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