamos I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY clínica I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY archivo I-PAST_MEDICAL_HISTORY central I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY hospital I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY referencia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY realizando I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY resumen I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ésta, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY enferma I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY han I-PAST_MEDICAL_HISTORY extirpado I-PAST_MEDICAL_HISTORY nódulos I-PAST_MEDICAL_HISTORY coloides I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tiroides, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY fibroquística I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY mama, I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY ulcus I-PAST_MEDICAL_HISTORY gástrico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY varias I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY han I-PAST_MEDICAL_HISTORY extirpado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY endoscópica I-PAST_MEDICAL_HISTORY pólipos I-PAST_MEDICAL_HISTORY gástricos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Las I-PAST_MEDICAL_HISTORY lesiones I-PAST_MEDICAL_HISTORY extirpadas I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY brazo I-PAST_MEDICAL_HISTORY resultaron I-PAST_MEDICAL_HISTORY ser I-PAST_MEDICAL_HISTORY hiperplasias I-PAST_MEDICAL_HISTORY reactivas I-PAST_MEDICAL_HISTORY inflamatorias I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Ackerman, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY pies I-PAST_MEDICAL_HISTORY verrugas I-PAST_MEDICAL_HISTORY plantares. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Ante B-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION realizamos I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION afectación I-EXPLORATION oral I-EXPLORATION de I-EXPLORATION Síndrome I-EXPLORATION de I-EXPLORATION Cowden. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS y I-PRESENT_ILLNESS raza I-PRESENT_ILLNESS blanca, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS lento, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS localizada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS glándula I-PRESENT_ILLNESS parótida I-PRESENT_ILLNESS izquierda. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY existían I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY patológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY y B-PRESENT_ILLNESS la I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS que I-PRESENT_ILLNESS motivó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS era I-PRESENT_ILLNESS asintomática. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION permitió I-EXPLORATION detectar I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION insensible I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION y I-EXPLORATION cubierta I-EXPLORATION por I-EXPLORATION una I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION normal, I-EXPLORATION desplazable I-EXPLORATION con I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION los I-EXPLORATION tejidos I-EXPLORATION profundos. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION cervicocefálica I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION no I-EXPLORATION habiéndose I-EXPLORATION detectado I-EXPLORATION adenomegalias I-EXPLORATION cervicales. I-EXPLORATION Se I-EXPLORATION practicaron I-EXPLORATION estudios I-EXPLORATION rutinarios I-EXPLORATION (radiografías I-EXPLORATION torácicas I-EXPLORATION y I-EXPLORATION analítica I-EXPLORATION sistemática) I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION hallazgos I-EXPLORATION patológicos. I-EXPLORATION La B-TREATMENT tumoración I-TREATMENT fue I-TREATMENT extirpada I-TREATMENT mediante I-TREATMENT una I-TREATMENT parotidectomía I-TREATMENT extrafacial, I-TREATMENT observándose, I-TREATMENT en I-TREATMENT el I-TREATMENT transcurso I-TREATMENT de I-TREATMENT la I-TREATMENT misma, I-TREATMENT que I-TREATMENT la I-TREATMENT lesión I-TREATMENT mostraba I-TREATMENT un I-TREATMENT aspecto I-TREATMENT bien I-TREATMENT delimitado, I-TREATMENT un I-TREATMENT color I-TREATMENT amarillento I-TREATMENT grisáceo I-TREATMENT y I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT un I-TREATMENT tejido I-TREATMENT salival I-TREATMENT circundante I-TREATMENT de I-TREATMENT apariencia I-TREATMENT normal. I-TREATMENT I-TREATMENT El B-EXPLORATION procesamiento I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION fue I-EXPLORATION rutinario, I-EXPLORATION practicándose I-EXPLORATION secciones I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION espesor I-EXPLORATION que I-EXPLORATION fueron I-EXPLORATION teñidas I-EXPLORATION con I-EXPLORATION hematoxilina-eosina. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION las I-EXPLORATION mismas I-EXPLORATION permitió I-EXPLORATION constatar I-EXPLORATION que I-EXPLORATION la I-EXPLORATION lesión, I-EXPLORATION que I-EXPLORATION estaba I-EXPLORATION rodeada I-EXPLORATION por I-EXPLORATION una I-EXPLORATION cápsula I-EXPLORATION incompletamente I-EXPLORATION formada, I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION constituida I-EXPLORATION por I-EXPLORATION masas I-EXPLORATION sólidas I-EXPLORATION de I-EXPLORATION células I-EXPLORATION epiteliales I-EXPLORATION estrechamente I-EXPLORATION asociadas I-EXPLORATION a I-EXPLORATION conductos I-EXPLORATION tapizados I-EXPLORATION por I-EXPLORATION dos I-EXPLORATION capas I-EXPLORATION de I-EXPLORATION células, I-EXPLORATION y I-EXPLORATION amplias I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION diferenciación I-EXPLORATION sebácea. I-EXPLORATION En I-EXPLORATION ocasiones, I-EXPLORATION las I-EXPLORATION estructuras I-EXPLORATION ductales I-EXPLORATION mostraban I-EXPLORATION proliferaciones I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION quística I-EXPLORATION cuyas I-EXPLORATION luces I-EXPLORATION estaban I-EXPLORATION ocupadas I-EXPLORATION por I-EXPLORATION material I-EXPLORATION sebáceo I-EXPLORATION y I-EXPLORATION ocasionales I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION metaplasia I-EXPLORATION oncocítica. I-EXPLORATION Tras B-EVOLUTION cinco I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION producido I-EVOLUTION una I-EVOLUTION recidiva I-EVOLUTION lesional. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS remitido B-DERIVED_FROM/TO al I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Estomatología I-DERIVED_FROM/TO y I-DERIVED_FROM/TO Cirugía I-DERIVED_FROM/TO Oral I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Universidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Cartagena I-DERIVED_FROM/TO por I-DERIVED_FROM/TO un I-DERIVED_FROM/TO odontólogo I-DERIVED_FROM/TO rehabilitador, I-DERIVED_FROM/TO que I-DERIVED_FROM/TO descubrió I-DERIVED_FROM/TO una I-DERIVED_FROM/TO imagen I-DERIVED_FROM/TO radiolúcida I-DERIVED_FROM/TO circunscrita I-DERIVED_FROM/TO en I-DERIVED_FROM/TO zona I-DERIVED_FROM/TO periapical I-DERIVED_FROM/TO de I-DERIVED_FROM/TO órgano I-DERIVED_FROM/TO dentario I-DERIVED_FROM/TO 21 I-DERIVED_FROM/TO en I-DERIVED_FROM/TO una I-DERIVED_FROM/TO radiografía I-DERIVED_FROM/TO con I-DERIVED_FROM/TO el I-DERIVED_FROM/TO propósito I-DERIVED_FROM/TO de I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO para I-DERIVED_FROM/TO rehabilitación. I-DERIVED_FROM/TO Durante B-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY anamnesis I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY reportó I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY refiere I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY trauma I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY superior I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY relata I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY malestar I-PAST_MEDICAL_HISTORY relacionados I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY caso. I-PAST_MEDICAL_HISTORY Radiográficamente B-EXPLORATION muestra I-EXPLORATION imagen I-EXPLORATION radiolúcida I-EXPLORATION ovalada I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION de I-EXPLORATION vidrio I-EXPLORATION esmerilado, I-EXPLORATION bien I-EXPLORATION circunscrita I-EXPLORATION con I-EXPLORATION bordes I-EXPLORATION radiopacos, I-EXPLORATION perirradicular I-EXPLORATION al I-EXPLORATION órgano I-EXPLORATION dentario I-EXPLORATION 21. I-EXPLORATION Los I-EXPLORATION diagnósticos I-EXPLORATION presuntivos I-EXPLORATION fueron I-EXPLORATION quiste I-EXPLORATION óseo I-EXPLORATION traumático I-EXPLORATION y I-EXPLORATION KCOT. I-EXPLORATION Bajo I-EXPLORATION anestesia I-EXPLORATION local I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION incisión I-EXPLORATION intraoral I-EXPLORATION exponiendo I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION involucrada, I-EXPLORATION encontrando I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION encapsulada I-EXPLORATION que I-EXPLORATION se I-EXPLORATION rompe I-EXPLORATION haciendo I-EXPLORATION evidente I-EXPLORATION el I-EXPLORATION contenido I-EXPLORATION quístico I-EXPLORATION color I-EXPLORATION achocolatado; I-EXPLORATION luego I-EXPLORATION se I-EXPLORATION separa I-EXPLORATION la I-EXPLORATION cápsula I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION curetaje I-EXPLORATION cuidadoso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cavidad. I-EXPLORATION El I-EXPLORATION material I-EXPLORATION extraído I-EXPLORATION fue I-EXPLORATION enviado I-EXPLORATION para I-EXPLORATION análisis I-EXPLORATION anatomohistopatológico. I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION reportó I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION quística I-EXPLORATION benigna I-EXPLORATION tapizada I-EXPLORATION por I-EXPLORATION un I-EXPLORATION epitelio I-EXPLORATION de I-EXPLORATION apariencia I-EXPLORATION escamosa, I-EXPLORATION descansando I-EXPLORATION en I-EXPLORATION un I-EXPLORATION estroma I-EXPLORATION fibroconectivo I-EXPLORATION con I-EXPLORATION escasas I-EXPLORATION células I-EXPLORATION inflamatorias I-EXPLORATION tipo I-EXPLORATION linfocitos, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION confirma I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION KCTO. I-EXPLORATION I-EXPLORATION Comentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY torácico I-PAST_MEDICAL_HISTORY atípico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cuyo I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY cardiovascular I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA), I-PAST_MEDICAL_HISTORY dislipemia I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY índice I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY masa I-PAST_MEDICAL_HISTORY corporal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 31 I-PAST_MEDICAL_HISTORY (no I-PAST_MEDICAL_HISTORY fumador, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY diabético, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY bebedor); I-PAST_MEDICAL_HISTORY además, I-PAST_MEDICAL_HISTORY estaba I-PAST_MEDICAL_HISTORY diagnosticado I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY depresión. I-PAST_MEDICAL_HISTORY Seguía I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY simvastatina I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY bisoprolol I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY 20 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY ácido I-PAST_MEDICAL_HISTORY acetilsalicílico I-PAST_MEDICAL_HISTORY (AAS) I-PAST_MEDICAL_HISTORY 100 I-PAST_MEDICAL_HISTORY mg, I-PAST_MEDICAL_HISTORY alprazolam I-PAST_MEDICAL_HISTORY 0, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ketazolam I-PAST_MEDICAL_HISTORY 45 I-PAST_MEDICAL_HISTORY mg. I-PAST_MEDICAL_HISTORY Acudió I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY médico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY familia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY urgencias I-PAST_MEDICAL_HISTORY hospitalarias I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY numerosas I-PAST_MEDICAL_HISTORY ocasiones I-PAST_MEDICAL_HISTORY presentando I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY torácico I-PAST_MEDICAL_HISTORY atípico I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY electrocardiogramas I-PAST_MEDICAL_HISTORY normales, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY constatar I-PAST_MEDICAL_HISTORY cambios I-PAST_MEDICAL_HISTORY eléctricos I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY elevación I-PAST_MEDICAL_HISTORY enzimática. I-PAST_MEDICAL_HISTORY Hace I-PAST_MEDICAL_HISTORY unos I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY valorado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cardiología, I-PAST_MEDICAL_HISTORY presentando I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY ecocardiografía I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY anomalías, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ergometría I-PAST_MEDICAL_HISTORY positiva I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY carga I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tomografía I-PAST_MEDICAL_HISTORY computerizada I-PAST_MEDICAL_HISTORY coronaria I-PAST_MEDICAL_HISTORY informada I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY aterosclerosis I-PAST_MEDICAL_HISTORY coronaria I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY obstructiva. I-PAST_MEDICAL_HISTORY Tras B-PRESENT_ILLNESS numerosos I-PRESENT_ILLNESS episodios, I-PRESENT_ILLNESS finalmente I-PRESENT_ILLNESS ingresa I-PRESENT_ILLNESS para I-PRESENT_ILLNESS un I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS posible I-PRESENT_ILLNESS angina I-PRESENT_ILLNESS inestable. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION cateterismo, I-EXPLORATION visualizando I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION severa I-EXPLORATION de I-EXPLORATION monovaso I-EXPLORATION (en I-EXPLORATION concreto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION circunfleja I-EXPLORATION derecha I-EXPLORATION media), I-EXPLORATION precisando B-TREATMENT angioplastia I-TREATMENT coronaria I-TREATMENT transluminal I-TREATMENT percutánea I-TREATMENT e I-TREATMENT implantación I-TREATMENT de I-TREATMENT stent I-TREATMENT farmacoactivo. I-TREATMENT En I-TREATMENT tratamiento I-TREATMENT actual I-TREATMENT con I-TREATMENT nitroglicerina I-TREATMENT sl I-TREATMENT si I-TREATMENT dolor I-TREATMENT precordial, I-TREATMENT ramipril I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT mg, I-TREATMENT clopidogrel I-TREATMENT 75 I-TREATMENT mg, I-TREATMENT AAS I-TREATMENT 100 I-TREATMENT mg, I-TREATMENT simvastatina I-TREATMENT 40 I-TREATMENT mg, I-TREATMENT bisoprolol I-TREATMENT 2, I-TREATMENT 5 I-TREATMENT mg, I-TREATMENT ranitidina I-TREATMENT 150 I-TREATMENT mg, I-TREATMENT ketazolam I-TREATMENT 45 I-TREATMENT mg I-TREATMENT y I-TREATMENT alprazolam I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT mg. I-TREATMENT Tras B-EVOLUTION la I-EVOLUTION colocación I-EVOLUTION del I-EVOLUTION stent, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION mejoría I-EVOLUTION clínica. I-EVOLUTION I-EVOLUTION Posteriormente, I-EVOLUTION en I-EVOLUTION la I-EVOLUTION valoración I-EVOLUTION de I-EVOLUTION consulta I-EVOLUTION de I-EVOLUTION crónicos I-EVOLUTION de I-EVOLUTION enfermería I-EVOLUTION se I-EVOLUTION aprecia I-EVOLUTION de I-EVOLUTION forma I-EVOLUTION casual I-EVOLUTION una I-EVOLUTION hendidura I-EVOLUTION diagonal I-EVOLUTION en I-EVOLUTION el I-EVOLUTION lóbulo I-EVOLUTION del I-EVOLUTION pabellón I-EVOLUTION auricular I-EVOLUTION que I-EVOLUTION discurre I-EVOLUTION desde I-EVOLUTION la I-EVOLUTION porción I-EVOLUTION anterior I-EVOLUTION y I-EVOLUTION cercano I-EVOLUTION al I-EVOLUTION trago I-EVOLUTION en I-EVOLUTION 45o I-EVOLUTION hacia I-EVOLUTION la I-EVOLUTION cara I-EVOLUTION posterior I-EVOLUTION del I-EVOLUTION pabellón I-EVOLUTION auricular, I-EVOLUTION bilateral, I-EVOLUTION conocido I-EVOLUTION como I-EVOLUTION signo I-EVOLUTION de I-EVOLUTION Frank. I-EVOLUTION Este I-EVOLUTION hallazgo I-EVOLUTION nos I-EVOLUTION hizo I-EVOLUTION pensar I-EVOLUTION que I-EVOLUTION pueda I-EVOLUTION existir I-EVOLUTION una I-EVOLUTION interrelación I-EVOLUTION entre I-EVOLUTION este I-EVOLUTION surco I-EVOLUTION y I-EVOLUTION la I-EVOLUTION cardiopatía I-EVOLUTION diagnosticada. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 33 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 ansiedad, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY sigue I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY escitalopram I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY alprazolam I-PAST_MEDICAL_HISTORY 0, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg. I-PAST_MEDICAL_HISTORY Exfumador I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY meses. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Atención I-PRESENT_ILLNESS Primaria I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS "asfixia", I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS falta I-PRESENT_ILLNESS de I-PRESENT_ILLNESS aire I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS extraño I-PRESENT_ILLNESS faríngeo. I-PRESENT_ILLNESS A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presenta I-EXPLORATION buen I-EXPLORATION murmullo I-EXPLORATION vesicular I-EXPLORATION sin I-EXPLORATION ruidos I-EXPLORATION sobreañadidos, I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION 98 I-EXPLORATION %. I-EXPLORATION A I-EXPLORATION la I-EXPLORATION inspección I-EXPLORATION de I-EXPLORATION la I-EXPLORATION faringe I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION úvula I-EXPLORATION con I-EXPLORATION prolongación I-EXPLORATION filiforme I-EXPLORATION y I-EXPLORATION en I-EXPLORATION su I-EXPLORATION base I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION papilomatosa I-EXPLORATION engrosada. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION tranquiliza I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION y I-EXPLORATION se I-EXPLORATION le I-EXPLORATION explica I-EXPLORATION la I-EXPLORATION patología. I-EXPLORATION Se B-DERIVED_FROM/TO aconseja I-DERIVED_FROM/TO valoración I-DERIVED_FROM/TO por I-DERIVED_FROM/TO su I-DERIVED_FROM/TO médico I-DERIVED_FROM/TO de I-DERIVED_FROM/TO familia, I-DERIVED_FROM/TO quien I-DERIVED_FROM/TO deriva I-DERIVED_FROM/TO al I-DERIVED_FROM/TO otorrinolaringólogo I-DERIVED_FROM/TO (ORL). I-DERIVED_FROM/TO Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION cribado I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION patologías I-EXPLORATION de I-EXPLORATION transmisión I-EXPLORATION sexual I-EXPLORATION con I-EXPLORATION resultados I-EXPLORATION negativos I-EXPLORATION para I-EXPLORATION infección I-EXPLORATION por I-EXPLORATION sífilis, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION inmunodeficiencia I-EXPLORATION humana, I-EXPLORATION herpes I-EXPLORATION y I-EXPLORATION hepatitis. I-EXPLORATION I-EXPLORATION El I-EXPLORATION ORL I-EXPLORATION le I-EXPLORATION diagnostica I-EXPLORATION de I-EXPLORATION poliposis I-EXPLORATION senonasal I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION remodelación I-EXPLORATION ósea, I-EXPLORATION desviación I-EXPLORATION del I-EXPLORATION tabique I-EXPLORATION nasal, I-EXPLORATION ensanchamiento I-EXPLORATION del I-EXPLORATION infundíbulo I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION maxilar I-EXPLORATION y I-EXPLORATION úvula I-EXPLORATION con I-EXPLORATION formación I-EXPLORATION papilomatosa I-EXPLORATION en I-EXPLORATION su I-EXPLORATION base I-EXPLORATION y I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma. I-EXPLORATION Se B-TREATMENT interviene I-TREATMENT y B-EXPLORATION desde I-EXPLORATION Anatomía I-EXPLORATION Patológica I-EXPLORATION informan I-EXPLORATION de I-EXPLORATION un I-EXPLORATION papiloma I-EXPLORATION invertido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seno I-EXPLORATION nasal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION en I-EXPLORATION úvula I-EXPLORATION como I-EXPLORATION papiloma I-EXPLORATION escamoso. I-EXPLORATION I-EXPLORATION Actualmente B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION mejorado I-EVOLUTION notablemente I-EVOLUTION tanto I-EVOLUTION por I-EVOLUTION la I-EVOLUTION sintomatología I-EVOLUTION nasal I-EVOLUTION a I-EVOLUTION la I-EVOLUTION que I-EVOLUTION no I-EVOLUTION hizo I-EVOLUTION referencia I-EVOLUTION hasta I-EVOLUTION llegar I-EVOLUTION al I-EVOLUTION ORL I-EVOLUTION como I-EVOLUTION por I-EVOLUTION la I-EVOLUTION sensación I-EVOLUTION de I-EVOLUTION cuerpo I-EVOLUTION extraño. I-EVOLUTION I-EVOLUTION En B-EXPLORATION este I-EXPLORATION caso I-EXPLORATION en I-EXPLORATION particular I-EXPLORATION sería I-EXPLORATION interesante I-EXPLORATION poner I-EXPLORATION en I-EXPLORATION conocimiento I-EXPLORATION que I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION mantiene I-EXPLORATION buena I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION su I-EXPLORATION médico I-EXPLORATION de I-EXPLORATION familia I-EXPLORATION porque I-EXPLORATION en I-EXPLORATION su I-EXPLORATION opinión I-EXPLORATION no I-EXPLORATION le I-EXPLORATION trata I-EXPLORATION bien I-EXPLORATION su I-EXPLORATION clínica I-EXPLORATION ansioso-depresiva. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION suele I-EXPLORATION acudir I-EXPLORATION a I-EXPLORATION consulta I-EXPLORATION cuando I-EXPLORATION su I-EXPLORATION médico I-EXPLORATION esta I-EXPLORATION saliente I-EXPLORATION de I-EXPLORATION guardia I-EXPLORATION o I-EXPLORATION de I-EXPLORATION vacaciones; I-EXPLORATION de B-TREATMENT hecho I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antidepresivo I-TREATMENT y I-TREATMENT ansiolítico I-TREATMENT no I-TREATMENT fue I-TREATMENT instaurado I-TREATMENT por I-TREATMENT su I-TREATMENT médico, I-TREATMENT haciendo I-TREATMENT complicado I-TREATMENT el I-TREATMENT seguimiento I-TREATMENT de I-TREATMENT su I-TREATMENT patología. I-TREATMENT El B-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION comentó I-EXPLORATION nada I-EXPLORATION sobre I-EXPLORATION la I-EXPLORATION congestión I-EXPLORATION que I-EXPLORATION le I-EXPLORATION provocaba I-EXPLORATION la I-EXPLORATION poliposis I-EXPLORATION nasal I-EXPLORATION por I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION motivo. I-EXPLORATION La I-EXPLORATION relación I-EXPLORATION que I-EXPLORATION tiene I-EXPLORATION con I-EXPLORATION su I-EXPLORATION médico I-EXPLORATION de I-EXPLORATION familia I-EXPLORATION también I-EXPLORATION ayuda I-EXPLORATION a I-EXPLORATION explicar I-EXPLORATION por I-EXPLORATION qué I-EXPLORATION acude I-EXPLORATION a I-EXPLORATION urgencias I-EXPLORATION por I-EXPLORATION una I-EXPLORATION consulta I-EXPLORATION que I-EXPLORATION realmente I-EXPLORATION no I-EXPLORATION es I-EXPLORATION aguda. I-EXPLORATION Tampoco I-EXPLORATION podemos I-EXPLORATION descartar I-EXPLORATION que I-EXPLORATION sus I-EXPLORATION síntomas I-EXPLORATION hayan I-EXPLORATION pasado I-EXPLORATION desapercibidos I-EXPLORATION por I-EXPLORATION los I-EXPLORATION facultativos I-EXPLORATION relacionándolos I-EXPLORATION con I-EXPLORATION la I-EXPLORATION ansiedad. I-EXPLORATION I-EXPLORATION El B-PRESENT_ILLNESS 23 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS agosto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2011 I-PRESENT_ILLNESS el I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Role I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS informa I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Medical I-PRESENT_ILLNESS Advisor I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Operación I-PRESENT_ILLNESS European I-PRESENT_ILLNESS Union I-PRESENT_ILLNESS Training I-PRESENT_ILLNESS Mission I-PRESENT_ILLNESS (EUTM) I-PRESENT_ILLNESS Somalia I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS prueba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS "quick I-PRESENT_ILLNESS test" I-PRESENT_ILLNESS realizada I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS enfermeras I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Role I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS ha I-PRESENT_ILLNESS resultado I-PRESENT_ILLNESS positiva. I-PRESENT_ILLNESS Por B-DERIVED_FROM/TO lo I-DERIVED_FROM/TO que I-DERIVED_FROM/TO se I-DERIVED_FROM/TO va I-DERIVED_FROM/TO a I-DERIVED_FROM/TO proceder I-DERIVED_FROM/TO a I-DERIVED_FROM/TO su I-DERIVED_FROM/TO traslado I-DERIVED_FROM/TO de I-DERIVED_FROM/TO forma I-DERIVED_FROM/TO urgente I-DERIVED_FROM/TO al I-DERIVED_FROM/TO Hospital I-DERIVED_FROM/TO Nakasero I-DERIVED_FROM/TO en I-DERIVED_FROM/TO Kampala I-DERIVED_FROM/TO situado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO 400 I-DERIVED_FROM/TO km I-DERIVED_FROM/TO aproximadamente I-DERIVED_FROM/TO por I-DERIVED_FROM/TO carreteras I-DERIVED_FROM/TO en I-DERIVED_FROM/TO muy I-DERIVED_FROM/TO malas I-DERIVED_FROM/TO condiciones. I-DERIVED_FROM/TO La I-DERIVED_FROM/TO decisión I-DERIVED_FROM/TO de I-DERIVED_FROM/TO cómo I-DERIVED_FROM/TO realizar I-DERIVED_FROM/TO el I-DERIVED_FROM/TO traslado I-DERIVED_FROM/TO no I-DERIVED_FROM/TO depende I-DERIVED_FROM/TO de I-DERIVED_FROM/TO EUTM-Somalia, I-DERIVED_FROM/TO el I-DERIVED_FROM/TO Role I-DERIVED_FROM/TO 2 I-DERIVED_FROM/TO puede I-DERIVED_FROM/TO decidir I-DERIVED_FROM/TO de I-DERIVED_FROM/TO forma I-DERIVED_FROM/TO independiente I-DERIVED_FROM/TO al I-DERIVED_FROM/TO estar I-DERIVED_FROM/TO éste I-DERIVED_FROM/TO contratado I-DERIVED_FROM/TO por I-DERIVED_FROM/TO EUTM-Somalia. I-DERIVED_FROM/TO El I-DERIVED_FROM/TO personal I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Role-2 I-DERIVED_FROM/TO tiene I-DERIVED_FROM/TO su I-DERIVED_FROM/TO propio I-DERIVED_FROM/TO seguro I-DERIVED_FROM/TO sanitario. I-DERIVED_FROM/TO Quiere I-DERIVED_FROM/TO decir I-DERIVED_FROM/TO que, I-DERIVED_FROM/TO pueden I-DERIVED_FROM/TO gestionarse I-DERIVED_FROM/TO sus I-DERIVED_FROM/TO propias I-DERIVED_FROM/TO evacuaciones I-DERIVED_FROM/TO e I-DERIVED_FROM/TO ingresos I-DERIVED_FROM/TO en I-DERIVED_FROM/TO hospitales. I-DERIVED_FROM/TO Al I-DERIVED_FROM/TO igual I-DERIVED_FROM/TO que I-DERIVED_FROM/TO cuentan I-DERIVED_FROM/TO siempre I-DERIVED_FROM/TO con I-DERIVED_FROM/TO la I-DERIVED_FROM/TO ayuda I-DERIVED_FROM/TO y I-DERIVED_FROM/TO colaboración I-DERIVED_FROM/TO del I-DERIVED_FROM/TO Cuartel I-DERIVED_FROM/TO General I-DERIVED_FROM/TO EUTM-Somalia. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Los B-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS alarmantes I-PRESENT_ILLNESS que I-PRESENT_ILLNESS llevan I-PRESENT_ILLNESS a I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS compañeros I-PRESENT_ILLNESS a I-PRESENT_ILLNESS realizar I-PRESENT_ILLNESS el I-PRESENT_ILLNESS Quik I-PRESENT_ILLNESS test I-PRESENT_ILLNESS es I-PRESENT_ILLNESS un I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS agudo I-PRESENT_ILLNESS pseudo-confusional, I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS cansancio, I-PRESENT_ILLNESS cefalea, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38oC. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS parecer, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS posteriores I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS confirmación I-PRESENT_ILLNESS del I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS se I-PRESENT_ILLNESS suman I-PRESENT_ILLNESS antecedentes I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS no I-PRESENT_ILLNESS había I-PRESENT_ILLNESS revelado I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS ese I-PRESENT_ILLNESS momento: I-PRESENT_ILLNESS astenia I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS quince I-PRESENT_ILLNESS días, I-PRESENT_ILLNESS cefaleas, I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS aparentemente I-PRESENT_ILLNESS infeccioso I-PRESENT_ILLNESS que I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS había I-PRESENT_ILLNESS comenzado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS automedicarse I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antibiótico I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS amoxicilina I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ácido I-PRESENT_ILLNESS clavulánico. I-PRESENT_ILLNESS Como B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY sufría I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY migrañas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY personal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY Role I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY permanecía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY periodos I-PAST_MEDICAL_HISTORY largos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY (con I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY mes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY descanso I-PAST_MEDICAL_HISTORY cada I-PAST_MEDICAL_HISTORY seis I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estancia I-PAST_MEDICAL_HISTORY aproximadamente), I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY llevado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY muchos I-PAST_MEDICAL_HISTORY casos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY abandono I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY voluntaria I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY quimioprofilaxis I-PAST_MEDICAL_HISTORY (Lariam®, I-PAST_MEDICAL_HISTORY Malarone® I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY Doxiciclina). I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Se B-EVOLUTION decide I-EVOLUTION realizar I-EVOLUTION el I-EVOLUTION traslado I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION por I-EVOLUTION carretera I-EVOLUTION con I-EVOLUTION ambulancia I-EVOLUTION procedente I-EVOLUTION de I-EVOLUTION Kampala I-EVOLUTION y I-EVOLUTION se I-EVOLUTION informa I-EVOLUTION al I-EVOLUTION Medical I-EVOLUTION Advisor I-EVOLUTION que I-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION será I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION Nakasero I-EVOLUTION de I-EVOLUTION Kampala. I-EVOLUTION A I-EVOLUTION las I-EVOLUTION 12 I-EVOLUTION horas I-EVOLUTION aproximadamente I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ingresa I-EVOLUTION en I-EVOLUTION el I-EVOLUTION citado I-EVOLUTION Hospital I-EVOLUTION y I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION más I-EVOLUTION tarde I-EVOLUTION entra I-EVOLUTION en I-EVOLUTION coma. I-EVOLUTION Ya I-EVOLUTION entonces I-EVOLUTION se I-EVOLUTION estaba I-EVOLUTION gestionando I-EVOLUTION la I-EVOLUTION aeroevacuación I-EVOLUTION a I-EVOLUTION Italia. I-EVOLUTION Dado I-EVOLUTION el I-EVOLUTION estado I-EVOLUTION avanzado I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION aeroevacuada I-EVOLUTION por I-EVOLUTION la I-EVOLUTION compañía I-EVOLUTION de I-EVOLUTION "Flying I-EVOLUTION Doctors" I-EVOLUTION a I-EVOLUTION Nairobi I-EVOLUTION dos I-EVOLUTION días I-EVOLUTION más I-EVOLUTION tarde. I-EVOLUTION Tras I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION en I-EVOLUTION el I-EVOLUTION hospital I-EVOLUTION de I-EVOLUTION Nairobi I-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION persiste I-EVOLUTION muy I-EVOLUTION desfavorablemente I-EVOLUTION falleciendo I-EVOLUTION pocas I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION al I-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION su I-EVOLUTION diagnóstico I-EVOLUTION inicial. I-EVOLUTION I-EVOLUTION Se I-EVOLUTION puede I-EVOLUTION pensar I-EVOLUTION que I-EVOLUTION una I-EVOLUTION de I-EVOLUTION las I-EVOLUTION causas I-EVOLUTION de I-EVOLUTION la I-EVOLUTION rápida I-EVOLUTION y I-EVOLUTION mala I-EVOLUTION evolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION enfermedad I-EVOLUTION de I-EVOLUTION nuestra I-EVOLUTION compañera I-EVOLUTION fue I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION un I-EVOLUTION diagnóstico I-EVOLUTION e I-EVOLUTION inicio I-EVOLUTION del I-EVOLUTION tratamiento I-EVOLUTION tardíos, I-EVOLUTION la I-EVOLUTION falta I-EVOLUTION de I-EVOLUTION inmunidad I-EVOLUTION adquirida I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION y I-EVOLUTION el I-EVOLUTION abandono I-EVOLUTION de I-EVOLUTION la I-EVOLUTION quimioprofilaxis I-EVOLUTION que I-EVOLUTION pudo I-EVOLUTION ayudar I-EVOLUTION al I-EVOLUTION plasmodium I-EVOLUTION a I-EVOLUTION una I-EVOLUTION reproducción I-EVOLUTION e I-EVOLUTION invasión I-EVOLUTION rápida. I-EVOLUTION I-EVOLUTION El I-EVOLUTION Medical I-EVOLUTION Advisor I-EVOLUTION I-EVOLUTION Durante I-EVOLUTION todo I-EVOLUTION este I-EVOLUTION proceso I-EVOLUTION y I-EVOLUTION como I-EVOLUTION es I-EVOLUTION habitual, I-EVOLUTION el I-EVOLUTION Medical I-EVOLUTION Advisor I-EVOLUTION informa I-EVOLUTION en I-EVOLUTION cada I-EVOLUTION momento I-EVOLUTION al I-EVOLUTION Jefe I-EVOLUTION de I-EVOLUTION Estado I-EVOLUTION Mayor I-EVOLUTION y I-EVOLUTION éste I-EVOLUTION mantiene I-EVOLUTION informado I-EVOLUTION al I-EVOLUTION Jefe I-EVOLUTION de I-EVOLUTION la I-EVOLUTION Mision, I-EVOLUTION quien I-EVOLUTION a I-EVOLUTION su I-EVOLUTION vez I-EVOLUTION transmite I-EVOLUTION todo I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION acontece I-EVOLUTION en I-EVOLUTION nuestra I-EVOLUTION Misión I-EVOLUTION en I-EVOLUTION Uganda I-EVOLUTION al I-EVOLUTION Cuartel I-EVOLUTION General I-EVOLUTION en I-EVOLUTION Bruselas. I-EVOLUTION La I-EVOLUTION preocupación I-EVOLUTION de I-EVOLUTION Bruselas I-EVOLUTION se I-EVOLUTION hace I-EVOLUTION evidente. I-EVOLUTION Asimismo I-EVOLUTION el I-EVOLUTION Medical I-EVOLUTION Advisor I-EVOLUTION informa I-EVOLUTION al I-EVOLUTION Mando I-EVOLUTION de I-EVOLUTION Operaciones I-EVOLUTION (CMOPS) I-EVOLUTION y I-EVOLUTION al I-EVOLUTION Instituto I-EVOLUTION de I-EVOLUTION Medicina I-EVOLUTION Preventiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION Defensa I-EVOLUTION (IMPDEF) I-EVOLUTION para I-EVOLUTION que I-EVOLUTION se I-EVOLUTION informe I-EVOLUTION a I-EVOLUTION la I-EVOLUTION mayor I-EVOLUTION brevedad I-EVOLUTION posible I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Inspección I-EVOLUTION General I-EVOLUTION de I-EVOLUTION Sanidad. I-EVOLUTION I-EVOLUTION Tras I-EVOLUTION esta I-EVOLUTION amarga I-EVOLUTION experiencia, I-EVOLUTION cobra I-EVOLUTION mayor I-EVOLUTION relieve I-EVOLUTION la I-EVOLUTION figura I-EVOLUTION del I-EVOLUTION Medical I-EVOLUTION Advisor I-EVOLUTION en I-EVOLUTION Uganda, I-EVOLUTION una I-EVOLUTION de I-EVOLUTION cuyas I-EVOLUTION funciones I-EVOLUTION es I-EVOLUTION la I-EVOLUTION de I-EVOLUTION recordar I-EVOLUTION a I-EVOLUTION todo I-EVOLUTION el I-EVOLUTION contingente I-EVOLUTION desplegado I-EVOLUTION en I-EVOLUTION la I-EVOLUTION misión I-EVOLUTION las I-EVOLUTION enfermedades I-EVOLUTION de I-EVOLUTION riesgo I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona, I-EVOLUTION les I-EVOLUTION aconseja I-EVOLUTION e I-EVOLUTION instruye I-EVOLUTION sobre I-EVOLUTION la I-EVOLUTION prevención I-EVOLUTION de I-EVOLUTION dichas I-EVOLUTION enfermedades I-EVOLUTION y I-EVOLUTION sobre I-EVOLUTION las I-EVOLUTION medidas I-EVOLUTION higiénico-sanitarias I-EVOLUTION a I-EVOLUTION tomar I-EVOLUTION para I-EVOLUTION prevenirlas. I-EVOLUTION En B-TREATMENT relación I-TREATMENT a I-TREATMENT la I-TREATMENT Malaria I-TREATMENT se I-TREATMENT remarca I-TREATMENT lo I-TREATMENT importante I-TREATMENT que I-TREATMENT es I-TREATMENT tomar I-TREATMENT la I-TREATMENT quimioprofilaxis, I-TREATMENT además I-TREATMENT de I-TREATMENT llevar I-TREATMENT a I-TREATMENT cabo I-TREATMENT medidas I-TREATMENT defensivas I-TREATMENT que I-TREATMENT todos I-TREATMENT conocemos I-TREATMENT para I-TREATMENT evitar I-TREATMENT la I-TREATMENT picadura I-TREATMENT del I-TREATMENT mosquito I-TREATMENT como: I-TREATMENT I-TREATMENT 1. I-TREATMENT Utilizar I-TREATMENT repelente I-TREATMENT de I-TREATMENT insectos I-TREATMENT de I-TREATMENT tipo I-TREATMENT dietiltoluamida, I-TREATMENT de I-TREATMENT aplicación I-TREATMENT en I-TREATMENT zonas I-TREATMENT expuestas I-TREATMENT sobre I-TREATMENT todo I-TREATMENT desde I-TREATMENT las I-TREATMENT 18 I-TREATMENT p.m. I-TREATMENT a I-TREATMENT las I-TREATMENT 05 I-TREATMENT a.m. I-TREATMENT I-TREATMENT 2. I-TREATMENT En I-TREATMENT el I-TREATMENT exterior I-TREATMENT utilizar I-TREATMENT ropa I-TREATMENT de I-TREATMENT manga I-TREATMENT larga I-TREATMENT y I-TREATMENT pantalón I-TREATMENT largo. I-TREATMENT Incluso I-TREATMENT impregnar I-TREATMENT el I-TREATMENT uniforme I-TREATMENT con I-TREATMENT permetrina. I-TREATMENT I-TREATMENT 3. I-TREATMENT Disponer I-TREATMENT de I-TREATMENT mosquiteras I-TREATMENT en I-TREATMENT las I-TREATMENT ventanas I-TREATMENT de I-TREATMENT las I-TREATMENT habitaciones. I-TREATMENT Malla I-TREATMENT mosquitera I-TREATMENT impregnada I-TREATMENT en I-TREATMENT permetrina I-TREATMENT en I-TREATMENT la I-TREATMENT cama, I-TREATMENT que I-TREATMENT se I-TREATMENT mantenga I-TREATMENT bien I-TREATMENT tensada I-TREATMENT y I-TREATMENT metida I-TREATMENT por I-TREATMENT debajo I-TREATMENT del I-TREATMENT colchón, I-TREATMENT y I-TREATMENT que I-TREATMENT nunca I-TREATMENT se I-TREATMENT apoye I-TREATMENT en I-TREATMENT el I-TREATMENT suelo. I-TREATMENT I-TREATMENT 4. I-TREATMENT En I-TREATMENT el I-TREATMENT interior I-TREATMENT de I-TREATMENT la I-TREATMENT habitación I-TREATMENT utilizar I-TREATMENT insecticidas I-TREATMENT para I-TREATMENT el I-TREATMENT cuarto. I-TREATMENT I-TREATMENT Se I-TREATMENT les I-TREATMENT informa I-TREATMENT y I-TREATMENT recuerda I-TREATMENT continuamente I-TREATMENT que I-TREATMENT para I-TREATMENT evitar I-TREATMENT un I-TREATMENT desenlace I-TREATMENT fatal I-TREATMENT con I-TREATMENT la I-TREATMENT malaria I-TREATMENT es I-TREATMENT fundamental I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT precoz I-TREATMENT y, I-TREATMENT para I-TREATMENT ello I-TREATMENT es I-TREATMENT fundamental I-TREATMENT que I-TREATMENT adviertan I-TREATMENT al I-TREATMENT médico I-TREATMENT del I-TREATMENT Role I-TREATMENT 1 I-TREATMENT (en I-TREATMENT Bihanga I-TREATMENT o I-TREATMENT Kampala) I-TREATMENT de I-TREATMENT cualquier I-TREATMENT síntoma I-TREATMENT que I-TREATMENT se I-TREATMENT presente, I-TREATMENT en I-TREATMENT general I-TREATMENT "cuando I-TREATMENT uno I-TREATMENT se I-TREATMENT encuentre I-TREATMENT mal". I-TREATMENT Se I-TREATMENT dice I-TREATMENT que I-TREATMENT cuando I-TREATMENT aparece I-TREATMENT fiebre I-TREATMENT en I-TREATMENT zona I-TREATMENT endémica I-TREATMENT de I-TREATMENT malaria I-TREATMENT "hay I-TREATMENT que I-TREATMENT pensar I-TREATMENT como I-TREATMENT primera I-TREATMENT opción I-TREATMENT en I-TREATMENT esta I-TREATMENT enfermedad". I-TREATMENT Es I-TREATMENT muy I-TREATMENT importante I-TREATMENT tener I-TREATMENT en I-TREATMENT cuenta I-TREATMENT este I-TREATMENT principio I-TREATMENT pero, I-TREATMENT no I-TREATMENT hay I-TREATMENT que I-TREATMENT olvidar I-TREATMENT además, I-TREATMENT todos I-TREATMENT los I-TREATMENT síntomas I-TREATMENT que I-TREATMENT pueden I-TREATMENT aparecer I-TREATMENT en I-TREATMENT la I-TREATMENT malaria: I-TREATMENT cefalea, I-TREATMENT dolor I-TREATMENT de I-TREATMENT garganta, I-TREATMENT astenia I-TREATMENT intensa, I-TREATMENT escalofríos, I-TREATMENT sudoración, I-TREATMENT náuseas, I-TREATMENT diarrea I-TREATMENT y I-TREATMENT vómitos. I-TREATMENT Estos, I-TREATMENT son I-TREATMENT síntomas I-TREATMENT comunes I-TREATMENT a I-TREATMENT otras I-TREATMENT afecciones I-TREATMENT frecuentes I-TREATMENT en I-TREATMENT la I-TREATMENT zona I-TREATMENT como I-TREATMENT es I-TREATMENT el I-TREATMENT caso I-TREATMENT de I-TREATMENT la I-TREATMENT gastroenteritis, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT puede I-TREATMENT no I-TREATMENT darles I-TREATMENT importancia. I-TREATMENT Se I-TREATMENT debe I-TREATMENT insistir I-TREATMENT en I-TREATMENT la I-TREATMENT necesidad I-TREATMENT de I-TREATMENT consultar I-TREATMENT con I-TREATMENT el I-TREATMENT médico I-TREATMENT de I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT cualquiera I-TREATMENT de I-TREATMENT ellos. I-TREATMENT I-TREATMENT Durante I-TREATMENT la I-TREATMENT misión, I-TREATMENT el I-TREATMENT Medical I-TREATMENT Advisor I-TREATMENT viaja I-TREATMENT a I-TREATMENT la I-TREATMENT capital I-TREATMENT de I-TREATMENT Kenya I-TREATMENT para I-TREATMENT informarse I-TREATMENT de I-TREATMENT las I-TREATMENT prestaciones I-TREATMENT y I-TREATMENT servicios I-TREATMENT de I-TREATMENT los I-TREATMENT hospitales I-TREATMENT que I-TREATMENT allí I-TREATMENT se I-TREATMENT encuentran. I-TREATMENT Así I-TREATMENT mismo I-TREATMENT se I-TREATMENT informa I-TREATMENT sobre I-TREATMENT el I-TREATMENT protocolo I-TREATMENT que I-TREATMENT siguen I-TREATMENT para I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT malaria. I-TREATMENT Todos I-TREATMENT ellos I-TREATMENT coinciden I-TREATMENT en I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT precoz I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad, I-TREATMENT siendo I-TREATMENT suficiente I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT síntomas I-TREATMENT clínicos I-TREATMENT aunque I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT microscópico I-TREATMENT sea I-TREATMENT negativo. I-TREATMENT En I-TREATMENT la I-TREATMENT mayoría I-TREATMENT de I-TREATMENT los I-TREATMENT casos I-TREATMENT se I-TREATMENT utiliza I-TREATMENT Artemether I-TREATMENT 20mg/Lumefantrine I-TREATMENT 120mg I-TREATMENT cuatro I-TREATMENT unidades I-TREATMENT cada I-TREATMENT 12 I-TREATMENT horas I-TREATMENT durante I-TREATMENT 3 I-TREATMENT días. I-TREATMENT En I-TREATMENT el I-TREATMENT Cuartel I-TREATMENT General I-TREATMENT de I-TREATMENT Kampala, I-TREATMENT se I-TREATMENT trataron I-TREATMENT dos I-TREATMENT casos I-TREATMENT sospechosos I-TREATMENT de I-TREATMENT malaria, I-TREATMENT sin I-TREATMENT diagnóstico I-TREATMENT evidente I-TREATMENT al I-TREATMENT microscopio. I-TREATMENT La I-TREATMENT evolución I-TREATMENT fue I-TREATMENT muy I-TREATMENT buena. I-TREATMENT I-TREATMENT Otra I-TREATMENT medida I-TREATMENT de I-TREATMENT prevención I-TREATMENT que I-TREATMENT se I-TREATMENT tuvo I-TREATMENT en I-TREATMENT cuenta, I-TREATMENT fue I-TREATMENT luchar I-TREATMENT contra I-TREATMENT el I-TREATMENT vector. I-TREATMENT Se I-TREATMENT visitaron I-TREATMENT varias I-TREATMENT compañías I-TREATMENT expertas I-TREATMENT en I-TREATMENT la I-TREATMENT lucha I-TREATMENT contra I-TREATMENT el I-TREATMENT vector I-TREATMENT de I-TREATMENT la I-TREATMENT malaria I-TREATMENT y I-TREATMENT se I-TREATMENT pidió I-TREATMENT estudio I-TREATMENT para I-TREATMENT la I-TREATMENT desinfección I-TREATMENT del I-TREATMENT Campamento I-TREATMENT de I-TREATMENT Bihanga. I-TREATMENT En I-TREATMENT el I-TREATMENT Cuartel I-TREATMENT General I-TREATMENT de I-TREATMENT Kampala I-TREATMENT se I-TREATMENT desinfecta I-TREATMENT una I-TREATMENT vez I-TREATMENT al I-TREATMENT mes I-TREATMENT dentro I-TREATMENT de I-TREATMENT las I-TREATMENT habitaciones I-TREATMENT y I-TREATMENT en I-TREATMENT el I-TREATMENT exterior I-TREATMENT más I-TREATMENT próximo, I-TREATMENT incluyendo I-TREATMENT toda I-TREATMENT la I-TREATMENT vegetación I-TREATMENT que I-TREATMENT allí I-TREATMENT se I-TREATMENT encuentra. I-TREATMENT I-TREATMENT La I-TREATMENT desinfección I-TREATMENT completa I-TREATMENT del I-TREATMENT Campamento I-TREATMENT de I-TREATMENT Bihanga I-TREATMENT es I-TREATMENT más I-TREATMENT complicada, I-TREATMENT al I-TREATMENT estar I-TREATMENT rodeado I-TREATMENT de I-TREATMENT zonas I-TREATMENT verdes I-TREATMENT muy I-TREATMENT extensas I-TREATMENT y I-TREATMENT de I-TREATMENT una I-TREATMENT zona I-TREATMENT de I-TREATMENT vida I-TREATMENT de I-TREATMENT los I-TREATMENT militares I-TREATMENT de I-TREATMENT Uganda I-TREATMENT y I-TREATMENT sus I-TREATMENT familias I-TREATMENT que I-TREATMENT no I-TREATMENT reúnen I-TREATMENT las I-TREATMENT condiciones I-TREATMENT higiénico I-TREATMENT sanitarias I-TREATMENT suficientes I-TREATMENT para I-TREATMENT la I-TREATMENT lucha I-TREATMENT contra I-TREATMENT el I-TREATMENT vector, I-TREATMENT y I-TREATMENT el I-TREATMENT plan I-TREATMENT de I-TREATMENT desinfección I-TREATMENT implicarían I-TREATMENT medidas I-TREATMENT que I-TREATMENT precisaría I-TREATMENT de I-TREATMENT la I-TREATMENT autorización I-TREATMENT de I-TREATMENT los I-TREATMENT militares I-TREATMENT Ugandeses. I-TREATMENT I-TREATMENT Se I-TREATMENT realizó I-TREATMENT un I-TREATMENT estudio I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT la I-TREATMENT compañía I-TREATMENT experta I-TREATMENT para I-TREATMENT la I-TREATMENT desinfección I-TREATMENT dentro I-TREATMENT de I-TREATMENT las I-TREATMENT viviendas, I-TREATMENT medidas I-TREATMENT para I-TREATMENT evitar I-TREATMENT que I-TREATMENT entren I-TREATMENT mosquitos I-TREATMENT en I-TREATMENT el I-TREATMENT interior, I-TREATMENT drenaje I-TREATMENT de I-TREATMENT charcas I-TREATMENT y I-TREATMENT desecación I-TREATMENT de I-TREATMENT colecciones I-TREATMENT de I-TREATMENT agua I-TREATMENT estancada, I-TREATMENT además I-TREATMENT de I-TREATMENT eliminación I-TREATMENT de I-TREATMENT vegetación I-TREATMENT que I-TREATMENT pueda I-TREATMENT favorecer I-TREATMENT el I-TREATMENT desarrollo I-TREATMENT de I-TREATMENT larvas. I-TREATMENT Todo I-TREATMENT ello I-TREATMENT en I-TREATMENT un I-TREATMENT radio I-TREATMENT mínimo I-TREATMENT de I-TREATMENT un I-TREATMENT kilómetro. I-TREATMENT I-TREATMENT La I-TREATMENT misión I-TREATMENT del I-TREATMENT Medical I-TREATMENT Advisor I-TREATMENT en I-TREATMENT Uganda I-TREATMENT terminó I-TREATMENT sin I-TREATMENT haberse I-TREATMENT decidido I-TREATMENT sobre I-TREATMENT muchas I-TREATMENT de I-TREATMENT las I-TREATMENT medidas I-TREATMENT anteriores. I-TREATMENT Al I-TREATMENT no I-TREATMENT poner I-TREATMENT ningún I-TREATMENT país I-TREATMENT Europeo I-TREATMENT un I-TREATMENT Medical I-TREATMENT Advisor I-TREATMENT que I-TREATMENT reemplace I-TREATMENT al I-TREATMENT anterior, I-TREATMENT todos I-TREATMENT estos I-TREATMENT temas I-TREATMENT quedan I-TREATMENT abiertos I-TREATMENT y I-TREATMENT pendientes I-TREATMENT de I-TREATMENT que I-TREATMENT se I-TREATMENT tome I-TREATMENT una I-TREATMENT decisión I-TREATMENT por I-TREATMENT el I-TREATMENT nuevo I-TREATMENT Jefe I-TREATMENT de I-TREATMENT la I-TREATMENT Mision, I-TREATMENT asesorado I-TREATMENT por I-TREATMENT el I-TREATMENT Jefe I-TREATMENT de I-TREATMENT Estado I-TREATMENT Mayor I-TREATMENT y I-TREATMENT los I-TREATMENT estudios I-TREATMENT realizados. I-TREATMENT I-TREATMENT En I-TREATMENT las I-TREATMENT Figuras I-TREATMENT 1 I-TREATMENT y I-TREATMENT 2 I-TREATMENT se I-TREATMENT observan I-TREATMENT las I-TREATMENT condiciones I-TREATMENT de I-TREATMENT las I-TREATMENT viviendas I-TREATMENT de I-TREATMENT las I-TREATMENT familias I-TREATMENT de I-TREATMENT militares I-TREATMENT Ugandeses I-TREATMENT muy I-TREATMENT próximas I-TREATMENT a I-TREATMENT la I-TREATMENT zona I-TREATMENT de I-TREATMENT vida I-TREATMENT de I-TREATMENT los I-TREATMENT europeos. I-TREATMENT Debieran I-TREATMENT tratarse I-TREATMENT y I-TREATMENT cerrar I-TREATMENT ventanas I-TREATMENT y I-TREATMENT puertas I-TREATMENT con I-TREATMENT mosquiteras I-TREATMENT para I-TREATMENT una I-TREATMENT correcta I-TREATMENT desinfección I-TREATMENT y I-TREATMENT eliminación I-TREATMENT del I-TREATMENT vector. I-TREATMENT I-TREATMENT La I-TREATMENT Figura I-TREATMENT 3, I-TREATMENT nos I-TREATMENT da I-TREATMENT clara I-TREATMENT idea I-TREATMENT de I-TREATMENT la I-TREATMENT cercanía I-TREATMENT de I-TREATMENT las I-TREATMENT viviendas I-TREATMENT de I-TREATMENT militares I-TREATMENT europeos I-TREATMENT (con I-TREATMENT tejados I-TREATMENT azules) I-TREATMENT y I-TREATMENT las I-TREATMENT viviendas I-TREATMENT de I-TREATMENT militares I-TREATMENT ugandeses I-TREATMENT (construcciones I-TREATMENT propias I-TREATMENT de I-TREATMENT la I-TREATMENT zona). I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (178 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS Kg), I-PRESENT_ILLNESS varón, B-PAST_MEDICAL_HISTORY militar I-PAST_MEDICAL_HISTORY afgano, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS quemadura I-PRESENT_ILLNESS de I-PRESENT_ILLNESS segundo I-PRESENT_ILLNESS grado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS interna I-PRESENT_ILLNESS del I-PRESENT_ILLNESS antebrazo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS (7% I-PRESENT_ILLNESS de I-PRESENT_ILLNESS superficie I-PRESENT_ILLNESS corporal I-PRESENT_ILLNESS quemada) I-PRESENT_ILLNESS secundaria I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS explosión I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS horas. I-PRESENT_ILLNESS Se B-TREATMENT aplicó I-TREATMENT tratamiento I-TREATMENT tópico I-TREATMENT que I-TREATMENT resultó I-TREATMENT ineficaz. I-TREATMENT Debido I-TREATMENT a I-TREATMENT la I-TREATMENT evolución I-TREATMENT tórpida I-TREATMENT de I-TREATMENT la I-TREATMENT lesión, I-TREATMENT se I-TREATMENT decidió I-TREATMENT desbridamiento I-TREATMENT mecánico I-TREATMENT local I-TREATMENT y I-TREATMENT aplicación I-TREATMENT de I-TREATMENT sulfadiacina I-TREATMENT argéntica I-TREATMENT y I-TREATMENT apósito I-TREATMENT Tulgrasum® I-TREATMENT cicatrizante I-TREATMENT impregnado I-TREATMENT de I-TREATMENT antibiótico I-TREATMENT (bacitracina-zinc, I-TREATMENT neomicina, I-TREATMENT sulfato I-TREATMENT de I-TREATMENT polimixina I-TREATMENT B). I-TREATMENT Para I-TREATMENT permitir I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT se I-TREATMENT administró I-TREATMENT de I-TREATMENT forma I-TREATMENT previa I-TREATMENT midazolam I-TREATMENT (3 I-TREATMENT mg I-TREATMENT i.m) I-TREATMENT y I-TREATMENT a I-TREATMENT los I-TREATMENT 5 I-TREATMENT minutos I-TREATMENT ketamina I-TREATMENT (200 I-TREATMENT mg I-TREATMENT i.m). I-TREATMENT Se I-TREATMENT consiguió I-TREATMENT analgesia I-TREATMENT (grado I-TREATMENT 1 I-TREATMENT según I-TREATMENT la I-TREATMENT escala I-TREATMENT verbal I-TREATMENT del I-TREATMENT dolor) I-TREATMENT y I-TREATMENT sedación I-TREATMENT a I-TREATMENT los I-TREATMENT 12 I-TREATMENT minutos I-TREATMENT (puntuación I-TREATMENT 3 I-TREATMENT en I-TREATMENT escala I-TREATMENT Ramsay), I-TREATMENT permitiendo I-TREATMENT realizar I-TREATMENT la I-TREATMENT cura I-TREATMENT sin I-TREATMENT incidencias I-TREATMENT durante I-TREATMENT 16 I-TREATMENT minutos. I-TREATMENT El I-TREATMENT paciente I-TREATMENT recuperó I-TREATMENT sensibilidad I-TREATMENT y I-TREATMENT vigilia I-TREATMENT a I-TREATMENT los I-TREATMENT 55 I-TREATMENT minutos I-TREATMENT de I-TREATMENT la I-TREATMENT administración I-TREATMENT del I-TREATMENT tratamiento. I-TREATMENT El I-TREATMENT grado I-TREATMENT de I-TREATMENT amnesia I-TREATMENT del I-TREATMENT procedimiento I-TREATMENT quirúrgico I-TREATMENT valorado I-TREATMENT por I-TREATMENT la I-TREATMENT escala I-TREATMENT de I-TREATMENT Korttila I-TREATMENT y I-TREATMENT Linnolia I-TREATMENT fue I-TREATMENT total. I-TREATMENT I-TREATMENT Ambos I-TREATMENT casos I-TREATMENT presentaron I-TREATMENT una I-TREATMENT evolución I-TREATMENT favorable I-TREATMENT sin I-TREATMENT efectos I-TREATMENT adversos I-TREATMENT durante I-TREATMENT curas I-TREATMENT posteriores. I-TREATMENT I-TREATMENT En I-TREATMENT zona I-TREATMENT de I-TREATMENT combate, I-TREATMENT es I-TREATMENT frecuente I-TREATMENT encontrar I-TREATMENT heridos I-TREATMENT que I-TREATMENT presentan I-TREATMENT quemaduras I-TREATMENT de I-TREATMENT distinto I-TREATMENT grado I-TREATMENT y I-TREATMENT extensión I-TREATMENT debido I-TREATMENT principalmente I-TREATMENT al I-TREATMENT empleo I-TREATMENT de I-TREATMENT artefactos I-TREATMENT explosivos I-TREATMENT por I-TREATMENT parte I-TREATMENT de I-TREATMENT los I-TREATMENT contendientes. I-TREATMENT En I-TREATMENT un I-TREATMENT estudio I-TREATMENT realizado I-TREATMENT sobre I-TREATMENT 256 I-TREATMENT heridos I-TREATMENT por I-TREATMENT arma I-TREATMENT de I-TREATMENT fuego I-TREATMENT o I-TREATMENT por I-TREATMENT artefacto I-TREATMENT explosivo I-TREATMENT improvisado I-TREATMENT atendidos I-TREATMENT en I-TREATMENT el I-TREATMENT hospital I-TREATMENT militar I-TREATMENT español I-TREATMENT de I-TREATMENT Herat I-TREATMENT (Afganistán) I-TREATMENT entre I-TREATMENT 2005 I-TREATMENT y I-TREATMENT 2008, I-TREATMENT se I-TREATMENT describe I-TREATMENT que I-TREATMENT 23 I-TREATMENT (9%) I-TREATMENT sufrieron I-TREATMENT quemaduras5. I-TREATMENT I-TREATMENT A I-TREATMENT dosis I-TREATMENT adecuadas I-TREATMENT el I-TREATMENT empleo I-TREATMENT de I-TREATMENT ketamina I-TREATMENT y I-TREATMENT midazolam I-TREATMENT consigue I-TREATMENT un I-TREATMENT adecuado I-TREATMENT estado I-TREATMENT analgésico, I-TREATMENT hipnótico I-TREATMENT y I-TREATMENT ansiolítico I-TREATMENT con I-TREATMENT una I-TREATMENT estabilidad I-TREATMENT hemodinámica I-TREATMENT notable I-TREATMENT y I-TREATMENT un I-TREATMENT mantenimiento I-TREATMENT espontáneo I-TREATMENT de I-TREATMENT la I-TREATMENT función I-TREATMENT respiratoria. I-TREATMENT Además, I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT emplear I-TREATMENT ambos I-TREATMENT fármacos I-TREATMENT por I-TREATMENT vía I-TREATMENT intramuscular I-TREATMENT minimiza I-TREATMENT ostensiblemente I-TREATMENT los I-TREATMENT requerimientos I-TREATMENT logísticos I-TREATMENT necesarios I-TREATMENT en I-TREATMENT cada I-TREATMENT paciente. I-TREATMENT La I-TREATMENT sedación I-TREATMENT con I-TREATMENT midazolam I-TREATMENT debe I-TREATMENT ser I-TREATMENT previa I-TREATMENT a I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT la I-TREATMENT ketamina, I-TREATMENT ya I-TREATMENT que I-TREATMENT en I-TREATMENT caso I-TREATMENT contrario I-TREATMENT podría I-TREATMENT producirse I-TREATMENT una I-TREATMENT marcada I-TREATMENT estimulación I-TREATMENT cardiovascular I-TREATMENT y I-TREATMENT presentarse I-TREATMENT desagradables I-TREATMENT reacciones I-TREATMENT psicomiméticas I-TREATMENT al I-TREATMENT despertar. I-TREATMENT Así I-TREATMENT mismo I-TREATMENT se I-TREATMENT podría I-TREATMENT añadir I-TREATMENT atropina I-TREATMENT para I-TREATMENT minimizar I-TREATMENT la I-TREATMENT posible I-TREATMENT aparición I-TREATMENT de I-TREATMENT sialorrea, I-TREATMENT aunque I-TREATMENT en I-TREATMENT ninguno I-TREATMENT de I-TREATMENT los I-TREATMENT dos I-TREATMENT casos I-TREATMENT fue I-TREATMENT administrada I-TREATMENT ni I-TREATMENT apareció I-TREATMENT un I-TREATMENT aumento I-TREATMENT de I-TREATMENT secreciones I-TREATMENT en I-TREATMENT estos I-TREATMENT pacientes. I-TREATMENT Dichas I-TREATMENT características I-TREATMENT hacen I-TREATMENT estos I-TREATMENT fármacos I-TREATMENT de I-TREATMENT elección I-TREATMENT para I-TREATMENT la I-TREATMENT anestesia I-TREATMENT en I-TREATMENT ambientes I-TREATMENT austeros, I-TREATMENT como I-TREATMENT es I-TREATMENT el I-TREATMENT de I-TREATMENT la I-TREATMENT guerra I-TREATMENT de I-TREATMENT Afganistán. I-TREATMENT I-TREATMENT Ricardo I-TREATMENT Navarro I-TREATMENT Suay1, I-TREATMENT Sergio I-TREATMENT Castillejo I-TREATMENT Pérez2, I-TREATMENT Javier I-TREATMENT de I-TREATMENT las I-TREATMENT Heras I-TREATMENT Díez3 I-TREATMENT y I-TREATMENT Rafael I-TREATMENT Tamburri I-TREATMENT Bariain4 I-TREATMENT 1Cte. I-TREATMENT Médico. I-TREATMENT 2Cap. I-TREATMENT Médico. I-TREATMENT 3Cap. I-TREATMENT Médico. I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Anestesiología I-TREATMENT y I-TREATMENT Reanimación I-TREATMENT 4Cte. I-TREATMENT Médico. I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Traumatología. I-TREATMENT Hospital I-TREATMENT Central I-TREATMENT de I-TREATMENT la I-TREATMENT Defensa I-TREATMENT «Gómez I-TREATMENT Ulla». I-TREATMENT Madrid I-TREATMENT I-TREATMENT Un B-PRESENT_ILLNESS soldado I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 25 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY fue B-PRESENT_ILLNESS evacuado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ROLE I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS base I-PRESENT_ILLNESS Miguel I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Cervantes I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS una I-PRESENT_ILLNESS posición I-PRESENT_ILLNESS cercana I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS sufrir I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS picaduras I-PRESENT_ILLNESS de I-PRESENT_ILLNESS escorpión, I-PRESENT_ILLNESS localizadas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS derecha, I-PRESENT_ILLNESS menos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS horas I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS llegada. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS primera I-PRESENT_ILLNESS estaba I-PRESENT_ILLNESS localizada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tercio I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS tibial. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS segunda, I-PRESENT_ILLNESS prácticamente I-PRESENT_ILLNESS indetectable, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS hallaba I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS misma I-PRESENT_ILLNESS altura I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS posterior. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refirió I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS como I-PRESENT_ILLNESS única I-PRESENT_ILLNESS manifestación, I-PRESENT_ILLNESS más I-PRESENT_ILLNESS acentuado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS segunda I-PRESENT_ILLNESS picadura. I-PRESENT_ILLNESS Durante B-EXPLORATION la I-EXPLORATION asistencia I-EXPLORATION inicial, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION (PA) I-EXPLORATION de I-EXPLORATION 130/ I-EXPLORATION 60, I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION de I-EXPLORATION 62 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION una I-EXPLORATION saturación I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION inicial I-EXPLORATION del I-EXPLORATION 96% I-EXPLORATION y I-EXPLORATION una I-EXPLORATION temperatura I-EXPLORATION de I-EXPLORATION 36oC. I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION objetivaron I-EXPLORATION otras I-EXPLORATION manifestaciones I-EXPLORATION sistémicas. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT 2 I-TREATMENT gramos I-TREATMENT de I-TREATMENT dipirona I-TREATMENT intravenosa I-TREATMENT y I-TREATMENT la I-TREATMENT vacuna I-TREATMENT antitetánica. I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT local I-TREATMENT incluyó I-TREATMENT una I-TREATMENT exhaustiva I-TREATMENT irrigación I-TREATMENT con I-TREATMENT povidona I-TREATMENT diluida I-TREATMENT para I-TREATMENT su I-TREATMENT limpieza. I-TREATMENT Tras I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT una I-TREATMENT reacción I-TREATMENT edematosa I-TREATMENT localizada I-TREATMENT en I-TREATMENT la I-TREATMENT pierna I-TREATMENT derecha I-TREATMENT se I-TREATMENT administró I-TREATMENT una I-TREATMENT dosis I-TREATMENT única I-TREATMENT de I-TREATMENT corticoterapia I-TREATMENT intravenosa. I-TREATMENT Durante B-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION la I-EVOLUTION PA I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION entre I-EVOLUTION 100 I-EVOLUTION y I-EVOLUTION 130 I-EVOLUTION (sistólica) I-EVOLUTION y I-EVOLUTION 55 I-EVOLUTION y I-EVOLUTION 70 I-EVOLUTION (diastólica). I-EVOLUTION La I-EVOLUTION temperatura I-EVOLUTION corporal I-EVOLUTION nunca I-EVOLUTION superó I-EVOLUTION los I-EVOLUTION 36´5oC. I-EVOLUTION I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION abandonó I-EVOLUTION el I-EVOLUTION ROLE I-EVOLUTION 1 I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION sin I-EVOLUTION requerir I-EVOLUTION ningún I-EVOLUTION tipo I-EVOLUTION de I-EVOLUTION medicación I-EVOLUTION (sólo I-EVOLUTION analgesia I-EVOLUTION convencional I-EVOLUTION a I-EVOLUTION demanda). I-EVOLUTION Las I-EVOLUTION heridas I-EVOLUTION cicatrizaron I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION I-EVOLUTION El I-EVOLUTION ejemplar I-EVOLUTION fue I-EVOLUTION capturado I-EVOLUTION en I-EVOLUTION el I-EVOLUTION mismo I-EVOLUTION lugar I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION produjo I-EVOLUTION la I-EVOLUTION picadura. I-EVOLUTION Se I-EVOLUTION trataba I-EVOLUTION de I-EVOLUTION un I-EVOLUTION escorpión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION familia I-EVOLUTION Buthidae, I-EVOLUTION muy I-EVOLUTION común I-EVOLUTION en I-EVOLUTION Líbano, I-EVOLUTION aunque I-EVOLUTION no I-EVOLUTION se I-EVOLUTION pudo I-EVOLUTION precisar I-EVOLUTION la I-EVOLUTION especie. I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS oficial I-PRESENT_ILLNESS afgano I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS evacuado I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ROLE I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Herat I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS ROLE I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Farah I-PRESENT_ILLNESS por I-PRESENT_ILLNESS una I-PRESENT_ILLNESS herida I-PRESENT_ILLNESS por I-PRESENT_ILLNESS arma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuego I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS región I-PRESENT_ILLNESS inguinal I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS Entre B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY destacaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY estenosis I-PAST_MEDICAL_HISTORY traqueal I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY disparo I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY arma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fuego I-PAST_MEDICAL_HISTORY sufrido I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás. I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION ROLE I-EXPLORATION 1 I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION y B-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT shunt I-TREATMENT de I-TREATMENT Argyle I-TREATMENT de I-TREATMENT 10F I-TREATMENT en I-TREATMENT la I-TREATMENT arteria I-TREATMENT femoral, I-TREATMENT tras I-TREATMENT constatar I-TREATMENT una I-TREATMENT pérdida I-TREATMENT de I-TREATMENT substancia I-TREATMENT que I-TREATMENT afectaba I-TREATMENT al I-TREATMENT 80 I-TREATMENT % I-TREATMENT de I-TREATMENT su I-TREATMENT circunferencia, I-TREATMENT 10 I-TREATMENT centímetros I-TREATMENT por I-TREATMENT debajo I-TREATMENT del I-TREATMENT pliegue I-TREATMENT inguinal, I-TREATMENT con B-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION consiguió I-EVOLUTION revascularizar I-EVOLUTION el I-EVOLUTION miembro I-EVOLUTION y I-EVOLUTION cohibir I-EVOLUTION la I-EVOLUTION hemorragia. I-EVOLUTION Durante B-TREATMENT su I-TREATMENT ingreso I-TREATMENT requirió I-TREATMENT 8 I-TREATMENT concentrados I-TREATMENT de I-TREATMENT hematíes, I-TREATMENT 9 I-TREATMENT de I-TREATMENT plaquetas I-TREATMENT y I-TREATMENT 1 I-TREATMENT de I-TREATMENT factores I-TREATMENT de I-TREATMENT coagulación. I-TREATMENT A I-TREATMENT su I-TREATMENT llegada I-TREATMENT a I-TREATMENT ROLE I-TREATMENT 2 I-TREATMENT estaba I-TREATMENT intubado. I-TREATMENT Los B-EXPLORATION valores I-EXPLORATION de I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION fueron I-EXPLORATION 13/7, I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 74 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION fiebre. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION destacaron I-EXPLORATION una I-EXPLORATION plaquetopenia I-EXPLORATION de I-EXPLORATION 67.000 I-EXPLORATION y I-EXPLORATION un I-EXPLORATION INR I-EXPLORATION de I-EXPLORATION 1´4, I-EXPLORATION aunque I-EXPLORATION no I-EXPLORATION existía I-EXPLORATION acidosis I-EXPLORATION y I-EXPLORATION el I-EXPLORATION lactato I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION extremidad I-EXPLORATION estaba I-EXPLORATION caliente I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION palidez I-EXPLORATION ni I-EXPLORATION cianosis, I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION pulsos I-EXPLORATION distales. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION fracturas. I-EXPLORATION Por I-EXPLORATION ello, I-EXPLORATION y I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION dificultad I-EXPLORATION para I-EXPLORATION trasladar I-EXPLORATION al I-EXPLORATION paciente I-EXPLORATION a I-EXPLORATION un I-EXPLORATION centro I-EXPLORATION de I-EXPLORATION referencia, I-EXPLORATION se I-EXPLORATION decidió I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida. I-EXPLORATION El I-EXPLORATION orificio I-EXPLORATION de I-EXPLORATION entrada, I-EXPLORATION de I-EXPLORATION 1 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION se I-EXPLORATION hallaba I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION medio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION externa I-EXPLORATION del I-EXPLORATION muslo, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION de I-EXPLORATION salida, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION interna, I-EXPLORATION cerca I-EXPLORATION del I-EXPLORATION canal I-EXPLORATION de I-EXPLORATION los I-EXPLORATION aductores. I-EXPLORATION El I-EXPLORATION lecho I-EXPLORATION de I-EXPLORATION la I-EXPLORATION herida I-EXPLORATION estaba I-EXPLORATION exangüe I-EXPLORATION y I-EXPLORATION no I-EXPLORATION había I-EXPLORATION compromiso I-EXPLORATION venoso. I-EXPLORATION La I-EXPLORATION arteria I-EXPLORATION femoral I-EXPLORATION se I-EXPLORATION hallaba I-EXPLORATION seccionada I-EXPLORATION en I-EXPLORATION un I-EXPLORATION 80% I-EXPLORATION de I-EXPLORATION su I-EXPLORATION circunferencia. I-EXPLORATION Seguidamente, B-TREATMENT se I-TREATMENT realizó I-TREATMENT una I-TREATMENT incisión I-TREATMENT en I-TREATMENT la I-TREATMENT cara I-TREATMENT interna I-TREATMENT del I-TREATMENT muslo I-TREATMENT contralateral I-TREATMENT hasta I-TREATMENT disecar I-TREATMENT la I-TREATMENT vena I-TREATMENT safena I-TREATMENT mediante I-TREATMENT disección I-TREATMENT roma I-TREATMENT y I-TREATMENT electrocoagulación. I-TREATMENT Tras I-TREATMENT la I-TREATMENT ligadura I-TREATMENT de I-TREATMENT las I-TREATMENT colaterales I-TREATMENT y I-TREATMENT de I-TREATMENT ambos I-TREATMENT extremos I-TREATMENT se I-TREATMENT obtuvo I-TREATMENT un I-TREATMENT injerto I-TREATMENT de I-TREATMENT 4 I-TREATMENT cm, I-TREATMENT el I-TREATMENT cual I-TREATMENT fue I-TREATMENT irrigado I-TREATMENT con I-TREATMENT una I-TREATMENT solución I-TREATMENT de I-TREATMENT suero I-TREATMENT salino I-TREATMENT heparinizado I-TREATMENT para I-TREATMENT evidenciar I-TREATMENT la I-TREATMENT ausencia I-TREATMENT de I-TREATMENT fugas. I-TREATMENT Tras I-TREATMENT ello, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT disección I-TREATMENT y I-TREATMENT exposición I-TREATMENT del I-TREATMENT tramo I-TREATMENT arterial I-TREATMENT afectado I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT la I-TREATMENT anticoagulación I-TREATMENT sistémica I-TREATMENT con I-TREATMENT 3.000 I-TREATMENT UI I-TREATMENT de I-TREATMENT heparina, I-TREATMENT teniendo I-TREATMENT en I-TREATMENT cuenta I-TREATMENT el I-TREATMENT valor I-TREATMENT elevado I-TREATMENT del I-TREATMENT INR I-TREATMENT y I-TREATMENT la I-TREATMENT plaquetopenia. I-TREATMENT Se I-TREATMENT liberó I-TREATMENT de I-TREATMENT forma I-TREATMENT controlada I-TREATMENT el I-TREATMENT clampaje I-TREATMENT de I-TREATMENT los I-TREATMENT cabos I-TREATMENT arteriales I-TREATMENT para I-TREATMENT evacuar I-TREATMENT los I-TREATMENT posibles I-TREATMENT trombos I-TREATMENT neoformados I-TREATMENT y I-TREATMENT se I-TREATMENT aplicó I-TREATMENT suero I-TREATMENT heparinizado. I-TREATMENT Se I-TREATMENT colocó I-TREATMENT el I-TREATMENT injerto I-TREATMENT venoso I-TREATMENT de I-TREATMENT modo I-TREATMENT invertido I-TREATMENT y I-TREATMENT se I-TREATMENT suturó I-TREATMENT de I-TREATMENT forma I-TREATMENT continua I-TREATMENT con I-TREATMENT Prolene I-TREATMENT de I-TREATMENT 5/0. I-TREATMENT Se I-TREATMENT comprobó I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT pulso I-TREATMENT distal I-TREATMENT pedio I-TREATMENT y I-TREATMENT tibial I-TREATMENT posterior I-TREATMENT con I-TREATMENT ultrasonidos I-TREATMENT y I-TREATMENT se I-TREATMENT lavó I-TREATMENT copiosamente I-TREATMENT la I-TREATMENT herida I-TREATMENT con I-TREATMENT suero I-TREATMENT salino. I-TREATMENT El I-TREATMENT tejido I-TREATMENT subcutáneo I-TREATMENT se I-TREATMENT cerró I-TREATMENT con I-TREATMENT Vicryl I-TREATMENT de I-TREATMENT 3/0 I-TREATMENT recubriendo I-TREATMENT la I-TREATMENT arteria I-TREATMENT reconstruida. I-TREATMENT Durante B-EVOLUTION su I-EVOLUTION estancia I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos I-EVOLUTION se I-EVOLUTION comprobó I-EVOLUTION cada I-EVOLUTION hora I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION pulsos I-EVOLUTION distales I-EVOLUTION con I-EVOLUTION ultrasonidos, I-EVOLUTION así I-EVOLUTION como I-EVOLUTION temperatura I-EVOLUTION y I-EVOLUTION aspecto I-EVOLUTION del I-EVOLUTION miembro, I-EVOLUTION sin I-EVOLUTION observarse I-EVOLUTION ninguna I-EVOLUTION anomalía I-EVOLUTION hasta I-EVOLUTION el I-EVOLUTION traslado I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION horas I-EVOLUTION de I-EVOLUTION su I-EVOLUTION ingreso. I-EVOLUTION La B-TREATMENT analgesia I-TREATMENT se I-TREATMENT controló I-TREATMENT con I-TREATMENT fentanilo I-TREATMENT y I-TREATMENT dipirona. I-TREATMENT Se I-TREATMENT administró I-TREATMENT cefazolina I-TREATMENT 1 I-TREATMENT gr I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT la I-TREATMENT anticoagulación I-TREATMENT con I-TREATMENT 25.000 I-TREATMENT UI I-TREATMENT de I-TREATMENT heparina I-TREATMENT en I-TREATMENT 500 I-TREATMENT cc I-TREATMENT de I-TREATMENT suero I-TREATMENT a I-TREATMENT 500 I-TREATMENT unidades I-TREATMENT por I-TREATMENT hora. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 42 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY conocidas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY desprendimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY retina I-PAST_MEDICAL_HISTORY bilateral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY paladar I-PAST_MEDICAL_HISTORY hendido. I-PAST_MEDICAL_HISTORY Valorado B-PRESENT_ILLNESS en I-PRESENT_ILLNESS consultas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Traumatología I-PRESENT_ILLNESS por I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS casual I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mano I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION tumefacción I-EXPLORATION en I-EXPLORATION dorso I-EXPLORATION de I-EXPLORATION mano I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION 4o I-EXPLORATION metacarpiano, I-EXPLORATION dolor I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION de I-EXPLORATION estructuras I-EXPLORATION óseas I-EXPLORATION y I-EXPLORATION una I-EXPLORATION marcada I-EXPLORATION limitación I-EXPLORATION para I-EXPLORATION la I-EXPLORATION flexión I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION metacarpofalángica I-EXPLORATION de I-EXPLORATION 3o I-EXPLORATION y I-EXPLORATION 4o I-EXPLORATION dedos. I-EXPLORATION El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY manifiesta I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY dicha I-PAST_MEDICAL_HISTORY limitación I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY traumatismo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Presenta B-EXPLORATION similar I-EXPLORATION limitación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION contralateral I-EXPLORATION que I-EXPLORATION afecta I-EXPLORATION a I-EXPLORATION los I-EXPLORATION mismos I-EXPLORATION dedos, I-EXPLORATION 3o I-EXPLORATION y I-EXPLORATION 4o. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicita I-EXPLORATION una I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION manos, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION traumática I-EXPLORATION ósea I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION contusión, I-EXPLORATION y I-EXPLORATION como I-EXPLORATION hallazgo I-EXPLORATION radiológico, I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION aplanamiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cabezas I-EXPLORATION metacarpianas I-EXPLORATION 3a I-EXPLORATION y I-EXPLORATION 4a I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION manos, I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION espejo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION sus I-EXPLORATION falanges I-EXPLORATION correspondientes, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION da I-EXPLORATION un I-EXPLORATION aspecto I-EXPLORATION «cuadrado» I-EXPLORATION a I-EXPLORATION la I-EXPLORATION articulación. I-EXPLORATION I-EXPLORATION Se B-TREATMENT pauta I-TREATMENT tratamiento I-TREATMENT para I-TREATMENT la I-TREATMENT contusión I-TREATMENT (reposo, I-TREATMENT crioterapia I-TREATMENT y I-TREATMENT toma I-TREATMENT de I-TREATMENT AINEs) I-TREATMENT y I-TREATMENT se I-TREATMENT le I-TREATMENT cita I-TREATMENT en I-TREATMENT dos I-TREATMENT semanas I-TREATMENT para I-TREATMENT una I-TREATMENT exploración I-TREATMENT funcional I-TREATMENT no I-TREATMENT alterada I-TREATMENT por I-TREATMENT el I-TREATMENT dolor. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION dos I-EVOLUTION semanas, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION refiere I-EVOLUTION mejoría I-EVOLUTION completa I-EVOLUTION de I-EVOLUTION su I-EVOLUTION proceso I-EVOLUTION traumático. I-EVOLUTION Se I-EVOLUTION observa I-EVOLUTION disminución I-EVOLUTION del I-EVOLUTION arco I-EVOLUTION de I-EVOLUTION movilidad I-EVOLUTION metacarpofalángico I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION manos I-EVOLUTION (valores I-EVOLUTION normales: I-EVOLUTION extensión I-EVOLUTION 0-20o I-EVOLUTION y I-EVOLUTION flexión I-EVOLUTION 0-90o) I-EVOLUTION consistente I-EVOLUTION en I-EVOLUTION pérdida I-EVOLUTION en I-EVOLUTION la I-EVOLUTION mano I-EVOLUTION derecha I-EVOLUTION de I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION 30o I-EVOLUTION de I-EVOLUTION flexión I-EVOLUTION en I-EVOLUTION el I-EVOLUTION 3o I-EVOLUTION dedo I-EVOLUTION y I-EVOLUTION de I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION 25o I-EVOLUTION en I-EVOLUTION el I-EVOLUTION 4o. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION mano I-EVOLUTION izquierda I-EVOLUTION tan I-EVOLUTION solo I-EVOLUTION se I-EVOLUTION aprecia I-EVOLUTION la I-EVOLUTION pérdida I-EVOLUTION de I-EVOLUTION los I-EVOLUTION últimos I-EVOLUTION 20o I-EVOLUTION en I-EVOLUTION la I-EVOLUTION flexión I-EVOLUTION del I-EVOLUTION 3o I-EVOLUTION y I-EVOLUTION 4o I-EVOLUTION dedos I-EVOLUTION (coincidente I-EVOLUTION con I-EVOLUTION una I-EVOLUTION menor I-EVOLUTION afectación I-EVOLUTION radiológica I-EVOLUTION en I-EVOLUTION esa I-EVOLUTION mano). I-EVOLUTION Pese I-EVOLUTION a I-EVOLUTION la I-EVOLUTION afectación I-EVOLUTION radiológica I-EVOLUTION de I-EVOLUTION más I-EVOLUTION articulaciones, I-EVOLUTION no I-EVOLUTION objetivamos I-EVOLUTION déficit I-EVOLUTION de I-EVOLUTION movilidad I-EVOLUTION en I-EVOLUTION ninguna I-EVOLUTION otra. I-EVOLUTION I-EVOLUTION No I-EVOLUTION tiene I-EVOLUTION dolor I-EVOLUTION actualmente, I-EVOLUTION ni I-EVOLUTION lo I-EVOLUTION ha I-EVOLUTION sufrido I-EVOLUTION en I-EVOLUTION el I-EVOLUTION pasado, I-EVOLUTION siendo I-EVOLUTION su I-EVOLUTION queja I-EVOLUTION principal I-EVOLUTION la I-EVOLUTION limitación I-EVOLUTION que I-EVOLUTION presenta I-EVOLUTION en I-EVOLUTION actividades I-EVOLUTION que I-EVOLUTION requieren I-EVOLUTION formar I-EVOLUTION un I-EVOLUTION puño I-EVOLUTION con I-EVOLUTION la I-EVOLUTION mano. I-EVOLUTION I-EVOLUTION Diagnóstico: I-EVOLUTION enfermedad I-EVOLUTION de I-EVOLUTION dieterich I-EVOLUTION I-EVOLUTION Un B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS no B-PAST_MEDICAL_HISTORY fumador, I-PAST_MEDICAL_HISTORY originario I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Perú, I-PAST_MEDICAL_HISTORY residente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY España I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY últimos I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY presentaba B-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS semanas I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS ingreso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tumefacción I-PRESENT_ILLNESS dolorosa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS color I-PRESENT_ILLNESS violáceo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS dorso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS progresó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS anterior I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pierna I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS un I-PRESENT_ILLNESS traumatismo I-PRESENT_ILLNESS mínimo I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS zona. I-PRESENT_ILLNESS La I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS no I-PRESENT_ILLNESS mejoró I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS antibiótico I-PRESENT_ILLNESS y I-PRESENT_ILLNESS antiinflamatorio. I-PRESENT_ILLNESS Una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS después I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS los I-PRESENT_ILLNESS mismos I-PRESENT_ILLNESS síntomas I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS añadiéndose I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS termometrada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 39oC. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION afebril, I-EXPLORATION no I-EXPLORATION se I-EXPLORATION palpaban I-EXPLORATION adenopatías, I-EXPLORATION la I-EXPLORATION auscultación I-EXPLORATION pulmonar I-EXPLORATION y I-EXPLORATION cardíaca I-EXPLORATION eran I-EXPLORATION normales, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION abdomen I-EXPLORATION no I-EXPLORATION se I-EXPLORATION apreciaban I-EXPLORATION datos I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores I-EXPLORATION destacaba I-EXPLORATION un I-EXPLORATION eritema I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION borde I-EXPLORATION no I-EXPLORATION definido I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION miembros I-EXPLORATION hasta I-EXPLORATION las I-EXPLORATION rodillas, I-EXPLORATION más I-EXPLORATION evidente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION izquierdo, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION inflamación I-EXPLORATION articular. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION leucocitosis I-EXPLORATION de I-EXPLORATION 21.000 I-EXPLORATION / I-EXPLORATION ml I-EXPLORATION con I-EXPLORATION neutrofilia I-EXPLORATION y I-EXPLORATION linfopenia, I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación: I-EXPLORATION 67 I-EXPLORATION mm I-EXPLORATION / I-EXPLORATION h, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva: I-EXPLORATION 24, I-EXPLORATION 48 I-EXPLORATION mg I-EXPLORATION / I-EXPLORATION dl I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION los I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION postero-anterior I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION revelaba I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION nodular I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION en I-EXPLORATION hilio I-EXPLORATION izquierdo, I-EXPLORATION sugestiva I-EXPLORATION de I-EXPLORATION adenopatía I-EXPLORATION hiliar. I-EXPLORATION Los I-EXPLORATION hemocultivos I-EXPLORATION y I-EXPLORATION urocultivos I-EXPLORATION fueron I-EXPLORATION negativos, I-EXPLORATION la I-EXPLORATION serología I-EXPLORATION a I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Hepatitis I-EXPLORATION A, I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C, I-EXPLORATION borrelia, I-EXPLORATION rickettsia I-EXPLORATION conorii, I-EXPLORATION coxiella, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION Epstein I-EXPLORATION Barr, I-EXPLORATION y I-EXPLORATION citomegalovirus I-EXPLORATION no I-EXPLORATION aportaba I-EXPLORATION datos I-EXPLORATION concordantes I-EXPLORATION con I-EXPLORATION infección I-EXPLORATION aguda. I-EXPLORATION Los I-EXPLORATION BAAR I-EXPLORATION y I-EXPLORATION cultivos I-EXPLORATION de I-EXPLORATION esputo I-EXPLORATION en I-EXPLORATION medios I-EXPLORATION habituales I-EXPLORATION y I-EXPLORATION el I-EXPLORATION Mantoux I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION TC I-EXPLORATION toraco-abdomino-pélvico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION pusieron I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION adenopatías I-EXPLORATION mediastínicas I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION significativo I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION paratraqueal I-EXPLORATION derecho, I-EXPLORATION pretraqueal I-EXPLORATION y I-EXPLORATION perivascular I-EXPLORATION e I-EXPLORATION hiliar I-EXPLORATION bilateral I-EXPLORATION de I-EXPLORATION naturaleza I-EXPLORATION indeterminada. I-EXPLORATION Adyacente I-EXPLORATION a I-EXPLORATION la I-EXPLORATION cúpula I-EXPLORATION diafragmática I-EXPLORATION y I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION los I-EXPLORATION segmentos I-EXPLORATION basales I-EXPLORATION del I-EXPLORATION LII, I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION imagen I-EXPLORATION pseudonodular I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 2, I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION anteroposterior, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION inflamatorio, I-EXPLORATION sin I-EXPLORATION poderse I-EXPLORATION descartar I-EXPLORATION otras I-EXPLORATION posibilidades. I-EXPLORATION Ambas I-EXPLORATION cisuras I-EXPLORATION mayores I-EXPLORATION presentaban I-EXPLORATION aspecto I-EXPLORATION engrosado I-EXPLORATION con I-EXPLORATION pequeña I-EXPLORATION cuña I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION derecho. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION fibroboncoscopia I-EXPLORATION con I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION broncoaspirado I-EXPLORATION (BAS), I-EXPLORATION lavado I-EXPLORATION broncoalveolar I-EXPLORATION (LBA), I-EXPLORATION biopsia I-EXPLORATION bronquial I-EXPLORATION y I-EXPLORATION transbronquial. I-EXPLORATION El I-EXPLORATION LBA I-EXPLORATION revelo I-EXPLORATION una I-EXPLORATION celularidad I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION linfocitario I-EXPLORATION con I-EXPLORATION un I-EXPLORATION cociente I-EXPLORATION CD4/CD8 I-EXPLORATION > I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION y I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION bronquial I-EXPLORATION y I-EXPLORATION transbronquial I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION epitelio I-EXPLORATION respiratorio I-EXPLORATION maduro, I-EXPLORATION con I-EXPLORATION glándulas I-EXPLORATION mucosas I-EXPLORATION y I-EXPLORATION acúmulos I-EXPLORATION linfoides I-EXPLORATION aislados I-EXPLORATION en I-EXPLORATION la I-EXPLORATION lámina I-EXPLORATION propia. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION elementos I-EXPLORATION granulomatosos I-EXPLORATION ni I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION malignidad. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION mediastinoscopia I-EXPLORATION con I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION adenopatía I-EXPLORATION paratraqueal I-EXPLORATION derecha I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION glanglio I-EXPLORATION linfático I-EXPLORATION ocupado I-EXPLORATION en I-EXPLORATION su I-EXPLORATION mayor I-EXPLORATION parte I-EXPLORATION por I-EXPLORATION granulomas I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION sarcoideo, I-EXPLORATION pequeños I-EXPLORATION y I-EXPLORATION coalescentes, I-EXPLORATION con I-EXPLORATION densa I-EXPLORATION corona I-EXPLORATION linfocitaria I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION necrosis I-EXPLORATION central, I-EXPLORATION no I-EXPLORATION objetivándose I-EXPLORATION estructuras I-EXPLORATION bacilares, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION linfadenitis I-EXPLORATION granulomatosa, I-EXPLORATION sarcoidosis. I-EXPLORATION Se I-EXPLORATION tomó I-EXPLORATION una I-EXPLORATION muestra I-EXPLORATION de I-EXPLORATION piel, I-EXPLORATION cuya I-EXPLORATION histología I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION inflamatorio I-EXPLORATION en I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION constituido I-EXPLORATION por I-EXPLORATION histiocitos, I-EXPLORATION algunos I-EXPLORATION con I-EXPLORATION aspecto I-EXPLORATION epitelioide, I-EXPLORATION polimorfonucleares, I-EXPLORATION neutrófilos I-EXPLORATION y I-EXPLORATION linfocitos I-EXPLORATION aislados, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION eritema I-EXPLORATION nodoso. I-EXPLORATION La I-EXPLORATION espirometría I-EXPLORATION y I-EXPLORATION la I-EXPLORATION difusión I-EXPLORATION pulmonar I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION así I-EXPLORATION como I-EXPLORATION el I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT los I-TREATMENT hallazgos I-TREATMENT clínicos I-TREATMENT y I-TREATMENT la I-TREATMENT biopsia I-TREATMENT compatible I-TREATMENT con I-TREATMENT granuloma I-TREATMENT sarcoideo I-TREATMENT se I-TREATMENT instauró I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT corticoides. I-TREATMENT I-TREATMENT Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS prurito I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS que I-PRESENT_ILLNESS desemboca I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS aparición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS eritematosa, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS bordes I-PRESENT_ILLNESS vesiculosos I-PRESENT_ILLNESS e I-PRESENT_ILLNESS irregulares I-PRESENT_ILLNESS y I-PRESENT_ILLNESS superficie I-PRESENT_ILLNESS ligeramente I-PRESENT_ILLNESS escamosa I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS brazo I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS aparecen I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS semejantes I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS resto I-PRESENT_ILLNESS del I-PRESENT_ILLNESS cuerpo I-PRESENT_ILLNESS incluyendo I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cara. I-PRESENT_ILLNESS Unos B-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY C I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY 135mg I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interferón I-PAST_MEDICAL_HISTORY alfa-2a I-PAST_MEDICAL_HISTORY semanalmente, I-PAST_MEDICAL_HISTORY administrado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY subcutánea I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ribavirina, I-PAST_MEDICAL_HISTORY 1.200 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY vía I-PAST_MEDICAL_HISTORY oral. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY A B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION presenta I-EXPLORATION una I-EXPLORATION placa I-EXPLORATION eccematosa, I-EXPLORATION pruriginosa, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION tercio I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION brazo I-EXPLORATION izquierdo. I-EXPLORATION Ver I-EXPLORATION figura. I-EXPLORATION Se I-EXPLORATION observan I-EXPLORATION lesiones I-EXPLORATION de I-EXPLORATION características I-EXPLORATION semejantes, I-EXPLORATION de I-EXPLORATION diversos I-EXPLORATION tamaños I-EXPLORATION que I-EXPLORATION se I-EXPLORATION distribuyen I-EXPLORATION por I-EXPLORATION los I-EXPLORATION miembros I-EXPLORATION inferiores I-EXPLORATION y I-EXPLORATION superiores, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION por I-EXPLORATION el I-EXPLORATION tórax, I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION y I-EXPLORATION pabellones I-EXPLORATION auriculares. I-EXPLORATION El I-EXPLORATION estado I-EXPLORATION general I-EXPLORATION del I-EXPLORATION paciente I-EXPLORATION es I-EXPLORATION bueno, I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION la I-EXPLORATION bioquímica I-EXPLORATION sanguínea I-EXPLORATION son I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION practica I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION del I-EXPLORATION borde I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION ubicada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION brazo I-EXPLORATION izquierdo. I-EXPLORATION El I-EXPLORATION laboratorio I-EXPLORATION de I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informa I-EXPLORATION que I-EXPLORATION se I-EXPLORATION trata I-EXPLORATION de I-EXPLORATION una I-EXPLORATION dermatitis I-EXPLORATION psoriasiforme I-EXPLORATION y I-EXPLORATION espongiótica I-EXPLORATION con I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION ampolla I-EXPLORATION intracórnea I-EXPLORATION con I-EXPLORATION neutrófilos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION establece I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION eccema I-EXPLORATION nummular I-EXPLORATION generalizado I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION la I-EXPLORATION ingesta I-EXPLORATION de I-EXPLORATION interferón I-EXPLORATION alfa-2a I-EXPLORATION y I-EXPLORATION ribavirina I-EXPLORATION para I-EXPLORATION el I-EXPLORATION tratamiento I-EXPLORATION de I-EXPLORATION una I-EXPLORATION hepatitis I-EXPLORATION C. I-EXPLORATION Tras B-TREATMENT consultar I-TREATMENT con I-TREATMENT el I-TREATMENT especialista I-TREATMENT de I-TREATMENT Digestivo I-TREATMENT se I-TREATMENT decide I-TREATMENT retirar I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT y I-TREATMENT se I-TREATMENT inicia I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT hidroxicina I-TREATMENT 25 I-TREATMENT mg I-TREATMENT cada I-TREATMENT 8 I-TREATMENT horas I-TREATMENT y I-TREATMENT beclometasona I-TREATMENT dipropionato I-TREATMENT al I-TREATMENT 0, I-TREATMENT 025% I-TREATMENT tópico I-TREATMENT cada I-TREATMENT 24 I-TREATMENT horas I-TREATMENT sobre I-TREATMENT las I-TREATMENT lesiones. I-TREATMENT El B-EVOLUTION cuadro I-EVOLUTION cutáneo I-EVOLUTION se I-EVOLUTION resuelve I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION sin I-EVOLUTION complicaciones. I-EVOLUTION I-EVOLUTION Diagnóstico: B-EXPLORATION Eccema I-EXPLORATION nummular I-EXPLORATION generalizado I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION interferón I-EXPLORATION alfa-2a I-EXPLORATION y I-EXPLORATION ribavirina I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY conocidas I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY personales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY Valorada B-PRESENT_ILLNESS en I-PRESENT_ILLNESS consultas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Traumatología I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS hombro I-PRESENT_ILLNESS izquierdo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS En B-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY profesión I-PAST_MEDICAL_HISTORY realiza I-PAST_MEDICAL_HISTORY esfuerzos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY repetición I-PAST_MEDICAL_HISTORY y B-PRESENT_ILLNESS no I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS limitación I-PRESENT_ILLNESS funcional I-PRESENT_ILLNESS para I-PRESENT_ILLNESS las I-PRESENT_ILLNESS actividades I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vida I-PRESENT_ILLNESS diaria I-PRESENT_ILLNESS con I-PRESENT_ILLNESS el I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS superior I-PRESENT_ILLNESS izquierdo. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION dolor I-EXPLORATION en I-EXPLORATION espacio I-EXPLORATION subacromial, I-EXPLORATION con I-EXPLORATION movilidad I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION hombro, I-EXPLORATION signo I-EXPLORATION de I-EXPLORATION Yocum I-EXPLORATION positivo I-EXPLORATION y I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Jobe I-EXPLORATION positivo. I-EXPLORATION Además, I-EXPLORATION el I-EXPLORATION antebrazo I-EXPLORATION izquierdo I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION bloqueo I-EXPLORATION en I-EXPLORATION pronación I-EXPLORATION de I-EXPLORATION unos I-EXPLORATION 50o, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION limitación I-EXPLORATION de I-EXPLORATION los I-EXPLORATION movimientos I-EXPLORATION de I-EXPLORATION pronación I-EXPLORATION y I-EXPLORATION supinación, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION compensaban I-EXPLORATION con I-EXPLORATION la I-EXPLORATION movilización I-EXPLORATION del I-EXPLORATION hombro, I-EXPLORATION y I-EXPLORATION una I-EXPLORATION flexoextensión I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION codo. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiográfico I-EXPLORATION del I-EXPLORATION codo I-EXPLORATION mostró I-EXPLORATION las I-EXPLORATION siguientes I-EXPLORATION imágenes. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION articulaciones I-EXPLORATION no I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION deformidades I-EXPLORATION óseas, I-EXPLORATION y I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION exploración I-EXPLORATION por I-EXPLORATION aparatos I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Diagnóstico: B-EVOLUTION sinostosis I-EVOLUTION radiocubital I-EVOLUTION proximal I-EVOLUTION congénita I-EVOLUTION "enfermedad I-EVOLUTION de I-EVOLUTION lennoire" I-EVOLUTION I-EVOLUTION Varón, B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 39 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (172 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS Kg), I-PRESENT_ILLNESS ASA I-PRESENT_ILLNESS I I-PRESENT_ILLNESS U, I-PRESENT_ILLNESS que B-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY buque I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY Armada I-PAST_MEDICAL_HISTORY española I-PAST_MEDICAL_HISTORY es B-PRESENT_ILLNESS evacuado I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS bimaleolar I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS subsidiaria I-PRESENT_ILLNESS de I-PRESENT_ILLNESS osteosíntesis. I-PRESENT_ILLNESS Se B-EXPLORATION le I-EXPLORATION monitorizó I-EXPLORATION la I-EXPLORATION SaO2, I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION cardíaca, I-EXPLORATION la I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION no I-EXPLORATION invasiva, I-EXPLORATION la I-EXPLORATION temperatura, I-EXPLORATION la I-EXPLORATION capnografía I-EXPLORATION y I-EXPLORATION el I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION hipnosis I-EXPLORATION mediante I-EXPLORATION el I-EXPLORATION monitor I-EXPLORATION BIS®. I-EXPLORATION Tras B-TREATMENT administración I-TREATMENT de I-TREATMENT 250 I-TREATMENT ml I-TREATMENT de I-TREATMENT coloide I-TREATMENT en I-TREATMENT bolo I-TREATMENT iv, I-TREATMENT se I-TREATMENT realizó I-TREATMENT anestesia I-TREATMENT intradural I-TREATMENT empleando I-TREATMENT bupivacaína I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT hiperbara I-TREATMENT 10 I-TREATMENT mg I-TREATMENT y I-TREATMENT fentanilo I-TREATMENT 10 I-TREATMENT µg. I-TREATMENT Como I-TREATMENT medicación I-TREATMENT coadyuvante I-TREATMENT se I-TREATMENT empleó I-TREATMENT midazolam I-TREATMENT (3 I-TREATMENT mg I-TREATMENT en I-TREATMENT bolo I-TREATMENT iv) I-TREATMENT y I-TREATMENT propofol I-TREATMENT (1, I-TREATMENT 5 I-TREATMENT mg/Kg/h). I-TREATMENT La I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT fue I-TREATMENT cefazolina I-TREATMENT 2 I-TREATMENT g I-TREATMENT iv. I-TREATMENT Asimismo I-TREATMENT se I-TREATMENT pautó I-TREATMENT omeprazol I-TREATMENT 40 I-TREATMENT mg I-TREATMENT iv, I-TREATMENT granisetron I-TREATMENT 3 I-TREATMENT mg I-TREATMENT iv I-TREATMENT y I-TREATMENT ácido I-TREATMENT tranexámico I-TREATMENT 1 I-TREATMENT g I-TREATMENT iv. I-TREATMENT Al I-TREATMENT final I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT se I-TREATMENT administró I-TREATMENT desketoprofeno I-TREATMENT (50 I-TREATMENT mg I-TREATMENT iv) I-TREATMENT y I-TREATMENT dexametasona I-TREATMENT (4 I-TREATMENT mg I-TREATMENT iv). I-TREATMENT Se I-TREATMENT finalizó I-TREATMENT la I-TREATMENT perfusión I-TREATMENT de I-TREATMENT propofol I-TREATMENT aproximadamente I-TREATMENT 5 I-TREATMENT minutos I-TREATMENT antes I-TREATMENT de I-TREATMENT la I-TREATMENT finalización I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION ingresó I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION reanimación I-EVOLUTION postquirúrgica I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION sala I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION I-EVOLUTION La B-EXPLORATION monitorización I-EXPLORATION mediante I-EXPLORATION BIS® I-EXPLORATION mostró I-EXPLORATION unos I-EXPLORATION valores I-EXPLORATION comprendidos I-EXPLORATION entre I-EXPLORATION 98 I-EXPLORATION y I-EXPLORATION 47, I-EXPLORATION la I-EXPLORATION curva I-EXPLORATION de I-EXPLORATION la I-EXPLORATION capnografía I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION (onda I-EXPLORATION cuadrada I-EXPLORATION con I-EXPLORATION valores I-EXPLORATION comprendidos I-EXPLORATION entre I-EXPLORATION 35 I-EXPLORATION y I-EXPLORATION 45 I-EXPLORATION mmHg) I-EXPLORATION durante I-EXPLORATION el I-EXPLORATION acto I-EXPLORATION quirúrgico I-EXPLORATION y I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION sedación I-EXPLORATION en I-EXPLORATION la I-EXPLORATION unidad I-EXPLORATION de I-EXPLORATION reanimación I-EXPLORATION postquirúrgica I-EXPLORATION fue I-EXPLORATION máxima: I-EXPLORATION 10 I-EXPLORATION puntos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION Escala I-EXPLORATION de I-EXPLORATION Aldrete I-EXPLORATION (actividad I-EXPLORATION muscular: I-EXPLORATION 0-2, I-EXPLORATION respiración: I-EXPLORATION 0-2, I-EXPLORATION hemodinámica: I-EXPLORATION 0-2, I-EXPLORATION conciencia: I-EXPLORATION 0-2 I-EXPLORATION y I-EXPLORATION coloración I-EXPLORATION de I-EXPLORATION piel: I-EXPLORATION 0-2). I-EXPLORATION I-EXPLORATION Varón, B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS (170 I-PRESENT_ILLNESS cm, I-PRESENT_ILLNESS 70 I-PRESENT_ILLNESS Kg), I-PRESENT_ILLNESS ASA I-PRESENT_ILLNESS I I-PRESENT_ILLNESS U, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS evacuado I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS con I-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fractura I-PRESENT_ILLNESS conminuta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fémur I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS por I-PRESENT_ILLNESS arma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuego I-PRESENT_ILLNESS subsidiaria I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS quirúrgico. I-PRESENT_ILLNESS Al B-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION le I-EXPLORATION monitorizó I-EXPLORATION de I-EXPLORATION igual I-EXPLORATION forma I-EXPLORATION que I-EXPLORATION al I-EXPLORATION primer I-EXPLORATION caso I-EXPLORATION clínico: I-EXPLORATION SaO2, I-EXPLORATION frecuencia I-EXPLORATION cardíaca, I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION no I-EXPLORATION invasiva, I-EXPLORATION temperatura, I-EXPLORATION capnografía I-EXPLORATION y I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION hipnosis I-EXPLORATION mediante I-EXPLORATION el I-EXPLORATION monitor I-EXPLORATION BIS®. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT administración I-TREATMENT de I-TREATMENT 250 I-TREATMENT ml I-TREATMENT de I-TREATMENT coloide I-TREATMENT en I-TREATMENT bolo I-TREATMENT iv, I-TREATMENT se I-TREATMENT realizó I-TREATMENT anestesia I-TREATMENT intradural I-TREATMENT empleando I-TREATMENT bupivacaína I-TREATMENT 0, I-TREATMENT 5% I-TREATMENT hiperbara I-TREATMENT 10 I-TREATMENT mg I-TREATMENT y I-TREATMENT fentanilo I-TREATMENT 10 I-TREATMENT µg. I-TREATMENT La I-TREATMENT medicación I-TREATMENT coadyuvante I-TREATMENT fue I-TREATMENT midazolam I-TREATMENT (3 I-TREATMENT mg I-TREATMENT en I-TREATMENT bolo I-TREATMENT iv) I-TREATMENT y I-TREATMENT propofol I-TREATMENT (1, I-TREATMENT 5 I-TREATMENT mg/Kg/h). I-TREATMENT La I-TREATMENT profilaxis I-TREATMENT antibiótica I-TREATMENT fue I-TREATMENT cefazolina I-TREATMENT 2 I-TREATMENT g I-TREATMENT iv. I-TREATMENT Asimismo I-TREATMENT también I-TREATMENT se I-TREATMENT pautó I-TREATMENT omeprazol I-TREATMENT 40 I-TREATMENT mg I-TREATMENT iv, I-TREATMENT granisetron I-TREATMENT 3 I-TREATMENT mg I-TREATMENT iv I-TREATMENT y I-TREATMENT ácido I-TREATMENT tranexámico I-TREATMENT 1 I-TREATMENT g I-TREATMENT iv. I-TREATMENT Al I-TREATMENT de I-TREATMENT la I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT se I-TREATMENT administró I-TREATMENT desketoprofeno I-TREATMENT (50 I-TREATMENT mg I-TREATMENT iv), I-TREATMENT se I-TREATMENT finalizó I-TREATMENT la I-TREATMENT perfusión I-TREATMENT de I-TREATMENT propofol I-TREATMENT y I-TREATMENT se I-TREATMENT infiltró I-TREATMENT la I-TREATMENT herida I-TREATMENT con I-TREATMENT mepivacaína I-TREATMENT 2% I-TREATMENT 200 I-TREATMENT mg. I-TREATMENT El I-TREATMENT paciente I-TREATMENT ingresó I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT de I-TREATMENT reanimación I-TREATMENT postquirúrgica, I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT un I-TREATMENT bloqueo I-TREATMENT nervioso I-TREATMENT ecoguiado I-TREATMENT a I-TREATMENT nivel I-TREATMENT femoral I-TREATMENT con I-TREATMENT bupivacaína I-TREATMENT 0, I-TREATMENT 25% I-TREATMENT 25 I-TREATMENT mg I-TREATMENT y I-TREATMENT tras I-TREATMENT recobrar I-TREATMENT la I-TREATMENT sensibilidad I-TREATMENT y I-TREATMENT motricidad I-TREATMENT en I-TREATMENT miembros I-TREATMENT inferiores I-TREATMENT fue I-TREATMENT dado I-TREATMENT de I-TREATMENT alta I-TREATMENT a I-TREATMENT sala I-TREATMENT de I-TREATMENT hospitalización I-TREATMENT sin I-TREATMENT incidencias. I-TREATMENT I-TREATMENT La B-EVOLUTION monitorización I-EVOLUTION mediante I-EVOLUTION BIS® I-EVOLUTION mostró I-EVOLUTION unos I-EVOLUTION valores I-EVOLUTION comprendidos I-EVOLUTION entre I-EVOLUTION 97 I-EVOLUTION y I-EVOLUTION 30. I-EVOLUTION La I-EVOLUTION curva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION capnografía I-EVOLUTION fue I-EVOLUTION normal I-EVOLUTION y I-EVOLUTION la I-EVOLUTION valoración I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sedación I-EVOLUTION en I-EVOLUTION la I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION reanimación I-EVOLUTION postquirúrgica I-EVOLUTION fue I-EVOLUTION máxima I-EVOLUTION (10 I-EVOLUTION puntos I-EVOLUTION en I-EVOLUTION la I-EVOLUTION Escala I-EVOLUTION de I-EVOLUTION Aldrete). I-EVOLUTION I-EVOLUTION Exponemos B-PRESENT_ILLNESS los I-PRESENT_ILLNESS efectos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS programa I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ejercicio I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS (55 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS kg, I-PRESENT_ILLNESS 158 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS y I-PRESENT_ILLNESS 22, I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS kg/m2), I-PRESENT_ILLNESS jubilada I-PRESENT_ILLNESS por B-PAST_MEDICAL_HISTORY incapacidad I-PAST_MEDICAL_HISTORY física, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY MG I-PAST_MEDICAL_HISTORY grado I-PAST_MEDICAL_HISTORY III I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY marcada I-PAST_MEDICAL_HISTORY debilidad I-PAST_MEDICAL_HISTORY muscular, I-PAST_MEDICAL_HISTORY especialmente I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY (necesitaba I-PAST_MEDICAL_HISTORY sujetar I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY manos I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY cabeza I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY comía I-PAST_MEDICAL_HISTORY o I-PAST_MEDICAL_HISTORY cuando I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY iba I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tumbar) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY que, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY nivel I-PAST_MEDICAL_HISTORY dorsal, I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY causaba I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY actitud I-PAST_MEDICAL_HISTORY cifótica. I-PAST_MEDICAL_HISTORY Había I-PAST_MEDICAL_HISTORY recibido I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY plasmaféresis, I-PAST_MEDICAL_HISTORY Prograf® I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY Inmurel® I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ejercicio I-PAST_MEDICAL_HISTORY tomaba I-PAST_MEDICAL_HISTORY Ciclosporina® I-PAST_MEDICAL_HISTORY (500 I-PAST_MEDICAL_HISTORY mg/15días), I-PAST_MEDICAL_HISTORY Dacortin® I-PAST_MEDICAL_HISTORY (5 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY h), I-PAST_MEDICAL_HISTORY Escitalopram® I-PAST_MEDICAL_HISTORY (10 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY h), I-PAST_MEDICAL_HISTORY Mestinon® I-PAST_MEDICAL_HISTORY (60 I-PAST_MEDICAL_HISTORY mg/8 I-PAST_MEDICAL_HISTORY h), I-PAST_MEDICAL_HISTORY Lanzoprazol® I-PAST_MEDICAL_HISTORY (30 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY h), I-PAST_MEDICAL_HISTORY Lexatin® I-PAST_MEDICAL_HISTORY (1, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg/24 I-PAST_MEDICAL_HISTORY h) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Calcium I-PAST_MEDICAL_HISTORY Sandoz I-PAST_MEDICAL_HISTORY D® I-PAST_MEDICAL_HISTORY (1.000 I-PAST_MEDICAL_HISTORY mg/880 I-PAST_MEDICAL_HISTORY UI/24 I-PAST_MEDICAL_HISTORY h). I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY practicado I-PAST_MEDICAL_HISTORY timectomía I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY situación I-PAST_MEDICAL_HISTORY era I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY eutiroidismo I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nódulos I-PAST_MEDICAL_HISTORY tiroideos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY padecía I-PAST_MEDICAL_HISTORY osteoporosis. I-PAST_MEDICAL_HISTORY Tras B-TREATMENT ser I-TREATMENT informada I-TREATMENT dio I-TREATMENT su I-TREATMENT consentimiento I-TREATMENT por I-TREATMENT escrito I-TREATMENT para I-TREATMENT su I-TREATMENT participación I-TREATMENT en I-TREATMENT el I-TREATMENT estudio. I-TREATMENT El I-TREATMENT diseño I-TREATMENT y I-TREATMENT realización I-TREATMENT de I-TREATMENT esta I-TREATMENT investigación I-TREATMENT respetaron I-TREATMENT las I-TREATMENT recomendaciones I-TREATMENT éticas I-TREATMENT de I-TREATMENT la I-TREATMENT Asociación I-TREATMENT Médica I-TREATMENT Mundial I-TREATMENT y I-TREATMENT la I-TREATMENT Declaración I-TREATMENT de I-TREATMENT Helsinki I-TREATMENT y I-TREATMENT fue I-TREATMENT aprobado I-TREATMENT por I-TREATMENT el I-TREATMENT comité I-TREATMENT de I-TREATMENT Ética I-TREATMENT de I-TREATMENT Asociación I-TREATMENT Miastenia I-TREATMENT de I-TREATMENT España I-TREATMENT (AMES). I-TREATMENT I-TREATMENT Programa I-TREATMENT de I-TREATMENT ejercicio I-TREATMENT y I-TREATMENT valoraciones I-TREATMENT efectuadas I-TREATMENT I-TREATMENT El I-TREATMENT programa I-TREATMENT de I-TREATMENT ejercicio I-TREATMENT se I-TREATMENT inició I-TREATMENT el I-TREATMENT 20 I-TREATMENT de I-TREATMENT junio I-TREATMENT de I-TREATMENT 2012 I-TREATMENT y I-TREATMENT concluyó I-TREATMENT el I-TREATMENT 17 I-TREATMENT de I-TREATMENT julio I-TREATMENT de I-TREATMENT 2012 I-TREATMENT y I-TREATMENT consistió I-TREATMENT en I-TREATMENT la I-TREATMENT realización I-TREATMENT de I-TREATMENT 2 I-TREATMENT sesiones I-TREATMENT matinales I-TREATMENT semanales. I-TREATMENT Los I-TREATMENT componentes I-TREATMENT de I-TREATMENT cada I-TREATMENT sesión I-TREATMENT consistían I-TREATMENT en I-TREATMENT ejercicios I-TREATMENT de I-TREATMENT Pilates I-TREATMENT suelo, I-TREATMENT ejercicios I-TREATMENT de I-TREATMENT fuerza I-TREATMENT para I-TREATMENT los I-TREATMENT grupos I-TREATMENT musculares I-TREATMENT de I-TREATMENT bíceps, I-TREATMENT tríceps, I-TREATMENT pectoral I-TREATMENT y I-TREATMENT dorsal I-TREATMENT ancho, I-TREATMENT mediante I-TREATMENT contracciones I-TREATMENT auxotónicas, I-TREATMENT con I-TREATMENT banda I-TREATMENT elástica I-TREATMENT de I-TREATMENT dureza I-TREATMENT baja I-TREATMENT (Domyos® I-TREATMENT Villeneuve I-TREATMENT D'Ascq. I-TREATMENT Francia), I-TREATMENT ejercicios I-TREATMENT de I-TREATMENT propiocepción I-TREATMENT de I-TREATMENT tobillo I-TREATMENT con I-TREATMENT pelota I-TREATMENT 100% I-TREATMENT de I-TREATMENT FOAM I-TREATMENT de I-TREATMENT 16 I-TREATMENT cm I-TREATMENT (Gui-an I-TREATMENT S.L. I-TREATMENT Servicios I-TREATMENT Deportivos®, I-TREATMENT San I-TREATMENT Sebastián I-TREATMENT de I-TREATMENT los I-TREATMENT Reyes, I-TREATMENT Madrid), I-TREATMENT ejercicios I-TREATMENT de I-TREATMENT flexibilidad I-TREATMENT (ejercicios I-TREATMENT pasivos I-TREATMENT asistidos I-TREATMENT de I-TREATMENT cuádriceps, I-TREATMENT isquiotibiliales, I-TREATMENT sóleo, I-TREATMENT cuadrado I-TREATMENT lumbar, I-TREATMENT dorsal I-TREATMENT ancho, I-TREATMENT trapecios, I-TREATMENT esternocleidomastoideo, I-TREATMENT tríceps, I-TREATMENT deltoides I-TREATMENT y I-TREATMENT pectoral) I-TREATMENT y I-TREATMENT ejercicios I-TREATMENT de I-TREATMENT facilitación I-TREATMENT neuromuscular I-TREATMENT propioceptiva I-TREATMENT (PNF) I-TREATMENT asistidos I-TREATMENT por I-TREATMENT un I-TREATMENT fisioterapeuta I-TREATMENT profesional I-TREATMENT (isquiotibiales, I-TREATMENT cuádriceps, I-TREATMENT cuadrado I-TREATMENT lumbar, I-TREATMENT dorsal I-TREATMENT y I-TREATMENT trapecios). I-TREATMENT Durante B-EXPLORATION las I-EXPLORATION sesiones I-EXPLORATION de I-EXPLORATION ejercicio I-EXPLORATION se I-EXPLORATION monitorizó I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION (FC) I-EXPLORATION para I-EXPLORATION evitar I-EXPLORATION que I-EXPLORATION esta I-EXPLORATION aumentase I-EXPLORATION más I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION pulsaciones I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION (ppm). I-EXPLORATION I-EXPLORATION Al I-EXPLORATION inicio I-EXPLORATION y I-EXPLORATION al I-EXPLORATION final I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION midieron: I-EXPLORATION peso I-EXPLORATION (kg), I-EXPLORATION talla I-EXPLORATION (cm) I-EXPLORATION mediante I-EXPLORATION báscula I-EXPLORATION con I-EXPLORATION tallímetro I-EXPLORATION (modelo I-EXPLORATION PS10®DINA, I-EXPLORATION Derio, I-EXPLORATION España), I-EXPLORATION FC I-EXPLORATION en I-EXPLORATION reposo, I-EXPLORATION en I-EXPLORATION ejercicio I-EXPLORATION y I-EXPLORATION a I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION minutos I-EXPLORATION de I-EXPLORATION recuperación I-EXPLORATION mediante I-EXPLORATION pulsímetro I-EXPLORATION (modelo I-EXPLORATION M22 I-EXPLORATION Polar®, I-EXPLORATION Helsinki, I-EXPLORATION Finlandia) I-EXPLORATION y I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION (PA, I-EXPLORATION en I-EXPLORATION mmHg) I-EXPLORATION mediante I-EXPLORATION tensiómetro I-EXPLORATION (modelo I-EXPLORATION M2 I-EXPLORATION BASIC I-EXPLORATION OMRON I-EXPLORATION HEALTHCARE®, I-EXPLORATION Hoofddorp, I-EXPLORATION Holanda). I-EXPLORATION En I-EXPLORATION cada I-EXPLORATION sesión I-EXPLORATION de I-EXPLORATION ejercicio I-EXPLORATION se I-EXPLORATION determinaron I-EXPLORATION la I-EXPLORATION temperatura I-EXPLORATION y I-EXPLORATION la I-EXPLORATION humedad I-EXPLORATION ambientales I-EXPLORATION mediante I-EXPLORATION un I-EXPLORATION termómetro-higrómetro-barómetro-altímetro-cronómetro I-EXPLORATION digital I-EXPLORATION modelo I-EXPLORATION AT701-H® I-EXPLORATION (Atech I-EXPLORATION Navigator, I-EXPLORATION Hirschau, I-EXPLORATION Alemania). I-EXPLORATION Para I-EXPLORATION valorar I-EXPLORATION el I-EXPLORATION ejercicio I-EXPLORATION realizado I-EXPLORATION se I-EXPLORATION midió I-EXPLORATION el I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION ejercicio I-EXPLORATION completado. I-EXPLORATION I-EXPLORATION A I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION le I-EXPLORATION practicaron, I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION y I-EXPLORATION al I-EXPLORATION final I-EXPLORATION del I-EXPLORATION programa, I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION test: I-EXPLORATION I-EXPLORATION -Caminata I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION minutos I-EXPLORATION (Six-minute I-EXPLORATION Walk I-EXPLORATION Test, I-EXPLORATION 6MWT) I-EXPLORATION 11, I-EXPLORATION la I-EXPLORATION distancia I-EXPLORATION recorrida I-EXPLORATION se I-EXPLORATION midió I-EXPLORATION mediante I-EXPLORATION un I-EXPLORATION podómetro I-EXPLORATION modelo I-EXPLORATION Dista I-EXPLORATION Newfeel I-EXPLORATION 100® I-EXPLORATION (Oxylane, I-EXPLORATION Madrid, I-EXPLORATION España) I-EXPLORATION I-EXPLORATION -Dinamometría I-EXPLORATION manual: I-EXPLORATION se I-EXPLORATION midió I-EXPLORATION la I-EXPLORATION fuerza I-EXPLORATION máxima I-EXPLORATION ejercida I-EXPLORATION por I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION al I-EXPLORATION instante I-EXPLORATION y I-EXPLORATION la I-EXPLORATION fuerza I-EXPLORATION resistencia I-EXPLORATION (aquella I-EXPLORATION que I-EXPLORATION aplica I-EXPLORATION el I-EXPLORATION sujeto I-EXPLORATION durante I-EXPLORATION 10" I-EXPLORATION con I-EXPLORATION cada I-EXPLORATION mano, I-EXPLORATION manteniendo I-EXPLORATION el I-EXPLORATION brazo I-EXPLORATION estirado I-EXPLORATION y I-EXPLORATION presionando I-EXPLORATION la I-EXPLORATION perilla I-EXPLORATION del I-EXPLORATION dinamómetro I-EXPLORATION tanto I-EXPLORATION como I-EXPLORATION se I-EXPLORATION pueda) I-EXPLORATION en I-EXPLORATION ambos I-EXPLORATION miembros I-EXPLORATION superiores12, I-EXPLORATION 13. I-EXPLORATION Para I-EXPLORATION evitar I-EXPLORATION que I-EXPLORATION la I-EXPLORATION fatiga I-EXPLORATION alterase I-EXPLORATION los I-EXPLORATION resultados, I-EXPLORATION se I-EXPLORATION instruyó I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION un I-EXPLORATION día I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION la I-EXPLORATION prueba I-EXPLORATION al I-EXPLORATION siguiente. I-EXPLORATION Ambas I-EXPLORATION variables I-EXPLORATION se I-EXPLORATION midieron I-EXPLORATION en I-EXPLORATION kg I-EXPLORATION mediante I-EXPLORATION un I-EXPLORATION dinamómetro I-EXPLORATION de I-EXPLORATION precisión I-EXPLORATION 100 I-EXPLORATION g I-EXPLORATION (modelo I-EXPLORATION SH50008 I-EXPLORATION Squeeze I-EXPLORATION Saehan I-EXPLORATION Corporation®, I-EXPLORATION North I-EXPLORATION Lincolnshire, I-EXPLORATION Inglaterra). I-EXPLORATION I-EXPLORATION -Flexibilidad I-EXPLORATION de I-EXPLORATION tronco, I-EXPLORATION extremidades I-EXPLORATION superiores I-EXPLORATION e I-EXPLORATION inferiores14: I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION sentó I-EXPLORATION al I-EXPLORATION borde I-EXPLORATION de I-EXPLORATION una I-EXPLORATION silla I-EXPLORATION de I-EXPLORATION 44 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION altura. I-EXPLORATION Una I-EXPLORATION pierna I-EXPLORATION permanecía I-EXPLORATION flexionada I-EXPLORATION con I-EXPLORATION la I-EXPLORATION planta I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION apoyada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION suelo. I-EXPLORATION La I-EXPLORATION otra I-EXPLORATION estirada I-EXPLORATION lo I-EXPLORATION máximo I-EXPLORATION posible, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION talón I-EXPLORATION en I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION el I-EXPLORATION suelo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION pie I-EXPLORATION en I-EXPLORATION flexión I-EXPLORATION de I-EXPLORATION 90o. I-EXPLORATION Espalda I-EXPLORATION y I-EXPLORATION cabeza I-EXPLORATION erectas. I-EXPLORATION La I-EXPLORATION mano I-EXPLORATION derecha I-EXPLORATION colocada I-EXPLORATION encima I-EXPLORATION de I-EXPLORATION la I-EXPLORATION izquierda, I-EXPLORATION con I-EXPLORATION los I-EXPLORATION terceros I-EXPLORATION dedos I-EXPLORATION superpuestos. I-EXPLORATION Se I-EXPLORATION invitó I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION a I-EXPLORATION alcanzar I-EXPLORATION la I-EXPLORATION punta I-EXPLORATION del I-EXPLORATION pie I-EXPLORATION con I-EXPLORATION las I-EXPLORATION manos I-EXPLORATION mientras I-EXPLORATION se I-EXPLORATION expulsa I-EXPLORATION el I-EXPLORATION aire. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION intento I-EXPLORATION con I-EXPLORATION cada I-EXPLORATION pierna. I-EXPLORATION Se I-EXPLORATION permitió I-EXPLORATION una I-EXPLORATION familiarización I-EXPLORATION previa I-EXPLORATION al I-EXPLORATION test. I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION es I-EXPLORATION la I-EXPLORATION máxima I-EXPLORATION distancia I-EXPLORATION alcanzada I-EXPLORATION (cm), I-EXPLORATION mantenida I-EXPLORATION durante I-EXPLORATION 2", I-EXPLORATION medida I-EXPLORATION con I-EXPLORATION cinta I-EXPLORATION antropométrica I-EXPLORATION (Clase I-EXPLORATION I I-EXPLORATION modelo I-EXPLORATION CM040 I-EXPLORATION Gisibérica®, I-EXPLORATION Cáceres, I-EXPLORATION España). I-EXPLORATION I-EXPLORATION -Flexibilidad I-EXPLORATION de I-EXPLORATION extremidades I-EXPLORATION superiores14: I-EXPLORATION la I-EXPLORATION participante I-EXPLORATION se I-EXPLORATION colocó I-EXPLORATION en I-EXPLORATION bipedestación, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION de I-EXPLORATION las I-EXPLORATION manos I-EXPLORATION por I-EXPLORATION encima I-EXPLORATION del I-EXPLORATION hombro, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION codo I-EXPLORATION apuntando I-EXPLORATION hacia I-EXPLORATION arriba, I-EXPLORATION los I-EXPLORATION dedos I-EXPLORATION extendidos I-EXPLORATION con I-EXPLORATION la I-EXPLORATION palma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mano I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION escápula I-EXPLORATION e I-EXPLORATION intentando I-EXPLORATION deslizar I-EXPLORATION esta I-EXPLORATION lo I-EXPLORATION máximo I-EXPLORATION posible I-EXPLORATION a I-EXPLORATION lo I-EXPLORATION largo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION espalda. I-EXPLORATION Al I-EXPLORATION mismo I-EXPLORATION tiempo, I-EXPLORATION se I-EXPLORATION colocaba I-EXPLORATION la I-EXPLORATION otra I-EXPLORATION mano I-EXPLORATION detrás I-EXPLORATION de I-EXPLORATION la I-EXPLORATION espalda, I-EXPLORATION con I-EXPLORATION el I-EXPLORATION dorso I-EXPLORATION hacia I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION dorsal, I-EXPLORATION intentando I-EXPLORATION alcanzar I-EXPLORATION o I-EXPLORATION sobrepasar I-EXPLORATION la I-EXPLORATION otra I-EXPLORATION mano. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION intento I-EXPLORATION con I-EXPLORATION cada I-EXPLORATION brazo. I-EXPLORATION Hubo I-EXPLORATION una I-EXPLORATION familiarización I-EXPLORATION previa I-EXPLORATION al I-EXPLORATION test. I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION es I-EXPLORATION la I-EXPLORATION mínima I-EXPLORATION distancia I-EXPLORATION (cm) I-EXPLORATION alcanzada I-EXPLORATION entre I-EXPLORATION los I-EXPLORATION terceros I-EXPLORATION dedos I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION manos, I-EXPLORATION mantenida I-EXPLORATION durante I-EXPLORATION 2", I-EXPLORATION medida I-EXPLORATION mediante I-EXPLORATION cinta I-EXPLORATION antropométrica I-EXPLORATION (Clase I-EXPLORATION I I-EXPLORATION modelo I-EXPLORATION CM040 I-EXPLORATION Gisibérica®, I-EXPLORATION Cáceres, I-EXPLORATION España). I-EXPLORATION I-EXPLORATION -Fuerza I-EXPLORATION de I-EXPLORATION las I-EXPLORATION extremidades I-EXPLORATION inferiores: I-EXPLORATION se I-EXPLORATION midió I-EXPLORATION el I-EXPLORATION número I-EXPLORATION de I-EXPLORATION sentadillas I-EXPLORATION realizadas I-EXPLORATION en I-EXPLORATION 30" I-EXPLORATION con I-EXPLORATION las I-EXPLORATION manos I-EXPLORATION cruzadas I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION pecho14. I-EXPLORATION Se I-EXPLORATION ha I-EXPLORATION utilizado I-EXPLORATION una I-EXPLORATION silla I-EXPLORATION de I-EXPLORATION 44 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION altura I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cronómetro I-EXPLORATION (modelo I-EXPLORATION AT701-H® I-EXPLORATION Atech, I-EXPLORATION Hirschau, I-EXPLORATION Alemania). I-EXPLORATION I-EXPLORATION Para I-EXPLORATION valorar I-EXPLORATION la I-EXPLORATION percepción I-EXPLORATION del I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION salud I-EXPLORATION se I-EXPLORATION le I-EXPLORATION aplicó I-EXPLORATION el I-EXPLORATION cuestionario I-EXPLORATION de I-EXPLORATION Percepción I-EXPLORATION del I-EXPLORATION Estado I-EXPLORATION de I-EXPLORATION Salud I-EXPLORATION y I-EXPLORATION Calidad I-EXPLORATION de I-EXPLORATION Vida I-EXPLORATION SF-36 I-EXPLORATION validada I-EXPLORATION para I-EXPLORATION español I-EXPLORATION por I-EXPLORATION Alonso I-EXPLORATION et I-EXPLORATION al.15. I-EXPLORATION I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION los I-EXPLORATION test I-EXPLORATION funcionales I-EXPLORATION y I-EXPLORATION del I-EXPLORATION test I-EXPLORATION de I-EXPLORATION Percepción I-EXPLORATION del I-EXPLORATION Estado I-EXPLORATION de I-EXPLORATION Salud, I-EXPLORATION SF-36, I-EXPLORATION obtenidos I-EXPLORATION al I-EXPLORATION inicio I-EXPLORATION y I-EXPLORATION tras I-EXPLORATION realizar I-EXPLORATION el I-EXPLORATION programa I-EXPLORATION de I-EXPLORATION ejercicios, I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION en I-EXPLORATION las I-EXPLORATION tablas I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION 3 I-EXPLORATION respectivamente. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 47 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY hábitos I-PAST_MEDICAL_HISTORY tóxicos I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY alergias I-PAST_MEDICAL_HISTORY conocidas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY fármacos, I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY enfermedades I-PAST_MEDICAL_HISTORY médicas I-PAST_MEDICAL_HISTORY relevantes. I-PAST_MEDICAL_HISTORY Acudió B-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS en I-PRESENT_ILLNESS enero I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2010 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tobillo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS año I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS aumentaba I-PRESENT_ILLNESS con I-PRESENT_ILLNESS la I-PRESENT_ILLNESS carga I-PRESENT_ILLNESS y I-PRESENT_ILLNESS se I-PRESENT_ILLNESS acompañaba I-PRESENT_ILLNESS de I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS flogóticos. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION y I-EXPLORATION una I-EXPLORATION RMN I-EXPLORATION que I-EXPLORATION objetivó I-EXPLORATION un I-EXPLORATION intenso I-EXPLORATION edema I-EXPLORATION óseo I-EXPLORATION con I-EXPLORATION severa I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION mineral, I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION osteonecrosis I-EXPLORATION del I-EXPLORATION astrágalo I-EXPLORATION con I-EXPLORATION derrame I-EXPLORATION articular I-EXPLORATION asociado. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT pamidronato I-TREATMENT intravenoso, I-TREATMENT pero I-TREATMENT la I-TREATMENT paciente I-TREATMENT presentó I-TREATMENT fiebre I-TREATMENT alta I-TREATMENT tras I-TREATMENT la I-TREATMENT infusión I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT su I-TREATMENT administración. I-TREATMENT Se I-TREATMENT pautó I-TREATMENT tramadol, I-TREATMENT diclofenaco I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT rehabilitador, I-TREATMENT sin I-TREATMENT evidente I-TREATMENT mejoría I-TREATMENT del I-TREATMENT dolor. I-TREATMENT En B-EVOLUTION septiembre I-EVOLUTION de I-EVOLUTION 2010 I-EVOLUTION refiere I-EVOLUTION dolor I-EVOLUTION intenso I-EVOLUTION en I-EVOLUTION región I-EVOLUTION inguinal I-EVOLUTION derecha, I-EVOLUTION que I-EVOLUTION aumentaba I-EVOLUTION con I-EVOLUTION la I-EVOLUTION deambulación. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION RMN I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION caderas I-EXPLORATION observándose I-EXPLORATION una I-EXPLORATION necrosis I-EXPLORATION avascular I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cabeza I-EXPLORATION femoral I-EXPLORATION derecha, I-EXPLORATION estadío I-EXPLORATION I-II I-EXPLORATION de I-EXPLORATION la I-EXPLORATION clasificación I-EXPLORATION de I-EXPLORATION FICAT. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT gabapentina I-TREATMENT oral I-TREATMENT (600 I-TREATMENT mg/8 I-TREATMENT horas), I-TREATMENT y B-DERIVED_FROM/TO se I-DERIVED_FROM/TO remitió I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO de I-DERIVED_FROM/TO metabolismo I-DERIVED_FROM/TO óseo. I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION en I-EXPLORATION nuestra I-EXPLORATION consulta I-EXPLORATION llamaba I-EXPLORATION la I-EXPLORATION atención I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION escleras I-EXPLORATION azuladas. I-EXPLORATION Reinterrogada B-FAMILY_HISTORY la I-FAMILY_HISTORY paciente, I-FAMILY_HISTORY señalaba I-FAMILY_HISTORY que I-FAMILY_HISTORY su I-FAMILY_HISTORY madre I-FAMILY_HISTORY había I-FAMILY_HISTORY presentado I-FAMILY_HISTORY múltiples I-FAMILY_HISTORY fracturas I-FAMILY_HISTORY desde I-FAMILY_HISTORY los I-FAMILY_HISTORY 49 I-FAMILY_HISTORY años, I-FAMILY_HISTORY que I-FAMILY_HISTORY la I-FAMILY_HISTORY mantenían I-FAMILY_HISTORY inmovilizada. I-FAMILY_HISTORY Un I-FAMILY_HISTORY hermano I-FAMILY_HISTORY y I-FAMILY_HISTORY dos I-FAMILY_HISTORY tías I-FAMILY_HISTORY maternas I-FAMILY_HISTORY también I-FAMILY_HISTORY habían I-FAMILY_HISTORY padecido I-FAMILY_HISTORY fracturas I-FAMILY_HISTORY de I-FAMILY_HISTORY cadera I-FAMILY_HISTORY precoces. I-FAMILY_HISTORY La B-EXPLORATION densitometría I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION osteoporosis I-EXPLORATION grave I-EXPLORATION en I-EXPLORATION las I-EXPLORATION tres I-EXPLORATION localizaciones I-EXPLORATION habituales I-EXPLORATION (columna I-EXPLORATION lumbar: I-EXPLORATION T-score=-3, I-EXPLORATION Z-score=-1, I-EXPLORATION 8; I-EXPLORATION cuello I-EXPLORATION femoral: I-EXPLORATION T-score=-3, I-EXPLORATION 1, I-EXPLORATION Z-score=-2, I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION cadera I-EXPLORATION total: I-EXPLORATION T-score=-2, I-EXPLORATION 7, I-EXPLORATION Z-score= I-EXPLORATION -2, I-EXPLORATION 0). I-EXPLORATION La I-EXPLORATION calciuria I-EXPLORATION era I-EXPLORATION de I-EXPLORATION 336 I-EXPLORATION mg/dl, I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION 25 I-EXPLORATION (OH) I-EXPLORATION vitamina I-EXPLORATION D I-EXPLORATION de I-EXPLORATION 11 I-EXPLORATION ng/ml I-EXPLORATION y I-EXPLORATION la I-EXPLORATION PTH I-EXPLORATION intacta, I-EXPLORATION de I-EXPLORATION 49 I-EXPLORATION pg/ml. I-EXPLORATION Los I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION remodelado I-EXPLORATION óseo I-EXPLORATION estaban I-EXPLORATION elevados I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION franca I-EXPLORATION (CTX: I-EXPLORATION 1, I-EXPLORATION 036 I-EXPLORATION ng/ml). I-EXPLORATION Dados I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION clínicos I-EXPLORATION y I-EXPLORATION los I-EXPLORATION antecedentes I-EXPLORATION familiares, I-EXPLORATION se I-EXPLORATION estableció I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION osteogénesis I-EXPLORATION imperfecta I-EXPLORATION tipo I-EXPLORATION I. I-EXPLORATION La I-EXPLORATION audiometría I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION mínima I-EXPLORATION caída I-EXPLORATION en I-EXPLORATION los I-EXPLORATION tonos I-EXPLORATION agudos. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT calcio I-TREATMENT (1.000 I-TREATMENT mg/día), I-TREATMENT vitamina I-TREATMENT D I-TREATMENT (800 I-TREATMENT UI/día) I-TREATMENT y I-TREATMENT risedronato I-TREATMENT (35 I-TREATMENT mg/semana), I-TREATMENT en I-TREATMENT enero I-TREATMENT de I-TREATMENT 2011. I-TREATMENT En I-TREATMENT marzo I-TREATMENT de I-TREATMENT ese I-TREATMENT año, I-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT risedronato I-TREATMENT por I-TREATMENT teriparatida I-TREATMENT subcutánea I-TREATMENT (20 I-TREATMENT mcg/día) I-TREATMENT debido I-TREATMENT a I-TREATMENT intolerancia I-TREATMENT digestiva. I-TREATMENT En B-EXPLORATION mayo I-EXPLORATION de I-EXPLORATION 2011, I-EXPLORATION una I-EXPLORATION RMN I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION franca I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION óseo I-EXPLORATION y I-EXPLORATION del I-EXPLORATION derrame I-EXPLORATION articular I-EXPLORATION del I-EXPLORATION tobillo I-EXPLORATION así I-EXPLORATION como I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION medular I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cadera I-EXPLORATION derecha. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION cumplió I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION teriparatida I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION y I-EVOLUTION con I-EVOLUTION progresiva I-EVOLUTION mejoría I-EVOLUTION clínica. I-EVOLUTION Los I-EVOLUTION marcadores I-EVOLUTION de I-EVOLUTION formación I-EVOLUTION se I-EVOLUTION mantuvieron I-EVOLUTION elevados I-EVOLUTION durante I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION (propéptido I-EVOLUTION aminoterminal I-EVOLUTION del I-EVOLUTION procolágeno I-EVOLUTION tipo I-EVOLUTION 1 I-EVOLUTION -PINP-: I-EVOLUTION 45 I-EVOLUTION ng/ml; I-EVOLUTION osteocalcina: I-EVOLUTION >100 I-EVOLUTION ng/ml), I-EVOLUTION así I-EVOLUTION como I-EVOLUTION los I-EVOLUTION niveles I-EVOLUTION de I-EVOLUTION 25 I-EVOLUTION (OH) I-EVOLUTION vitamina I-EVOLUTION D. I-EVOLUTION En B-TREATMENT marzo I-TREATMENT de I-TREATMENT 2013 I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT denosumab I-TREATMENT (60 I-TREATMENT mg/6 I-TREATMENT meses), I-TREATMENT presentando B-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION y I-EVOLUTION radiológica I-EVOLUTION satisfactoria. I-EVOLUTION En B-EXPLORATION la I-EXPLORATION última I-EXPLORATION consulta, I-EXPLORATION en I-EXPLORATION enero I-EXPLORATION de I-EXPLORATION 2015, I-EXPLORATION los I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION remodelado I-EXPLORATION estaban I-EXPLORATION suprimidos I-EXPLORATION (PINP: I-EXPLORATION 5, I-EXPLORATION 8 I-EXPLORATION ng/ml; I-EXPLORATION telopéptido I-EXPLORATION carboxiterminal I-EXPLORATION del I-EXPLORATION colágeno I-EXPLORATION tipo I-EXPLORATION 1 I-EXPLORATION -CTX-: I-EXPLORATION <0, I-EXPLORATION 030 I-EXPLORATION ng/ml) I-EXPLORATION y I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION 25 I-EXPLORATION (OH) I-EXPLORATION vitamina I-EXPLORATION D I-EXPLORATION son I-EXPLORATION de I-EXPLORATION 31 I-EXPLORATION ng/ml. I-EXPLORATION La I-EXPLORATION densidad I-EXPLORATION mineral I-EXPLORATION ósea I-EXPLORATION (DMO) I-EXPLORATION de I-EXPLORATION control I-EXPLORATION no I-EXPLORATION se I-EXPLORATION redujo I-EXPLORATION significativamente I-EXPLORATION respecto I-EXPLORATION a I-EXPLORATION la I-EXPLORATION basal I-EXPLORATION (columna I-EXPLORATION lumbar: I-EXPLORATION T-score=-3, I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION Z-score=-1, I-EXPLORATION 5; I-EXPLORATION cuello I-EXPLORATION femoral: I-EXPLORATION T-score=-3, I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION Z-score=-2; I-EXPLORATION cadera I-EXPLORATION total: I-EXPLORATION T-score=-3 I-EXPLORATION y I-EXPLORATION Z-score=-2), I-EXPLORATION pero I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION no I-EXPLORATION había I-EXPLORATION sufrido I-EXPLORATION ninguna I-EXPLORATION fractura I-EXPLORATION ni I-EXPLORATION osteonecrosis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION seguimiento. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS mujer, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 68 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 que B-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS repetidos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS e I-PRESENT_ILLNESS inflamación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS rodillas, I-PRESENT_ILLNESS atribuido I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS entonces I-PRESENT_ILLNESS a I-PRESENT_ILLNESS un I-PRESENT_ILLNESS proceso I-PRESENT_ILLNESS degenerativo, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS que I-PRESENT_ILLNESS mejoraban I-PRESENT_ILLNESS con I-PRESENT_ILLNESS antiinflamatorios I-PRESENT_ILLNESS no I-PRESENT_ILLNESS esteroideos. I-PRESENT_ILLNESS Durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS años I-PRESENT_ILLNESS también I-PRESENT_ILLNESS había I-PRESENT_ILLNESS presentado I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS en I-PRESENT_ILLNESS ambas I-PRESENT_ILLNESS muñecas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS raquis I-PRESENT_ILLNESS cervical, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS características I-PRESENT_ILLNESS mecánicas. I-PRESENT_ILLNESS No I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS padecido I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS vómitos, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS consumía I-PRESENT_ILLNESS diuréticos I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS ningún I-PRESENT_ILLNESS otro I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fármacos. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION mostraba I-EXPLORATION a I-EXPLORATION una I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION normohidratada, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 120/80 I-EXPLORATION mmHg. I-EXPLORATION Del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION destacaba I-EXPLORATION el I-EXPLORATION dolor I-EXPLORATION y I-EXPLORATION la I-EXPLORATION limitación I-EXPLORATION a I-EXPLORATION flexo-extensión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION rodilla I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION maniobras I-EXPLORATION meniscales I-EXPLORATION positivas, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION derrame I-EXPLORATION articular. I-EXPLORATION En I-EXPLORATION las I-EXPLORATION manos I-EXPLORATION mostraba I-EXPLORATION signos I-EXPLORATION degenerativos I-EXPLORATION en I-EXPLORATION articulaciones I-EXPLORATION interfalángicas I-EXPLORATION distales I-EXPLORATION sugestivas I-EXPLORATION de I-EXPLORATION nódulos I-EXPLORATION de I-EXPLORATION Heberden. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica, I-EXPLORATION el I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION fórmula I-EXPLORATION fueron I-EXPLORATION normales; I-EXPLORATION los I-EXPLORATION análisis I-EXPLORATION bioquímicos I-EXPLORATION mostraron I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION resultados: I-EXPLORATION urea, I-EXPLORATION 37 I-EXPLORATION mg/dl; I-EXPLORATION creatinina, I-EXPLORATION 0, I-EXPLORATION 71 I-EXPLORATION mg/dl; I-EXPLORATION filtrado I-EXPLORATION glomerular, I-EXPLORATION >60 I-EXPLORATION mL/min/1, I-EXPLORATION 73m2; I-EXPLORATION calcio I-EXPLORATION total, I-EXPLORATION 9, I-EXPLORATION 45 I-EXPLORATION mg/dl; I-EXPLORATION fosfato I-EXPLORATION inorgánico, I-EXPLORATION 3, I-EXPLORATION 51 I-EXPLORATION mg/dl; I-EXPLORATION fosfatasa I-EXPLORATION alcalina, I-EXPLORATION 56 I-EXPLORATION U/L; I-EXPLORATION sodio I-EXPLORATION (Na), I-EXPLORATION 140 I-EXPLORATION mEq/l; I-EXPLORATION potasio I-EXPLORATION (K), I-EXPLORATION 3, I-EXPLORATION 4 I-EXPLORATION mEq/l; I-EXPLORATION TSH, I-EXPLORATION 3, I-EXPLORATION 45 I-EXPLORATION mUL; I-EXPLORATION PTH I-EXPLORATION plasma, I-EXPLORATION 2, I-EXPLORATION 9 I-EXPLORATION pmol/L I-EXPLORATION (1,6-6,9); I-EXPLORATION 25-hidroxicolecalciferol, I-EXPLORATION 30, I-EXPLORATION 9 I-EXPLORATION ng/ml I-EXPLORATION (30-100); I-EXPLORATION fosfatasa I-EXPLORATION alcalina I-EXPLORATION ósea, I-EXPLORATION 9, I-EXPLORATION 7 I-EXPLORATION ug/L; I-EXPLORATION magnesio I-EXPLORATION (Mg), I-EXPLORATION 0, I-EXPLORATION 54 I-EXPLORATION mmol/L I-EXPLORATION (0,66-0,99). I-EXPLORATION En I-EXPLORATION orina I-EXPLORATION de I-EXPLORATION 24 I-EXPLORATION horas: I-EXPLORATION proteinuria I-EXPLORATION negativa; I-EXPLORATION calciuria, I-EXPLORATION 69, I-EXPLORATION 56 I-EXPLORATION mg I-EXPLORATION (100-250); I-EXPLORATION fosfaturia, I-EXPLORATION 588, I-EXPLORATION 30 I-EXPLORATION mg; I-EXPLORATION Mg, I-EXPLORATION 1, I-EXPLORATION 31 I-EXPLORATION mg/dL I-EXPLORATION (1,7-5,7); I-EXPLORATION fosfato I-EXPLORATION en I-EXPLORATION primera I-EXPLORATION orina I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mañana, I-EXPLORATION 15, I-EXPLORATION 9 I-EXPLORATION mg/dL I-EXPLORATION (40-136). I-EXPLORATION Los I-EXPLORATION reactantes I-EXPLORATION de I-EXPLORATION fase I-EXPLORATION aguda, I-EXPLORATION factor I-EXPLORATION reumatoide, I-EXPLORATION anticuerpo I-EXPLORATION anticitrulinado I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (ANA, I-EXPLORATION anti-ENA) I-EXPLORATION fueron I-EXPLORATION normales I-EXPLORATION o I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION radiológico I-EXPLORATION mostró I-EXPLORATION calcificaciones I-EXPLORATION de I-EXPLORATION los I-EXPLORATION meniscos I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION rodillas I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION degenerativos I-EXPLORATION añadidos, I-EXPLORATION de I-EXPLORATION sínfisis I-EXPLORATION púbica, I-EXPLORATION ambos I-EXPLORATION carpos, I-EXPLORATION en I-EXPLORATION cartílago I-EXPLORATION hialino I-EXPLORATION de I-EXPLORATION coxofemorales I-EXPLORATION y I-EXPLORATION también I-EXPLORATION en I-EXPLORATION metatarsofalángicas I-EXPLORATION de I-EXPLORATION primer I-EXPLORATION dedo I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION pies. I-EXPLORATION I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnérico I-EXPLORATION nuclear I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION rodilla I-EXPLORATION derecha I-EXPLORATION mostraba I-EXPLORATION severos I-EXPLORATION signos I-EXPLORATION degenerativos I-EXPLORATION de I-EXPLORATION artrosis I-EXPLORATION fémoro-rotuliana, I-EXPLORATION fémoro-tibial I-EXPLORATION interna I-EXPLORATION y I-EXPLORATION externa, I-EXPLORATION con I-EXPLORATION rotura I-EXPLORATION degenerativa I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION meniscos. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION molecular I-EXPLORATION mediante I-EXPLORATION amplificación I-EXPLORATION PCR I-EXPLORATION y I-EXPLORATION secuenciación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION SCL112A3, I-EXPLORATION detectando I-EXPLORATION homozigosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION c2576T>C I-EXPLORATION (p. I-EXPLORATION L859P) I-EXPLORATION en I-EXPLORATION el I-EXPLORATION exón I-EXPLORATION del I-EXPLORATION citado I-EXPLORATION gen I-EXPLORATION y I-EXPLORATION que I-EXPLORATION confirmaba I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Gitelman. I-EXPLORATION I-EXPLORATION El B-TREATMENT tratamiento I-TREATMENT fue I-TREATMENT de I-TREATMENT suplementos I-TREATMENT orales I-TREATMENT de I-TREATMENT magnesio I-TREATMENT a I-TREATMENT dosis I-TREATMENT variables I-TREATMENT según I-TREATMENT resultados I-TREATMENT analíticos I-TREATMENT de I-TREATMENT seguimiento, I-TREATMENT y I-TREATMENT colchicina I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT para I-TREATMENT evitar I-TREATMENT los I-TREATMENT episodios I-TREATMENT de I-TREATMENT pseudogota I-TREATMENT que I-TREATMENT venía I-TREATMENT padeciendo I-TREATMENT la I-TREATMENT paciente. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 30 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hija B-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY anterior, I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY infancia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY OI I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY raíz I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tibia I-PAST_MEDICAL_HISTORY desplazada I-PAST_MEDICAL_HISTORY seguida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY clavícula I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY traumatismos I-PAST_MEDICAL_HISTORY leves. I-PAST_MEDICAL_HISTORY Posteriormente I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY nuevas I-PAST_MEDICAL_HISTORY fracturas, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY última I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 12 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY precisando I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellas I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY quirúrgico I-PAST_MEDICAL_HISTORY (olécranon). I-PAST_MEDICAL_HISTORY Entre I-PAST_MEDICAL_HISTORY otros I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY destacaban I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY esguinces I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tobillo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY estapedectomía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY oído I-PAST_MEDICAL_HISTORY derecho. I-PAST_MEDICAL_HISTORY Nunca I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY recibido I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontraba I-PAST_MEDICAL_HISTORY asintomática. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS deseaba I-PRESENT_ILLNESS conocer I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS opciones I-PRESENT_ILLNESS reproductivas I-PRESENT_ILLNESS para I-PRESENT_ILLNESS tener I-PRESENT_ILLNESS un I-PRESENT_ILLNESS hijo I-PRESENT_ILLNESS libre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS enfermedad. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION talla I-EXPLORATION de I-EXPLORATION 153 I-EXPLORATION cm, I-EXPLORATION escleras I-EXPLORATION azules I-EXPLORATION y I-EXPLORATION dientes I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION apreciaron I-EXPLORATION deformidades I-EXPLORATION a I-EXPLORATION ningún I-EXPLORATION nivel. I-EXPLORATION I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION resultaron I-EXPLORATION normales, I-EXPLORATION salvo I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION 25OHCC: I-EXPLORATION 23 I-EXPLORATION ng/ml, I-EXPLORATION y I-EXPLORATION también I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION realizado I-EXPLORATION (radiografía I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION cervical, I-EXPLORATION ecocardiograma, I-EXPLORATION espirometría, I-EXPLORATION ecografía I-EXPLORATION abdominal). I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION la I-EXPLORATION densitometría I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION densidad I-EXPLORATION mineral I-EXPLORATION ósea I-EXPLORATION normal: I-EXPLORATION T-scores I-EXPLORATION de I-EXPLORATION -0, I-EXPLORATION 9 I-EXPLORATION en I-EXPLORATION columna I-EXPLORATION lumbar I-EXPLORATION (L1-L4), I-EXPLORATION 0, I-EXPLORATION 0 I-EXPLORATION en I-EXPLORATION cuello I-EXPLORATION femoral I-EXPLORATION y I-EXPLORATION -0, I-EXPLORATION 1 I-EXPLORATION en I-EXPLORATION fémur I-EXPLORATION total. I-EXPLORATION Se B-TREATMENT recomendó I-TREATMENT suplementación I-TREATMENT con I-TREATMENT vitamina I-TREATMENT D. I-TREATMENT I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION dirigido I-EXPLORATION para I-EXPLORATION la I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION identificada I-EXPLORATION en I-EXPLORATION su I-EXPLORATION padre, I-EXPLORATION confirmando I-EXPLORATION que I-EXPLORATION la I-EXPLORATION hija I-EXPLORATION es I-EXPLORATION portadora I-EXPLORATION de I-EXPLORATION la I-EXPLORATION misma I-EXPLORATION deleción I-EXPLORATION en I-EXPLORATION heterocigosis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION gen I-EXPLORATION COL1A1 I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION su I-EXPLORATION padre. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION asesoramiento I-EXPLORATION genético I-EXPLORATION para I-EXPLORATION informar I-EXPLORATION sobre I-EXPLORATION las I-EXPLORATION posibles I-EXPLORATION consecuencias I-EXPLORATION para I-EXPLORATION el I-EXPLORATION afecto I-EXPLORATION a I-EXPLORATION su I-EXPLORATION descendencia, I-EXPLORATION de I-EXPLORATION los I-EXPLORATION resultados I-EXPLORATION de I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION y I-EXPLORATION sus I-EXPLORATION ventajas I-EXPLORATION y I-EXPLORATION riesgos, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION informarle I-EXPLORATION de I-EXPLORATION las I-EXPLORATION posibles I-EXPLORATION alternativas I-EXPLORATION derivadas I-EXPLORATION del I-EXPLORATION análisis. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 26 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY ERC I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY glomerulonefritis I-PAST_MEDICAL_HISTORY proliferativa I-PAST_MEDICAL_HISTORY extracapilar I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY I. I-PAST_MEDICAL_HISTORY Fumadora I-PAST_MEDICAL_HISTORY activa, I-PAST_MEDICAL_HISTORY Hipertensa I-PAST_MEDICAL_HISTORY aunque I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY precisa I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY farmacológico I-PAST_MEDICAL_HISTORY actualmente. I-PAST_MEDICAL_HISTORY Presenta I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Darier I-PAST_MEDICAL_HISTORY cutánea. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Recibió I-PAST_MEDICAL_HISTORY 14 I-PAST_MEDICAL_HISTORY sesiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY plasmaféresis I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 2006. I-PAST_MEDICAL_HISTORY Posteriormente I-PAST_MEDICAL_HISTORY abandonó I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY revisiones I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY finalmente I-PAST_MEDICAL_HISTORY acudió I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY urgencias I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY después I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY situación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY uremia I-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY iniciando I-PAST_MEDICAL_HISTORY diálisis. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY La B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS da I-PRESENT_ILLNESS consentimiento I-PRESENT_ILLNESS expreso I-PRESENT_ILLNESS para I-PRESENT_ILLNESS la I-PRESENT_ILLNESS exposición I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS caso. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Historia I-PRESENT_ILLNESS del I-PRESENT_ILLNESS acceso I-PRESENT_ILLNESS vascular I-PRESENT_ILLNESS I-PRESENT_ILLNESS • B-TREATMENT Varios I-TREATMENT intentos I-TREATMENT de I-TREATMENT Fístula I-TREATMENT Arteriovenosa I-TREATMENT (FAV), I-TREATMENT todos I-TREATMENT ellos I-TREATMENT infructuosos: I-TREATMENT FAV I-TREATMENT radio-cefálica I-TREATMENT izquierda I-TREATMENT en I-TREATMENT 01-2009, I-TREATMENT húmero-cefálica I-TREATMENT izquierda I-TREATMENT en I-TREATMENT 03-09, I-TREATMENT radio-cefálica I-TREATMENT derecha I-TREATMENT en I-TREATMENT 04-09 I-TREATMENT y I-TREATMENT húmero-cefálica I-TREATMENT derecha I-TREATMENT en I-TREATMENT 05-11. I-TREATMENT Se B-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION mapa I-EXPLORATION vascular I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION ninguna I-EXPLORATION vena I-EXPLORATION apta I-EXPLORATION en I-EXPLORATION MMSS. I-EXPLORATION I-EXPLORATION • B-TREATMENT Catéter I-TREATMENT venoso I-TREATMENT permanente I-TREATMENT yugular I-TREATMENT derecho, I-TREATMENT implantado I-TREATMENT el I-TREATMENT 14/01/09 I-TREATMENT y I-TREATMENT retirado I-TREATMENT el I-TREATMENT 05/11/09 I-TREATMENT por I-TREATMENT Endocarditis I-TREATMENT Tricuspídea I-TREATMENT secundaria I-TREATMENT a I-TREATMENT MARS. I-TREATMENT I-TREATMENT • I-TREATMENT Varios I-TREATMENT catéteres I-TREATMENT temporales I-TREATMENT en I-TREATMENT ambas I-TREATMENT venas I-TREATMENT femorales I-TREATMENT retirados I-TREATMENT por I-TREATMENT trombosis I-TREATMENT o I-TREATMENT disfunción. I-TREATMENT I-TREATMENT • I-TREATMENT Catéter I-TREATMENT permanente I-TREATMENT yugular I-TREATMENT izquierdo I-TREATMENT colocado I-TREATMENT el I-TREATMENT 16/11/09 I-TREATMENT y I-TREATMENT retirado I-TREATMENT el I-TREATMENT 21/06/10 I-TREATMENT por I-TREATMENT trombosis I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT yugular I-TREATMENT izquierda. I-TREATMENT I-TREATMENT • I-TREATMENT Catéter I-TREATMENT permanente I-TREATMENT femoral I-TREATMENT derecho I-TREATMENT colocado I-TREATMENT el I-TREATMENT 21/06/10 I-TREATMENT y I-TREATMENT retirado I-TREATMENT 4 I-TREATMENT días I-TREATMENT después I-TREATMENT por I-TREATMENT disfunción I-TREATMENT persistente. I-TREATMENT I-TREATMENT • B-EXPLORATION Tras I-EXPLORATION ello I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION endovascular I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION oclusión I-EXPLORATION completa I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION iliaca I-EXPLORATION izquierda I-EXPLORATION y I-EXPLORATION de I-EXPLORATION cava I-EXPLORATION inferior, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION inhabilitaba I-EXPLORATION los I-EXPLORATION accesos I-EXPLORATION femorales. I-EXPLORATION En I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION respecta I-EXPLORATION a I-EXPLORATION los I-EXPLORATION troncos I-EXPLORATION superiores I-EXPLORATION la I-EXPLORATION situación I-EXPLORATION no I-EXPLORATION es I-EXPLORATION mejor I-EXPLORATION pues I-EXPLORATION existe I-EXPLORATION oclusión I-EXPLORATION de I-EXPLORATION venas I-EXPLORATION subclavias, I-EXPLORATION yugular I-EXPLORATION derecha, I-EXPLORATION tronco I-EXPLORATION braquio-cefálico I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION cava I-EXPLORATION superior. I-EXPLORATION Ante B-TREATMENT esta I-TREATMENT situación I-TREATMENT se I-TREATMENT colocó I-TREATMENT catéter I-TREATMENT permanente I-TREATMENT por I-TREATMENT abordaje I-TREATMENT transhepático I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT vena I-TREATMENT suprahepática I-TREATMENT derecha, I-TREATMENT con I-TREATMENT extremo I-TREATMENT en I-TREATMENT aurícula I-TREATMENT derecha9. I-TREATMENT Se I-TREATMENT recambió I-TREATMENT el I-TREATMENT 03/07/2012 I-TREATMENT por I-TREATMENT disfunción. I-TREATMENT Desde B-EVOLUTION entonces I-EVOLUTION ha I-EVOLUTION sufrido I-EVOLUTION continuas I-EVOLUTION infecciones I-EVOLUTION que I-EVOLUTION han I-EVOLUTION obligado I-EVOLUTION a I-EVOLUTION instaurar I-EVOLUTION tratamiento I-EVOLUTION antibiótico I-EVOLUTION casi I-EVOLUTION de I-EVOLUTION manera I-EVOLUTION continua. I-EVOLUTION I-EVOLUTION • I-EVOLUTION En I-EVOLUTION 12/2012 I-EVOLUTION sufre I-EVOLUTION extrusión I-EVOLUTION espontánea I-EVOLUTION colocándose B-TREATMENT catéter I-TREATMENT femoral I-TREATMENT provisional I-TREATMENT izquierdo. I-TREATMENT I-TREATMENT • B-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realizó I-EXPLORATION nuevo I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION troncos I-EXPLORATION venosos I-EXPLORATION encontrando I-EXPLORATION oclusión I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION iliaca I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION del I-EXPLORATION flujo I-EXPLORATION por I-EXPLORATION rama I-EXPLORATION hipogástrica I-EXPLORATION hasta I-EXPLORATION iliaca I-EXPLORATION común, I-EXPLORATION de I-EXPLORATION modo I-EXPLORATION que I-EXPLORATION no I-EXPLORATION es I-EXPLORATION subsidiaria I-EXPLORATION de I-EXPLORATION catéter I-EXPLORATION de I-EXPLORATION diálisis I-EXPLORATION permanente I-EXPLORATION por I-EXPLORATION este I-EXPLORATION acceso. I-EXPLORATION La I-EXPLORATION vena I-EXPLORATION femoral I-EXPLORATION común I-EXPLORATION derecha I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION permeable I-EXPLORATION pero I-EXPLORATION no I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION flujo I-EXPLORATION doppler I-EXPLORATION en I-EXPLORATION vena I-EXPLORATION iliaca, I-EXPLORATION probablemente I-EXPLORATION por I-EXPLORATION trombosis. I-EXPLORATION Se I-EXPLORATION realizaron I-EXPLORATION flebografías I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION brazos I-EXPLORATION encontrando I-EXPLORATION que I-EXPLORATION el I-EXPLORATION flujo I-EXPLORATION va I-EXPLORATION por I-EXPLORATION colaterales I-EXPLORATION a I-EXPLORATION intercostales I-EXPLORATION hasta I-EXPLORATION acigos-hemiacigos I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION bilateral I-EXPLORATION debido I-EXPLORATION a I-EXPLORATION la I-EXPLORATION oclusión I-EXPLORATION de I-EXPLORATION las I-EXPLORATION venas I-EXPLORATION subclavias. I-EXPLORATION Se I-EXPLORATION descartó I-EXPLORATION colocar I-EXPLORATION un I-EXPLORATION catéter I-EXPLORATION por I-EXPLORATION subclavia. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION doppler I-EXPLORATION de I-EXPLORATION ambas I-EXPLORATION yugulares I-EXPLORATION visualizando I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION yugular I-EXPLORATION izquierda I-EXPLORATION permeable I-EXPLORATION aunque I-EXPLORATION es I-EXPLORATION muy I-EXPLORATION probable I-EXPLORATION estenosis I-EXPLORATION central I-EXPLORATION del I-EXPLORATION tronco I-EXPLORATION braquiocefálico I-EXPLORATION venoso I-EXPLORATION izquierdo I-EXPLORATION dada I-EXPLORATION la I-EXPLORATION flebografía I-EXPLORATION de I-EXPLORATION ese I-EXPLORATION miembro I-EXPLORATION y I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION yugular I-EXPLORATION derecha I-EXPLORATION ocluida I-EXPLORATION crónica I-EXPLORATION (no I-EXPLORATION visible I-EXPLORATION en I-EXPLORATION la I-EXPLORATION ecografía). I-EXPLORATION I-EXPLORATION • B-TREATMENT El I-TREATMENT 17/01/2013 I-TREATMENT se I-TREATMENT le I-TREATMENT implantó I-TREATMENT nuevo I-TREATMENT catéter I-TREATMENT transhepático I-TREATMENT que I-TREATMENT fue I-TREATMENT recambiado I-TREATMENT el I-TREATMENT 20/03/2013 I-TREATMENT por I-TREATMENT disfunción. I-TREATMENT Este B-EVOLUTION es I-EVOLUTION su I-EVOLUTION acceso I-EVOLUTION actual I-EVOLUTION y I-EVOLUTION probablemente I-EVOLUTION el I-EVOLUTION único I-EVOLUTION posible. I-EVOLUTION I-EVOLUTION A I-EVOLUTION todos I-EVOLUTION estos I-EVOLUTION problemas I-EVOLUTION vasculares I-EVOLUTION que I-EVOLUTION ponen I-EVOLUTION en I-EVOLUTION riesgo I-EVOLUTION su I-EVOLUTION supervivencia I-EVOLUTION se I-EVOLUTION suma I-EVOLUTION la I-EVOLUTION situación I-EVOLUTION social I-EVOLUTION complicadísima I-EVOLUTION que I-EVOLUTION vive I-EVOLUTION la I-EVOLUTION paciente, I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION no I-EVOLUTION recibe I-EVOLUTION ningún I-EVOLUTION apoyo I-EVOLUTION familiar I-EVOLUTION y I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION totalmente I-EVOLUTION desmotivada I-EVOLUTION presentando I-EVOLUTION en I-EVOLUTION la I-EVOLUTION mayoría I-EVOLUTION de I-EVOLUTION ocasiones I-EVOLUTION un I-EVOLUTION comportamiento I-EVOLUTION rebelde I-EVOLUTION y I-EVOLUTION de I-EVOLUTION rechazo I-EVOLUTION a I-EVOLUTION cualquier I-EVOLUTION cambio I-EVOLUTION en I-EVOLUTION sus I-EVOLUTION opciones I-EVOLUTION de I-EVOLUTION tratamiento, I-EVOLUTION hecho I-EVOLUTION que I-EVOLUTION dificulta I-EVOLUTION enormemente I-EVOLUTION la I-EVOLUTION labor I-EVOLUTION de I-EVOLUTION enfermería I-EVOLUTION en I-EVOLUTION el I-EVOLUTION ámbito I-EVOLUTION de I-EVOLUTION educación I-EVOLUTION para I-EVOLUTION la I-EVOLUTION salud. I-EVOLUTION I-EVOLUTION Cabe B-TREATMENT reseñar I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT rechaza I-TREATMENT iniciar I-TREATMENT cualquier I-TREATMENT tipo I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT anticoagulante I-TREATMENT (se I-TREATMENT le I-TREATMENT ha I-TREATMENT propuesto I-TREATMENT tomar I-TREATMENT sintrom® I-TREATMENT en I-TREATMENT muchas I-TREATMENT ocasiones). I-TREATMENT I-TREATMENT Por I-TREATMENT otra I-TREATMENT parte I-TREATMENT se I-TREATMENT descartó I-TREATMENT su I-TREATMENT inclusión I-TREATMENT en I-TREATMENT la I-TREATMENT lista I-TREATMENT de I-TREATMENT trasplante I-TREATMENT al I-TREATMENT no I-TREATMENT acudir I-TREATMENT a I-TREATMENT las I-TREATMENT reiteradas I-TREATMENT citas, I-TREATMENT autoexcluyéndose I-TREATMENT además I-TREATMENT como I-TREATMENT candidata I-TREATMENT a I-TREATMENT diálisis I-TREATMENT peritoneal I-TREATMENT dada I-TREATMENT su I-TREATMENT negativa I-TREATMENT a I-TREATMENT cumplir I-TREATMENT con I-TREATMENT las I-TREATMENT pautas I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT propuestas I-TREATMENT por I-TREATMENT el I-TREATMENT personal I-TREATMENT médico I-TREATMENT y I-TREATMENT de I-TREATMENT enfermería. I-TREATMENT I-TREATMENT En I-TREATMENT las I-TREATMENT figuras I-TREATMENT 1 I-TREATMENT y I-TREATMENT 2 I-TREATMENT se I-TREATMENT muestra I-TREATMENT el I-TREATMENT acceso I-TREATMENT actual I-TREATMENT de I-TREATMENT la I-TREATMENT paciente: I-TREATMENT el I-TREATMENT catéter I-TREATMENT transhepático. I-TREATMENT I-TREATMENT Cuidados I-TREATMENT de I-TREATMENT enfermería I-TREATMENT I-TREATMENT En B-EVOLUTION cada I-EVOLUTION sesión I-EVOLUTION se I-EVOLUTION informa I-EVOLUTION a I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION de I-EVOLUTION los I-EVOLUTION cuidados I-EVOLUTION que I-EVOLUTION debe I-EVOLUTION tener I-EVOLUTION para I-EVOLUTION cuidar I-EVOLUTION al I-EVOLUTION máximo I-EVOLUTION su I-EVOLUTION AV I-EVOLUTION haciendo I-EVOLUTION especial I-EVOLUTION hincapié I-EVOLUTION en I-EVOLUTION la I-EVOLUTION importancia I-EVOLUTION de I-EVOLUTION mantener I-EVOLUTION el I-EVOLUTION apósito I-EVOLUTION seco I-EVOLUTION y I-EVOLUTION limpio I-EVOLUTION y I-EVOLUTION de I-EVOLUTION informar I-EVOLUTION al I-EVOLUTION personal I-EVOLUTION de I-EVOLUTION enfermería I-EVOLUTION acerca I-EVOLUTION de I-EVOLUTION cualquier I-EVOLUTION incidencia I-EVOLUTION que I-EVOLUTION note, I-EVOLUTION especialmente I-EVOLUTION si I-EVOLUTION aparece I-EVOLUTION dolor I-EVOLUTION o I-EVOLUTION calor I-EVOLUTION en I-EVOLUTION la I-EVOLUTION zona I-EVOLUTION de I-EVOLUTION inserción I-EVOLUTION y I-EVOLUTION fiebre. I-EVOLUTION I-EVOLUTION Todo I-EVOLUTION el I-EVOLUTION equipo I-EVOLUTION de I-EVOLUTION enfermería I-EVOLUTION cumple I-EVOLUTION con I-EVOLUTION los I-EVOLUTION protocolos I-EVOLUTION de I-EVOLUTION cura I-EVOLUTION del I-EVOLUTION orificio I-EVOLUTION de I-EVOLUTION salida I-EVOLUTION del I-EVOLUTION catéter, I-EVOLUTION conexión I-EVOLUTION y I-EVOLUTION desconexión I-EVOLUTION según I-EVOLUTION los I-EVOLUTION criterios I-EVOLUTION aceptados I-EVOLUTION en I-EVOLUTION nuestra I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION diálisis: I-EVOLUTION I-EVOLUTION • B-TREATMENT La I-TREATMENT cura I-TREATMENT del I-TREATMENT orificio I-TREATMENT de I-TREATMENT salida I-TREATMENT del I-TREATMENT catéter I-TREATMENT (OSC) I-TREATMENT se I-TREATMENT realiza I-TREATMENT de I-TREATMENT forma I-TREATMENT aséptica I-TREATMENT con I-TREATMENT cloruro I-TREATMENT sódico I-TREATMENT al I-TREATMENT 20%, I-TREATMENT clorhexidina I-TREATMENT alcohólica I-TREATMENT al I-TREATMENT 2% I-TREATMENT y I-TREATMENT gasas I-TREATMENT estériles, I-TREATMENT observando I-TREATMENT de I-TREATMENT forma I-TREATMENT exhaustiva I-TREATMENT la I-TREATMENT zona I-TREATMENT para I-TREATMENT detectar I-TREATMENT precozmente I-TREATMENT la I-TREATMENT aparición I-TREATMENT de I-TREATMENT eritema, I-TREATMENT secreción, I-TREATMENT etc. I-TREATMENT Después I-TREATMENT se I-TREATMENT cubre I-TREATMENT el I-TREATMENT orificio I-TREATMENT con I-TREATMENT un I-TREATMENT apósito I-TREATMENT estéril. I-TREATMENT I-TREATMENT • I-TREATMENT El I-TREATMENT sellado I-TREATMENT de I-TREATMENT las I-TREATMENT ramas I-TREATMENT del I-TREATMENT catéter I-TREATMENT se I-TREATMENT realiza I-TREATMENT con I-TREATMENT Taurolock® I-TREATMENT y I-TREATMENT tapones I-TREATMENT tipo I-TREATMENT luer-lock. I-TREATMENT Desde I-TREATMENT el I-TREATMENT último I-TREATMENT recambio I-TREATMENT del I-TREATMENT catéter I-TREATMENT transhepático I-TREATMENT en I-TREATMENT la I-TREATMENT primera I-TREATMENT sesión I-TREATMENT de I-TREATMENT diálisis I-TREATMENT semanal I-TREATMENT se I-TREATMENT sella I-TREATMENT con I-TREATMENT Urokinasa I-TREATMENT 50.000 I-TREATMENT UI/rama I-TREATMENT como I-TREATMENT terapia I-TREATMENT fibrinolítica I-TREATMENT intraluminal I-TREATMENT según I-TREATMENT protocolo I-TREATMENT de I-TREATMENT nuestra I-TREATMENT unidad. I-TREATMENT I-TREATMENT Se B-EXPLORATION valora I-EXPLORATION el I-EXPLORATION funcionamiento I-EXPLORATION adecuado I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION en I-EXPLORATION cada I-EXPLORATION sesión I-EXPLORATION de I-EXPLORATION hemodiálisis I-EXPLORATION alcanzando I-EXPLORATION flujos I-EXPLORATION sanguíneos I-EXPLORATION adecuados I-EXPLORATION superiores I-EXPLORATION a I-EXPLORATION 300 I-EXPLORATION ml/min I-EXPLORATION y I-EXPLORATION Kt I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 45 I-EXPLORATION L. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION figura I-EXPLORATION 3 I-EXPLORATION se I-EXPLORATION muestran I-EXPLORATION los I-EXPLORATION datos I-EXPLORATION obtenidos I-EXPLORATION de I-EXPLORATION las I-EXPLORATION sesiones I-EXPLORATION de I-EXPLORATION diálisis I-EXPLORATION desde I-EXPLORATION enero I-EXPLORATION de I-EXPLORATION 2013. I-EXPLORATION I-EXPLORATION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ERC I-PRESENT_ILLNESS estadio I-PRESENT_ILLNESS V I-PRESENT_ILLNESS de I-PRESENT_ILLNESS perfil I-PRESENT_ILLNESS intersticial I-PRESENT_ILLNESS que I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS recibir I-PRESENT_ILLNESS educación I-PRESENT_ILLNESS en I-PRESENT_ILLNESS opciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS elige I-PRESENT_ILLNESS DPCA. I-PRESENT_ILLNESS En B-TREATMENT septiembre I-TREATMENT de I-TREATMENT 2014 I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT implantación I-TREATMENT de I-TREATMENT catéter I-TREATMENT de I-TREATMENT silicona I-TREATMENT Swan-neck I-TREATMENT con I-TREATMENT doble I-TREATMENT cuff I-TREATMENT y I-TREATMENT reparación I-TREATMENT de I-TREATMENT dos I-TREATMENT hernias, I-TREATMENT inguinal I-TREATMENT y I-TREATMENT umbilical. I-TREATMENT Su B-EXPLORATION superficie I-EXPLORATION corporal I-EXPLORATION era I-EXPLORATION 2.06 I-EXPLORATION m2 I-EXPLORATION y I-EXPLORATION su I-EXPLORATION Indice I-EXPLORATION de I-EXPLORATION Masa I-EXPLORATION Corporal I-EXPLORATION 26.1. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT la I-TREATMENT educación I-TREATMENT para I-TREATMENT el I-TREATMENT aprendizaje I-TREATMENT de I-TREATMENT la I-TREATMENT técnica I-TREATMENT y I-TREATMENT en I-TREATMENT Noviembre I-TREATMENT de I-TREATMENT 2014 I-TREATMENT comenzó I-TREATMENT tratamiento I-TREATMENT en I-TREATMENT domicilio I-TREATMENT con I-TREATMENT 4 I-TREATMENT intercambios I-TREATMENT de I-TREATMENT Bicavera I-TREATMENT al I-TREATMENT 1, I-TREATMENT 5% I-TREATMENT de I-TREATMENT glucosa I-TREATMENT y I-TREATMENT 2000 I-TREATMENT ml I-TREATMENT de I-TREATMENT volumen, I-TREATMENT sin I-TREATMENT complicaciones. I-TREATMENT Los B-EXPLORATION volúmenes I-EXPLORATION de I-EXPLORATION UF I-EXPLORATION eran I-EXPLORATION de I-EXPLORATION 500-700 I-EXPLORATION ml/ I-EXPLORATION 24 I-EXPLORATION horas I-EXPLORATION y I-EXPLORATION la I-EXPLORATION diuresis I-EXPLORATION residual I-EXPLORATION de I-EXPLORATION 1700 I-EXPLORATION ml. I-EXPLORATION En B-EVOLUTION diciembre I-EVOLUTION de I-EVOLUTION 2014 I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION Prueba I-EVOLUTION de I-EVOLUTION función I-EVOLUTION peritoneal I-EVOLUTION catalogándose I-EVOLUTION como I-EVOLUTION alto I-EVOLUTION transportador I-EVOLUTION con I-EVOLUTION un I-EVOLUTION volumen I-EVOLUTION residual I-EVOLUTION de I-EVOLUTION 411, I-EVOLUTION 39 I-EVOLUTION ml I-EVOLUTION y I-EVOLUTION Presión I-EVOLUTION Intraperitoneal I-EVOLUTION (PIP) I-EVOLUTION de I-EVOLUTION 16, I-EVOLUTION 05 I-EVOLUTION cm I-EVOLUTION H2O. I-EVOLUTION El I-EVOLUTION 2 I-EVOLUTION de I-EVOLUTION febrero I-EVOLUTION de I-EVOLUTION 2015 I-EVOLUTION acudió I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION dificultad I-EVOLUTION para I-EVOLUTION el I-EVOLUTION drenaje, I-EVOLUTION su I-EVOLUTION patrón I-EVOLUTION intestinal I-EVOLUTION era I-EVOLUTION normal I-EVOLUTION sin I-EVOLUTION estreñimiento I-EVOLUTION ni I-EVOLUTION diarrea I-EVOLUTION y I-EVOLUTION la I-EVOLUTION radiografía I-EVOLUTION de I-EVOLUTION abdomen I-EVOLUTION mostró I-EVOLUTION migración I-EVOLUTION del I-EVOLUTION catéter, I-EVOLUTION tratado I-EVOLUTION con I-EVOLUTION laxantes I-EVOLUTION mejoraron I-EVOLUTION los I-EVOLUTION drenajes I-EVOLUTION pero I-EVOLUTION presentó I-EVOLUTION una I-EVOLUTION ganancia I-EVOLUTION de I-EVOLUTION 4 I-EVOLUTION kg I-EVOLUTION de I-EVOLUTION peso. I-EVOLUTION Se B-TREATMENT cambió I-TREATMENT pauta I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT 2 I-TREATMENT intercambios I-TREATMENT de I-TREATMENT 2, I-TREATMENT 3 I-TREATMENT % I-TREATMENT y I-TREATMENT 2 I-TREATMENT de I-TREATMENT 1, I-TREATMENT 5% I-TREATMENT de I-TREATMENT glucosa I-TREATMENT bajando I-TREATMENT 800 I-TREATMENT gr I-TREATMENT de I-TREATMENT peso. I-TREATMENT Al B-EVOLUTION día I-EVOLUTION siguiente I-EVOLUTION en I-EVOLUTION consulta I-EVOLUTION telefónica I-EVOLUTION se I-EVOLUTION percibió I-EVOLUTION disnea I-EVOLUTION al I-EVOLUTION hablar I-EVOLUTION y I-EVOLUTION tos, I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION le I-EVOLUTION indicó I-EVOLUTION acudir I-EVOLUTION urgentemente I-EVOLUTION a I-EVOLUTION la I-EVOLUTION consulta I-EVOLUTION del I-EVOLUTION hospital. I-EVOLUTION La B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION mostró I-EXPLORATION gran I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION derecho I-EXPLORATION que I-EXPLORATION no I-EXPLORATION existía I-EXPLORATION en I-EXPLORATION radiografías I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION posteriores I-EXPLORATION al I-EXPLORATION comienzo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION DP. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT toracentesis, I-TREATMENT mostrando I-TREATMENT la I-TREATMENT bioquímica I-TREATMENT del I-TREATMENT líquido I-TREATMENT una I-TREATMENT concentración I-TREATMENT de I-TREATMENT glucosa I-TREATMENT en I-TREATMENT líquido I-TREATMENT pleural I-TREATMENT mayor I-TREATMENT de I-TREATMENT la I-TREATMENT presentada I-TREATMENT en I-TREATMENT plasma I-TREATMENT y I-TREATMENT compatible I-TREATMENT con I-TREATMENT líquido I-TREATMENT de I-TREATMENT diálisis. I-TREATMENT Ante I-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT fuga I-TREATMENT de I-TREATMENT líquido I-TREATMENT hacia I-TREATMENT la I-TREATMENT cavidad I-TREATMENT pleural, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT diálisis I-TREATMENT peritoneal. I-TREATMENT I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION gammagrafía I-EXPLORATION administrando I-EXPLORATION 117 I-EXPLORATION MBq I-EXPLORATION de I-EXPLORATION Nanocoloide I-EXPLORATION de I-EXPLORATION albumina I-EXPLORATION TC I-EXPLORATION 99 I-EXPLORATION m. I-EXPLORATION I-EXPLORATION La I-EXPLORATION administración I-EXPLORATION del I-EXPLORATION radio I-EXPLORATION fármaco I-EXPLORATION requirió I-EXPLORATION la I-EXPLORATION colaboración I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermería I-EXPLORATION de I-EXPLORATION DP I-EXPLORATION y I-EXPLORATION la I-EXPLORATION de I-EXPLORATION Medicina I-EXPLORATION Nuclear I-EXPLORATION (MN). I-EXPLORATION La I-EXPLORATION enfermera I-EXPLORATION de I-EXPLORATION DP I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION intercambio I-EXPLORATION manual I-EXPLORATION y I-EXPLORATION la I-EXPLORATION de I-EXPLORATION MN I-EXPLORATION dosificó I-EXPLORATION e I-EXPLORATION inyectó I-EXPLORATION el I-EXPLORATION radiofármaco I-EXPLORATION en I-EXPLORATION la I-EXPLORATION solución I-EXPLORATION de I-EXPLORATION diálisis, I-EXPLORATION según I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION administración I-EXPLORATION de I-EXPLORATION medicación I-EXPLORATION en I-EXPLORATION líquido I-EXPLORATION de I-EXPLORATION diálisis, I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION infundirlo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION peritoneal. I-EXPLORATION I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 10-15 I-EXPLORATION minutos I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION lectura I-EXPLORATION y I-EXPLORATION tras I-EXPLORATION 3-4 I-EXPLORATION horas I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION tardías. I-EXPLORATION Al B-TREATMENT finalizar, I-TREATMENT se I-TREATMENT realizó I-TREATMENT un I-TREATMENT nuevo I-TREATMENT intercambio I-TREATMENT manual I-TREATMENT para I-TREATMENT drenar I-TREATMENT completamente I-TREATMENT el I-TREATMENT abdomen, I-TREATMENT desechando I-TREATMENT el I-TREATMENT líquido I-TREATMENT drenado I-TREATMENT en I-TREATMENT el I-TREATMENT contenedor I-TREATMENT específico I-TREATMENT según I-TREATMENT protocolo I-TREATMENT de I-TREATMENT MN. I-TREATMENT El I-TREATMENT estudio I-TREATMENT fue I-TREATMENT indicativo I-TREATMENT de I-TREATMENT comunicación I-TREATMENT peritoneopleural, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT suspendió I-TREATMENT definitivamente I-TREATMENT la I-TREATMENT DP. I-TREATMENT Se I-TREATMENT transfirió I-TREATMENT a I-TREATMENT hemodialisis I-TREATMENT (HD), I-TREATMENT resolviendose I-TREATMENT el I-TREATMENT hidrotórax. I-TREATMENT Actualmente B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION esta I-EVOLUTION trasplantado. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 83 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY terminal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY etiología I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY filiada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY centro I-PAST_MEDICAL_HISTORY periférico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diálisis I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY Octubre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2004. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Antecedentes I-PAST_MEDICAL_HISTORY personales: I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY dislipemia, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus, I-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY reumatoide I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY larga I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY actual, I-PAST_MEDICAL_HISTORY osteoporosis I-PAST_MEDICAL_HISTORY severa I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fractura I-PAST_MEDICAL_HISTORY vertebral, I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardíaca I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY disfunción I-PAST_MEDICAL_HISTORY diastólica I-PAST_MEDICAL_HISTORY moderada/leve. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemodiálisis I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY le I-PAST_MEDICAL_HISTORY han I-PAST_MEDICAL_HISTORY realizado I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY fístulas I-PAST_MEDICAL_HISTORY arteriovenosas I-PAST_MEDICAL_HISTORY internas I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY pérdida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY función I-PAST_MEDICAL_HISTORY posterior, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY actualmente I-PAST_MEDICAL_HISTORY porta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY catéter I-PAST_MEDICAL_HISTORY venoso I-PAST_MEDICAL_HISTORY central I-PAST_MEDICAL_HISTORY tunelizado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY yugular I-PAST_MEDICAL_HISTORY interna I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY acceso I-PAST_MEDICAL_HISTORY vascular. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY hospitalarios. I-PAST_MEDICAL_HISTORY Durante I-PAST_MEDICAL_HISTORY este I-PAST_MEDICAL_HISTORY tiempo I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY modificado I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY pauta I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diálisis, I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sesiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 240 I-PAST_MEDICAL_HISTORY minutos I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY días/semana, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY dializador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY permeabilidad I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 2m2 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY superficie, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Qb I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 350 I-PAST_MEDICAL_HISTORY ml/min, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY ha I-PAST_MEDICAL_HISTORY conseguido I-PAST_MEDICAL_HISTORY mantener I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY estable I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY sesiones I-PAST_MEDICAL_HISTORY confortables I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY asintomáticas, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY adecuadas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY peso I-PAST_MEDICAL_HISTORY seco I-PAST_MEDICAL_HISTORY entre I-PAST_MEDICAL_HISTORY 42-43 I-PAST_MEDICAL_HISTORY Kg, I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY índice I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diálisis I-PAST_MEDICAL_HISTORY adecuada I-PAST_MEDICAL_HISTORY Kt/v I-PAST_MEDICAL_HISTORY >1.8. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Situación B-PRESENT_ILLNESS actual: I-PRESENT_ILLNESS I-PRESENT_ILLNESS Aproximadamente I-PRESENT_ILLNESS desde I-PRESENT_ILLNESS el I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS del I-PRESENT_ILLNESS verano, I-PRESENT_ILLNESS la I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS mala I-PRESENT_ILLNESS tolerancia I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ultrafiltración I-PRESENT_ILLNESS con I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS severos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipotensión I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS prácticamente I-PRESENT_ILLNESS en I-PRESENT_ILLNESS todas I-PRESENT_ILLNESS las I-PRESENT_ILLNESS sesiones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS diálisis, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS requirieron I-PRESENT_ILLNESS infusión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fluidos I-PRESENT_ILLNESS para I-PRESENT_ILLNESS su I-PRESENT_ILLNESS estabilización, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS reprogramación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS sesiones I-PRESENT_ILLNESS renunciando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS lograr I-PRESENT_ILLNESS el I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS seco I-PRESENT_ILLNESS al I-PRESENT_ILLNESS final I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS sesiones. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Por B-DERIVED_FROM/TO ello I-DERIVED_FROM/TO el I-DERIVED_FROM/TO día I-DERIVED_FROM/TO 8/08/16, I-DERIVED_FROM/TO es I-DERIVED_FROM/TO trasladada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO unidad I-DERIVED_FROM/TO hospitalaria I-DERIVED_FROM/TO de I-DERIVED_FROM/TO diálisis I-DERIVED_FROM/TO para I-DERIVED_FROM/TO mejor I-DERIVED_FROM/TO control I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO la I-DERIVED_FROM/TO hemodiálisis. I-DERIVED_FROM/TO I-DERIVED_FROM/TO A B-EXPLORATION su I-EXPLORATION llegada I-EXPLORATION a I-EXPLORATION la I-EXPLORATION unidad, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION presenta I-EXPLORATION signos I-EXPLORATION evidentes I-EXPLORATION de I-EXPLORATION sobrecarga I-EXPLORATION hídrica, I-EXPLORATION con I-EXPLORATION hipertensión I-EXPLORATION arterial I-EXPLORATION pre I-EXPLORATION hemodiálisis, I-EXPLORATION peso I-EXPLORATION prediálisis I-EXPLORATION de I-EXPLORATION 47.5 I-EXPLORATION Kg I-EXPLORATION que I-EXPLORATION indica I-EXPLORATION un I-EXPLORATION sobrepeso I-EXPLORATION de I-EXPLORATION 4.2 I-EXPLORATION Kg I-EXPLORATION sobre I-EXPLORATION su I-EXPLORATION peso I-EXPLORATION seco I-EXPLORATION anterior, I-EXPLORATION ortopnea, I-EXPLORATION y I-EXPLORATION edemas I-EXPLORATION muy I-EXPLORATION intensos I-EXPLORATION en I-EXPLORATION MMII. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION anamnesis I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION refiere I-EXPLORATION que I-EXPLORATION desde I-EXPLORATION que I-EXPLORATION empezó I-EXPLORATION el I-EXPLORATION calor I-EXPLORATION del I-EXPLORATION verano, I-EXPLORATION prácticamente I-EXPLORATION no I-EXPLORATION comía I-EXPLORATION nada, I-EXPLORATION y I-EXPLORATION destaca I-EXPLORATION en I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION albuminemia I-EXPLORATION 2.6 I-EXPLORATION g/dl I-EXPLORATION y I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION en I-EXPLORATION suero I-EXPLORATION 5.5 I-EXPLORATION g/dl, I-EXPLORATION motivo B-TREATMENT por I-TREATMENT el I-TREATMENT cual I-TREATMENT se I-TREATMENT le I-TREATMENT prescribió I-TREATMENT hace I-TREATMENT 10 I-TREATMENT días I-TREATMENT suplementación I-TREATMENT oral I-TREATMENT con I-TREATMENT Renilón7.5©, I-TREATMENT 1 I-TREATMENT frasco I-TREATMENT al I-TREATMENT día. I-TREATMENT I-TREATMENT Durante I-TREATMENT las I-TREATMENT dos I-TREATMENT primeras I-TREATMENT semanas I-TREATMENT de I-TREATMENT su I-TREATMENT estancia I-TREATMENT en I-TREATMENT la I-TREATMENT unidad I-TREATMENT hospitalaria, I-TREATMENT se I-TREATMENT intenta I-TREATMENT sin I-TREATMENT éxito I-TREATMENT conseguir I-TREATMENT el I-TREATMENT peso I-TREATMENT seco I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT al I-TREATMENT persistir I-TREATMENT los I-TREATMENT episodios I-TREATMENT de I-TREATMENT hipotensión I-TREATMENT intradiálisis. I-TREATMENT Incluso I-TREATMENT ganó I-TREATMENT 1 I-TREATMENT Kg I-TREATMENT en I-TREATMENT este I-TREATMENT periodo, I-TREATMENT a I-TREATMENT pesar I-TREATMENT de I-TREATMENT poner I-TREATMENT en I-TREATMENT práctica I-TREATMENT diferentes I-TREATMENT estrategias I-TREATMENT como I-TREATMENT limitar I-TREATMENT la I-TREATMENT ultrafiltración I-TREATMENT horaria I-TREATMENT a I-TREATMENT 300- I-TREATMENT 400 I-TREATMENT ml/h, I-TREATMENT haciendo I-TREATMENT diálisis I-TREATMENT secuencial I-TREATMENT prolongando I-TREATMENT las I-TREATMENT sesiones I-TREATMENT con I-TREATMENT tiempos I-TREATMENT de I-TREATMENT ultrafiltración I-TREATMENT aislada I-TREATMENT pre I-TREATMENT o I-TREATMENT post I-TREATMENT hemodiálisis, I-TREATMENT bajando I-TREATMENT la I-TREATMENT temperatura I-TREATMENT del I-TREATMENT baño I-TREATMENT a I-TREATMENT 35oC, I-TREATMENT y I-TREATMENT fijando I-TREATMENT la I-TREATMENT concentración I-TREATMENT de I-TREATMENT Na I-TREATMENT en I-TREATMENT el I-TREATMENT baño I-TREATMENT en I-TREATMENT 140 I-TREATMENT meq/l. I-TREATMENT I-TREATMENT Durante I-TREATMENT este I-TREATMENT tiempo, I-TREATMENT se I-TREATMENT revisa I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT retirándole I-TREATMENT toda I-TREATMENT la I-TREATMENT medicación I-TREATMENT hipotensora, I-TREATMENT se B-EXPLORATION realiza I-EXPLORATION ecocardiograma I-EXPLORATION descartando I-EXPLORATION agravamiento I-EXPLORATION de I-EXPLORATION su I-EXPLORATION insuficiencia I-EXPLORATION cardíaca, I-EXPLORATION y I-EXPLORATION al I-EXPLORATION persistir I-EXPLORATION los I-EXPLORATION intensos I-EXPLORATION edemas I-EXPLORATION en I-EXPLORATION MMII, I-EXPLORATION aparecen I-EXPLORATION heridas I-EXPLORATION ulcerosas I-EXPLORATION que B-TREATMENT requieren I-TREATMENT curas I-TREATMENT diarias I-TREATMENT según I-TREATMENT pauta I-TREATMENT descrita I-TREATMENT por I-TREATMENT cirugía I-TREATMENT plástica, I-TREATMENT y I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT IV I-TREATMENT (Vancomicina) I-TREATMENT por I-TREATMENT cultivo I-TREATMENT + I-TREATMENT a I-TREATMENT staphylococo I-TREATMENT epidermidis. I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT cuarta I-TREATMENT semana I-TREATMENT de I-TREATMENT tratamiento I-TREATMENT en I-TREATMENT la I-TREATMENT unidad, I-TREATMENT ante I-TREATMENT la I-TREATMENT intolerancia I-TREATMENT a I-TREATMENT la I-TREATMENT ultrafiltración, I-TREATMENT y I-TREATMENT para I-TREATMENT limitar I-TREATMENT en I-TREATMENT lo I-TREATMENT posible I-TREATMENT un I-TREATMENT sobrepeso I-TREATMENT excesivo I-TREATMENT entre I-TREATMENT sesiones, I-TREATMENT se I-TREATMENT pasa I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT a I-TREATMENT hemodiálisis I-TREATMENT diaria, I-TREATMENT prescribiéndose I-TREATMENT 6 I-TREATMENT sesiones I-TREATMENT semanales I-TREATMENT de I-TREATMENT 2.5 I-TREATMENT h, I-TREATMENT haciendo I-TREATMENT ultrafiltración I-TREATMENT aislada I-TREATMENT pre I-TREATMENT diálisis, I-TREATMENT y I-TREATMENT se I-TREATMENT cursa I-TREATMENT interconsulta I-TREATMENT a I-TREATMENT Endocrinología- I-TREATMENT Nutrición, I-TREATMENT para I-TREATMENT valorar I-TREATMENT la I-TREATMENT indicación I-TREATMENT de I-TREATMENT nutrición I-TREATMENT parenteral I-TREATMENT intradiálisis I-TREATMENT (NPID), I-TREATMENT ya I-TREATMENT que I-TREATMENT con I-TREATMENT los I-TREATMENT suplementos I-TREATMENT orales I-TREATMENT las I-TREATMENT cifras I-TREATMENT de I-TREATMENT albuminemia I-TREATMENT y I-TREATMENT proteínas I-TREATMENT totales I-TREATMENT en I-TREATMENT suero I-TREATMENT han I-TREATMENT bajado I-TREATMENT situándose I-TREATMENT en I-TREATMENT 2.4 I-TREATMENT g/dl I-TREATMENT y I-TREATMENT 5.3 I-TREATMENT g/dl I-TREATMENT respectivamente. I-TREATMENT I-TREATMENT Aunque I-TREATMENT en I-TREATMENT principio I-TREATMENT Endocrinología I-TREATMENT descartó I-TREATMENT la I-TREATMENT prescripción I-TREATMENT de I-TREATMENT nutrición I-TREATMENT parenteral, I-TREATMENT al I-TREATMENT considerar I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT tenía I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT alimentación I-TREATMENT por I-TREATMENT vía I-TREATMENT oral, I-TREATMENT y I-TREATMENT propuso I-TREATMENT su I-TREATMENT seguimiento I-TREATMENT en I-TREATMENT consulta I-TREATMENT de I-TREATMENT dietética I-TREATMENT manteniendo I-TREATMENT los I-TREATMENT suplementos I-TREATMENT que I-TREATMENT tenía I-TREATMENT prescritos, I-TREATMENT en I-TREATMENT la I-TREATMENT sexta I-TREATMENT semana I-TREATMENT tras I-TREATMENT valorar I-TREATMENT de I-TREATMENT nuevo I-TREATMENT a I-TREATMENT la I-TREATMENT paciente I-TREATMENT prescribieron I-TREATMENT NPID I-TREATMENT con I-TREATMENT bajo I-TREATMENT volumen I-TREATMENT (900 I-TREATMENT ml/sesión), I-TREATMENT al I-TREATMENT considerar I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT estaba I-TREATMENT en I-TREATMENT riesgo I-TREATMENT nutricional I-TREATMENT alto/intermedio, I-TREATMENT con I-TREATMENT mala I-TREATMENT respuesta I-TREATMENT al I-TREATMENT suplemento I-TREATMENT oral. I-TREATMENT I-TREATMENT A I-TREATMENT partir I-TREATMENT del I-TREATMENT inicio I-TREATMENT de I-TREATMENT la I-TREATMENT NPID, I-TREATMENT la I-TREATMENT cual I-TREATMENT es I-TREATMENT bien I-TREATMENT tolerada I-TREATMENT por I-TREATMENT la I-TREATMENT paciente I-TREATMENT sin I-TREATMENT requerimientos I-TREATMENT de I-TREATMENT insulina I-TREATMENT adicionales I-TREATMENT por I-TREATMENT hiperglucemias, I-TREATMENT la I-TREATMENT paciente I-TREATMENT presenta I-TREATMENT buena I-TREATMENT tolerancia I-TREATMENT a I-TREATMENT la I-TREATMENT ultrafiltración I-TREATMENT que I-TREATMENT nos I-TREATMENT permite I-TREATMENT aumentar I-TREATMENT el I-TREATMENT tiempo I-TREATMENT de I-TREATMENT las I-TREATMENT sesiones I-TREATMENT a I-TREATMENT 3 I-TREATMENT horas I-TREATMENT manteniendo I-TREATMENT las I-TREATMENT seis I-TREATMENT semanales, I-TREATMENT y I-TREATMENT se I-TREATMENT consigue I-TREATMENT bajar I-TREATMENT el I-TREATMENT peso I-TREATMENT seco I-TREATMENT (44.5 I-TREATMENT Kg), I-TREATMENT hasta I-TREATMENT niveles I-TREATMENT próximos I-TREATMENT al I-TREATMENT peso I-TREATMENT seco I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT tenía I-TREATMENT antes I-TREATMENT del I-TREATMENT traslado I-TREATMENT a I-TREATMENT la I-TREATMENT unidad I-TREATMENT hospitalaria I-TREATMENT (43.3 I-TREATMENT Kg). I-TREATMENT I-TREATMENT En I-TREATMENT la I-TREATMENT octava I-TREATMENT semana I-TREATMENT se I-TREATMENT revisa I-TREATMENT la I-TREATMENT prescripción I-TREATMENT de I-TREATMENT la I-TREATMENT NPID, I-TREATMENT bajando I-TREATMENT el I-TREATMENT volumen I-TREATMENT a I-TREATMENT infundir I-TREATMENT en I-TREATMENT cada I-TREATMENT sesión I-TREATMENT a I-TREATMENT 700 I-TREATMENT ml, I-TREATMENT los B-EVOLUTION edemas I-EVOLUTION en I-EVOLUTION MMII I-EVOLUTION persisten I-EVOLUTION aunque I-EVOLUTION son I-EVOLUTION casi I-EVOLUTION inapreciables I-EVOLUTION post I-EVOLUTION diálisis, I-EVOLUTION las I-EVOLUTION heridas I-EVOLUTION ulcerosas I-EVOLUTION están I-EVOLUTION prácticamente I-EVOLUTION cicatrizadas, I-EVOLUTION y I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION transcurren I-EVOLUTION sin I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION hipotensión. I-EVOLUTION Por B-TREATMENT tanto I-TREATMENT se I-TREATMENT decide I-TREATMENT reducir I-TREATMENT el I-TREATMENT número I-TREATMENT de I-TREATMENT sesiones I-TREATMENT semanales I-TREATMENT a I-TREATMENT cinco, I-TREATMENT y I-TREATMENT seguir I-TREATMENT bajando I-TREATMENT el I-TREATMENT peso I-TREATMENT seco I-TREATMENT paulatinamente I-TREATMENT hasta I-TREATMENT alcanzar I-TREATMENT los I-TREATMENT 42 I-TREATMENT Kg, I-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT consigue I-TREATMENT en I-TREATMENT la I-TREATMENT semana I-TREATMENT décima. I-TREATMENT I-TREATMENT A B-EVOLUTION partir I-EVOLUTION de I-EVOLUTION esta I-EVOLUTION semana, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ha I-EVOLUTION permanecido I-EVOLUTION estable I-EVOLUTION hemodinámicamente I-EVOLUTION durante I-EVOLUTION las I-EVOLUTION sesiones I-EVOLUTION de I-EVOLUTION hemodiálisis, I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION dificultades I-EVOLUTION para I-EVOLUTION la I-EVOLUTION ultrafiltración I-EVOLUTION ni I-EVOLUTION para I-EVOLUTION alcanzar I-EVOLUTION el I-EVOLUTION peso I-EVOLUTION seco I-EVOLUTION al I-EVOLUTION final I-EVOLUTION de I-EVOLUTION las I-EVOLUTION sesiones, I-EVOLUTION y B-TREATMENT se I-TREATMENT decide I-TREATMENT mantener I-TREATMENT la I-TREATMENT NPID I-TREATMENT hasta I-TREATMENT recuperación I-TREATMENT total I-TREATMENT de I-TREATMENT las I-TREATMENT cifras I-TREATMENT analíticas I-TREATMENT y I-TREATMENT hasta I-TREATMENT la I-TREATMENT cicatrización I-TREATMENT completa I-TREATMENT de I-TREATMENT las I-TREATMENT úlceras I-TREATMENT en I-TREATMENT MMII, I-TREATMENT y I-TREATMENT cuando I-TREATMENT la I-TREATMENT dieta I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT corrija I-TREATMENT para I-TREATMENT que I-TREATMENT tenga I-TREATMENT todos I-TREATMENT los I-TREATMENT aportes I-TREATMENT necesarios I-TREATMENT asegurados, I-TREATMENT e I-TREATMENT ir I-TREATMENT reduciendo I-TREATMENT paulatinamente I-TREATMENT los I-TREATMENT días I-TREATMENT de I-TREATMENT diálisis I-TREATMENT prescritos I-TREATMENT hasta I-TREATMENT llegar I-TREATMENT a I-TREATMENT su I-TREATMENT esquema I-TREATMENT original I-TREATMENT de I-TREATMENT tres I-TREATMENT días I-TREATMENT en I-TREATMENT semana. I-TREATMENT I-TREATMENT Presentamos B-PRESENT_ILLNESS un I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 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 diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Von I-PAST_MEDICAL_HISTORY Willebrand I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY ingresos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hemorragia I-PAST_MEDICAL_HISTORY digestiva I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY secundaria I-PAST_MEDICAL_HISTORY glomerulonefritis, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY programa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY DP I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2011. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tuvo I-PAST_MEDICAL_HISTORY cinco I-PAST_MEDICAL_HISTORY episodios I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY peritonitis, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY último I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY diciembre I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY 2015 I-PAST_MEDICAL_HISTORY recibiendo I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY vancomicina I-PAST_MEDICAL_HISTORY intraperitoneal, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY buena I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY peritonitis. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS último I-PRESENT_ILLNESS día I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS ictericia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS malestar I-PRESENT_ILLNESS general I-PRESENT_ILLNESS con I-PRESENT_ILLNESS elevación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS transaminasas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS bilirrubina. I-PRESENT_ILLNESS Tras B-TREATMENT la I-TREATMENT suspensión I-TREATMENT del I-TREATMENT fármaco I-TREATMENT hubo I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT y I-TREATMENT normalización I-TREATMENT de I-TREATMENT la I-TREATMENT analítica. I-TREATMENT I-TREATMENT En I-TREATMENT marzo I-TREATMENT del I-TREATMENT 2016, I-TREATMENT tuvo I-TREATMENT nuevo I-TREATMENT episodio I-TREATMENT de I-TREATMENT peritonitis, I-TREATMENT decidiéndose I-TREATMENT tratamiento I-TREATMENT empírico I-TREATMENT con I-TREATMENT teicoplanina I-TREATMENT y I-TREATMENT tobramicina. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION estar I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION consulta I-EVOLUTION por I-EVOLUTION malestar I-EVOLUTION generalizado, I-EVOLUTION vómitos, I-EVOLUTION diarrea, I-EVOLUTION fiebre I-EVOLUTION e I-EVOLUTION ictericia. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS crónica I-PRESENT_ILLNESS (ERC) I-PRESENT_ILLNESS estadio I-PRESENT_ILLNESS 5 I-PRESENT_ILLNESS atribuida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nefroangioes-clerosis, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY hiperparatiroidismo I-PAST_MEDICAL_HISTORY secundario, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY anémico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY leucemia I-PAST_MEDICAL_HISTORY linfática I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY B, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY eligió I-PAST_MEDICAL_HISTORY terapia I-PAST_MEDICAL_HISTORY sustitutiva I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY DP I-PAST_MEDICAL_HISTORY tras I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY proceso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY toma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY decisión. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Tiene I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY hijos I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY vive I-PAST_MEDICAL_HISTORY acompañada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dos, I-PAST_MEDICAL_HISTORY cuida I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY nietos, I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY sabe I-PAST_MEDICAL_HISTORY leer I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY escribir, I-PAST_MEDICAL_HISTORY pero I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY independiente I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY actividades I-PAST_MEDICAL_HISTORY diarias I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY instrumentales: I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY (Enero I-PAST_MEDICAL_HISTORY 2014) I-PAST_MEDICAL_HISTORY = I-PAST_MEDICAL_HISTORY Barthel I-PAST_MEDICAL_HISTORY 100%, I-PAST_MEDICAL_HISTORY Lawton-Brody I-PAST_MEDICAL_HISTORY 8/8, I-PAST_MEDICAL_HISTORY Calidad I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY (sf-12): I-PAST_MEDICAL_HISTORY PCS I-PAST_MEDICAL_HISTORY 50.6, I-PAST_MEDICAL_HISTORY MCS I-PAST_MEDICAL_HISTORY 59, I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY 10/04/2013 B-TREATMENT se I-TREATMENT colocó I-TREATMENT catéter I-TREATMENT peritoneal I-TREATMENT e I-TREATMENT inició I-TREATMENT DPCA I-TREATMENT en I-TREATMENT domicilio I-TREATMENT el I-TREATMENT 22/5/2013, I-TREATMENT siendo I-TREATMENT la I-TREATMENT propia I-TREATMENT paciente I-TREATMENT la I-TREATMENT cuidadora I-TREATMENT principal. I-TREATMENT I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT DPCA I-TREATMENT inicial I-TREATMENT fue I-TREATMENT de: I-TREATMENT 3 I-TREATMENT intercambios/ I-TREATMENT día I-TREATMENT (2 I-TREATMENT con I-TREATMENT Phisioneal I-TREATMENT 35 I-TREATMENT 1, I-TREATMENT 36% I-TREATMENT de I-TREATMENT glucosa I-TREATMENT y I-TREATMENT 1 I-TREATMENT con I-TREATMENT Extraneal, I-TREATMENT con I-TREATMENT volúmenes I-TREATMENT de I-TREATMENT 2000 I-TREATMENT ml). I-TREATMENT Diariamente I-TREATMENT ultrafiltraba I-TREATMENT 500 I-TREATMENT ml I-TREATMENT con I-TREATMENT los I-TREATMENT intercambios I-TREATMENT y I-TREATMENT mantenía I-TREATMENT un I-TREATMENT volumen I-TREATMENT de I-TREATMENT diuresis I-TREATMENT de I-TREATMENT 1500 I-TREATMENT ml. I-TREATMENT El B-EXPLORATION resultado I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION peritoneal I-EXPLORATION antes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ultima I-EXPLORATION peritonitis I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION membrana I-EXPLORATION peritoneal I-EXPLORATION HA I-EXPLORATION (transportador I-EXPLORATION medio I-EXPLORATION alto). I-EXPLORATION I-EXPLORATION En B-EVOLUTION 8 I-EVOLUTION meses I-EVOLUTION presentó I-EVOLUTION 4 I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION peritonitis, I-EVOLUTION de I-EVOLUTION los I-EVOLUTION cuales I-EVOLUTION 3 I-EVOLUTION fueron I-EVOLUTION recidivante, I-EVOLUTION con I-EVOLUTION cultivo I-EVOLUTION positivo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION bacteria I-EVOLUTION (Staphylococcus I-EVOLUTION epidermidis). I-EVOLUTION I-EVOLUTION Se B-TREATMENT administró I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT protocolizado: I-TREATMENT Vancomicina I-TREATMENT 1gr/72h I-TREATMENT intraperitoneal I-TREATMENT (IP) I-TREATMENT durante I-TREATMENT 15 I-TREATMENT días I-TREATMENT y I-TREATMENT Fluconazol I-TREATMENT via I-TREATMENT oral I-TREATMENT (vo) I-TREATMENT durante I-TREATMENT 21 I-TREATMENT días. I-TREATMENT Tras I-TREATMENT la I-TREATMENT resolución I-TREATMENT de I-TREATMENT la I-TREATMENT ultima I-TREATMENT infección I-TREATMENT peritoneal I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar, I-TREATMENT además, I-TREATMENT sellados I-TREATMENT del I-TREATMENT catéter I-TREATMENT con I-TREATMENT Daptomicina I-TREATMENT (35 I-TREATMENT mg I-TREATMENT en I-TREATMENT 7, I-TREATMENT 2 I-TREATMENT ml I-TREATMENT de I-TREATMENT ringer/24h I-TREATMENT después I-TREATMENT del I-TREATMENT último I-TREATMENT intercambio I-TREATMENT del I-TREATMENT día) I-TREATMENT medicación I-TREATMENT que I-TREATMENT se I-TREATMENT preparaba I-TREATMENT en I-TREATMENT el I-TREATMENT hospital, I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT recogía I-TREATMENT semanalmente I-TREATMENT y I-TREATMENT se I-TREATMENT auto I-TREATMENT administraba I-TREATMENT después I-TREATMENT del I-TREATMENT último I-TREATMENT intercambio I-TREATMENT del I-TREATMENT día I-TREATMENT en I-TREATMENT el I-TREATMENT domicilio. I-TREATMENT I-TREATMENT Episodio B-EVOLUTION de I-EVOLUTION peritonitis I-EVOLUTION fúngica: I-EVOLUTION I-EVOLUTION Durante I-EVOLUTION el I-EVOLUTION periodo I-EVOLUTION de I-EVOLUTION sellado I-EVOLUTION (14/8/2014) I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION avisa I-EVOLUTION al I-EVOLUTION teléfono I-EVOLUTION de I-EVOLUTION urgencias, I-EVOLUTION por I-EVOLUTION líquido I-EVOLUTION turbio, I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION y I-EVOLUTION malestar I-EVOLUTION general. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION líquido I-EXPLORATION peritoneal I-EXPLORATION protocolizado I-EXPLORATION y I-EXPLORATION quedó I-EXPLORATION ingresada I-EXPLORATION en I-EXPLORATION espera I-EXPLORATION de I-EXPLORATION resultados. I-EXPLORATION Tras B-TREATMENT el I-TREATMENT resultado I-TREATMENT del I-TREATMENT recuento I-TREATMENT celular, I-TREATMENT se I-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT empírico I-TREATMENT con I-TREATMENT Vancomicina I-TREATMENT 1gr/72h I-TREATMENT y I-TREATMENT Ceftazidima I-TREATMENT 1gr/24h I-TREATMENT IP. I-TREATMENT El B-EXPLORATION cultivo I-EXPLORATION mostró I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION BGN I-EXPLORATION (Klebsiella I-EXPLORATION oxytoca I-EXPLORATION y I-EXPLORATION Acinetobacter I-EXPLORATION sp I-EXPLORATION multisensible), I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT Ceftazidima I-TREATMENT 1gr/24h/IP, I-TREATMENT añadiéndose I-TREATMENT Gentamicina I-TREATMENT 40mgr/24h/IP I-TREATMENT y I-TREATMENT Ciprofloxacino I-TREATMENT 500 I-TREATMENT mg/12h I-TREATMENT vo. I-TREATMENT I-TREATMENT Ante B-EVOLUTION la I-EVOLUTION mejoría I-EVOLUTION clínica I-EVOLUTION (efluente I-EVOLUTION claro I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION problemas I-EVOLUTION de I-EVOLUTION drenaje) I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION domicilio. I-EVOLUTION Se B-TREATMENT realizó I-TREATMENT reentrenamiento I-TREATMENT de I-TREATMENT la I-TREATMENT técnica I-TREATMENT y I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT medicación I-TREATMENT antibiótica I-TREATMENT domiciliaria I-TREATMENT (tratamiento I-TREATMENT IP I-TREATMENT durante I-TREATMENT 21 I-TREATMENT días). I-TREATMENT I-TREATMENT A B-EVOLUTION los I-EVOLUTION ocho I-EVOLUTION días, I-EVOLUTION acude I-EVOLUTION nuevamente I-EVOLUTION a I-EVOLUTION urgencias I-EVOLUTION por I-EVOLUTION líquido I-EVOLUTION turbio, I-EVOLUTION apareciendo B-EXPLORATION en I-EXPLORATION el I-EXPLORATION cultivo I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION patógeno I-EXPLORATION (Cándida I-EXPLORATION parapsilosis) I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT añadió I-TREATMENT al I-TREATMENT tratamiento I-TREATMENT Fluconazol I-TREATMENT 200 I-TREATMENT mg I-TREATMENT vo/24h, I-TREATMENT y I-TREATMENT quedó I-TREATMENT nuevamente I-TREATMENT ingresada. I-TREATMENT I-TREATMENT Debido B-EVOLUTION a I-EVOLUTION la I-EVOLUTION mala I-EVOLUTION respuesta I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION se B-TREATMENT decidió I-TREATMENT retirar I-TREATMENT el I-TREATMENT catéter I-TREATMENT Tenckoff, I-TREATMENT como I-TREATMENT recomienda I-TREATMENT el I-TREATMENT protocolo, I-TREATMENT y I-TREATMENT transferirla I-TREATMENT a I-TREATMENT Hemodiálisis I-TREATMENT definitivamente. I-TREATMENT I-TREATMENT Se I-TREATMENT le I-TREATMENT coloco I-TREATMENT un I-TREATMENT catéter I-TREATMENT venoso I-TREATMENT bilumen I-TREATMENT (yugular I-TREATMENT derecho) I-TREATMENT provisional, I-TREATMENT en I-TREATMENT espera I-TREATMENT de I-TREATMENT programar I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT de I-TREATMENT fístula I-TREATMENT arterio-venosa I-TREATMENT interna I-TREATMENT en I-TREATMENT codo I-TREATMENT derecho I-TREATMENT (5/09/2014). I-TREATMENT I-TREATMENT Cinco B-EVOLUTION días I-EVOLUTION después, I-EVOLUTION se I-EVOLUTION recambió I-EVOLUTION el I-EVOLUTION catéter I-EVOLUTION venoso I-EVOLUTION por I-EVOLUTION disfunción I-EVOLUTION y I-EVOLUTION se I-EVOLUTION visualizó I-EVOLUTION mediante I-EVOLUTION angio I-EVOLUTION TAC, I-EVOLUTION importante I-EVOLUTION trombo I-EVOLUTION en I-EVOLUTION vena I-EVOLUTION yugular I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT precisó I-TREATMENT cirugía, I-TREATMENT ingreso I-TREATMENT en I-TREATMENT cuidados I-TREATMENT intensivos I-TREATMENT y I-TREATMENT colocación I-TREATMENT de I-TREATMENT un I-TREATMENT nuevo I-TREATMENT catéter I-TREATMENT (ubicación I-TREATMENT femoral). I-TREATMENT Este B-EVOLUTION nuevo I-EVOLUTION catéter, I-EVOLUTION también, I-EVOLUTION presentó I-EVOLUTION trombosis I-EVOLUTION venosa I-EVOLUTION no I-EVOLUTION oclusiva, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT precisó I-TREATMENT anticoagulación I-TREATMENT y I-TREATMENT retirada I-TREATMENT en I-TREATMENT 2-3 I-TREATMENT semanas. I-TREATMENT I-TREATMENT A B-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION la I-EVOLUTION utilización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION fistula I-EVOLUTION arterio-venosa I-EVOLUTION interna I-EVOLUTION al I-EVOLUTION mes I-EVOLUTION de I-EVOLUTION su I-EVOLUTION intervención, I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION mala I-EVOLUTION adaptación I-EVOLUTION al I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION HD I-EVOLUTION por I-EVOLUTION continuas I-EVOLUTION hipotensiones, I-EVOLUTION dificultad I-EVOLUTION en I-EVOLUTION la I-EVOLUTION canalización I-EVOLUTION venosa I-EVOLUTION y I-EVOLUTION dolor I-EVOLUTION de I-EVOLUTION la I-EVOLUTION extremidad I-EVOLUTION por I-EVOLUTION síndrome I-EVOLUTION de I-EVOLUTION "robo". I-EVOLUTION I-EVOLUTION La I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION de I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION había I-EVOLUTION empeorado I-EVOLUTION notablemente, I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION ingreso I-EVOLUTION de I-EVOLUTION 74 I-EVOLUTION días I-EVOLUTION y I-EVOLUTION el I-EVOLUTION traspaso I-EVOLUTION a I-EVOLUTION hemodiálisis: I-EVOLUTION I-EVOLUTION (Octubre I-EVOLUTION 2014) I-EVOLUTION = I-EVOLUTION Barthel I-EVOLUTION 95%, I-EVOLUTION Lawton-Brody I-EVOLUTION 6/8, I-EVOLUTION Calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION (sf-12): I-EVOLUTION PCS I-EVOLUTION 20, I-EVOLUTION 1, I-EVOLUTION MCS I-EVOLUTION 40, I-EVOLUTION 3 I-EVOLUTION I-EVOLUTION Debido I-EVOLUTION a I-EVOLUTION las I-EVOLUTION complicaciones, I-EVOLUTION la I-EVOLUTION mala I-EVOLUTION adaptación I-EVOLUTION a I-EVOLUTION HD I-EVOLUTION y B-TREATMENT por I-TREATMENT petición I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT se I-TREATMENT replanteó I-TREATMENT volver I-TREATMENT a I-TREATMENT DP I-TREATMENT con I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT de I-TREATMENT cicladora I-TREATMENT nocturna. I-TREATMENT I-TREATMENT Regreso I-TREATMENT a I-TREATMENT Dialisis I-TREATMENT Peritoneal: I-TREATMENT I-TREATMENT Así I-TREATMENT pues, I-TREATMENT el I-TREATMENT 19/12/14 I-TREATMENT se I-TREATMENT colocó I-TREATMENT catéter I-TREATMENT Tenckoff I-TREATMENT (vía I-TREATMENT laparoscopia I-TREATMENT para I-TREATMENT poder I-TREATMENT valorar I-TREATMENT las I-TREATMENT posibles I-TREATMENT adherencias, I-TREATMENT que I-TREATMENT pueden I-TREATMENT aparecer I-TREATMENT tras I-TREATMENT la I-TREATMENT peritonitis I-TREATMENT fúngicas) I-TREATMENT y I-TREATMENT como I-TREATMENT no I-TREATMENT hubieron I-TREATMENT problemas, I-TREATMENT en I-TREATMENT 1 I-TREATMENT mes I-TREATMENT la I-TREATMENT paciente I-TREATMENT reinició I-TREATMENT terapia I-TREATMENT domiciliaria I-TREATMENT de I-TREATMENT diálisis I-TREATMENT peritoneal I-TREATMENT automática I-TREATMENT (DPA). I-TREATMENT Como I-TREATMENT cuidador I-TREATMENT principal I-TREATMENT quedó I-TREATMENT la I-TREATMENT hija I-TREATMENT menor I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT que I-TREATMENT aunque I-TREATMENT no I-TREATMENT vive I-TREATMENT con I-TREATMENT ella I-TREATMENT realizaba I-TREATMENT el I-TREATMENT montaje I-TREATMENT y I-TREATMENT conexión I-TREATMENT desplazándose I-TREATMENT al I-TREATMENT domicilio I-TREATMENT diariamente. I-TREATMENT La I-TREATMENT desconexión, I-TREATMENT solución I-TREATMENT de I-TREATMENT alarmas I-TREATMENT nocturnas I-TREATMENT y I-TREATMENT desmontaje I-TREATMENT de I-TREATMENT la I-TREATMENT maquina, I-TREATMENT lo I-TREATMENT realiza I-TREATMENT la I-TREATMENT paciente I-TREATMENT sin I-TREATMENT supervisión. I-TREATMENT I-TREATMENT El I-TREATMENT tratamiento I-TREATMENT pautado I-TREATMENT con I-TREATMENT cicladora I-TREATMENT fue I-TREATMENT de: I-TREATMENT 8 I-TREATMENT horas, I-TREATMENT 4 I-TREATMENT ciclos I-TREATMENT de I-TREATMENT 2000 I-TREATMENT ml I-TREATMENT (Phisioneal I-TREATMENT 35 I-TREATMENT 1, I-TREATMENT 36%), I-TREATMENT 80 I-TREATMENT minutos I-TREATMENT de I-TREATMENT permanencia I-TREATMENT y I-TREATMENT día I-TREATMENT seco. I-TREATMENT I-TREATMENT Diariamente B-EVOLUTION tiene I-EVOLUTION una I-EVOLUTION ultrafiltrafiltración I-EVOLUTION con I-EVOLUTION el I-EVOLUTION tratamiento I-EVOLUTION de I-EVOLUTION 400-500 I-EVOLUTION ml I-EVOLUTION y I-EVOLUTION mantiene I-EVOLUTION un I-EVOLUTION volumen I-EVOLUTION de I-EVOLUTION diuresis I-EVOLUTION de I-EVOLUTION 1500 I-EVOLUTION ml. I-EVOLUTION El I-EVOLUTION test I-EVOLUTION de I-EVOLUTION equilibrio I-EVOLUTION peritoneal I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION igual I-EVOLUTION que I-EVOLUTION al I-EVOLUTION inicio. I-EVOLUTION I-EVOLUTION Actualmente I-EVOLUTION lleva I-EVOLUTION > I-EVOLUTION de I-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION sin I-EVOLUTION ningún I-EVOLUTION tipo I-EVOLUTION de I-EVOLUTION problema, I-EVOLUTION recuperando I-EVOLUTION prácticamente I-EVOLUTION la I-EVOLUTION autonomía I-EVOLUTION y I-EVOLUTION calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION del I-EVOLUTION inicio: I-EVOLUTION I-EVOLUTION (Septiembre I-EVOLUTION 2015) I-EVOLUTION = I-EVOLUTION Barthel I-EVOLUTION 100%, I-EVOLUTION Lawton-Brody I-EVOLUTION 8/8, I-EVOLUTION Calidad I-EVOLUTION de I-EVOLUTION vida I-EVOLUTION (sf-12): I-EVOLUTION PCS I-EVOLUTION 43, I-EVOLUTION 6, I-EVOLUTION MCS I-EVOLUTION 51, I-EVOLUTION 5 I-EVOLUTION I-EVOLUTION Las B-TREATMENT guías I-TREATMENT SEN I-TREATMENT recomiendan I-TREATMENT realizar I-TREATMENT reentrenamiento I-TREATMENT después I-TREATMENT de I-TREATMENT cada I-TREATMENT episodio I-TREATMENT de I-TREATMENT peritonitis. I-TREATMENT El I-TREATMENT objetivo I-TREATMENT es I-TREATMENT buscar I-TREATMENT causas I-TREATMENT posibles, I-TREATMENT evaluar I-TREATMENT la I-TREATMENT capacitación I-TREATMENT del I-TREATMENT responsable I-TREATMENT y I-TREATMENT rectificar I-TREATMENT aquellos I-TREATMENT procedimientos I-TREATMENT erróneos. I-TREATMENT Esta I-TREATMENT metodología I-TREATMENT nos I-TREATMENT ayuda I-TREATMENT a I-TREATMENT revelar I-TREATMENT la I-TREATMENT posible I-TREATMENT causa I-TREATMENT de I-TREATMENT la I-TREATMENT infección. I-TREATMENT En I-TREATMENT nuestro I-TREATMENT caso, I-TREATMENT el I-TREATMENT resultado I-TREATMENT indicó I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT no I-TREATMENT había I-TREATMENT seguido I-TREATMENT las I-TREATMENT medidas I-TREATMENT de I-TREATMENT asepsia I-TREATMENT recomendadas I-TREATMENT en I-TREATMENT la I-TREATMENT manipulación I-TREATMENT del I-TREATMENT antibiótico I-TREATMENT para I-TREATMENT el I-TREATMENT sellado. I-TREATMENT I-TREATMENT Con I-TREATMENT el I-TREATMENT primer I-TREATMENT resultado I-TREATMENT del I-TREATMENT cultivo I-TREATMENT del I-TREATMENT líquido I-TREATMENT peritoneal I-TREATMENT se I-TREATMENT diagnosticó I-TREATMENT la I-TREATMENT peritonitis I-TREATMENT bacteriana, I-TREATMENT pero I-TREATMENT acabo I-TREATMENT añadiendose, I-TREATMENT también, I-TREATMENT una I-TREATMENT peritonitis I-TREATMENT fúngica. I-TREATMENT Así I-TREATMENT pues, I-TREATMENT la I-TREATMENT infección I-TREATMENT fúngica I-TREATMENT condicionó I-TREATMENT la I-TREATMENT retirada I-TREATMENT del I-TREATMENT catéter I-TREATMENT peritoneal I-TREATMENT y I-TREATMENT el I-TREATMENT abandono I-TREATMENT del I-TREATMENT programa I-TREATMENT de I-TREATMENT diálisis I-TREATMENT peritoneal. I-TREATMENT El I-TREATMENT equipo I-TREATMENT multidisciplinar I-TREATMENT tomó I-TREATMENT la I-TREATMENT decisión I-TREATMENT de I-TREATMENT transferirla I-TREATMENT a I-TREATMENT HD I-TREATMENT definitivamente I-TREATMENT tras I-TREATMENT el I-TREATMENT diagnostico I-TREATMENT de I-TREATMENT peritonitis I-TREATMENT fúngica. I-TREATMENT I-TREATMENT Muchos I-TREATMENT autores I-TREATMENT describen I-TREATMENT que I-TREATMENT la I-TREATMENT supervivencia I-TREATMENT de I-TREATMENT la I-TREATMENT técnica I-TREATMENT tras I-TREATMENT una I-TREATMENT peritonitis I-TREATMENT fúngica I-TREATMENT por I-TREATMENT Candidas I-TREATMENT no I-TREATMENT Albicans I-TREATMENT es I-TREATMENT muy I-TREATMENT baja, I-TREATMENT y I-TREATMENT además I-TREATMENT existen I-TREATMENT pocos I-TREATMENT pacientes I-TREATMENT que I-TREATMENT pueden I-TREATMENT retornar I-TREATMENT de I-TREATMENT nuevo I-TREATMENT a I-TREATMENT la I-TREATMENT terapia I-TREATMENT de I-TREATMENT DP I-TREATMENT tras I-TREATMENT el I-TREATMENT suceso, I-TREATMENT así I-TREATMENT lo I-TREATMENT describen I-TREATMENT García-Martos1, I-TREATMENT 2 I-TREATMENT y I-TREATMENT Molina3 I-TREATMENT en I-TREATMENT sus I-TREATMENT estudios. I-TREATMENT I-TREATMENT Las I-TREATMENT causas I-TREATMENT de I-TREATMENT que I-TREATMENT nos I-TREATMENT planteáramos I-TREATMENT que I-TREATMENT la I-TREATMENT paciente I-TREATMENT volviera I-TREATMENT a I-TREATMENT DP, I-TREATMENT fueron: I-TREATMENT la I-TREATMENT mala I-TREATMENT adaptación I-TREATMENT a I-TREATMENT la I-TREATMENT HD, I-TREATMENT las I-TREATMENT complicaciones I-TREATMENT surgidas I-TREATMENT durante I-TREATMENT el I-TREATMENT traspaso I-TREATMENT a I-TREATMENT hemodiálisis I-TREATMENT y I-TREATMENT la I-TREATMENT petición I-TREATMENT de I-TREATMENT la I-TREATMENT propia I-TREATMENT paciente. I-TREATMENT También I-TREATMENT se I-TREATMENT tuvo I-TREATMENT en I-TREATMENT cuenta I-TREATMENT la I-TREATMENT recomendación I-TREATMENT de I-TREATMENT las I-TREATMENT guías I-TREATMENT sobre I-TREATMENT la I-TREATMENT posibilidad I-TREATMENT de I-TREATMENT reinserción I-TREATMENT de I-TREATMENT un I-TREATMENT nuevo I-TREATMENT catéter I-TREATMENT peritoneal I-TREATMENT a I-TREATMENT las I-TREATMENT 4-6 I-TREATMENT semanas I-TREATMENT de I-TREATMENT la I-TREATMENT resolución I-TREATMENT del I-TREATMENT cuadro I-TREATMENT clínico. I-TREATMENT I-TREATMENT Una I-TREATMENT vez I-TREATMENT tomada I-TREATMENT la I-TREATMENT decisión I-TREATMENT de I-TREATMENT regresar I-TREATMENT al I-TREATMENT programa I-TREATMENT de I-TREATMENT DP, I-TREATMENT estaba I-TREATMENT claro I-TREATMENT que I-TREATMENT era I-TREATMENT necesario I-TREATMENT un I-TREATMENT cambio I-TREATMENT de I-TREATMENT estrategia, I-TREATMENT de I-TREATMENT manera I-TREATMENT que I-TREATMENT se I-TREATMENT propuso I-TREATMENT iniciar I-TREATMENT en I-TREATMENT forma I-TREATMENT de I-TREATMENT cicladora I-TREATMENT automática, I-TREATMENT con I-TREATMENT la I-TREATMENT finalidad I-TREATMENT de I-TREATMENT disminuir I-TREATMENT el I-TREATMENT número I-TREATMENT de I-TREATMENT manipulaciones I-TREATMENT del I-TREATMENT paciente/familia I-TREATMENT con I-TREATMENT el I-TREATMENT catéter. I-TREATMENT Pero I-TREATMENT también, I-TREATMENT era I-TREATMENT imprescindible I-TREATMENT evitar I-TREATMENT nuevos I-TREATMENT episodios I-TREATMENT de I-TREATMENT infección, I-TREATMENT por I-TREATMENT eso, I-TREATMENT se I-TREATMENT pensó I-TREATMENT en I-TREATMENT buscar I-TREATMENT un I-TREATMENT nuevo I-TREATMENT responsable I-TREATMENT para I-TREATMENT realizar I-TREATMENT la I-TREATMENT técnica I-TREATMENT y I-TREATMENT todo I-TREATMENT ello I-TREATMENT nos I-TREATMENT condujo I-TREATMENT a I-TREATMENT reiniciar I-TREATMENT el I-TREATMENT proceso I-TREATMENT de I-TREATMENT entrenamiento I-TREATMENT con I-TREATMENT la I-TREATMENT hija I-TREATMENT y I-TREATMENT puesta I-TREATMENT en I-TREATMENT marcha I-TREATMENT de I-TREATMENT la I-TREATMENT técnica I-TREATMENT en I-TREATMENT casa. I-TREATMENT I-TREATMENT