diff --git "a/data/test.conll" "b/data/test.conll" --- "a/data/test.conll" +++ "b/data/test.conll" @@ -1,3 +1,16072 @@ +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 +asma I-PAST_MEDICAL_HISTORY +bronquial, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +hipertrofia I-PAST_MEDICAL_HISTORY +miocárdica I-PAST_MEDICAL_HISTORY +septal, I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +data. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +pesquisa I-PRESENT_ILLNESS +facies I-PRESENT_ILLNESS +acromegaloide, I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +anchas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dedos I-PRESENT_ILLNESS +gruesos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pies I-PRESENT_ILLNESS +grandes. I-PRESENT_ILLNESS +Se B-EXPLORATION +solicitó I-EXPLORATION +GH I-EXPLORATION +basal I-EXPLORATION +que I-EXPLORATION +estaba I-EXPLORATION +elevada: I-EXPLORATION +2, I-EXPLORATION +8 I-EXPLORATION +y I-EXPLORATION +1, I-EXPLORATION +6 I-EXPLORATION +ng/ml. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +medición I-EXPLORATION +postcarga I-EXPLORATION +de I-EXPLORATION +75 I-EXPLORATION +g I-EXPLORATION +de I-EXPLORATION +glucosa, I-EXPLORATION +observándose I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +60 I-EXPLORATION +min I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +GH I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +suprimió: I-EXPLORATION +2, I-EXPLORATION +3 I-EXPLORATION +ng/ml I-EXPLORATION +con I-EXPLORATION +glicemia I-EXPLORATION +de I-EXPLORATION +166 I-EXPLORATION +mg/dl. I-EXPLORATION +Hormonas I-EXPLORATION +tiroideas I-EXPLORATION +bajo I-EXPLORATION +terapia I-EXPLORATION +de I-EXPLORATION +sustitución I-EXPLORATION +con I-EXPLORATION +levotiroxina I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal I-EXPLORATION +(T4L: I-EXPLORATION +1, I-EXPLORATION +49 I-EXPLORATION +ng/dl, I-EXPLORATION +TSH: I-EXPLORATION +1, I-EXPLORATION +45 I-EXPLORATION +mUI/L) I-EXPLORATION +y I-EXPLORATION +prolactina I-EXPLORATION +(PRL): I-EXPLORATION +22, I-EXPLORATION +9 I-EXPLORATION +ng/ml. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +silla I-EXPLORATION +turca I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +adenoma I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mm I-EXPLORATION +lateralizado I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +desviación I-EXPLORATION +del I-EXPLORATION +tallo I-EXPLORATION +a I-EXPLORATION +derecha. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +rechazó I-TREATMENT +tratamiento I-TREATMENT +quirúrgico. I-TREATMENT +Tres B-EXPLORATION +años I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +nueva I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +silla I-EXPLORATION +turca I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +adenoma I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mm I-EXPLORATION +que I-EXPLORATION +deformaba I-EXPLORATION +el I-EXPLORATION +diafragma I-EXPLORATION +selar I-EXPLORATION +y I-EXPLORATION +provocaba I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +hundimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +silla I-EXPLORATION +turca, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +intratumoral. I-EXPLORATION +En I-EXPLORATION +ese I-EXPLORATION +momento, I-EXPLORATION +el I-EXPLORATION +IGF I-EXPLORATION +1 I-EXPLORATION +(factor I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +insulino-simil I-EXPLORATION +1) I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal I-EXPLORATION +bajo I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad: I-EXPLORATION +64, I-EXPLORATION +1 I-EXPLORATION +ng/ml I-EXPLORATION +(64-188 I-EXPLORATION +ng/ml). I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +siete I-EXPLORATION +años I-EXPLORATION +de I-EXPLORATION +seguimiento, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +nueva I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +GH I-EXPLORATION +postcarga I-EXPLORATION +de I-EXPLORATION +glucosa, I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +60 I-EXPLORATION +min I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +ng/ml I-EXPLORATION +con I-EXPLORATION +glicemia I-EXPLORATION +de I-EXPLORATION +174 I-EXPLORATION +mg/dl. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +nueve I-EXPLORATION +años I-EXPLORATION +se I-EXPLORATION +reevaluó I-EXPLORATION +con I-EXPLORATION +resonancia I-EXPLORATION +nuclear I-EXPLORATION +magnética I-EXPLORATION +(RM), I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +adenoma I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mm, I-EXPLORATION +lateralizado I-EXPLORATION +a I-EXPLORATION +izquierda, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +y I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +IGF1 I-EXPLORATION +bajo I-EXPLORATION +el I-EXPLORATION +rango I-EXPLORATION +normal: I-EXPLORATION +48, I-EXPLORATION +1 I-EXPLORATION +ng/ml I-EXPLORATION +(55-166 I-EXPLORATION +ng/ml). I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +depresión, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hemorragia I-PRESENT_ILLNESS +digestiva I-PRESENT_ILLNESS +alta I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +mL I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +paraquat I-PRESENT_ILLNESS +(138 I-PRESENT_ILLNESS +mg/kg) I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +intención I-PRESENT_ILLNESS +suicida. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Ingresó B-EXPLORATION +consciente, I-EXPLORATION +Glasgow I-EXPLORATION +15, I-EXPLORATION +con I-EXPLORATION +hemodinamia I-EXPLORATION +estable I-EXPLORATION +y I-EXPLORATION +afebril. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaban I-EXPLORATION +úlceras I-EXPLORATION +orales I-EXPLORATION +y I-EXPLORATION +faríngeas. I-EXPLORATION +En I-EXPLORATION +su I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +injuria I-EXPLORATION +renal I-EXPLORATION +aguda I-EXPLORATION +(creatinina: I-EXPLORATION +9, I-EXPLORATION +58 I-EXPLORATION +mg/dL, I-EXPLORATION +BUN: I-EXPLORATION +95 I-EXPLORATION +mg/dL) I-EXPLORATION +y I-EXPLORATION +hepática I-EXPLORATION +(bilirrubina I-EXPLORATION +total: I-EXPLORATION +6, I-EXPLORATION +3 I-EXPLORATION +mg/dL, I-EXPLORATION +GOT: I-EXPLORATION +140 I-EXPLORATION +U/L, I-EXPLORATION +GPT I-EXPLORATION +331 I-EXPLORATION +U/L). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +mostró I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +condensación I-EXPLORATION +pulmonar I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +neumonía I-EXPLORATION +basal I-EXPLORATION +izquierda, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +perforación I-EXPLORATION +esofágica. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +hidratación I-TREATMENT +parenteral, I-TREATMENT +hemodiálisis, I-TREATMENT +antibióticos I-TREATMENT +empíricos I-TREATMENT +(ceftriaxona) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +ingresó I-TREATMENT +a I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +cuidados I-TREATMENT +intensivos. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +endoscopía I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +diferida I-EXPLORATION +(día I-EXPLORATION +4 I-EXPLORATION +de I-EXPLORATION +hospitalización) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +panesofagitis I-EXPLORATION +cáustica I-EXPLORATION +grado I-EXPLORATION +2. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +estable I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización, I-EVOLUTION +presentando I-EVOLUTION +insuficiencia I-EVOLUTION +respiratoria I-EVOLUTION +grave I-EVOLUTION +rápidamente I-EVOLUTION +progresiva I-EVOLUTION +con I-EVOLUTION +imágenes I-EVOLUTION +compatibles I-EVOLUTION +con I-EVOLUTION +fibrosis I-EVOLUTION +pulmonar I-EVOLUTION +aguda. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +inmunosupresora I-TREATMENT +con I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +metilprednisolona I-TREATMENT +1 I-TREATMENT +g/día I-TREATMENT +por I-TREATMENT +3 I-TREATMENT +días, I-TREATMENT +ciclofosfamida I-TREATMENT +1 I-TREATMENT +g/día I-TREATMENT +IV I-TREATMENT +por I-TREATMENT +2 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +N-acetilcisteína I-TREATMENT +para I-TREATMENT +modular I-TREATMENT +daño I-TREATMENT +por I-TREATMENT +estrés I-TREATMENT +oxidativo, I-TREATMENT +el B-EVOLUTION +cual I-EVOLUTION +no I-EVOLUTION +tuvo I-EVOLUTION +respuesta, I-EVOLUTION +presentando I-EVOLUTION +caída I-EVOLUTION +de I-EVOLUTION +PaFi I-EVOLUTION +a I-EVOLUTION +40, I-EVOLUTION +falleciendo I-EVOLUTION +al I-EVOLUTION +octavo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +89 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +el 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 +que B-PRESENT_ILLNESS +anamnésticamente I-PRESENT_ILLNESS +comunicó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +decaimiento I-PRESENT_ILLNESS +físico, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +fronto-temporal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso, I-PRESENT_ILLNESS +condición I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +interpretada I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carácter I-PRESENT_ILLNESS +depresivo. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +instalación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +borrosa, I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +(OI), I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agravó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +ocular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +(OD) I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +obligaron I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consultar I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +oftalmología. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Evaluada B-EXPLORATION +en I-EXPLORATION +neuro-oftalmología I-EXPLORATION +se I-EXPLORATION +definió I-EXPLORATION +un I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +con I-EXPLORATION +papilas I-EXPLORATION +rosadas, I-EXPLORATION +planas I-EXPLORATION +y I-EXPLORATION +netas. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OI I-EXPLORATION +exudados I-EXPLORATION +blanquecinos I-EXPLORATION +(temporales I-EXPLORATION +superiores) I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +macula, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +interpretaron I-EXPLORATION +como I-EXPLORATION +posible I-EXPLORATION +área I-EXPLORATION +isquémica I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +arterial, I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +la I-EXPLORATION +parálisis I-EXPLORATION +del I-EXPLORATION +III I-EXPLORATION +par I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pupila. I-EXPLORATION +Debido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +estos I-DERIVED_FROM/TO +hallazgos I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +examen I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +destacaba I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +PCR I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +57, I-DERIVED_FROM/TO +7 I-DERIVED_FROM/TO +(VR: I-DERIVED_FROM/TO +< I-DERIVED_FROM/TO +5, I-DERIVED_FROM/TO +0), I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +hospitalización I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Neurología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Salvador I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +arteritis I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +temporal. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +hospitalización, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +síntomas I-EXPLORATION +de I-EXPLORATION +claudicación I-EXPLORATION +mandibular, I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +polimialgia I-EXPLORATION +reumática, I-EXPLORATION +tampoco I-EXPLORATION +se I-EXPLORATION +vieron I-EXPLORATION +o I-EXPLORATION +palparon I-EXPLORATION +cambios I-EXPLORATION +o I-EXPLORATION +induraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trayecto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +temporales. I-EXPLORATION +Llamó I-EXPLORATION +la I-EXPLORATION +atención, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mirada I-EXPLORATION +binocular I-EXPLORATION +se I-EXPLORATION +produjera I-EXPLORATION +una I-EXPLORATION +desviación I-EXPLORATION +espontánea I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +hacia I-EXPLORATION +afuera I-EXPLORATION +y I-EXPLORATION +abajo, I-EXPLORATION +que I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +oclusión I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +derecho, I-EXPLORATION +el I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +volvía I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +posición I-EXPLORATION +central I-EXPLORATION +(sugerente I-EXPLORATION +de I-EXPLORATION +exclusión I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +por I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +visión). I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +una I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +visión I-EXPLORATION +que I-EXPLORATION +sólo I-EXPLORATION +llegaba I-EXPLORATION +a I-EXPLORATION +cuenta I-EXPLORATION +dedos. I-EXPLORATION +El I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +limitación I-EXPLORATION +completa I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +aducción I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +limitación I-EXPLORATION +menor I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +elevación I-EXPLORATION +y I-EXPLORATION +depresión. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +vías I-EXPLORATION +motoras I-EXPLORATION +o I-EXPLORATION +sensitivas I-EXPLORATION +centrales, I-EXPLORATION +ni I-EXPLORATION +periféricas. I-EXPLORATION +Se I-EXPLORATION +completó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacando I-EXPLORATION +VHS: I-EXPLORATION +80, I-EXPLORATION +0 I-EXPLORATION +mm/h I-EXPLORATION +(VR: I-EXPLORATION +1, I-EXPLORATION +0-24, I-EXPLORATION +0) I-EXPLORATION +y I-EXPLORATION +Recuento I-EXPLORATION +de I-EXPLORATION +blancos: I-EXPLORATION +7.870, I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +Resonancia I-EXPLORATION +Magnética I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +en I-EXPLORATION +secuencias I-EXPLORATION +ponderadas I-EXPLORATION +de I-EXPLORATION +T2 I-EXPLORATION +con I-EXPLORATION +saturación I-EXPLORATION +grasa, I-EXPLORATION +permitió I-EXPLORATION +destacar I-EXPLORATION +un I-EXPLORATION +incremento I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +arterias I-EXPLORATION +temporales I-EXPLORATION +superficiales I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +periarteriales. I-EXPLORATION +Con I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +se I-EXPLORATION +acentuó I-EXPLORATION +el I-EXPLORATION +realce I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +partes I-EXPLORATION +blandas. I-EXPLORATION +Además, I-EXPLORATION +en I-EXPLORATION +T1WI I-EXPLORATION +con I-EXPLORATION +gadolinio I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +impregnación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vaina I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +nervios I-EXPLORATION +ópticos, I-EXPLORATION +realce I-EXPLORATION +irregular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +intraconal I-EXPLORATION +y I-EXPLORATION +periférica I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +arterias I-EXPLORATION +oftálmicas. I-EXPLORATION +Realce I-EXPLORATION +parietal I-EXPLORATION +supraclinoídeo I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +sifones I-EXPLORATION +carotideos. I-EXPLORATION +Corte I-EXPLORATION +axial I-EXPLORATION +en I-EXPLORATION +FLAIR I-EXPLORATION +y I-EXPLORATION +difusión I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +corte, I-EXPLORATION +muestra I-EXPLORATION +lesiones I-EXPLORATION +isquémicas I-EXPLORATION +agudas I-EXPLORATION +cerebelosas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION +En I-EXPLORATION +TOF I-EXPLORATION +importantes I-EXPLORATION +irregularidades I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +V4 I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +arterias I-EXPLORATION +vertebrales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +complementó I-EXPLORATION +con I-EXPLORATION +Ecotomografía I-EXPLORATION +Doppler I-EXPLORATION +color I-EXPLORATION +con I-EXPLORATION +transductor I-EXPLORATION +lineal I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +frecuencia, I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +lumen I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +arterias I-EXPLORATION +temporales I-EXPLORATION +superficiales, I-EXPLORATION +más I-EXPLORATION +importante I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +parietal I-EXPLORATION +hipoecogénico I-EXPLORATION +(signo I-EXPLORATION +del I-EXPLORATION +halo). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +dexametasona I-TREATMENT +endovenosa, I-TREATMENT +que I-TREATMENT +debió I-TREATMENT +suspenderse I-TREATMENT +al I-TREATMENT +tercer I-TREATMENT +día I-TREATMENT +por I-TREATMENT +un I-TREATMENT +episodio I-TREATMENT +confusional I-TREATMENT +agudo, I-TREATMENT +atribuido I-TREATMENT +al I-TREATMENT +tratamiento, I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +por I-TREATMENT +bolos I-TREATMENT +de I-TREATMENT +metilprednisolona I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +prednisona I-TREATMENT +oral. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +sin I-EVOLUTION +dolor, I-EVOLUTION +manteniendo I-EVOLUTION +escaso I-EVOLUTION +lenguaje I-EVOLUTION +y I-EVOLUTION +cierto I-EVOLUTION +compromiso I-EVOLUTION +cuantitativo I-EVOLUTION +de I-EVOLUTION +conciencia. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +subsiguientes I-EVOLUTION +apareció I-EVOLUTION +hipotonía I-EVOLUTION +del I-EVOLUTION +hemicuerpo I-EVOLUTION +izquierdo, I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +signo I-EVOLUTION +de I-EVOLUTION +Babinski I-EVOLUTION +ipsilateral, I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +pudo I-EVOLUTION +asociar I-EVOLUTION +a I-EVOLUTION +importante I-EVOLUTION +hipodensidad I-EVOLUTION +cerebelosa I-EVOLUTION +bilateral I-EVOLUTION +e I-EVOLUTION +hipodensidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +lóbulos I-EVOLUTION +occipitales I-EVOLUTION +y I-EVOLUTION +tálamo I-EVOLUTION +derecho, I-EVOLUTION +sugerentes I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +lesiones I-EVOLUTION +del I-EVOLUTION +territorio I-EVOLUTION +posterior, I-EVOLUTION +acaecidas I-EVOLUTION +en I-EVOLUTION +pleno I-EVOLUTION +tratamiento I-EVOLUTION +corticoidal. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 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 +de I-PAST_MEDICAL_HISTORY +Tibú, I-PAST_MEDICAL_HISTORY +Norte I-PAST_MEDICAL_HISTORY +de 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 +fiebre, I-PRESENT_ILLNESS +escalofríos, I-PRESENT_ILLNESS +dolores I-PRESENT_ILLNESS +musculares, I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +artralgias, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +adinamia. I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +para I-EXPLORATION +hemoparásitos, I-EXPLORATION +encontrándose I-EXPLORATION +ocasionales I-EXPLORATION +tripomastigotes, I-EXPLORATION +según I-EXPLORATION +el I-EXPLORATION +reporte I-EXPLORATION +del I-EXPLORATION +Laboratorio I-EXPLORATION +Clínico I-EXPLORATION +del I-EXPLORATION +Hospital I-EXPLORATION +Erasmo I-EXPLORATION +Meoz. I-EXPLORATION +El I-EXPLORATION +ecocardiograma I-EXPLORATION +mostró I-EXPLORATION +leve I-EXPLORATION +derrame I-EXPLORATION +pericárdico I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +dilatación I-EXPLORATION +ventricular I-EXPLORATION +izquierda. I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +franca I-EXPLORATION +leucopenia I-EXPLORATION +(3.200 I-EXPLORATION +leucocitos/µl) I-EXPLORATION +y I-EXPLORATION +plaquetopenia I-EXPLORATION +(69.000 I-EXPLORATION +plaquetas/µl). I-EXPLORATION +Se B-TREATMENT +administró I-TREATMENT +tratamiento I-TREATMENT +etiológico I-TREATMENT +con I-TREATMENT +benzonidazol I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +350 I-TREATMENT +mg/día I-TREATMENT +por I-TREATMENT +60 I-TREATMENT +días. I-TREATMENT +El I-TREATMENT +diagnóstico I-TREATMENT +se I-TREATMENT +confirmó I-TREATMENT +por I-TREATMENT +lectura I-TREATMENT +de I-TREATMENT +lámina I-TREATMENT +de I-TREATMENT +extendido I-TREATMENT +de I-TREATMENT +sangre I-TREATMENT +periférica I-TREATMENT +en I-TREATMENT +el I-TREATMENT +INS. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +padres I-PAST_MEDICAL_HISTORY +consanguíneos, I-PAST_MEDICAL_HISTORY +oriundos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Medellín, I-PAST_MEDICAL_HISTORY +con B-FAMILY_HISTORY +el I-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +de I-FAMILY_HISTORY +un I-FAMILY_HISTORY +hermano I-FAMILY_HISTORY +medio I-FAMILY_HISTORY +fallecido I-FAMILY_HISTORY +con I-FAMILY_HISTORY +esta I-FAMILY_HISTORY +misma I-FAMILY_HISTORY +entidad I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +periodo I-FAMILY_HISTORY +perinatal. I-FAMILY_HISTORY +La B-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +prenatal I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +reportada I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +Nació I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2.030 I-PAST_MEDICAL_HISTORY +g I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +talla I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +38 I-PAST_MEDICAL_HISTORY +cm. I-PAST_MEDICAL_HISTORY +Se B-PRESENT_ILLNESS +observó I-PRESENT_ILLNESS +cuello I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tórax I-PRESENT_ILLNESS +cortos, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +abdomen I-PRESENT_ILLNESS +ligeramente I-PRESENT_ILLNESS +distendido. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +primeros I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida. I-PRESENT_ILLNESS +En B-TREATMENT +la I-TREATMENT +actualidad, I-TREATMENT +necesita I-TREATMENT +oxígeno I-TREATMENT +permanente. I-TREATMENT +La B-EXPLORATION +ecocardiografía I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +apiñamiento I-EXPLORATION +de I-EXPLORATION +vertebras I-EXPLORATION +cérvico-torácicas I-EXPLORATION +y I-EXPLORATION +fusión I-EXPLORATION +costal I-EXPLORATION +posterior, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +hemivértebras I-EXPLORATION +lumbares. 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 +3 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +llevada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +urticaria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +angioedema I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +contacto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +fría. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ocasión, I-PAST_MEDICAL_HISTORY +mientras I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +piscina, I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipotonía I-PAST_MEDICAL_HISTORY +generalizada, I-PAST_MEDICAL_HISTORY +palidez I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conciencia, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +requirió I-PAST_MEDICAL_HISTORY +hospitalización. I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bebidas I-PAST_MEDICAL_HISTORY +frías I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +eritema I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +edema I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cuello. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +practicó I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +prueba I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cubo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hielo, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +positiva I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +minutos. I-PAST_MEDICAL_HISTORY +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciproheptadina, I-TREATMENT +consiguiéndose I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sintomatología. I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +se I-EVOLUTION +hizo I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +prueba I-EVOLUTION +con I-EVOLUTION +cubo I-EVOLUTION +de I-EVOLUTION +hielo, I-EVOLUTION +la I-EVOLUTION +cual I-EVOLUTION +fue I-EVOLUTION +negativa I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +minutos. I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +ciproheptadina I-TREATMENT +por I-TREATMENT +seis I-TREATMENT +meses I-TREATMENT +llegando I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +tope I-TREATMENT +para I-TREATMENT +su I-TREATMENT +peso, I-TREATMENT +pero I-TREATMENT +por I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +síntomas I-TREATMENT +asociados I-TREATMENT +al I-TREATMENT +contacto I-TREATMENT +con I-TREATMENT +el I-TREATMENT +frío, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +cambiar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +por I-TREATMENT +cetirizina I-TREATMENT +más I-TREATMENT +montelukast. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +seguida I-EVOLUTION +durante I-EVOLUTION +cuatro I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +todavía I-EVOLUTION +presenta I-EVOLUTION +urticaria I-EVOLUTION +asociada I-EVOLUTION +al I-EVOLUTION +baño I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +piscinas, I-EVOLUTION +pero I-EVOLUTION +sin I-EVOLUTION +afectación I-EVOLUTION +respiratoria I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +resolución I-EVOLUTION +espontánea. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +proveniente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Orito, I-PAST_MEDICAL_HISTORY +Putumayo I-PAST_MEDICAL_HISTORY +(Amazonia I-PAST_MEDICAL_HISTORY +colombiana), I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +recurrente, I-PRESENT_ILLNESS +tratada I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +repetida I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +agentes I-PRESENT_ILLNESS +antiparasitarios I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hallazgos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estrongiloidiasis I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +materia I-PRESENT_ILLNESS +fecal. I-PRESENT_ILLNESS +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +referida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Universitario I-DERIVED_FROM/TO +Clínica I-DERIVED_FROM/TO +Universitaria I-DERIVED_FROM/TO +Colombia, I-DERIVED_FROM/TO +ubicado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +Bogotá. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Presentaba B-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +conducto I-EXPLORATION +biliar I-EXPLORATION +extrahepático I-EXPLORATION +demostrada I-EXPLORATION +por I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(colangiorresonancia). I-EXPLORATION +Presentaba I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +deshidrogenasa I-EXPLORATION +láctica I-EXPLORATION +de I-EXPLORATION +337 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +reporte I-EXPLORATION +de I-EXPLORATION +calcio I-EXPLORATION +sérico. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +revisión I-EXPLORATION +por I-EXPLORATION +sistemas, I-EXPLORATION +refería I-EXPLORATION +malestar I-EXPLORATION +e I-EXPLORATION +importante I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +peso; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +manifestaciones I-EXPLORATION +cutáneas. I-EXPLORATION +Tenía B-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +proctitis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +específica, I-PAST_MEDICAL_HISTORY +colecistectomía, I-PAST_MEDICAL_HISTORY +histerectomía, I-PAST_MEDICAL_HISTORY +obstrucción I-PAST_MEDICAL_HISTORY +intestinal I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +adherencias I-PAST_MEDICAL_HISTORY +pélvicas I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +infecciones I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vías I-PAST_MEDICAL_HISTORY +urinarias. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Después B-TREATMENT +de I-TREATMENT +una I-TREATMENT +biopsia I-TREATMENT +no I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ampolla I-TREATMENT +de I-TREATMENT +Vater, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +requirió I-TREATMENT +una I-TREATMENT +pancreatoduodenectomía. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +duodenal I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +linfoide I-EXPLORATION +pleomorfa I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes, I-EXPLORATION +con I-EXPLORATION +expresión I-EXPLORATION +difusa I-EXPLORATION +de I-EXPLORATION +CD3, I-EXPLORATION +CD4 I-EXPLORATION +y I-EXPLORATION +CD56; I-EXPLORATION +CD20 I-EXPLORATION +y I-EXPLORATION +CD30 I-EXPLORATION +focal, I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +(MIB1) I-EXPLORATION +de I-EXPLORATION +60 I-EXPLORATION +% I-EXPLORATION +y I-EXPLORATION +eosinofilia I-EXPLORATION +tisular I-EXPLORATION +asociada, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +llevó I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +linfoma I-EXPLORATION +T I-EXPLORATION +periférico, I-EXPLORATION +NOS I-EXPLORATION +( I-EXPLORATION +Peripheral I-EXPLORATION +T-Cell I-EXPLORATION +Lymphoma, I-EXPLORATION +Not I-EXPLORATION +Otherwise I-EXPLORATION +Specified I-EXPLORATION +). I-EXPLORATION +Se I-EXPLORATION +determinó I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +medula I-EXPLORATION +ósea I-EXPLORATION +por I-EXPLORATION +histología I-EXPLORATION +y I-EXPLORATION +citometría I-EXPLORATION +de I-EXPLORATION +flujo. I-EXPLORATION + I-EXPLORATION +Considerando I-EXPLORATION +como I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +la I-EXPLORATION +leucemia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +T I-EXPLORATION +del I-EXPLORATION +adulto, I-EXPLORATION +se I-EXPLORATION +ordenó I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +ELISA I-EXPLORATION +para I-EXPLORATION +HTLV1/2, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +resultó I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +mediante I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +Western I-EXPLORATION +Blot, I-EXPLORATION +también I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +HTLV-1 I-EXPLORATION +(presencia I-EXPLORATION +de I-EXPLORATION +bandas I-EXPLORATION +de I-EXPLORATION +discriminación I-EXPLORATION +p19-I, I-EXPLORATION +gp46-I I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +GP46-II). I-EXPLORATION +El B-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +leucemia/linfoma I-EVOLUTION +de I-EVOLUTION +células I-EVOLUTION +T I-EVOLUTION +del I-EVOLUTION +adulto I-EVOLUTION +identificado I-EVOLUTION +correspondió I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +linfoma I-EVOLUTION +agresivo. I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +cinco I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +combinada I-TREATMENT +(CHOP) I-TREATMENT +antes B-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +fallecimiento. I-EVOLUTION +No I-EVOLUTION +se I-EVOLUTION +hizo I-EVOLUTION +estudio I-EVOLUTION +post I-EVOLUTION +mórtem. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +mestizo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Medellín I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +residente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Bogotá, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +viajado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +Estados I-PAST_MEDICAL_HISTORY +Unidos I-PAST_MEDICAL_HISTORY +recientemente. I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +epilepsia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +tratadas I-PAST_MEDICAL_HISTORY +adecuadamente; I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +fumaba I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +ocasional. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 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 +"difícil I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +describir" I-PRESENT_ILLNESS +(más I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +regiones I-PRESENT_ILLNESS +mesogástrica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +epigástrica), I-PRESENT_ILLNESS +interrupciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +sueño, I-PRESENT_ILLNESS +hiporexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +frecuencia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cantidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +previos. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +asociaba I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingestión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +grifo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +casa. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +consultado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +igual I-PRESENT_ILLNESS +motivo. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +ingreso, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +hidratado, I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +123/74 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +75 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +37 I-EXPLORATION +o I-EXPLORATION +C, I-EXPLORATION +faringe I-EXPLORATION +normal, I-EXPLORATION +cuello I-EXPLORATION +sin I-EXPLORATION +alteraciones, I-EXPLORATION +estado I-EXPLORATION +cardiopulmonar I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +auscultación, I-EXPLORATION +ruidos I-EXPLORATION +peristálticos I-EXPLORATION +reducidos, I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +marco I-EXPLORATION +cólico, I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal, I-EXPLORATION +en I-EXPLORATION +tanto I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +demás I-EXPLORATION +aspectos I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +hospitalizó I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +practicaron I-EXPLORATION +evaluaciones I-EXPLORATION +paraclínicas I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +resultados: I-EXPLORATION +leucocitos: I-EXPLORATION +8.120 I-EXPLORATION +por I-EXPLORATION +mm I-EXPLORATION +3, I-EXPLORATION +neutrófilos: I-EXPLORATION +59, I-EXPLORATION +4 I-EXPLORATION +%, I-EXPLORATION +linfocitos: I-EXPLORATION +16, I-EXPLORATION +0 I-EXPLORATION +%, I-EXPLORATION +eosinófilos: I-EXPLORATION +18, I-EXPLORATION +6 I-EXPLORATION +%, I-EXPLORATION +hemoglobina: I-EXPLORATION +17, I-EXPLORATION +4 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito: I-EXPLORATION +48, I-EXPLORATION +4 I-EXPLORATION +% I-EXPLORATION +y I-EXPLORATION +plaquetas: I-EXPLORATION +275.000 I-EXPLORATION +por I-EXPLORATION +µl; I-EXPLORATION +el I-EXPLORATION +uroanálisis I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +demás I-EXPLORATION +exámenes I-EXPLORATION +paraclínicos I-EXPLORATION +pertinentes I-EXPLORATION +estuvieron I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +normales I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +simple, I-EXPLORATION +la I-EXPLORATION +ecografía, I-EXPLORATION +la I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +colangiopancreatografía I-EXPLORATION +retrógrada I-EXPLORATION +endoscópica I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +alteraciones. I-EXPLORATION +La I-EXPLORATION +endoscopia I-EXPLORATION +de I-EXPLORATION +vías I-EXPLORATION +digestivas I-EXPLORATION +altas I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +hernia I-EXPLORATION +hiatal I-EXPLORATION +con I-EXPLORATION +anillo I-EXPLORATION +de I-EXPLORATION +Schatzki, I-EXPLORATION +y I-EXPLORATION +mucosa I-EXPLORATION +antral I-EXPLORATION +congestiva I-EXPLORATION +y I-EXPLORATION +edematosa I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +erosiones. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +evidenció I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +activa, I-EXPLORATION +en I-EXPLORATION +tanto I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +de I-EXPLORATION +vías I-EXPLORATION +digestivas I-EXPLORATION +bajas I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +anomalías. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +la I-EVOLUTION +hospitalización, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +varias I-EVOLUTION +crisis I-EVOLUTION +de I-EVOLUTION +pánico, I-EVOLUTION +agitación I-EVOLUTION +y I-EVOLUTION +ansiedad I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +exacerbación I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +requirió I-EVOLUTION +manejo I-EVOLUTION +médico I-EVOLUTION +y I-EVOLUTION +farmacológico I-EVOLUTION +psiquiátrico. I-EVOLUTION +Al I-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización, I-EVOLUTION +apareció I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +flanco I-EVOLUTION +abdominal I-EVOLUTION +derecho I-EVOLUTION +un I-EVOLUTION +área I-EVOLUTION +dolorosa I-EVOLUTION +y I-EVOLUTION +eritematosa I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +x I-EVOLUTION +2 I-EVOLUTION +cm, I-EVOLUTION +que I-EVOLUTION +evolucionó I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +patrón I-EVOLUTION +migratorio I-EVOLUTION +serpentino I-EVOLUTION +y I-EVOLUTION +avanzó I-EVOLUTION +atravesando I-EVOLUTION +la I-EVOLUTION +línea I-EVOLUTION +media I-EVOLUTION +y I-EVOLUTION +regresando I-EVOLUTION +para I-EVOLUTION +describir I-EVOLUTION +un I-EVOLUTION +trazado I-EVOLUTION +similar I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +"X" I-EVOLUTION +alargada. I-EVOLUTION +Se B-EXPLORATION +tomó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +sitio I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +cuyo I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +mostró I-EXPLORATION +atrofia I-EXPLORATION +dermoepidérmica I-EXPLORATION +y I-EXPLORATION +gran I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +eosinófilos I-EXPLORATION +perivasculares I-EXPLORATION +e I-EXPLORATION +intersticiales. I-EXPLORATION +Una I-EXPLORATION +semana I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +un I-EXPLORATION +cuidadoso I-EXPLORATION +examen I-EXPLORATION +manual I-EXPLORATION +y, I-EXPLORATION +al I-EXPLORATION +parpar I-EXPLORATION +la I-EXPLORATION +lesión, I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +levantada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +flanco I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +extrajo I-EXPLORATION +una I-EXPLORATION +larva I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +8 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +largo I-EXPLORATION +usando I-EXPLORATION +aceite I-EXPLORATION +mineral I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +bajalenguas. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +larva I-EXPLORATION +bajo I-EXPLORATION +el I-EXPLORATION +microscopio I-EXPLORATION +de I-EXPLORATION +luz I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +gusano I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +bulbo I-EXPLORATION +cefálico I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cuerpo; I-EXPLORATION +alrededor I-EXPLORATION +del I-EXPLORATION +bulbo I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +las I-EXPLORATION +cuatro I-EXPLORATION +hileras I-EXPLORATION +de I-EXPLORATION +ganchos I-EXPLORATION +características, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +largo I-EXPLORATION +esófago I-EXPLORATION +circundado I-EXPLORATION +por I-EXPLORATION +los I-EXPLORATION +sacos I-EXPLORATION +cervicales I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +unía I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +intestino, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +apareció I-EXPLORATION +tapizado I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +cilíndrico I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +núcleos I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +hematoxilina I-EXPLORATION +y I-EXPLORATION +eosina. I-EXPLORATION +Esta I-EXPLORATION +característica I-EXPLORATION +permitió I-EXPLORATION +identificar I-EXPLORATION +al I-EXPLORATION +espécimen I-EXPLORATION +como I-EXPLORATION +perteneciente I-EXPLORATION +al I-EXPLORATION +género I-EXPLORATION +Florida I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +Estados I-EXPLORATION +Unidos, I-EXPLORATION +donde I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +consumió I-EXPLORATION +alimentos I-EXPLORATION +preparados I-EXPLORATION +con I-EXPLORATION +pescado I-EXPLORATION +y I-EXPLORATION +mariscos; I-EXPLORATION +aunque I-EXPLORATION +es I-EXPLORATION +claro I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +área I-EXPLORATION +geográfica I-EXPLORATION +descrita I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +endémica I-EXPLORATION +para I-EXPLORATION +esta I-EXPLORATION +condición, I-EXPLORATION +se I-EXPLORATION +sabe I-EXPLORATION +que I-EXPLORATION +más I-EXPLORATION +del I-EXPLORATION +90 I-EXPLORATION +% I-EXPLORATION +del I-EXPLORATION +pescado I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +mariscos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +expenden I-EXPLORATION +allí I-EXPLORATION +son I-EXPLORATION +importados I-EXPLORATION +desde I-EXPLORATION +países I-EXPLORATION +como I-EXPLORATION +China, I-EXPLORATION +Filipinas, I-EXPLORATION +Tailandia, I-EXPLORATION +Vietnam, I-EXPLORATION +Ecuador, I-EXPLORATION +Perú I-EXPLORATION +y I-EXPLORATION +México, I-EXPLORATION +naciones I-EXPLORATION +reconocidas I-EXPLORATION +por I-EXPLORATION +ser I-EXPLORATION +endémicas I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +gnatostomiasis I-EXPLORATION +(15,16). I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +identificación I-EXPLORATION +taxonómica I-EXPLORATION +se I-EXPLORATION +basa I-EXPLORATION +en I-EXPLORATION +ciertas I-EXPLORATION +características I-EXPLORATION +morfológicas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +larva I-EXPLORATION +(17), I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +incluyen I-EXPLORATION +la I-EXPLORATION +forma I-EXPLORATION +del I-EXPLORATION +cuerpo, I-EXPLORATION +el I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +hileras I-EXPLORATION +de I-EXPLORATION +ganchos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +extremo I-EXPLORATION +cefálico I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +ganchos I-EXPLORATION +en I-EXPLORATION +cada I-EXPLORATION +hilera, I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +cubierto I-EXPLORATION +por I-EXPLORATION +espinas I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +núcleos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +intestinales, I-EXPLORATION +rasgos I-EXPLORATION +que I-EXPLORATION +varían I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +especies. I-EXPLORATION +Las I-EXPLORATION +hileras I-EXPLORATION +de I-EXPLORATION +ganchos I-EXPLORATION +le I-EXPLORATION +permiten I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +larva I-EXPLORATION +abrirse I-EXPLORATION +camino I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +tejidos I-EXPLORATION +del I-EXPLORATION +huésped I-EXPLORATION +y I-EXPLORATION +producen I-EXPLORATION +el I-EXPLORATION +daño I-EXPLORATION +mecánico I-EXPLORATION +tisular I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +síntomas. I-EXPLORATION +La I-EXPLORATION +identificación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +especie I-EXPLORATION +es I-EXPLORATION +útil I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +vista I-EXPLORATION +epidemiológico, I-EXPLORATION +pues I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +es I-EXPLORATION +el I-EXPLORATION +mismo I-EXPLORATION +para I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +especies I-EXPLORATION +(3,5). I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +características I-EXPLORATION +clínicas I-EXPLORATION +pueden I-EXPLORATION +dividirse I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +síntomas I-EXPLORATION +inmediatos I-EXPLORATION +posteriores I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +infección I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +síntomas I-EXPLORATION +cutáneos I-EXPLORATION +o I-EXPLORATION +viscerales, I-EXPLORATION +según I-EXPLORATION +sea I-EXPLORATION +el I-EXPLORATION +caso. I-EXPLORATION +Entre I-EXPLORATION +24 I-EXPLORATION +y I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ingestión I-EXPLORATION +del I-EXPLORATION +parásito, I-EXPLORATION +el I-EXPLORATION +individuo I-EXPLORATION +puede I-EXPLORATION +presentar I-EXPLORATION +malestar I-EXPLORATION +general, I-EXPLORATION +fiebre, I-EXPLORATION +anorexia, I-EXPLORATION +náuseas, I-EXPLORATION +vómito, I-EXPLORATION +diarrea I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +abdominal, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +puede I-EXPLORATION +ser I-EXPLORATION +difuso, I-EXPLORATION +epigástrico I-EXPLORATION +o I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cuadrante I-EXPLORATION +superior I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Gnathostoma I-EXPLORATION +y I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +especie I-EXPLORATION +más I-EXPLORATION +probable I-EXPLORATION +a I-EXPLORATION +G. I-EXPLORATION +spinigerum, I-EXPLORATION +con I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +gnatostomiasis I-EXPLORATION +cutánea. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +200 I-TREATMENT +mg I-TREATMENT +diarios I-TREATMENT +de I-TREATMENT +albendazol I-TREATMENT +durante I-TREATMENT +18 I-TREATMENT +días I-TREATMENT +y B-EVOLUTION +evolucionó I-EVOLUTION +satisfactoriamente. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +testicular I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +grandes I-PRESENT_ILLNESS +dimensiones I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +espalda I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ninguna I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +demuestran I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +testicular I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +retroperitoneal I-EXPLORATION +ganglionar. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +metástasis I-EXPLORATION +pulmonares I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +confirmadas I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +TAC, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +inguinales I-EXPLORATION +y I-EXPLORATION +paratraqueales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +se I-EXPLORATION +halla I-EXPLORATION +una I-EXPLORATION +β-HCG I-EXPLORATION +de I-EXPLORATION +17702 I-EXPLORATION +mUI/ml I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +α-FP I-EXPLORATION +de I-EXPLORATION +28025 I-EXPLORATION +ng/ml. I-EXPLORATION +En B-TREATMENT +octubre I-TREATMENT +de I-TREATMENT +2002 I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +orquiectomía I-TREATMENT +radical I-TREATMENT +derecha I-TREATMENT +con I-TREATMENT +un I-TREATMENT +resultado I-TREATMENT +anatomopatológico I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +germinal I-TREATMENT +mixto I-TREATMENT +(compuesto I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +embrionario, I-TREATMENT +yolk I-TREATMENT +sac I-TREATMENT +tumor, I-TREATMENT +teratoma I-TREATMENT +maduro I-TREATMENT +e I-TREATMENT +inmaduro I-TREATMENT +y I-TREATMENT +mínimos I-TREATMENT +focos I-TREATMENT +de I-TREATMENT +seminoma I-TREATMENT +y I-TREATMENT +coriocarcinoma). I-TREATMENT +El I-TREATMENT +estadio I-TREATMENT +tumoral I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +T3N3M1a I-TREATMENT +(estadio I-TREATMENT +IIIC). I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +varios I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +agresiva I-TREATMENT +según I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +BOMP/EPI, I-TREATMENT +se I-TREATMENT +produce I-TREATMENT +respuesta I-TREATMENT +parcial I-TREATMENT +a I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +con I-TREATMENT +reducción I-TREATMENT +de I-TREATMENT +las I-TREATMENT +metástasis I-TREATMENT +pulmonares, I-TREATMENT +pero I-TREATMENT +presenta I-TREATMENT +una I-TREATMENT +gran I-TREATMENT +masa I-TREATMENT +residual I-TREATMENT +en I-TREATMENT +la I-TREATMENT +TAC I-TREATMENT +realizada, I-TREATMENT +que I-TREATMENT +obliga I-TREATMENT +al I-TREATMENT +planteamiento I-TREATMENT +de I-TREATMENT +cirugía I-TREATMENT +exerética I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +procede, I-TREATMENT +tras I-TREATMENT +adecuado I-TREATMENT +estudio I-TREATMENT +preoperatorio, I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +linfadenectomía I-TREATMENT +retroperitoneal I-TREATMENT +y I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +masa I-TREATMENT +residual I-TREATMENT +mediante I-TREATMENT +abordaje I-TREATMENT +laparotómico I-TREATMENT +medio I-TREATMENT +xifopubiano. I-TREATMENT +La B-EXPLORATION +masa I-EXPLORATION +englobaba, I-EXPLORATION +como I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +observar I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +TAC, I-EXPLORATION +los I-EXPLORATION +grandes I-EXPLORATION +vasos I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +bifurcación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +iliacas I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profunda I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +menor I-EXPLORATION +medida I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION +Tras I-EXPLORATION +una I-EXPLORATION +compleja I-EXPLORATION +intervención I-EXPLORATION +se I-EXPLORATION +consigue I-EXPLORATION +exéresis I-EXPLORATION +completa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +quedando I-EXPLORATION +como I-EXPLORATION +resultado I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +que I-EXPLORATION +muestran I-EXPLORATION +las I-EXPLORATION +Figs. I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +4. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +patológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +revela I-EXPLORATION +tumoración I-EXPLORATION +teratomatosa I-EXPLORATION +madura. I-EXPLORATION +Actualmente B-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +valorado I-TREATMENT +por I-TREATMENT +Oncología I-TREATMENT +por I-TREATMENT +si I-TREATMENT +precisa I-TREATMENT +nuevos I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +postcirugía, I-TREATMENT +a I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +que I-TREATMENT +remitan I-TREATMENT +las I-TREATMENT +metástasis I-TREATMENT +pulmonares. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +visto I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +nodular I-PRESENT_ILLNESS +subcutánea I-PRESENT_ILLNESS +dolorosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pene. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +incremento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +citada I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +erección, I-PRESENT_ILLNESS +produciéndose I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +significativo I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +impedía I-PRESENT_ILLNESS +mantener I-PRESENT_ILLNESS +relaciones I-PRESENT_ILLNESS +sexuales I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +normalidad. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +subcutánea I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +4 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +elevada I-EXPLORATION +consistencia, I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +proximidades I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +dorsal I-EXPLORATION +superficial. I-EXPLORATION +No I-EXPLORATION +existían I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +significativas I-EXPLORATION +ni I-EXPLORATION +adenopatías I-EXPLORATION +locorregionales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +urológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +tratara I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +vascular, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +doppler I-EXPLORATION +peneano I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +flujo I-EXPLORATION +intralesional, I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +erección, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +propuso I-EXPLORATION +su I-EXPLORATION +extirpación. I-EXPLORATION + I-EXPLORATION +Durante B-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +objetivó I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +una I-TREATMENT +dilatación I-TREATMENT +nodular I-TREATMENT +en I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +dorsal I-TREATMENT +superficial I-TREATMENT +del I-TREATMENT +pene, I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +parcialmente I-TREATMENT +resecada I-TREATMENT +2 I-TREATMENT +cm I-TREATMENT +proximal I-TREATMENT +y I-TREATMENT +distalmente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +análisis I-EXPLORATION +histológico I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +intravascular I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +endoteliales I-EXPLORATION +bien I-EXPLORATION +diferenciadas, I-EXPLORATION +con I-EXPLORATION +obliteración I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +vascular, I-EXPLORATION +acompañados I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +eosinófilos. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +"hiperplasia I-EXPLORATION +angiolinfoide I-EXPLORATION +con I-EXPLORATION +eosinofilia I-EXPLORATION +intravascular". I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +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 +hábito I-PAST_MEDICAL_HISTORY +tabáquico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +paquete I-PAST_MEDICAL_HISTORY +diario. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Remitido B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestras I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +macroscópica I-PRESENT_ILLNESS +monosintomática I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +coágulos. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +reno-vesicoprostática I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +masa I-EXPLORATION +hiperecogénica I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +resección I-EXPLORATION +transuretral I-EXPLORATION +endoscópica I-EXPLORATION +que I-EXPLORATION +determinó I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +vesical I-EXPLORATION +infiltrante I-EXPLORATION +de I-EXPLORATION +estirpe I-EXPLORATION +urotelial I-EXPLORATION +(pT2G3). I-EXPLORATION + I-EXPLORATION +Durante I-EXPLORATION +la I-EXPLORATION +cistectomía I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +peroperatoria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +uretra I-EXPLORATION +prostática I-EXPLORATION +para I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +posibilidad I-EXPLORATION +de I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +vejiga I-EXPLORATION +ortotópica; I-EXPLORATION +tras B-TREATMENT +resultar I-TREATMENT +positiva I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +derivación I-TREATMENT +urinaria I-TREATMENT +tipo I-TREATMENT +Bricker I-TREATMENT +y I-TREATMENT +uretrectomía I-TREATMENT +total I-TREATMENT +en I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +acto I-TREATMENT +quirúrgico. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +linfoepitelioma-like I-EXPLORATION +vesical I-EXPLORATION +puro I-EXPLORATION +con I-EXPLORATION +invasión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +perivesical I-EXPLORATION +(pT3a). I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +técnicas I-EXPLORATION +de I-EXPLORATION +inmunohistoquimia I-EXPLORATION +resultando I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +CK I-EXPLORATION +19 I-EXPLORATION +y I-EXPLORATION +Ki I-EXPLORATION +67, I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +componente I-EXPLORATION +epitelial I-EXPLORATION +tumoral; I-EXPLORATION +y I-EXPLORATION +también I-EXPLORATION +para I-EXPLORATION +CD I-EXPLORATION +45, I-EXPLORATION +CD I-EXPLORATION +43, I-EXPLORATION +CD I-EXPLORATION +20 I-EXPLORATION +y I-EXPLORATION +bcl I-EXPLORATION +2, I-EXPLORATION +corroborando I-EXPLORATION +el I-EXPLORATION +componente I-EXPLORATION +linfoide I-EXPLORATION +tumoral. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +intensa I-EXPLORATION +positividad I-EXPLORATION +citoplasmática I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +80% I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr. I-EXPLORATION +Asimismo I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +prostático I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado I-EXPLORATION +gleason I-EXPLORATION +6/10. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +requirió I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +Neurología I-EVOLUTION +por I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +múltiples I-EVOLUTION +infartos I-EVOLUTION +isquémicos I-EVOLUTION +cerebrales I-EVOLUTION +de I-EVOLUTION +pequeño I-EVOLUTION +tamaño I-EVOLUTION +bilaterales I-EVOLUTION +de I-EVOLUTION +posible I-EVOLUTION +causa I-EVOLUTION +cardioembólica. I-EVOLUTION +Actualmente I-EVOLUTION +asintomático I-EVOLUTION +bajo B-TREATMENT +tratamiento I-TREATMENT +anticoagulante. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +TAC I-EXPLORATION +abdomino-pélvico I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +varias I-EXPLORATION +imágenes I-EXPLORATION +ganglionares I-EXPLORATION +múltiples I-EXPLORATION +subcentimétricas. I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +grandes I-EXPLORATION +vasos I-EXPLORATION +retroperitoneales I-EXPLORATION +y I-EXPLORATION +raíz I-EXPLORATION +de I-EXPLORATION +mesenterio. I-EXPLORATION +En B-TREATMENT +este I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +adyuvante I-TREATMENT +con I-TREATMENT +gemcitabina I-TREATMENT +y I-TREATMENT +cisplatino. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +20 I-EVOLUTION +meses 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 +libre I-EVOLUTION +de I-EVOLUTION +enfermedad, I-EVOLUTION +pendiente I-EVOLUTION +de I-EVOLUTION +próximo I-EVOLUTION +control I-EVOLUTION +radiológico. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +paratesticular I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +lento I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +progresivo, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +demuestra I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +intraescrotal I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +no I-EXPLORATION +dolorosa, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura, I-EXPLORATION +con I-EXPLORATION +transiluminación I-EXPLORATION +negativa, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpan I-EXPLORATION +adenopatías I-EXPLORATION +regionales; I-EXPLORATION +al I-EXPLORATION +tacto I-EXPLORATION +rectal, I-EXPLORATION +la I-EXPLORATION +próstata I-EXPLORATION +es I-EXPLORATION +grado I-EXPLORATION +I I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +pétreo I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +derecho. I-EXPLORATION +Estudios I-EXPLORATION +complementarios: I-EXPLORATION +PSA I-EXPLORATION +1276 I-EXPLORATION +ng/ml, I-EXPLORATION +fosfatasas I-EXPLORATION +alcalinas I-EXPLORATION +172 I-EXPLORATION +U/l, I-EXPLORATION +Bgonadotropina I-EXPLORATION +y I-EXPLORATION +Alfa-fetoproteína I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +hipoecoica, I-EXPLORATION +homogénea, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +ecogenicidad I-EXPLORATION +e I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +vascularización I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +establecer I-EXPLORATION +las I-EXPLORATION +estructuras I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +depende; I-EXPLORATION +ambos I-EXPLORATION +testículos I-EXPLORATION +son I-EXPLORATION +normales, I-EXPLORATION +estando I-EXPLORATION +el I-EXPLORATION +izquierdo I-EXPLORATION +rechazado I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +escrotal; I-EXPLORATION +la I-EXPLORATION +próstata I-EXPLORATION +tiene I-EXPLORATION +un I-EXPLORATION +volumen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +70 I-EXPLORATION +cc, I-EXPLORATION +con I-EXPLORATION +parénquima I-EXPLORATION +heterogéneo; I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +urológica I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +gammagrafía I-EXPLORATION +que I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +óseas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +fémur I-EXPLORATION +derecho, I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +vertebral, I-EXPLORATION +la I-EXPLORATION +parrilla I-EXPLORATION +costal, I-EXPLORATION +el I-EXPLORATION +sacro I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +hombro I-EXPLORATION +izquierdo. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +prostática I-EXPLORATION +transrectal I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +realizada I-EXPLORATION +por I-EXPLORATION +decisión I-EXPLORATION +del I-EXPLORATION +paciente. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenido I-TREATMENT +quirúrgicamente I-TREATMENT +realizándose I-TREATMENT +orquiectomía I-TREATMENT +radical. I-TREATMENT +Se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +bloqueo I-TREATMENT +hormonal I-TREATMENT +completo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +administra I-TREATMENT +radioterapia I-TREATMENT +externa I-TREATMENT +sobre I-TREATMENT +lesión I-TREATMENT +ósea I-TREATMENT +de I-TREATMENT +fémur I-TREATMENT +derecho, I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +describe I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +aspecto I-EXPLORATION +tumoral, I-EXPLORATION +encapsulada, I-EXPLORATION +color I-EXPLORATION +blanquecino-amarillento, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +centrales I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +amarillo I-EXPLORATION +más I-EXPLORATION +intenso I-EXPLORATION +; I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +atraviesa I-EXPLORATION +la I-EXPLORATION +cápsula, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +pleomórficas I-EXPLORATION +grandes I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +prolongaciones, I-EXPLORATION +el I-EXPLORATION +estroma I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +hialino I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +escasa I-EXPLORATION +vascularización, I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +mitosis. I-EXPLORATION +La I-EXPLORATION +inmunohistoquímica I-EXPLORATION +evidencia I-EXPLORATION +positividad I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +menor I-EXPLORATION +medida I-EXPLORATION +al I-EXPLORATION +CD34 I-EXPLORATION +y, I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +PSA, I-EXPLORATION +desmina, I-EXPLORATION +S-100, I-EXPLORATION +actina I-EXPLORATION +HHF35, I-EXPLORATION +actina I-EXPLORATION +músculo I-EXPLORATION +liso I-EXPLORATION +y I-EXPLORATION +myogenina I-EXPLORATION +D I-EXPLORATION +siendo I-EXPLORATION +diagnosticado I-EXPLORATION +de: I-EXPLORATION +liposarcoma I-EXPLORATION +desdiferenciado, I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +esclerosante. I-EXPLORATION +Tras B-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +no I-EVOLUTION +existe I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +PSA I-EVOLUTION +es I-EVOLUTION +de I-EVOLUTION +0, I-EVOLUTION +2 I-EVOLUTION +ng/ml I-EVOLUTION +y I-EVOLUTION +las I-EVOLUTION +fosfatasas I-EVOLUTION +alcalinas I-EVOLUTION +de I-EVOLUTION +125 I-EVOLUTION +U/l. I-EVOLUTION + I-EVOLUTION + +Niña B-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 +médico-quirúrgicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +salvo I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cistitis I-PAST_MEDICAL_HISTORY +aguda I-PAST_MEDICAL_HISTORY +(al I-PAST_MEDICAL_HISTORY +nacimiento, I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses), I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +macroscópica, I-PRESENT_ILLNESS +febrícula I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional I-PRESENT_ILLNESS +irritativo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disuria, I-PRESENT_ILLNESS +polaquiuria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tenesmo I-PRESENT_ILLNESS +vesical I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +mejoría I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +pese I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antibiótico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Amoxicilina-Clavulánico. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +de I-EXPLORATION +37.2º I-EXPLORATION +C. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +detectan I-EXPLORATION +masas I-EXPLORATION +ni I-EXPLORATION +organomegalias, I-EXPLORATION +apreciando I-EXPLORATION +leves I-EXPLORATION +molestias I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +periumbilical. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +datos I-EXPLORATION +analíticos I-EXPLORATION +sanguíneos I-EXPLORATION +son I-EXPLORATION +normales I-EXPLORATION +salvo I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +13.900 I-EXPLORATION +cel/mcl I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +del I-EXPLORATION +83 I-EXPLORATION +%, I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +51 I-EXPLORATION +mg/l I-EXPLORATION +y I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +de I-EXPLORATION +39 I-EXPLORATION +mm/h. I-EXPLORATION +El I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +muestra I-EXPLORATION +hematuria I-EXPLORATION +microscópica, I-EXPLORATION +siendo I-EXPLORATION +normales I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +parámetros. I-EXPLORATION +El I-EXPLORATION +urinocultivo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +es I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practica I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +anfractuosa I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +3x2 I-EXPLORATION +cm, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +abdomen I-EXPLORATION +llegando I-EXPLORATION +hasta I-EXPLORATION +cúpula I-EXPLORATION +vesical, I-EXPLORATION +con I-EXPLORATION +contenido I-EXPLORATION +ecogénico I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +y I-EXPLORATION +paredes I-EXPLORATION +con I-EXPLORATION +vascularización I-EXPLORATION +aumentada, I-EXPLORATION +sugestiva I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +de I-EXPLORATION +uraco I-EXPLORATION +complicado. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +quiste I-TREATMENT +de I-TREATMENT +uraco I-TREATMENT +infectado I-TREATMENT +iniciamos I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +Fosfomicina, I-TREATMENT +objetivándose I-TREATMENT +mejoría I-TREATMENT +clínica I-TREATMENT +evidente I-TREATMENT +a I-TREATMENT +las I-TREATMENT +pocas I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +seguimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +e I-EXPLORATION +irregular, I-EXPLORATION +situada I-EXPLORATION +encima I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cúpula I-EXPLORATION +vesical, I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +1, I-EXPLORATION +8x1, I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +uraco I-EXPLORATION +persistente. I-EXPLORATION +De I-EXPLORATION +igual I-EXPLORATION +forma, I-EXPLORATION +realizamos I-EXPLORATION +uretrocistografía I-EXPLORATION +donde I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +comunicación I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +vejiga, I-EXPLORATION +ni I-EXPLORATION +detectamos I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +reflujo I-EXPLORATION +vesicoureteral. I-EXPLORATION +Confirmado B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +quiste I-TREATMENT +de I-TREATMENT +uraco, I-TREATMENT +programamos I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +quirúrgica I-TREATMENT +del I-TREATMENT +mismo. I-TREATMENT +Tras I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +realizamos I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +infraumbilical-extraperitoneal, I-TREATMENT +procediendo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +uraco, I-TREATMENT +incluyendo I-TREATMENT +el I-TREATMENT +quiste I-TREATMENT +uracal I-TREATMENT +y I-TREATMENT +un I-TREATMENT +rodete I-TREATMENT +vesical. I-TREATMENT +No B-EVOLUTION +hubo I-EVOLUTION +complicaciones I-EVOLUTION +intraoperatorias I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +fue I-EVOLUTION +satisfactoria. I-EVOLUTION +Actualmente I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cistografía I-EVOLUTION +practicada I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +la I-EVOLUTION +vejiga I-EVOLUTION +presenta I-EVOLUTION +una I-EVOLUTION +morfología I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +adicción I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +marihuana, I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +promiscuidad I-PAST_MEDICAL_HISTORY +sexual. I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +verrucosas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +pene I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +indoloras, I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +cuales I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +aumentaron I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +número I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tamaño. I-PRESENT_ILLNESS +Negaba I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +urinarios. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +verrucosas, I-EXPLORATION +friables, I-EXPLORATION +en I-EXPLORATION +glande I-EXPLORATION +y I-EXPLORATION +cuerpo I-EXPLORATION +del I-EXPLORATION +pene. I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +imiquimod I-TREATMENT +al I-TREATMENT +5% I-TREATMENT +en I-TREATMENT +crema I-TREATMENT +(Aldara® I-TREATMENT +3M) I-TREATMENT +tres I-TREATMENT +veces I-TREATMENT +por I-TREATMENT +semana. I-TREATMENT +El B-EXPLORATION +paciente I-EXPLORATION +acudió I-EXPLORATION +a I-EXPLORATION +consulta I-EXPLORATION +al I-EXPLORATION +completar I-EXPLORATION +dos I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +tratamiento, I-EXPLORATION +encontrándose I-EXPLORATION +disminución I-EXPLORATION +importante I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +tamaño I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +número, I-EXPLORATION +apreciándose I-EXPLORATION +eritema I-EXPLORATION +importante I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +sitios I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +sin I-EXPLORATION +referir I-EXPLORATION +prurito I-EXPLORATION +o I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +dichas I-EXPLORATION +zonas. I-EXPLORATION +Se B-EVOLUTION +continuó I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +por I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +más, I-EVOLUTION +al I-EVOLUTION +término I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +cuales I-EVOLUTION +se I-EVOLUTION +revisó I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +encontrándose I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +total I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesiones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +HTA, I-PAST_MEDICAL_HISTORY +artrosis I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +histerectomía, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +constitucional, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +perdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +artromialgias I-PRESENT_ILLNESS +generalizadas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +mandibulares I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +masticación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +clínica I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +realizado I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +normocítica I-EXPLORATION +normocrómica, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +mg/dl, I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +28, I-EXPLORATION +6%, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +(VSG) I-EXPLORATION +de I-EXPLORATION +112 I-EXPLORATION +mm/h. I-EXPLORATION +Durante I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +Interna I-EXPLORATION +presenta I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +cefalea I-EXPLORATION +y I-EXPLORATION +claudicación I-EXPLORATION +mandibular I-EXPLORATION +motivo I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +temporal I-EXPLORATION +de I-EXPLORATION +1cm. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +histiocíticas I-EXPLORATION +gigantes I-EXPLORATION +multinucleadas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +arterial, I-EXPLORATION +con I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +llegó I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +Arteritis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Temporal. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Prednisona I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +diarios I-TREATMENT +que I-TREATMENT +desencadena I-TREATMENT +una I-TREATMENT +hiperglucemia I-TREATMENT +secundaria, I-TREATMENT +subsidiaria I-TREATMENT +de I-TREATMENT +insulinoterapia, I-TREATMENT +y I-TREATMENT +agravada I-TREATMENT +por I-TREATMENT +una I-TREATMENT +arritmia I-TREATMENT +completa I-TREATMENT +por I-TREATMENT +fibrilación I-TREATMENT +auricular I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +el I-TREATMENT +inicio I-TREATMENT +de I-TREATMENT +anticoagulación I-TREATMENT +con I-TREATMENT +dicumarínicos I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +indefinida. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +estabilizó I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +26 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +procedió I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +continuando I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +Prednisona I-EVOLUTION +50 I-EVOLUTION +mg/día. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +30 I-EVOLUTION +días I-EVOLUTION +acudió I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +a I-EVOLUTION +Urgencias I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +hematuria I-EVOLUTION +franca I-EVOLUTION +que I-EVOLUTION +requirió I-EVOLUTION +ingreso I-EVOLUTION +hospitalario, I-EVOLUTION +cediendo I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +anticoagulación. I-EVOLUTION +Durante I-EVOLUTION +su I-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +Urología I-EVOLUTION +se I-EVOLUTION +objetivo I-EVOLUTION +una I-EVOLUTION +anemia I-EVOLUTION +severa I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +elevación I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +VSG. I-EVOLUTION +Se B-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +heterogénea I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +5, I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +(TC) I-EXPLORATION +tóraco-abdómino-pélvica I-EXPLORATION +identifica I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +CCR I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +metástasis. I-EXPLORATION +El I-EXPLORATION +rastreo I-EXPLORATION +óseo I-EXPLORATION +descartó I-EXPLORATION +también I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +metástasis I-EXPLORATION +óseas. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +practicó I-TREATMENT +una I-TREATMENT +nefrectomía I-TREATMENT +radical I-TREATMENT +izquierda, I-TREATMENT +cuyo B-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +renal I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +granulares I-EXPLORATION +y I-EXPLORATION +fusiformes I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +al I-EXPLORATION +40% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza, I-EXPLORATION +invadiendo I-EXPLORATION +grasa I-EXPLORATION +perirenal I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +hiliar I-EXPLORATION +ipsilateral I-EXPLORATION +(pT3aN1M0). I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +dos I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +precisa I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +ingreso I-EVOLUTION +por I-EVOLUTION +empeoramiento I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +óseo I-EVOLUTION +generalizado I-EVOLUTION +diagnosticándose I-EVOLUTION +en I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +metástasis I-EVOLUTION +vertebrales I-EVOLUTION +dorsales, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +tórpida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +que I-EVOLUTION +ocasionó I-EVOLUTION +el I-EVOLUTION +fallecimiento I-EVOLUTION +de I-EVOLUTION +enferma I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +pocos I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +hospitalario. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +consulto I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +latero I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea; I-PRESENT_ILLNESS +al B-EXPLORATION +realizar I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +mucosa I-EXPLORATION +rectal I-EXPLORATION +mamelonada, I-EXPLORATION +irregular, I-EXPLORATION +y I-EXPLORATION +próstata I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +aprox. I-EXPLORATION +sin I-EXPLORATION +nódulos, I-EXPLORATION +indurada I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +con I-EXPLORATION +surco I-EXPLORATION +medio I-EXPLORATION +borrado; I-EXPLORATION +masa I-EXPLORATION +cervical I-EXPLORATION +lateral I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +pétrea, I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +planos, I-EXPLORATION +no I-EXPLORATION +dolorosa. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +adenopatía I-EXPLORATION +cervical I-EXPLORATION +reportándose I-EXPLORATION +adenocarcinoma I-EXPLORATION +prostático I-EXPLORATION +metastásico, I-EXPLORATION +con I-EXPLORATION +positividad I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +inmuno I-EXPLORATION +histoquímica I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +antígeno I-EXPLORATION +prostático I-EXPLORATION +específico, I-EXPLORATION +citoqueratina I-EXPLORATION +AE1/AE3 I-EXPLORATION +y I-EXPLORATION +PCNA I-EXPLORATION +(100%). I-EXPLORATION +El I-EXPLORATION +antígeno I-EXPLORATION +prostático I-EXPLORATION +especifico I-EXPLORATION +sérico I-EXPLORATION +reportó I-EXPLORATION +738, I-EXPLORATION +4 I-EXPLORATION +ng/ml I-EXPLORATION +y I-EXPLORATION +PSA I-EXPLORATION +libre I-EXPLORATION +92.8 I-EXPLORATION +ng/ml. I-EXPLORATION +Se I-EXPLORATION +realizo I-EXPLORATION +colonoscopia I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +hasta I-EXPLORATION +25 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +margen I-EXPLORATION +anal, I-EXPLORATION +pliegues I-EXPLORATION +gruesos I-EXPLORATION +edematizados, I-EXPLORATION +eritematosos, I-EXPLORATION +friables, I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +irregular, I-EXPLORATION +se I-EXPLORATION +tomo I-EXPLORATION +biopsia I-EXPLORATION +cuyos I-EXPLORATION +resultados I-EXPLORATION +mostraron I-EXPLORATION +carcinoma I-EXPLORATION +poco I-EXPLORATION +diferenciado I-EXPLORATION +en I-EXPLORATION +foco I-EXPLORATION +necrótico I-EXPLORATION +infiltrante I-EXPLORATION +a I-EXPLORATION +recto. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +prostática I-EXPLORATION +reportó I-EXPLORATION +adenocarcionama I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +poco I-EXPLORATION +diferenciado I-EXPLORATION +Gleason I-EXPLORATION +6 I-EXPLORATION +(3+3). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +gamma-gramma I-EXPLORATION +óseo I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +positivo I-EXPLORATION +con I-EXPLORATION +lesiones I-EXPLORATION +osteoblasticas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorsal I-EXPLORATION +y I-EXPLORATION +lumbar. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +complementarios I-EXPLORATION +incluyeron, I-EXPLORATION +ecosonograma I-EXPLORATION +abdominal, I-EXPLORATION +tomografía I-EXPLORATION +cuello, I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +con I-EXPLORATION +doble I-EXPLORATION +contraste I-EXPLORATION +demostró I-EXPLORATION +adenopatías I-EXPLORATION +pre I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +aorticas I-EXPLORATION +abdominales I-EXPLORATION +bilaterales, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +tórax. I-EXPLORATION +En I-EXPLORATION +vista I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +Hallazgos I-EXPLORATION +clínicos I-EXPLORATION +y I-EXPLORATION +paraclínicos I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +estadio I-EXPLORATION +T4 I-EXPLORATION +N2 I-EXPLORATION +M. I-EXPLORATION +Consecuentemente B-TREATMENT +se I-TREATMENT +indica I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +un I-TREATMENT +cáncer I-TREATMENT +de I-TREATMENT +próstata I-TREATMENT +avanzado I-TREATMENT +realizándose I-TREATMENT +bloqueo I-TREATMENT +androgénico I-TREATMENT +de I-TREATMENT +tipo I-TREATMENT +quirúrgico I-TREATMENT +con I-TREATMENT +orquirectomia I-TREATMENT +bilateral I-TREATMENT +considerando I-TREATMENT +la I-TREATMENT +condición I-TREATMENT +socioeconómica I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +frecuencia I-PRESENT_ILLNESS +miccional I-PRESENT_ILLNESS +elevada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8/4, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +macroscópica. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +vesical I-PAST_MEDICAL_HISTORY +reciente I-PAST_MEDICAL_HISTORY +revelaba I-PAST_MEDICAL_HISTORY +cistitis I-PAST_MEDICAL_HISTORY +crónica. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +realiza I-EXPLORATION +pielografía I-EXPLORATION +de I-EXPLORATION +eliminación I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +que I-EXPLORATION +resultan I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cistoscopía I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +vejiga I-EXPLORATION +eritematosa, I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +papilar I-EXPLORATION +en I-EXPLORATION +piso I-EXPLORATION +vesical. I-EXPLORATION +Se I-EXPLORATION +toma I-EXPLORATION +biopsia I-EXPLORATION +cuyo I-EXPLORATION +informe I-EXPLORATION +revela I-EXPLORATION +cistitis I-EXPLORATION +eosinofílica. I-EXPLORATION +Inició B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Hidroxicina I-TREATMENT +20 I-TREATMENT +mg. I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h 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 +Hubo B-EVOLUTION +respuesta I-EVOLUTION +parcial, I-EVOLUTION +cediendo I-EVOLUTION +la I-EVOLUTION +hematuria, I-EVOLUTION +pero I-EVOLUTION +aun I-EVOLUTION +con I-EVOLUTION +frecuencia I-EVOLUTION +miccional I-EVOLUTION +de I-EVOLUTION +5/3. I-EVOLUTION +Al B-TREATMENT +agregar I-TREATMENT +prednisona I-TREATMENT +20 I-TREATMENT +mg/día I-TREATMENT +cedieron B-EVOLUTION +las I-EVOLUTION +molestias I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +normalizó I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +miccional. I-EVOLUTION + I-EVOLUTION + +Una B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Los B-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +iniciales I-EXPLORATION +(ecografía I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +computarizada) I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +9, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +puntiformes I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +pared, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +íntima I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +suprarrenal I-EXPLORATION +derecha. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +basal I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +contraste, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +algunas I-EXPLORATION +áreas I-EXPLORATION +sólidas I-EXPLORATION +de I-EXPLORATION +diferente I-EXPLORATION +grosor I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared, I-EXPLORATION +que I-EXPLORATION +crecían I-EXPLORATION +hacia I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +del I-EXPLORATION +quiste I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realzaban I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +contraste, I-EXPLORATION +hallazgos I-EXPLORATION +que I-EXPLORATION +hicieron I-EXPLORATION +pensar I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +feocromocitoma I-EXPLORATION +quístico. I-EXPLORATION +Las I-EXPLORATION +determinaciones I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +habituales I-EXPLORATION +y I-EXPLORATION +endocrinológicas I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +exéresis I-TREATMENT +laparoscópica I-TREATMENT +transperitoneal I-TREATMENT +mediante I-TREATMENT +tres I-TREATMENT +accesos I-TREATMENT +subcostales, I-TREATMENT +extirpando I-TREATMENT +el I-TREATMENT +quiste I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +completa, I-TREATMENT +seguido I-TREATMENT +de I-TREATMENT +su I-TREATMENT +embolsado I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +aspiración I-TREATMENT +intraabdominal I-TREATMENT +de I-TREATMENT +su I-TREATMENT +contenido I-TREATMENT +mediante I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +de I-TREATMENT +colecistostomía I-TREATMENT +laparoscópica I-TREATMENT +(Karl I-TREATMENT +Storz, I-TREATMENT +Alemania), I-TREATMENT +con I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +evacuaron I-TREATMENT +150 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +marronáceo I-TREATMENT +sin I-TREATMENT +olor, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +permitió I-TREATMENT +extraer I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +por I-TREATMENT +uno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +orificios I-TREATMENT +de I-TREATMENT +acceso I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +mm, I-TREATMENT +minimizando I-TREATMENT +de I-TREATMENT +ese I-TREATMENT +modo I-TREATMENT +las I-TREATMENT +heridas I-TREATMENT +operatorias. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +macroscópico I-EXPLORATION +e I-EXPLORATION +histopatológico I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cavitada I-EXPLORATION +benigna, I-EXPLORATION +dependiente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +corteza I-EXPLORATION +adrenal, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +pared I-EXPLORATION +fibrosa I-EXPLORATION +densa I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +había I-EXPLORATION +restos I-EXPLORATION +de I-EXPLORATION +adrenal, I-EXPLORATION +infiltrados I-EXPLORATION +linfoplasmocitarios I-EXPLORATION +y I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +calcificación I-EXPLORATION +distrófica, I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +ningún I-EXPLORATION +momento I-EXPLORATION +se I-EXPLORATION +observara I-EXPLORATION +revestimiento I-EXPLORATION +epitelial I-EXPLORATION +destacable, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +era I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +quiste I-EXPLORATION +hemorrágico I-EXPLORATION +adrenal I-EXPLORATION +o I-EXPLORATION +seudoquiste I-EXPLORATION +benigno. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +contenido I-EXPLORATION +del I-EXPLORATION +quiste I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION + +Femenina B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sentada 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 +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 +Fue I-PRESENT_ILLNESS +transportada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +collarín I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inmovilizada 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 +y I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +admitida I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +DUP I-PRESENT_ILLNESS +aprox. I-PRESENT_ILLNESS +15min I-PRESENT_ILLNESS +posteriores I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +accidente. I-PRESENT_ILLNESS +Los B-EXPLORATION +signos I-EXPLORATION +vitales I-EXPLORATION +al I-EXPLORATION +ingreso: I-EXPLORATION +temperatura, I-EXPLORATION +36, I-EXPLORATION +4oC; I-EXPLORATION +pulso, I-EXPLORATION +76; I-EXPLORATION +PA, I-EXPLORATION +109/69mm I-EXPLORATION +Hg; I-EXPLORATION +y I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria, I-EXPLORATION +14. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +en I-EXPLORATION +calma I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +cooperadora, I-EXPLORATION +solo I-EXPLORATION +refirió I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +leve I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +EF I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +DUP. 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 +fueron I-EXPLORATION +normales I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +(sangre I-EXPLORATION +y I-EXPLORATION +orina) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +EF. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +mantenerla I-EXPLORATION +en I-EXPLORATION +observación. I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +algunas I-EXPLORATION +horas, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +continuó I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +leve, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +contrastada. I-EXPLORATION +Al B-EVOLUTION +evaluar I-EVOLUTION +la I-EVOLUTION +TAC I-EVOLUTION +el I-EVOLUTION +caso I-EVOLUTION +fue I-EVOLUTION +comentado I-EVOLUTION +con I-EVOLUTION +nuestro I-EVOLUTION +servicio. I-EVOLUTION +En I-EVOLUTION +este I-EVOLUTION +momento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tenía I-EVOLUTION +5hrs I-EVOLUTION +en I-EVOLUTION +observación, I-EVOLUTION +estable. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +sin I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +manejar I-TREATMENT +conservadoramente. I-TREATMENT +Fue B-EVOLUTION +egresada I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +36h I-EVOLUTION +de I-EVOLUTION +observación. I-EVOLUTION + I-EVOLUTION +Se I-EVOLUTION +revisaron I-EVOLUTION +106 I-EVOLUTION +artículos I-EVOLUTION +publicados I-EVOLUTION +en I-EVOLUTION +inglés I-EVOLUTION +(referencias I-EVOLUTION +no I-EVOLUTION +mostradas) I-EVOLUTION +buscando I-EVOLUTION +pacientes I-EVOLUTION +<16 I-EVOLUTION +con I-EVOLUTION +OAR I-EVOLUTION +unilateral I-EVOLUTION +tratados I-EVOLUTION +conservadoramente. 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 +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consecuencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +colisión I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +gran I-PRESENT_ILLNESS +velocidad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +vehículo I-PRESENT_ILLNESS +automotor I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +politraumatismo I-PRESENT_ILLNESS +grave. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +asistida I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +lúcida I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cinturón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seguridad I-PRESENT_ILLNESS +colocado. I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +trasladada I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lugar I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +cercano, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +constató I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +shock I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +abdomen I-PRESENT_ILLNESS +agudo, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +laparotomía I-PRESENT_ILLNESS +exploradora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia, I-PRESENT_ILLNESS +hallándose I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +pared I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +sección I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +músculo I-PRESENT_ILLNESS +recto I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cavidad I-PRESENT_ILLNESS +estallido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +colon I-PRESENT_ILLNESS +transverso, I-PRESENT_ILLNESS +realizándosele I-PRESENT_ILLNESS +lavado I-PRESENT_ILLNESS +peritoneal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +colostomía I-PRESENT_ILLNESS +transversa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Posteriormente I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +trasladada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +complejidad I-PRESENT_ILLNESS +llegando I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +mismo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +doce I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +trauma. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +inicial I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +lúcida, I-EXPLORATION +presentaba I-EXPLORATION +frialdad I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +con I-EXPLORATION +impotencia I-EXPLORATION +funcional I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +mismos, I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +sensibilidad I-EXPLORATION +(anestesia) I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulsos I-EXPLORATION +femorales I-EXPLORATION +y I-EXPLORATION +distales. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +radiológicos I-EXPLORATION +solicitados I-EXPLORATION +evidenciaban I-EXPLORATION +fractura I-EXPLORATION +por I-EXPLORATION +estallido I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +húmero I-EXPLORATION +derecho, I-EXPLORATION +fractura I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +diáfisis I-EXPLORATION +humeral I-EXPLORATION +derecha, I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +diáfisis I-EXPLORATION +media I-EXPLORATION +del I-EXPLORATION +fémur I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +neumotórax I-EXPLORATION +izquierdo I-EXPLORATION +grado I-EXPLORATION +I, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +drenado. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +lumbosacra I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +lesiones I-EXPLORATION +medulares, I-EXPLORATION +hallándose I-EXPLORATION +como I-EXPLORATION +única I-EXPLORATION +lesión I-EXPLORATION +una I-EXPLORATION +fractura I-EXPLORATION +del I-EXPLORATION +sacro. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +reanimación I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +tomografía I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +endovenoso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +descartaron I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +sólidos. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +visualizaron I-EXPLORATION +anormalidades I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +aórtico, I-EXPLORATION +pero I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +semiología I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +angiografía I-EXPLORATION +de I-EXPLORATION +aorta I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +oclusión I-EXPLORATION +aórtica I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +infrarrenal I-EXPLORATION +sin I-EXPLORATION +circulación I-EXPLORATION +distal. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +oclusión I-TREATMENT +de I-TREATMENT +aorta I-TREATMENT +abdominal I-TREATMENT +postraumática I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +cirugía I-TREATMENT +vascular I-TREATMENT +(habiendo I-TREATMENT +pasado I-TREATMENT +15 I-TREATMENT +horas I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +del I-TREATMENT +accidente). I-TREATMENT +La I-TREATMENT +técnica I-TREATMENT +quirúrgica I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +trombectomía I-TREATMENT +aórtica I-TREATMENT +con I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +Fogarty, I-TREATMENT +bajo I-TREATMENT +control I-TREATMENT +visual I-TREATMENT +y I-TREATMENT +manual I-TREATMENT +de I-TREATMENT +aorta I-TREATMENT +abdominal, I-TREATMENT +más I-TREATMENT +embolectomía I-TREATMENT +distal I-TREATMENT +de I-TREATMENT +las I-TREATMENT +arterias I-TREATMENT +femorales I-TREATMENT +comunes. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +laparotomía I-EVOLUTION +para I-EVOLUTION +abordar I-EVOLUTION +aorta I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +hipoperfusión I-EVOLUTION +del I-EVOLUTION +intestino I-EVOLUTION +delgado, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +interpretó I-EVOLUTION +como I-EVOLUTION +consecuencia I-EVOLUTION +del I-EVOLUTION +compromiso I-EVOLUTION +del I-EVOLUTION +flujo I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +ramas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +arteria I-EVOLUTION +mesentérica I-EVOLUTION +inferior I-EVOLUTION +secundarias I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +trombosis. I-EVOLUTION +Este I-EVOLUTION +cuadro I-EVOLUTION +revirtió I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +A B-TREATMENT +las I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +la I-TREATMENT +enferma I-TREATMENT +desarrolló I-TREATMENT +criterios I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +distrés I-TREATMENT +respiratorio I-TREATMENT +agudo I-TREATMENT +secundario I-TREATMENT +a I-TREATMENT +contusión I-TREATMENT +pulmonar I-TREATMENT +y I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +isquemia I-TREATMENT +en I-TREATMENT +pierna I-TREATMENT +derecha I-TREATMENT +distal I-TREATMENT +a I-TREATMENT +la I-TREATMENT +patela, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +fue I-TREATMENT +reintervenida I-TREATMENT +realizándose I-TREATMENT +embolectomía I-TREATMENT +con I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +Fogarty I-TREATMENT +poplíteo I-TREATMENT +y I-TREATMENT +del I-TREATMENT +tronco I-TREATMENT +tibioperoneo. I-TREATMENT +A B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +procedimiento I-EVOLUTION +persistieron I-EVOLUTION +los I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +isquemia I-EVOLUTION +distal, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +interpretó I-EVOLUTION +como I-EVOLUTION +secundario I-EVOLUTION +a I-EVOLUTION +barro I-EVOLUTION +distal. I-EVOLUTION +Se I-EVOLUTION +descartó I-EVOLUTION +la I-EVOLUTION +posibilidad I-EVOLUTION +de I-EVOLUTION +realizarle I-EVOLUTION +tratamiento I-EVOLUTION +trombolítico I-EVOLUTION +por I-EVOLUTION +las I-EVOLUTION +cirugías I-EVOLUTION +previas. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +arteriografía I-EXPLORATION +intraoperatoria I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +la I-EXPLORATION +permeabilidad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +ramas I-EXPLORATION +tibial I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +tibioperoneo. I-EXPLORATION +Los B-TREATMENT +signos I-TREATMENT +de I-TREATMENT +isquemia I-TREATMENT +permanecieron, I-TREATMENT +acompañados I-TREATMENT +de I-TREATMENT +acidosis I-TREATMENT +metabólica I-TREATMENT +en I-TREATMENT +ascenso I-TREATMENT +y I-TREATMENT +trombocitopenia I-TREATMENT +por I-TREATMENT +consumo, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +amputación I-TREATMENT +infrarrotuliana I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pierna I-TREATMENT +comprometida, I-TREATMENT +maniobra I-TREATMENT +que I-TREATMENT +corrigió I-TREATMENT +las I-TREATMENT +alteraciones I-TREATMENT +del I-TREATMENT +medio I-TREATMENT +interno. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +once I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +asistencia I-EVOLUTION +respiratoria I-EVOLUTION +mecánica I-EVOLUTION +con I-EVOLUTION +evolución I-EVOLUTION +satisfactoria, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +al I-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +veinticinco I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miomatosis I-PAST_MEDICAL_HISTORY +uterina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +ingresos I-PAST_MEDICAL_HISTORY +hospitalarios I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dermatología I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +psoriasis I-PAST_MEDICAL_HISTORY +pustulosa, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +cursaron I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +eritrodermia, I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +ampollosas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +disfagia, I-PAST_MEDICAL_HISTORY +previamente I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +corticoides, I-PAST_MEDICAL_HISTORY +acitretina, I-PAST_MEDICAL_HISTORY +ciclosporina, I-PAST_MEDICAL_HISTORY +etanercept I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antibióticos I-PAST_MEDICAL_HISTORY +(siempre I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +mejorado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ciclosporina); I-PAST_MEDICAL_HISTORY +a B-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +ingerido I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +comprimido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +amoxicilina-clavulánico, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +eritrodermia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +ampollosas I-PRESENT_ILLNESS +generalizadas I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +afectaban I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +85% I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +corporal. I-PRESENT_ILLNESS +Se B-TREATMENT +inició I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +precoz I-TREATMENT +ciclosporina I-TREATMENT +A; I-TREATMENT +a B-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +desapareció I-EVOLUTION +la I-EVOLUTION +eritrodermia I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +desepitelizó I-EVOLUTION +la I-EVOLUTION +piel I-EVOLUTION +afecta. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +siete I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +reepitelización I-EVOLUTION +subtotal I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +iniciales I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +posible I-EVOLUTION +su I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +planta. I-EVOLUTION + I-EVOLUTION + +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +(P) I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +sufrir I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +coronario I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +enero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2003, I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Universitario I-PRESENT_ILLNESS +Príncipe I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Asturias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +presenta, I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hospitalización, I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemiparesia I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +neurológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +refieren I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +hallazgos: I-EXPLORATION + I-EXPLORATION +-Funciones I-EXPLORATION +corticales I-EXPLORATION +normales I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +quejas I-EXPLORATION +verbalizadas I-EXPLORATION +de I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +memoria I-EXPLORATION +continua I-EXPLORATION +desde I-EXPLORATION +que I-EXPLORATION +ha I-EXPLORATION +ingresado. I-EXPLORATION + I-EXPLORATION +-Hemiparesia I-EXPLORATION +izquierda I-EXPLORATION +no I-EXPLORATION +congruente I-EXPLORATION +por: I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +No I-EXPLORATION +distribución I-EXPLORATION +piramidal. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Fluctuaciones I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +siendo I-EXPLORATION +las I-EXPLORATION +gesticulación I-EXPLORATION +manual I-EXPLORATION +aceptable. I-EXPLORATION + I-EXPLORATION +• I-EXPLORATION +Prácticamente I-EXPLORATION +anestesia I-EXPLORATION +global I-EXPLORATION +hemicorporal I-EXPLORATION +izquierda I-EXPLORATION +hasta I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +independiente. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +tanto, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +se I-EXPLORATION +concluye I-EXPLORATION +que I-EXPLORATION +existen I-EXPLORATION +datos I-EXPLORATION +discordantes I-EXPLORATION +que I-EXPLORATION +hacen I-EXPLORATION +sospechar I-EXPLORATION +origen I-EXPLORATION +no I-EXPLORATION +orgánico, I-EXPLORATION +al I-EXPLORATION +menos, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +explicaría I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +cuadro. I-EXPLORATION + I-EXPLORATION +También I-EXPLORATION +presentaba I-EXPLORATION +cefalea I-EXPLORATION +resistente I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +tensionales. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +ello, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +valoración I-EXPLORATION +psicológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION +P. I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +levemente I-EXPLORATION +confusa I-EXPLORATION +y I-EXPLORATION +angustiada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +situación I-EXPLORATION +de I-EXPLORATION +estar I-EXPLORATION +ingresada. I-EXPLORATION +No I-EXPLORATION +aparenta I-EXPLORATION +estar I-EXPLORATION +muy I-EXPLORATION +preocupada I-EXPLORATION +por I-EXPLORATION +los I-EXPLORATION +síntomas I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +y I-EXPLORATION +verbaliza I-EXPLORATION +en I-EXPLORATION +varias I-EXPLORATION +ocasiones I-EXPLORATION +sus I-EXPLORATION +deseos I-EXPLORATION +de I-EXPLORATION +ser I-EXPLORATION +dada I-EXPLORATION +de I-EXPLORATION +alta. I-EXPLORATION +Al I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +entrevista, I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +reticente I-EXPLORATION +a I-EXPLORATION +ser I-EXPLORATION +evaluada, I-EXPLORATION +afirmando I-EXPLORATION +que I-EXPLORATION +su I-EXPLORATION +problema I-EXPLORATION +es I-EXPLORATION +exclusivamente I-EXPLORATION +físico I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +entiende I-EXPLORATION +el I-EXPLORATION +sentido I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +exploración I-EXPLORATION +psicológica. I-EXPLORATION + I-EXPLORATION +Evaluación B-PAST_MEDICAL_HISTORY +psicológica I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +• I-PAST_MEDICAL_HISTORY +Historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Antecedentes I-PAST_MEDICAL_HISTORY +biográficos I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Nace I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ambiente I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +novena I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +11 I-PAST_MEDICAL_HISTORY +hermanos. I-PAST_MEDICAL_HISTORY +Acerca I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +niñez I-PAST_MEDICAL_HISTORY +comenta I-PAST_MEDICAL_HISTORY +"no I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +tenido I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +tenido I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +trabajar I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +campo I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +años". I-PAST_MEDICAL_HISTORY +Esta I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +impidió I-PAST_MEDICAL_HISTORY +aprender I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +leer I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +escribir, I-PAST_MEDICAL_HISTORY +circunstancia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +da I-PAST_MEDICAL_HISTORY +mucha I-PAST_MEDICAL_HISTORY +importancia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +actualidad, I-PAST_MEDICAL_HISTORY +sintiéndose I-PAST_MEDICAL_HISTORY +frustrada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ello. I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +excepción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +varones I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +hermanas, I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +escuela, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +resto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +hermanos I-PAST_MEDICAL_HISTORY +(mujeres) I-PAST_MEDICAL_HISTORY +compartieron I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +situación I-PAST_MEDICAL_HISTORY +similar. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Señala I-PAST_MEDICAL_HISTORY +cómo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +intensas I-PAST_MEDICAL_HISTORY +jornadas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +podía I-PAST_MEDICAL_HISTORY +ausentarse I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +caso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +alguna I-PAST_MEDICAL_HISTORY +ocasión I-PAST_MEDICAL_HISTORY +experimentó I-PAST_MEDICAL_HISTORY +mareos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desmayos. I-PAST_MEDICAL_HISTORY +Refiere I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +largo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +vuelto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +sufrir I-PAST_MEDICAL_HISTORY +esos I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +ante I-PAST_MEDICAL_HISTORY +diferentes I-PAST_MEDICAL_HISTORY +dificultades I-PAST_MEDICAL_HISTORY +(por I-PAST_MEDICAL_HISTORY +ejemplo, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +funeral I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +muerte I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +padre). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +cuanto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sociales, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +significativas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +iguales I-PAST_MEDICAL_HISTORY +aparte I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +hermanos. I-PAST_MEDICAL_HISTORY +Está I-PAST_MEDICAL_HISTORY +casada I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +describe I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +esposo I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +buena, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +conflictos I-PAST_MEDICAL_HISTORY +importantes. I-PAST_MEDICAL_HISTORY +Tiene I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +hijas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +38 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +ambas I-PAST_MEDICAL_HISTORY +casadas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hijos. I-PAST_MEDICAL_HISTORY +Refiere I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ellas I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +"de I-PAST_MEDICAL_HISTORY +amigas" I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +han I-PAST_MEDICAL_HISTORY +contado I-PAST_MEDICAL_HISTORY +todo; I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +reconoce I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +tachan I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sobreprotectora. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +psiquiátrico I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +psicológico I-PAST_MEDICAL_HISTORY +previo. I-PAST_MEDICAL_HISTORY +Hace I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +demandó I-PAST_MEDICAL_HISTORY +asistencia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Atención I-PAST_MEDICAL_HISTORY +Primaria I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +insomnio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +pautó I-PAST_MEDICAL_HISTORY +mianserina, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +estuvo I-PAST_MEDICAL_HISTORY +tomando I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año, I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Atención I-PAST_MEDICAL_HISTORY +Primaria I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cambió I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +paroxetina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bromazepam. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +alguna I-PAST_MEDICAL_HISTORY +ocasión I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +tomado I-PAST_MEDICAL_HISTORY +hipnóticos, I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +pautados I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +Centro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Salud, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +insomnio. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Asimismo, I-PAST_MEDICAL_HISTORY +P. I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +sufrido I-PAST_MEDICAL_HISTORY +numerosas I-PAST_MEDICAL_HISTORY +intervenciones I-PAST_MEDICAL_HISTORY +quirúrgicas. I-PAST_MEDICAL_HISTORY +Este B-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +aspecto I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +relevante I-PRESENT_ILLNESS +considerando I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +tenido I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +anteriores I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemiparesia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +todos I-PRESENT_ILLNESS +han I-PRESENT_ILLNESS +coincidido I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +períodos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +hospitalizada. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Antecedentes B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY + I-FAMILY_HISTORY +El I-FAMILY_HISTORY +único I-FAMILY_HISTORY +miembro I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +que I-FAMILY_HISTORY +tiene I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +personales I-FAMILY_HISTORY +psíquicos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés I-FAMILY_HISTORY +es I-FAMILY_HISTORY +la I-FAMILY_HISTORY +hija I-FAMILY_HISTORY +menor I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +que I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +actualidad I-FAMILY_HISTORY +se I-FAMILY_HISTORY +encuentra I-FAMILY_HISTORY +en I-FAMILY_HISTORY +tratamiento I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +Centro I-FAMILY_HISTORY +de I-FAMILY_HISTORY +Salud I-FAMILY_HISTORY +Mental I-FAMILY_HISTORY +por I-FAMILY_HISTORY +episodios I-FAMILY_HISTORY +de I-FAMILY_HISTORY +ataques I-FAMILY_HISTORY +de I-FAMILY_HISTORY +pánico. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Por I-FAMILY_HISTORY +otro I-FAMILY_HISTORY +lado, I-FAMILY_HISTORY +como I-FAMILY_HISTORY +se I-FAMILY_HISTORY +aprecia I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +figura I-FAMILY_HISTORY +1, I-FAMILY_HISTORY +hay I-FAMILY_HISTORY +varios I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +hemiplejías I-FAMILY_HISTORY +izquierdas I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia. I-FAMILY_HISTORY +En I-FAMILY_HISTORY +primer I-FAMILY_HISTORY +lugar, I-FAMILY_HISTORY +el I-FAMILY_HISTORY +padre, I-FAMILY_HISTORY +a I-FAMILY_HISTORY +quien I-FAMILY_HISTORY +P. I-FAMILY_HISTORY +describe I-FAMILY_HISTORY +como I-FAMILY_HISTORY +una I-FAMILY_HISTORY +persona I-FAMILY_HISTORY +muy I-FAMILY_HISTORY +autoritaria I-FAMILY_HISTORY +y I-FAMILY_HISTORY +rígida I-FAMILY_HISTORY +("era I-FAMILY_HISTORY +un I-FAMILY_HISTORY +dictador"), I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +vez I-FAMILY_HISTORY +que I-FAMILY_HISTORY +lo I-FAMILY_HISTORY +disculpa I-FAMILY_HISTORY +y I-FAMILY_HISTORY +justifica I-FAMILY_HISTORY +aclarando I-FAMILY_HISTORY +que I-FAMILY_HISTORY +la I-FAMILY_HISTORY +situación I-FAMILY_HISTORY +que I-FAMILY_HISTORY +les I-FAMILY_HISTORY +tocó I-FAMILY_HISTORY +vivir I-FAMILY_HISTORY +fue I-FAMILY_HISTORY +muy I-FAMILY_HISTORY +dura. I-FAMILY_HISTORY +En I-FAMILY_HISTORY +segundo I-FAMILY_HISTORY +lugar, I-FAMILY_HISTORY +dos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +sus I-FAMILY_HISTORY +hermanas, I-FAMILY_HISTORY +las I-FAMILY_HISTORY +únicas I-FAMILY_HISTORY +que, I-FAMILY_HISTORY +según I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente, I-FAMILY_HISTORY +se I-FAMILY_HISTORY +revelaron I-FAMILY_HISTORY +y I-FAMILY_HISTORY +enfrentaron I-FAMILY_HISTORY +a I-FAMILY_HISTORY +su I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +y I-FAMILY_HISTORY +que I-FAMILY_HISTORY +tenían I-FAMILY_HISTORY +un I-FAMILY_HISTORY +carácter I-FAMILY_HISTORY +más I-FAMILY_HISTORY +fuerte. I-FAMILY_HISTORY +El I-FAMILY_HISTORY +resto I-FAMILY_HISTORY +de I-FAMILY_HISTORY +las I-FAMILY_HISTORY +hermanas, I-FAMILY_HISTORY +son I-FAMILY_HISTORY +más I-FAMILY_HISTORY +sumisas I-FAMILY_HISTORY +y I-FAMILY_HISTORY +aceptaban I-FAMILY_HISTORY +las I-FAMILY_HISTORY +normas I-FAMILY_HISTORY +del I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +aunque I-FAMILY_HISTORY +todas I-FAMILY_HISTORY +coincidieron I-FAMILY_HISTORY +en I-FAMILY_HISTORY +que I-FAMILY_HISTORY +se I-FAMILY_HISTORY +casaron I-FAMILY_HISTORY +a I-FAMILY_HISTORY +edades I-FAMILY_HISTORY +muy I-FAMILY_HISTORY +tempranas I-FAMILY_HISTORY +para I-FAMILY_HISTORY +salir I-FAMILY_HISTORY +de I-FAMILY_HISTORY +casa I-FAMILY_HISTORY +lo I-FAMILY_HISTORY +más I-FAMILY_HISTORY +pronto I-FAMILY_HISTORY +posible. I-FAMILY_HISTORY + I-FAMILY_HISTORY +• B-EXPLORATION +Proceso I-EXPLORATION +de I-EXPLORATION +evaluación I-EXPLORATION + I-EXPLORATION +Instrumentos I-EXPLORATION +de I-EXPLORATION +evaluación I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +entrevista I-EXPLORATION +psicológica I-EXPLORATION +se I-EXPLORATION +emplearon I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +instrumentos: I-EXPLORATION + I-EXPLORATION +-Escala I-EXPLORATION +de I-EXPLORATION +Síntomas, I-EXPLORATION +SCL-90-R I-EXPLORATION +(Derogatis, I-EXPLORATION +1977) I-EXPLORATION +(3), I-EXPLORATION +nos I-EXPLORATION +permite I-EXPLORATION +una I-EXPLORATION +evaluación I-EXPLORATION +general I-EXPLORATION +de I-EXPLORATION +síntomas I-EXPLORATION +psicopatológicos. I-EXPLORATION +Es I-EXPLORATION +un I-EXPLORATION +listado I-EXPLORATION +de I-EXPLORATION +comprobación I-EXPLORATION +de I-EXPLORATION +síntomas I-EXPLORATION +recogidos I-EXPLORATION +en I-EXPLORATION +9 I-EXPLORATION +dimensiones I-EXPLORATION +con I-EXPLORATION +datos I-EXPLORATION +normativos I-EXPLORATION +españoles I-EXPLORATION +y I-EXPLORATION +propiedades I-EXPLORATION +psicométricas I-EXPLORATION +aceptables I-EXPLORATION +(4). I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +fiabilidad, I-EXPLORATION +ha I-EXPLORATION +presentado I-EXPLORATION +una I-EXPLORATION +buena I-EXPLORATION +consistencia I-EXPLORATION +interna I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +subescalas I-EXPLORATION +(oscilando I-EXPLORATION +la I-EXPLORATION +a I-EXPLORATION +de I-EXPLORATION +Cronbach I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +78 I-EXPLORATION +a I-EXPLORATION +0, I-EXPLORATION +90), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +adecuada I-EXPLORATION +validez I-EXPLORATION +predictiva I-EXPLORATION +(5). I-EXPLORATION +También I-EXPLORATION +ha I-EXPLORATION +demostrado I-EXPLORATION +adecuada I-EXPLORATION +validez I-EXPLORATION +discriminativa, I-EXPLORATION +la I-EXPLORATION +validez I-EXPLORATION +concurrente I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +IIP-C I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +GHQ-12) I-EXPLORATION +(6). I-EXPLORATION + I-EXPLORATION +-MCMI-II I-EXPLORATION +(Millon, I-EXPLORATION +1987), I-EXPLORATION +es I-EXPLORATION +un I-EXPLORATION +cuestionario I-EXPLORATION +que I-EXPLORATION +consta I-EXPLORATION +de I-EXPLORATION +175 I-EXPLORATION +ítems I-EXPLORATION +de I-EXPLORATION +respuesta I-EXPLORATION +verdadero-falso I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +informan I-EXPLORATION +sobre I-EXPLORATION +8 I-EXPLORATION +patrones I-EXPLORATION +clínicos I-EXPLORATION +de I-EXPLORATION +personalidad, I-EXPLORATION +3 I-EXPLORATION +formas I-EXPLORATION +graves I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +de I-EXPLORATION +personalidad, I-EXPLORATION +6 I-EXPLORATION +síndromes I-EXPLORATION +clínicos I-EXPLORATION +de I-EXPLORATION +intensidad I-EXPLORATION +moderada, I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +síndromes I-EXPLORATION +clínicos I-EXPLORATION +graves. I-EXPLORATION +Las I-EXPLORATION +puntuaciones I-EXPLORATION +se I-EXPLORATION +convierten I-EXPLORATION +en I-EXPLORATION +tasas I-EXPLORATION +base, I-EXPLORATION +cuyo I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +se I-EXPLORATION +sitúa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +75, I-EXPLORATION +siendo I-EXPLORATION +los I-EXPLORATION +valores I-EXPLORATION +superiores I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +algún I-EXPLORATION +problema I-EXPLORATION +clínico. I-EXPLORATION +Cuenta I-EXPLORATION +con I-EXPLORATION +medidas I-EXPLORATION +de I-EXPLORATION +validez I-EXPLORATION +y I-EXPLORATION +sinceridad I-EXPLORATION +(7). I-EXPLORATION + I-EXPLORATION +Resultados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +entrevista, I-EXPLORATION +P. I-EXPLORATION +resulta I-EXPLORATION +colaboradora. I-EXPLORATION +No I-EXPLORATION +muestra I-EXPLORATION +total I-EXPLORATION +indiferencia I-EXPLORATION +por I-EXPLORATION +su I-EXPLORATION +hemiparesia, I-EXPLORATION +pero I-EXPLORATION +le I-EXPLORATION +resta I-EXPLORATION +excesiva I-EXPLORATION +importancia, I-EXPLORATION +centrándose I-EXPLORATION +más I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +secuelas I-EXPLORATION +del I-EXPLORATION +síntoma I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +etiología. I-EXPLORATION +Se I-EXPLORATION +aprecia I-EXPLORATION +cierta I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +somatización I-EXPLORATION +ante I-EXPLORATION +conflictos I-EXPLORATION +personales I-EXPLORATION +y I-EXPLORATION +familiares, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +latencia I-EXPLORATION +de I-EXPLORATION +respuesta I-EXPLORATION +larga I-EXPLORATION +y I-EXPLORATION +dificultades I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +recuerdo I-EXPLORATION +de I-EXPLORATION +nombres I-EXPLORATION +propios I-EXPLORATION +y I-EXPLORATION +fechas, I-EXPLORATION +que I-EXPLORATION +mejoran I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +entrevista. I-EXPLORATION +Refiere I-EXPLORATION +ciertos I-EXPLORATION +sentimientos I-EXPLORATION +de I-EXPLORATION +culpa I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +preocupación I-EXPLORATION +que I-EXPLORATION +su I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +salud I-EXPLORATION +pueda I-EXPLORATION +producir I-EXPLORATION +en I-EXPLORATION +sus I-EXPLORATION +familiares. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +personalidad, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +describe I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +persona I-EXPLORATION +sociable, I-EXPLORATION +ansiosa, I-EXPLORATION +muy I-EXPLORATION +activa, I-EXPLORATION +autoexigente I-EXPLORATION +y I-EXPLORATION +controladora. I-EXPLORATION +Asimismo, I-EXPLORATION +coincide I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +definitorias I-EXPLORATION +del I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +conducta I-EXPLORATION +tipo-A I-EXPLORATION +(impaciencia, I-EXPLORATION +competitividad, I-EXPLORATION +hostilidad), I-EXPLORATION +teniendo I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +la I-EXPLORATION +forma I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +manifestaría I-EXPLORATION +considerando I-EXPLORATION +su I-EXPLORATION +género, I-EXPLORATION +edad I-EXPLORATION +y I-EXPLORATION +nivel I-EXPLORATION +cultural I-EXPLORATION +(8). I-EXPLORATION +Por I-EXPLORATION +otro I-EXPLORATION +lado, I-EXPLORATION +manifiesta I-EXPLORATION +repetidamente I-EXPLORATION +que I-EXPLORATION +intenta I-EXPLORATION +presentarse I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +persona I-EXPLORATION +fuerte I-EXPLORATION +y I-EXPLORATION +evita I-EXPLORATION +pedir I-EXPLORATION +ayuda I-EXPLORATION +a I-EXPLORATION +sus I-EXPLORATION +familiares I-EXPLORATION +para I-EXPLORATION +no I-EXPLORATION +preocuparlos. I-EXPLORATION +Por I-EXPLORATION +ejemplo, I-EXPLORATION +cuando I-EXPLORATION +empieza I-EXPLORATION +a I-EXPLORATION +percibir I-EXPLORATION +pequeños I-EXPLORATION +indicios I-EXPLORATION +de I-EXPLORATION +algún I-EXPLORATION +posible I-EXPLORATION +problema I-EXPLORATION +físico I-EXPLORATION +(síntomas I-EXPLORATION +pre-infarto), I-EXPLORATION +no I-EXPLORATION +dice I-EXPLORATION +nada I-EXPLORATION +a I-EXPLORATION +nadie I-EXPLORATION +hasta I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +situación I-EXPLORATION +requiere I-EXPLORATION +acudir I-EXPLORATION +a I-EXPLORATION +Urgencias I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +requiere I-EXPLORATION +hospitalización. I-EXPLORATION +Este I-EXPLORATION +funcionamiento, I-EXPLORATION +es I-EXPLORATION +similar I-EXPLORATION +en I-EXPLORATION +lo I-EXPLORATION +referente I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +estados I-EXPLORATION +emocionales. I-EXPLORATION +Paradójicamente, I-EXPLORATION +actúa I-EXPLORATION +en I-EXPLORATION +muchas I-EXPLORATION +ocasiones I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +persona I-EXPLORATION +muy I-EXPLORATION +dependiente I-EXPLORATION +con I-EXPLORATION +aquellas I-EXPLORATION +figuras I-EXPLORATION +idealizadas. I-EXPLORATION +No I-EXPLORATION +impresiona I-EXPLORATION +de I-EXPLORATION +histrionismo I-EXPLORATION +o I-EXPLORATION +teatralidad I-EXPLORATION +aunque I-EXPLORATION +sí I-EXPLORATION +se I-EXPLORATION +advierte I-EXPLORATION +una I-EXPLORATION +actitud I-EXPLORATION +seductora I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trato I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +terapeutas I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +tiende I-EXPLORATION +a I-EXPLORATION +idealizar, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vez I-EXPLORATION +que I-EXPLORATION +coloca I-EXPLORATION +al I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +profesionales I-EXPLORATION +(médicos, I-EXPLORATION +enfermería) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +otro I-EXPLORATION +extremo, I-EXPLORATION +desvalorizándolos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +refiere I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +variables I-EXPLORATION +psicopatológicas, I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +SCL-90-R I-EXPLORATION +destaca I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +puntuaciones I-EXPLORATION +más I-EXPLORATION +altas I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +dimensiones I-EXPLORATION +de I-EXPLORATION +somatización, I-EXPLORATION +depresión I-EXPLORATION +y I-EXPLORATION +ansiedad. I-EXPLORATION +Las I-EXPLORATION +puntuaciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +escalas, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +índices I-EXPLORATION +globales, I-EXPLORATION +quedan I-EXPLORATION +por I-EXPLORATION +debajo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +media I-EXPLORATION +obtenida I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +normativos I-EXPLORATION +españoles. I-EXPLORATION +Esta I-EXPLORATION +información I-EXPLORATION +coincide I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +obtenida I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +entrevista I-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cuestionario I-EXPLORATION +de I-EXPLORATION +Millon. I-EXPLORATION + I-EXPLORATION +Respecto I-EXPLORATION +al I-EXPLORATION +perfil I-EXPLORATION +obtenido I-EXPLORATION +por I-EXPLORATION +P. I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +MCMI-II, I-EXPLORATION +comentar I-EXPLORATION +lo I-EXPLORATION +siguiente; I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +escalas I-EXPLORATION +de I-EXPLORATION +validación, I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +resaltar I-EXPLORATION +el I-EXPLORATION +alto I-EXPLORATION +valor I-EXPLORATION +obtenido I-EXPLORATION +en I-EXPLORATION +"deseabilidad", I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +aunque I-EXPLORATION +es I-EXPLORATION +sincera I-EXPLORATION +contestando I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +tiende I-EXPLORATION +a I-EXPLORATION +hacer I-EXPLORATION +lo I-EXPLORATION +posible I-EXPLORATION +por I-EXPLORATION +presentar I-EXPLORATION +su I-EXPLORATION +mejor I-EXPLORATION +imagen, I-EXPLORATION +a I-EXPLORATION +parecer I-EXPLORATION +sana I-EXPLORATION +y I-EXPLORATION +causar I-EXPLORATION +una I-EXPLORATION +buena I-EXPLORATION +impresión I-EXPLORATION +negando I-EXPLORATION +tener I-EXPLORATION +alguna I-EXPLORATION +problemática I-EXPLORATION +en I-EXPLORATION +particular. I-EXPLORATION +En I-EXPLORATION +lo I-EXPLORATION +referente I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +escalas I-EXPLORATION +clínicas I-EXPLORATION +de I-EXPLORATION +personalidad I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +elevaciones I-EXPLORATION +significativas I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +escalas: I-EXPLORATION +"dependiente" I-EXPLORATION +(T: I-EXPLORATION +B I-EXPLORATION += I-EXPLORATION +98), I-EXPLORATION +"histriónica" I-EXPLORATION +(T: I-EXPLORATION +B= I-EXPLORATION +84), I-EXPLORATION +"compulsiva" I-EXPLORATION +(T.B=87). I-EXPLORATION +Es I-EXPLORATION +decir, I-EXPLORATION +estamos I-EXPLORATION +ante I-EXPLORATION +una I-EXPLORATION +persona I-EXPLORATION +que I-EXPLORATION +necesita I-EXPLORATION +constantemente I-EXPLORATION +aprobación, I-EXPLORATION +atención I-EXPLORATION +y I-EXPLORATION +afecto I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +rodean, I-EXPLORATION +esto I-EXPLORATION +lo I-EXPLORATION +conseguiría I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +parte I-EXPLORATION +comportándose I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +sumisa, I-EXPLORATION +mostrando I-EXPLORATION +escasa I-EXPLORATION +autonomía I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +notable I-EXPLORATION +falta I-EXPLORATION +de I-EXPLORATION +asertividad I-EXPLORATION +(escala I-EXPLORATION +"dependiente"). I-EXPLORATION +Y I-EXPLORATION +por I-EXPLORATION +otra, I-EXPLORATION +mediante I-EXPLORATION +cierta I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +llamar I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +demás I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +autodramatización I-EXPLORATION +(escala I-EXPLORATION +"histriónica"). I-EXPLORATION +La I-EXPLORATION +puntuación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +"compulsiva" I-EXPLORATION +podría I-EXPLORATION +indicar I-EXPLORATION +ese I-EXPLORATION +autocontrol I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +ante I-EXPLORATION +hacer I-EXPLORATION +aflorar I-EXPLORATION +sus I-EXPLORATION +deseos I-EXPLORATION +y I-EXPLORATION +sentimientos I-EXPLORATION +reales I-EXPLORATION +ante I-EXPLORATION +determinadas I-EXPLORATION +situaciones I-EXPLORATION +(en I-EXPLORATION +especial I-EXPLORATION +ante I-EXPLORATION +aquellas I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +provocan I-EXPLORATION +ira I-EXPLORATION +o I-EXPLORATION +enfado). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +escalas I-EXPLORATION +que I-EXPLORATION +indican I-EXPLORATION +síndromes I-EXPLORATION +clínicos I-EXPLORATION +de I-EXPLORATION +intensidad I-EXPLORATION +moderada: I-EXPLORATION +vemos I-EXPLORATION +que I-EXPLORATION +P. I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +tensa, I-EXPLORATION +nerviosa I-EXPLORATION +e I-EXPLORATION +inquieta I-EXPLORATION +(escala I-EXPLORATION +de I-EXPLORATION +"ansiedad" I-EXPLORATION +=109), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +ánimo I-EXPLORATION +bajo I-EXPLORATION +crónico I-EXPLORATION +(duración I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +años) I-EXPLORATION +con I-EXPLORATION +sentimientos I-EXPLORATION +de I-EXPLORATION +desanimo, I-EXPLORATION +apatía, I-EXPLORATION +baja I-EXPLORATION +autoestima I-EXPLORATION +(escala I-EXPLORATION +de I-EXPLORATION +"distimia"=92). I-EXPLORATION +Y I-EXPLORATION +a I-EXPLORATION +ello I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +añade I-EXPLORATION +su I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +expresar I-EXPLORATION +las I-EXPLORATION +dificultades I-EXPLORATION +psicológicas I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +canales I-EXPLORATION +somáticos I-EXPLORATION +(escala I-EXPLORATION +"histeriforme" I-EXPLORATION +=105). I-EXPLORATION +Por I-EXPLORATION +último, I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +escalas I-EXPLORATION +que I-EXPLORATION +indican I-EXPLORATION +trastornos I-EXPLORATION +graves I-EXPLORATION +de I-EXPLORATION +personalidad I-EXPLORATION +(esquizotipica, I-EXPLORATION +límite I-EXPLORATION +y I-EXPLORATION +paranoide) I-EXPLORATION +y I-EXPLORATION +síndromes I-EXPLORATION +clínicos I-EXPLORATION +graves I-EXPLORATION +(pensamiento I-EXPLORATION +psicótico, I-EXPLORATION +depresión I-EXPLORATION +mayor I-EXPLORATION +y I-EXPLORATION +trastorno I-EXPLORATION +delirante) I-EXPLORATION +ninguna I-EXPLORATION +de I-EXPLORATION +ellas I-EXPLORATION +sobrepasa I-EXPLORATION +una I-EXPLORATION +puntuación I-EXPLORATION +Tasa I-EXPLORATION +Base I-EXPLORATION +de I-EXPLORATION +75, I-EXPLORATION +siendo I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +tanto I-EXPLORATION +no I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rehabilitación I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +subagudos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Trastorno I-PRESENT_ILLNESS +Esquizofrénico. I-PRESENT_ILLNESS +Su B-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +54 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +discal I-PAST_MEDICAL_HISTORY +lumbar. I-PAST_MEDICAL_HISTORY +Es I-PAST_MEDICAL_HISTORY +diestro I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +escritura I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +precisa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +corrección I-PAST_MEDICAL_HISTORY +óptica I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +lectura. I-PAST_MEDICAL_HISTORY +Titulado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +administración, I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +desempeñado I-PAST_MEDICAL_HISTORY +bien I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +labor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +jefe I-PAST_MEDICAL_HISTORY +administrativo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +empresa. I-PAST_MEDICAL_HISTORY +Vive I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +esposa I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +hijos I-PAST_MEDICAL_HISTORY +menores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +54 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +sufre I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mutismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desconexión I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hipotonía. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +sospecha I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +epiléptico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +remite I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +neurología, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cataloga I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +parciales I-PAST_MEDICAL_HISTORY +complejas. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +EEG I-PAST_MEDICAL_HISTORY +inicial I-PAST_MEDICAL_HISTORY +(con I-PAST_MEDICAL_HISTORY +fotoestimulación I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +privación I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +sueño) I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +reflejan I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +paroxismos, I-PAST_MEDICAL_HISTORY +solo I-PAST_MEDICAL_HISTORY +hay I-PAST_MEDICAL_HISTORY +actividad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fondo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ritmo I-PAST_MEDICAL_HISTORY +alpha I-PAST_MEDICAL_HISTORY +occipital I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +Hz, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +signos I-PAST_MEDICAL_HISTORY +irritativos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +focalidad. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +inicia I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +valproato I-PAST_MEDICAL_HISTORY +sódico I-PAST_MEDICAL_HISTORY +(no I-PAST_MEDICAL_HISTORY +sabemos I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +duración) I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +prácticamente I-PAST_MEDICAL_HISTORY +nula I-PAST_MEDICAL_HISTORY +y, I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +repetirse I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +epsiodios, I-PAST_MEDICAL_HISTORY +abandona I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +medicación I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +seguimiento. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +describe I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +persistencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mutismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desconexión I-PAST_MEDICAL_HISTORY +recurrentes, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +frecuencia I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +vez I-PAST_MEDICAL_HISTORY +mayor. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Cumplidos I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +56 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +ingresa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +neurología I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +súbito I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +disartria, I-PAST_MEDICAL_HISTORY +parestesias I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +extremidad I-PAST_MEDICAL_HISTORY +superior I-PAST_MEDICAL_HISTORY +derecha, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desconexión I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +movimientos I-PAST_MEDICAL_HISTORY +masticatorios I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fijación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mirada. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +realiza I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +nuevo I-PAST_MEDICAL_HISTORY +EEG I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +aprecia I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +disfunción I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +temporal I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +sobre I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +actividad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fondo I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +TAC I-PAST_MEDICAL_HISTORY +craneal, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +RM I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Angio-RM I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +evidenciaron I-PAST_MEDICAL_HISTORY +cambios I-PAST_MEDICAL_HISTORY +patológicos. I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Probable I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +migraña I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +aura I-PAST_MEDICAL_HISTORY +visual I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipercolesterolemia, I-PAST_MEDICAL_HISTORY +pautándose I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +valproato I-PAST_MEDICAL_HISTORY +sódico I-PAST_MEDICAL_HISTORY +(500 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +atorvastatina I-PAST_MEDICAL_HISTORY +(80 I-PAST_MEDICAL_HISTORY +mg/día) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico I-PAST_MEDICAL_HISTORY +(300 I-PAST_MEDICAL_HISTORY +mg/día). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +ambulatorio I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +practica I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +SPECT I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +aprecia I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +mínimo I-PAST_MEDICAL_HISTORY +defecto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +perfusión I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +temporoparietal I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lado I-PAST_MEDICAL_HISTORY +izquierdo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +desaparece I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +horas I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +domicilio. I-PAST_MEDICAL_HISTORY +Le I-PAST_MEDICAL_HISTORY +encuentran I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +coche, I-PAST_MEDICAL_HISTORY +aparcado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +arcén, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mutismo I-PAST_MEDICAL_HISTORY +acinético I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +estímulos. I-PAST_MEDICAL_HISTORY +Estudian I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +caso I-PAST_MEDICAL_HISTORY +Medicina I-PAST_MEDICAL_HISTORY +Interna I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Neurología I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +encuentran I-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +justificativos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +pruebas I-PAST_MEDICAL_HISTORY +complementarias. I-PAST_MEDICAL_HISTORY +Sí I-PAST_MEDICAL_HISTORY +constatan I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +conflictiva I-PAST_MEDICAL_HISTORY +importante I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +laboral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +relacional, I-PAST_MEDICAL_HISTORY +sospechando I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fuga I-PAST_MEDICAL_HISTORY +disociativa. I-PAST_MEDICAL_HISTORY +Piden I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +interconsulta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +psiquiatría, I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +éste I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +contacto I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dicha I-PAST_MEDICAL_HISTORY +especialidad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +unidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +agudos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +psiquiatría I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +catatonia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +filiar. I-PAST_MEDICAL_HISTORY +Presenta I-PAST_MEDICAL_HISTORY +mutismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +estímulos I-PAST_MEDICAL_HISTORY +persistente I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diazepam I-PAST_MEDICAL_HISTORY +(40 I-PAST_MEDICAL_HISTORY +mg/día). I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +decide I-PAST_MEDICAL_HISTORY +administrar I-PAST_MEDICAL_HISTORY +TEC I-PAST_MEDICAL_HISTORY +(7 I-PAST_MEDICAL_HISTORY +sesiones) I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +iniciar I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antidepresivo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +venlafaxina I-PAST_MEDICAL_HISTORY +(150 I-PAST_MEDICAL_HISTORY +mg/día). I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +largo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +sesiones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +TEC I-PAST_MEDICAL_HISTORY +recupera I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +discurso I-PAST_MEDICAL_HISTORY +espontáneo, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +persiste I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +dificultad I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +expresión I-PAST_MEDICAL_HISTORY +(anomia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +palilalia), I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +amnesia I-PAST_MEDICAL_HISTORY +lacunar I-PAST_MEDICAL_HISTORY +completa I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +episodio, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +amnesia I-PAST_MEDICAL_HISTORY +incompleta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +eventos I-PAST_MEDICAL_HISTORY +ocurridos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +periodo I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +largo I-PAST_MEDICAL_HISTORY +(de I-PAST_MEDICAL_HISTORY +semanas). I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +hospitalaria I-PAST_MEDICAL_HISTORY +persisten I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +amnesia, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sensación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bloqueo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +motor I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lenguaje. I-PAST_MEDICAL_HISTORY +Tiene I-PAST_MEDICAL_HISTORY +dificultades I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +hacer I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +autónoma, I-PAST_MEDICAL_HISTORY +incluyendo I-PAST_MEDICAL_HISTORY +aspectos I-PAST_MEDICAL_HISTORY +básicos I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +autocuidado, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aparece I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +angustia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ánimo I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +motiva I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +segundo I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +psiquiátrico, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +semanas. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +describen I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +"episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +disociativos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +amnesia I-PAST_MEDICAL_HISTORY +posterior" I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +son I-PAST_MEDICAL_HISTORY +etiquetados I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conversivos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +recuperación I-PAST_MEDICAL_HISTORY +parcial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +amnesia. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +modifica I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antidepresivo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +escitalopram I-PAST_MEDICAL_HISTORY +(20 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +añadiendo I-PAST_MEDICAL_HISTORY +clorazepato I-PAST_MEDICAL_HISTORY +dipotásico I-PAST_MEDICAL_HISTORY +(15 I-PAST_MEDICAL_HISTORY +mg/día) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +trazodona I-PAST_MEDICAL_HISTORY +(100 I-PAST_MEDICAL_HISTORY +mg/día). I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +amnesia I-PAST_MEDICAL_HISTORY +disociativa. I-PAST_MEDICAL_HISTORY +Un I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +precisa I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +tercer I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +psiquiátrico I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +intensa I-PAST_MEDICAL_HISTORY +angustia, I-PAST_MEDICAL_HISTORY +desesperanza, I-PAST_MEDICAL_HISTORY +ideación I-PAST_MEDICAL_HISTORY +autolítica, I-PAST_MEDICAL_HISTORY +persistencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +amnésica, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +deterioro I-PAST_MEDICAL_HISTORY +grave I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +funcionamiento I-PAST_MEDICAL_HISTORY +global. I-PAST_MEDICAL_HISTORY +Por B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +alta I-DERIVED_FROM/TO +frecuencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ingresos I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +deterioro I-DERIVED_FROM/TO +funcional I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +deriva I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +subagudos, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +diagnostica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +trastorno I-DERIVED_FROM/TO +esquizofrénico. I-DERIVED_FROM/TO +Para I-DERIVED_FROM/TO +ello I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +basan I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +tórpida, I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +falta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +repuesta I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +medicación I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +ruptura I-DERIVED_FROM/TO +biográfica, I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +pesar I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +ausencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +psicótica I-DERIVED_FROM/TO +positiva. I-DERIVED_FROM/TO +Le B-TREATMENT +pautan I-TREATMENT +olanzapina I-TREATMENT +(20 I-TREATMENT +mg/día) I-TREATMENT +y I-TREATMENT +ceden I-TREATMENT +parcialmente I-TREATMENT +la I-TREATMENT +angustia I-TREATMENT +y I-TREATMENT +la I-TREATMENT +ideación I-TREATMENT +autolítica, I-TREATMENT +persistendo B-EVOLUTION +los I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +amnesia I-EVOLUTION +y I-EVOLUTION +cefaleas. I-EVOLUTION + I-EVOLUTION +La B-DERIVED_FROM/TO +importante I-DERIVED_FROM/TO +desestructuración I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +sufría I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +todos I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +ámbitos I-DERIVED_FROM/TO +vitales I-DERIVED_FROM/TO +motiva I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +derivación I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +rehabilitación I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +procede I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +revisar I-DERIVED_FROM/TO +toda I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +historia I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +considerar I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +hasta I-DERIVED_FROM/TO +ese I-DERIVED_FROM/TO +momento I-DERIVED_FROM/TO +era I-DERIVED_FROM/TO +impreciso. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Constatamos B-FAMILY_HISTORY +que I-FAMILY_HISTORY +no I-FAMILY_HISTORY +existían I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +enfermedades I-FAMILY_HISTORY +psiquiátricas I-FAMILY_HISTORY +o I-FAMILY_HISTORY +neurológicas. I-FAMILY_HISTORY +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +quinto I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +fratria I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +hermanos, I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +embarazo, I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +madurativo I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +escolarizó I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +describe I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +"feliz I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +normal", I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +rendimiento I-PAST_MEDICAL_HISTORY +académico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +funcionamiento I-PAST_MEDICAL_HISTORY +social. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +paciente I-EXPLORATION +describe I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +amnésicos I-EXPLORATION +como I-EXPLORATION +momentos I-EXPLORATION +de I-EXPLORATION +"pérdida I-EXPLORATION +de I-EXPLORATION +consciencia" I-EXPLORATION +de I-EXPLORATION +minutos I-EXPLORATION +de I-EXPLORATION +duración I-EXPLORATION +sin I-EXPLORATION +un I-EXPLORATION +desencadenante I-EXPLORATION +identificado, I-EXPLORATION +con I-EXPLORATION +cefalea I-EXPLORATION +y I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +ensoñación I-EXPLORATION +posterior. I-EXPLORATION +Hay I-EXPLORATION +amnesia I-EXPLORATION +del I-EXPLORATION +episodio. I-EXPLORATION +La I-EXPLORATION +frecuencia I-EXPLORATION +inicialmente I-EXPLORATION +es I-EXPLORATION +mensual I-EXPLORATION +o I-EXPLORATION +semanal, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +llega I-EXPLORATION +a I-EXPLORATION +ser I-EXPLORATION +diaria. I-EXPLORATION +Verbaliza I-EXPLORATION +fallos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +memoria I-EXPLORATION +autobiográfica, I-EXPLORATION +incluyendo I-EXPLORATION +hechos I-EXPLORATION +concretos I-EXPLORATION +e I-EXPLORATION +importantes I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +crianza I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +hijos, I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +relación I-EXPLORATION +conyugal I-EXPLORATION +y I-EXPLORATION +otros I-EXPLORATION +eventos, I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +es I-EXPLORATION +motivo I-EXPLORATION +de I-EXPLORATION +alarma I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +familia. I-EXPLORATION +Ésta I-EXPLORATION +constata I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +amnesia I-EXPLORATION +episódica I-EXPLORATION +recurrente. I-EXPLORATION +Según I-EXPLORATION +ellos I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +puede I-EXPLORATION +haber I-EXPLORATION +momentos I-EXPLORATION +de I-EXPLORATION +estupor, I-EXPLORATION +a I-EXPLORATION +menudo I-EXPLORATION +con I-EXPLORATION +automatismos I-EXPLORATION +motores I-EXPLORATION +masticatorios, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +aprecian I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +consciencia I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +funciones I-EXPLORATION +cognitivas I-EXPLORATION +parecen I-EXPLORATION +normales. I-EXPLORATION +Confirman I-EXPLORATION +la I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +memoria I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +episodios I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +autobiográficos I-EXPLORATION +previos, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +dificultad I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +retención I-EXPLORATION +de I-EXPLORATION +recuerdos I-EXPLORATION +generados I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +días I-EXPLORATION +y I-EXPLORATION +semanas I-EXPLORATION +posteriores I-EXPLORATION +(por I-EXPLORATION +ejemplo, I-EXPLORATION +durante I-EXPLORATION +los I-EXPLORATION +ingresos). I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +psicopatológico I-EXPLORATION +solo I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +clínica I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +episodio I-EXPLORATION +depresivo I-EXPLORATION +mayor, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +interpreta I-EXPLORATION +como I-EXPLORATION +secundario I-EXPLORATION +al I-EXPLORATION +grave I-EXPLORATION +y I-EXPLORATION +progresivo I-EXPLORATION +deterioro. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +neuropsicológica I-EXPLORATION +indica I-EXPLORATION +dificultades I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +memoria I-EXPLORATION +prospectiva, I-EXPLORATION +sin I-EXPLORATION +problemas I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +memorias I-EXPLORATION +inmediata I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +trabajo. I-EXPLORATION +Tiene I-EXPLORATION +dificultades I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +memoria I-EXPLORATION +a I-EXPLORATION +largo I-EXPLORATION +plazo I-EXPLORATION +visual I-EXPLORATION +y I-EXPLORATION +verbal, I-EXPLORATION +y I-EXPLORATION +dificultades I-EXPLORATION +para I-EXPLORATION +recuperar I-EXPLORATION +información I-EXPLORATION +de I-EXPLORATION +episodios I-EXPLORATION +pasados. I-EXPLORATION +No I-EXPLORATION +hay I-EXPLORATION +un I-EXPLORATION +deterioro I-EXPLORATION +cognitivo I-EXPLORATION +global I-EXPLORATION +(están I-EXPLORATION +preservados I-EXPLORATION +el I-EXPLORATION +lenguaje, I-EXPLORATION +las I-EXPLORATION +gnosias I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +praxias). I-EXPLORATION +Destaca I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +lentitud I-EXPLORATION +generalizada, I-EXPLORATION +en I-EXPLORATION +tareas I-EXPLORATION +con I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +componente I-EXPLORATION +motor, I-EXPLORATION +que I-EXPLORATION +podría I-EXPLORATION +explicarse I-EXPLORATION +por I-EXPLORATION +su I-EXPLORATION +cuadro I-EXPLORATION +afectivo. I-EXPLORATION +Aun I-EXPLORATION +así, I-EXPLORATION +las I-EXPLORATION +dificultades I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +memoria I-EXPLORATION +a I-EXPLORATION +largo I-EXPLORATION +plazo I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +explican I-EXPLORATION +por I-EXPLORATION +causas I-EXPLORATION +motivacionales, I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +esforzó I-EXPLORATION +en I-EXPLORATION +realizar I-EXPLORATION +las I-EXPLORATION +pruebas. I-EXPLORATION +La I-EXPLORATION +conclusión I-EXPLORATION +es I-EXPLORATION +que I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +explican I-EXPLORATION +solo I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +problemas I-EXPLORATION +psiquiátricos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +base I-EXPLORATION +a I-EXPLORATION +todo I-EXPLORATION +lo I-EXPLORATION +expuesto I-EXPLORATION +se I-EXPLORATION +plantea I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +amnesia I-EXPLORATION +epiléptica I-EXPLORATION +transitoria, I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +consideramos I-EXPLORATION +cumplidos I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +diagnósticos I-EXPLORATION +definidos I-EXPLORATION +para I-EXPLORATION +dicha I-EXPLORATION +dicha I-EXPLORATION +entidad. I-EXPLORATION + I-EXPLORATION +Como B-TREATMENT +medida I-TREATMENT +farmacológica I-TREATMENT +inicial, I-TREATMENT +y I-TREATMENT +de I-TREATMENT +cara I-TREATMENT +a I-TREATMENT +descartar I-TREATMENT +un I-TREATMENT +origen I-TREATMENT +funcional I-TREATMENT +de I-TREATMENT +la I-TREATMENT +clínica, I-TREATMENT +se I-TREATMENT +retira I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antipsicótico. I-TREATMENT +Se I-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +antidepresivo I-TREATMENT +con I-TREATMENT +venlafaxina I-TREATMENT +(225 I-TREATMENT +mg/día), I-TREATMENT +mirtazapina I-TREATMENT +(30 I-TREATMENT +mg/día) I-TREATMENT +y I-TREATMENT +aripiprazol I-TREATMENT +(como I-TREATMENT +potenciador I-TREATMENT +antidepresivo, I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mg/día), I-TREATMENT +y B-EVOLUTION +mejora I-EVOLUTION +significativamente I-EVOLUTION +la I-EVOLUTION +clínica I-EVOLUTION +afectiva I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +meses. I-EVOLUTION +Como B-TREATMENT +persistían I-TREATMENT +los I-TREATMENT +paroxismos I-TREATMENT +amnésicos I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +afectivo, I-TREATMENT +y I-TREATMENT +con I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +de I-TREATMENT +amnesia I-TREATMENT +epiléptica I-TREATMENT +transitoria, I-TREATMENT +se I-TREATMENT +introduce I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +levetiracetam I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +crecientes I-TREATMENT +(hasta I-TREATMENT +1500 I-TREATMENT +mg/ I-TREATMENT +12 I-TREATMENT +horas). I-TREATMENT +Durante B-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +incremento I-EVOLUTION +presentó I-EVOLUTION +episodios I-EVOLUTION +aislados I-EVOLUTION +de I-EVOLUTION +amnesia, I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +vuelto I-EVOLUTION +a I-EVOLUTION +registrar I-EVOLUTION +posteriormente I-EVOLUTION +durante I-EVOLUTION +4 I-EVOLUTION +meses. I-EVOLUTION +El I-EVOLUTION +paciente, I-EVOLUTION +actualmente I-EVOLUTION +asintomático, I-EVOLUTION +continúa I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +programa I-EVOLUTION +de I-EVOLUTION +rehabilitación I-EVOLUTION +psicosocial I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +recuperación I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +adecuado I-EVOLUTION +funcionamiento I-EVOLUTION +personal I-EVOLUTION +y I-EVOLUTION +reincorporación I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +domicilio. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +revascularizada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +disfunción I-PAST_MEDICAL_HISTORY +sistólica I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ateromatosis I-PAST_MEDICAL_HISTORY +generalizada. I-PAST_MEDICAL_HISTORY +Estaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +(40 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +atenolol I-PAST_MEDICAL_HISTORY +(50 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico I-PAST_MEDICAL_HISTORY +(300 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +fenofibrato I-PAST_MEDICAL_HISTORY +(200 I-PAST_MEDICAL_HISTORY +mg/día) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +combinación I-PAST_MEDICAL_HISTORY +fija I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +rosiglitazona/metformina I-PAST_MEDICAL_HISTORY +(2/500 I-PAST_MEDICAL_HISTORY +mg/12 I-PAST_MEDICAL_HISTORY +horas). I-PAST_MEDICAL_HISTORY +Es B-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +deterioro I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +taquipnea. I-PRESENT_ILLNESS +Había I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +epigastralgia I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea, I-PRESENT_ILLNESS +continuando I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +habitual. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +100/60 I-EXPLORATION +mmHg, I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +del I-EXPLORATION +84% I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +crepitantes I-EXPLORATION +en I-EXPLORATION +base I-EXPLORATION +pulmonar I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +soplo I-EXPLORATION +vascular I-EXPLORATION +abdominal. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +tenía I-EXPLORATION +Cr I-EXPLORATION +plasmática I-EXPLORATION +de I-EXPLORATION +21, I-EXPLORATION +4 I-EXPLORATION +mg/dl, I-EXPLORATION +glucosa I-EXPLORATION +de I-EXPLORATION +126 I-EXPLORATION +mg/dl, I-EXPLORATION +potasio I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +6 I-EXPLORATION +mEq/l, I-EXPLORATION +creatín I-EXPLORATION +fosfoquinasa I-EXPLORATION +(CPK) I-EXPLORATION +de I-EXPLORATION +315 I-EXPLORATION +con I-EXPLORATION +troponina I-EXPLORATION +I I-EXPLORATION +normal, I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +láctico I-EXPLORATION +de I-EXPLORATION +10, I-EXPLORATION +2 I-EXPLORATION +mmol/l. I-EXPLORATION +Además, I-EXPLORATION +tenía I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +16.210/µl, I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +13, I-EXPLORATION +3 I-EXPLORATION +g/dl I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +de I-EXPLORATION +407 I-EXPLORATION +x I-EXPLORATION +1.000/µl. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +condensación I-EXPLORATION +en I-EXPLORATION +base I-EXPLORATION +derecha. I-EXPLORATION +Fue B-TREATMENT +trasladado I-TREATMENT +a I-TREATMENT +la I-TREATMENT +UCI, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +intubación I-TREATMENT +orotraqueal, I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +fármacos I-TREATMENT +vasoactivos, I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +presentó I-TREATMENT +parada I-TREATMENT +cardiorrespiratoria I-TREATMENT +de I-TREATMENT +la I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +reanimado. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +hemofiltración I-TREATMENT +venovenosa I-TREATMENT +continua I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +durante I-TREATMENT +cinco I-TREATMENT +días I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +progresiva; I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +con I-EVOLUTION +Cr I-EVOLUTION +plasmática I-EVOLUTION +de I-EVOLUTION +3, I-EVOLUTION +5 I-EVOLUTION +mg/dl, I-EVOLUTION +potasio I-EVOLUTION +3, I-EVOLUTION +3 I-EVOLUTION +mEq/l, I-EVOLUTION +pH I-EVOLUTION +de I-EVOLUTION +7, I-EVOLUTION +39 I-EVOLUTION +y I-EVOLUTION +bicarbonato I-EVOLUTION +plasmático I-EVOLUTION +de I-EVOLUTION +20, I-EVOLUTION +6 I-EVOLUTION +mE/l. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +referida B-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Dermatología I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +función I-DERIVED_FROM/TO +renal I-DERIVED_FROM/TO +tras B-PAST_MEDICAL_HISTORY +contar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +epidermólisis I-PAST_MEDICAL_HISTORY +bullosa I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +disfagia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +alimentos I-PAST_MEDICAL_HISTORY +sólidos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +ameritó I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +endoscópico. I-PAST_MEDICAL_HISTORY +Endocrinología B-PRESENT_ILLNESS +descarta I-PRESENT_ILLNESS +hipotiroidismo I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +suprarrenal I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +previo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +año, I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +enviada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +azoemia. I-PRESENT_ILLNESS +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +presenta: I-EXPLORATION +peso I-EXPLORATION +45kg, I-EXPLORATION +talla I-EXPLORATION +1, I-EXPLORATION +55m, I-EXPLORATION +palidez I-EXPLORATION +tegumentaria I-EXPLORATION ++, I-EXPLORATION +alopecia I-EXPLORATION +parcial, I-EXPLORATION +cavidad I-EXPLORATION +oral I-EXPLORATION +con I-EXPLORATION +costras I-EXPLORATION +hemáticas I-EXPLORATION +escasas I-EXPLORATION +diseminadas, I-EXPLORATION +microstomía I-EXPLORATION +con I-EXPLORATION +fijación I-EXPLORATION +lingual I-EXPLORATION +a I-EXPLORATION +piso I-EXPLORATION +de I-EXPLORATION +cavidad I-EXPLORATION +oral, I-EXPLORATION +eritema I-EXPLORATION +generalizado, I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +dermoabrasión I-EXPLORATION +con I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +ampollas I-EXPLORATION +diseminadas I-EXPLORATION +respetando I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +cervical, I-EXPLORATION +deformidad I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +manos, I-EXPLORATION +cicatrices I-EXPLORATION +bilaterales I-EXPLORATION +y I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +eritema. I-EXPLORATION + I-EXPLORATION +Alteraciones I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +relevantes: I-EXPLORATION +hemoglobina I-EXPLORATION +9, I-EXPLORATION +1g/dl, I-EXPLORATION +K I-EXPLORATION +7, I-EXPLORATION +2mmol/l, I-EXPLORATION +urea I-EXPLORATION +345mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +9, I-EXPLORATION +5mg/dl, I-EXPLORATION +albúmina I-EXPLORATION +2g/dl; I-EXPLORATION +Examen I-EXPLORATION +general I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +(EGO) I-EXPLORATION +Densidad I-EXPLORATION +urinaria I-EXPLORATION +(DU) I-EXPLORATION +1009, I-EXPLORATION +pH I-EXPLORATION +5, I-EXPLORATION +5, I-EXPLORATION +proteínas I-EXPLORATION ++, I-EXPLORATION +eritrocitos I-EXPLORATION +150cels/μl; I-EXPLORATION +gasometría I-EXPLORATION +arterial: I-EXPLORATION +Ph I-EXPLORATION +7, I-EXPLORATION +21, I-EXPLORATION +PCo2 I-EXPLORATION +27, I-EXPLORATION +PO2 I-EXPLORATION +92%, I-EXPLORATION +Sat I-EXPLORATION +92%, I-EXPLORATION +HCO3 I-EXPLORATION +7, I-EXPLORATION +6; I-EXPLORATION +proteinuria I-EXPLORATION +de I-EXPLORATION +24h: I-EXPLORATION +1, I-EXPLORATION +8g/día; I-EXPLORATION +volumen I-EXPLORATION +urinario: I-EXPLORATION +1500cc; I-EXPLORATION +ultrasonido I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +7, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +5cm, I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +6cm, I-EXPLORATION +relación I-EXPLORATION +corteza I-EXPLORATION +médula I-EXPLORATION +perdida. I-EXPLORATION +Electrocardiograma: I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +picudas I-EXPLORATION +y I-EXPLORATION +simétricas I-EXPLORATION +con I-EXPLORATION +extrasístoles I-EXPLORATION +ventriculares I-EXPLORATION +aisladas I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +derivaciones I-EXPLORATION +precordiales. I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +permanente I-TREATMENT +tunelizado I-TREATMENT +ante I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +incremento I-TREATMENT +de I-TREATMENT +infección I-TREATMENT +con I-TREATMENT +catéter I-TREATMENT +Tenckhoff. I-TREATMENT + I-TREATMENT +Previa I-TREATMENT +monitorización I-TREATMENT +cardiológica, I-TREATMENT +monitoreo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +presión I-TREATMENT +arterial I-TREATMENT +no I-TREATMENT +invasivo I-TREATMENT +y I-TREATMENT +oximetría I-TREATMENT +de I-TREATMENT +pulso, I-TREATMENT +se I-TREATMENT +administra I-TREATMENT +analgésico I-TREATMENT +intravenoso I-TREATMENT +y I-TREATMENT +sedación. I-TREATMENT +Se I-TREATMENT +identifica I-TREATMENT +la I-TREATMENT +región I-TREATMENT +yugular I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +el I-TREATMENT +sitio I-TREATMENT +de I-TREATMENT +salida I-TREATMENT +con I-TREATMENT +el I-TREATMENT +mínimo I-TREATMENT +daño I-TREATMENT +epitelial, I-TREATMENT +se I-TREATMENT +tuneliza I-TREATMENT +el I-TREATMENT +catéter I-TREATMENT +y I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +catéter I-TREATMENT +Permacath, I-TREATMENT +verificando I-TREATMENT +su I-TREATMENT +posición I-TREATMENT +con I-TREATMENT +radiografía I-TREATMENT +de I-TREATMENT +tórax I-TREATMENT +portátil. I-TREATMENT +Se I-TREATMENT +obtiene I-TREATMENT +retorno I-TREATMENT +arterial I-TREATMENT +y I-TREATMENT +venoso I-TREATMENT +adecuado, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +sutura I-TREATMENT +la I-TREATMENT +piel. I-TREATMENT +Inicia I-TREATMENT +hemodiálisis I-TREATMENT +con B-EVOLUTION +remisión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología, I-EVOLUTION +siendo I-EVOLUTION +egresada I-EVOLUTION +por I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +e B-TREATMENT +incorporándose I-TREATMENT +a I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +hemodiálisis I-TREATMENT +crónica. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +cuello I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cisne I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +cuffs I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Dacron I-PAST_MEDICAL_HISTORY +implantado I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +DP, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cuff I-PAST_MEDICAL_HISTORY +externo I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +extruido I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +parte I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +recurrente I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +orificio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +salida. I-PAST_MEDICAL_HISTORY +Tres B-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +revisión I-PRESENT_ILLNESS +periódica, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +inspección I-PRESENT_ILLNESS +reveló I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +pequeño I-PRESENT_ILLNESS +orificio I-PRESENT_ILLNESS +cerca I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +restos I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuff I-PRESENT_ILLNESS +externo I-PRESENT_ILLNESS +extruido. I-PRESENT_ILLNESS +El B-TREATMENT +agujero I-TREATMENT +no I-TREATMENT +alcanzaba I-TREATMENT +la I-TREATMENT +luz I-TREATMENT +del I-TREATMENT +catéter, I-TREATMENT +pero I-TREATMENT +para I-TREATMENT +prevenir I-TREATMENT +una I-TREATMENT +perforación I-TREATMENT +completa I-TREATMENT +decidimos I-TREATMENT +reforzar I-TREATMENT +dicho I-TREATMENT +punto. I-TREATMENT +Para I-TREATMENT +ello, I-TREATMENT +envolvimos I-TREATMENT +el I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +la I-TREATMENT +perforación I-TREATMENT +con I-TREATMENT +el I-TREATMENT +molde I-TREATMENT +y I-TREATMENT +rellenamos I-TREATMENT +este I-TREATMENT +con I-TREATMENT +el I-TREATMENT +adhesivo I-TREATMENT +de I-TREATMENT +silicona. I-TREATMENT +El I-TREATMENT +segmento I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +extensión I-TREATMENT +del I-TREATMENT +kit I-TREATMENT +no I-TREATMENT +era I-TREATMENT +necesario I-TREATMENT +en I-TREATMENT +ese I-TREATMENT +caso, I-TREATMENT +puesto I-TREATMENT +que I-TREATMENT +no I-TREATMENT +había I-TREATMENT +rotura I-TREATMENT +completa. I-TREATMENT +La B-EVOLUTION +diálisis I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +interrumpió I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +hubo I-EVOLUTION +complicaciones I-EVOLUTION +infecciosas I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +procedimiento. 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 +portadora B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +autoposicionante. I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +DP, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +pequeña I-PAST_MEDICAL_HISTORY +interrupción I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +desaparición I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +línea I-PAST_MEDICAL_HISTORY +radioopaca I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +catéter, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +examen I-PAST_MEDICAL_HISTORY +cuidadoso I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +reveló I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +punto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fuga. I-PAST_MEDICAL_HISTORY +Sin B-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fuga I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dializado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +través I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +agujero I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +justo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +punto I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +línea I-PRESENT_ILLNESS +radioopaca I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +desaparecido. I-PRESENT_ILLNESS +Se B-TREATMENT +le I-TREATMENT +administró I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +profiláctico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +una I-TREATMENT +reparación I-TREATMENT +del I-TREATMENT +catéter, I-TREATMENT +usando I-TREATMENT +el I-TREATMENT +segmento I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +extensión I-TREATMENT +del I-TREATMENT +kit. I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +registró I-EVOLUTION +ningún I-EVOLUTION +tipo I-EVOLUTION +de I-EVOLUTION +complicación I-EVOLUTION +posterior. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Laurence-Moon-Biedl. I-PAST_MEDICAL_HISTORY +Inició I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +(HD) I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +11 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Recibió I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +siguiente, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fracasó I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +trombosis I-PAST_MEDICAL_HISTORY +venosa I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +injerto. I-PAST_MEDICAL_HISTORY +Fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +DP I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +dificultades I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +acceso I-DERIVED_FROM/TO +vascular I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +años I-DERIVED_FROM/TO +después. I-DERIVED_FROM/TO +Sufrió B-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +peritonitis I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hiperparatiroidismo I-PAST_MEDICAL_HISTORY +grave. I-PAST_MEDICAL_HISTORY +Inicialmente, I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +peritoneo I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +medio-alto I-PAST_MEDICAL_HISTORY +transportador. I-PAST_MEDICAL_HISTORY +Tras B-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +técnica, I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +nueva I-PRESENT_ILLNESS +peritonitis I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +túnel I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +eventración I-PRESENT_ILLNESS +peritoneal I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +orificio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +catéter. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +radiografías I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +esclerosis I-EXPLORATION +y I-EXPLORATION +calcificación I-EXPLORATION +del I-EXPLORATION +peritoneo, I-EXPLORATION +comprimiendo I-EXPLORATION +vísceras I-EXPLORATION +abdominales. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +antibióticos, I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +y I-TREATMENT +transferencia I-TREATMENT +a I-TREATMENT +HD. I-TREATMENT +Posteriormente, B-EVOLUTION +presentó I-EVOLUTION +isquemia I-EVOLUTION +aguda I-EVOLUTION +en I-EVOLUTION +miembro I-EVOLUTION +inferior I-EVOLUTION +derecho, I-EVOLUTION +por I-EVOLUTION +obstrucción I-EVOLUTION +femoropoplítea. I-EVOLUTION +La B-TREATMENT +situación I-TREATMENT +clínica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +desestimó I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +y B-EVOLUTION +falleció I-EVOLUTION +poco I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Medicina I-PRESENT_ILLNESS +Interna I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hospital, I-PRESENT_ILLNESS +procedente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +externas, I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +número I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8-10 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +raíz I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +iniciar I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +quimioterápico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tercera I-PRESENT_ILLNESS +línea I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Rituximab I-PRESENT_ILLNESS +(4 I-PRESENT_ILLNESS +sesiones). I-PRESENT_ILLNESS +En B-TREATMENT +principio I-TREATMENT +se I-TREATMENT +atribuyó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +infección I-TREATMENT +por I-TREATMENT +Clostridium I-TREATMENT +difficile I-TREATMENT +(ELISA I-TREATMENT +y I-TREATMENT +cultivo I-TREATMENT +positivos), I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +convenientemente I-TREATMENT +con I-TREATMENT +metronidazol, I-TREATMENT +obteniendo B-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +inicial I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +gastrointestinal, I-EVOLUTION +pero I-EVOLUTION +sin I-EVOLUTION +llegar I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +remisión I-EVOLUTION +completa; I-EVOLUTION +teniendo I-EVOLUTION +entre I-EVOLUTION +8-10 I-EVOLUTION +deposiciones I-EVOLUTION +diarias, I-EVOLUTION +de I-EVOLUTION +consistencia I-EVOLUTION +líquida, I-EVOLUTION +inicialmente I-EVOLUTION +sin I-EVOLUTION +productos I-EVOLUTION +patológicos I-EVOLUTION +añadidos. I-EVOLUTION +No I-EVOLUTION +presentaba I-EVOLUTION +fiebre, I-EVOLUTION +náuseas, I-EVOLUTION +vómitos I-EVOLUTION +ni I-EVOLUTION +intolerancia I-EVOLUTION +oral, I-EVOLUTION +sólo I-EVOLUTION +deposición I-EVOLUTION +líquida I-EVOLUTION +cada I-EVOLUTION +vez I-EVOLUTION +que I-EVOLUTION +ingería I-EVOLUTION +comida, I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +últimos I-EVOLUTION +3-4 I-EVOLUTION +meses I-EVOLUTION +había I-EVOLUTION +perdido I-EVOLUTION +entre I-EVOLUTION +8-10 I-EVOLUTION +kg. I-EVOLUTION +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +Leucemia I-PAST_MEDICAL_HISTORY +Linfática I-PAST_MEDICAL_HISTORY +Crónica I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +C3 I-PAST_MEDICAL_HISTORY +(LLC) I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +julio I-PAST_MEDICAL_HISTORY +2004; I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +quimioterapia I-PAST_MEDICAL_HISTORY +(ciclofosfamida I-PAST_MEDICAL_HISTORY ++ I-PAST_MEDICAL_HISTORY +fludarabina) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mayo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +06. I-PAST_MEDICAL_HISTORY +Actualmente I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dieta I-PAST_MEDICAL_HISTORY +astringente I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +sal, I-PAST_MEDICAL_HISTORY +Omeprazol I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg: I-PAST_MEDICAL_HISTORY +1-0-0; I-PAST_MEDICAL_HISTORY +Mastical®: I-PAST_MEDICAL_HISTORY +1-1-1; I-PAST_MEDICAL_HISTORY +Vitamina I-PAST_MEDICAL_HISTORY +D3: I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +gotas/día; I-PAST_MEDICAL_HISTORY +Coroprés® I-PAST_MEDICAL_HISTORY +6, I-PAST_MEDICAL_HISTORY +25: I-PAST_MEDICAL_HISTORY +½-0-½; I-PAST_MEDICAL_HISTORY +Prednisona®: I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Neupogen®: I-PAST_MEDICAL_HISTORY +500 I-PAST_MEDICAL_HISTORY +mg/3 I-PAST_MEDICAL_HISTORY +semanas. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +TA I-EXPLORATION +130/80, I-EXPLORATION +Fc I-EXPLORATION +80 I-EXPLORATION +lpm, I-EXPLORATION +apirético, I-EXPLORATION +talla I-EXPLORATION +176 I-EXPLORATION +cm, I-EXPLORATION +peso I-EXPLORATION +69 I-EXPLORATION +kg, I-EXPLORATION +IMC I-EXPLORATION +22. I-EXPLORATION +Sequedad I-EXPLORATION +de I-EXPLORATION +mucosas, I-EXPLORATION +adenopatías I-EXPLORATION +latero I-EXPLORATION +cervicales I-EXPLORATION +estables. I-EXPLORATION +Hipoventilación I-EXPLORATION +pulmonar I-EXPLORATION +bases. I-EXPLORATION +Abdomen: I-EXPLORATION +Hepatomegalia I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +con I-EXPLORATION +esplenomegalia I-EXPLORATION +con I-EXPLORATION +borde I-EXPLORATION +esplénico I-EXPLORATION +a I-EXPLORATION +5-6 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +costal. I-EXPLORATION +Resto I-EXPLORATION +sin I-EXPLORATION +interés. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +practicada I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +hipoproteinemia, I-EXPLORATION +anemia, I-EXPLORATION +linfopenia I-EXPLORATION +con I-EXPLORATION +marcadores I-EXPLORATION +inflamatorios I-EXPLORATION +elevados I-EXPLORATION +(ver I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tabla I-EXPLORATION +noviembre). I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +realizadas I-EXPLORATION +durante I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +fueron: I-EXPLORATION +ecografía I-EXPLORATION +hepática I-EXPLORATION +hepatopatía I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hipertensión I-EXPLORATION +portal. I-EXPLORATION +Esplenomegalia. I-EXPLORATION +Dilatación I-EXPLORATION +del I-EXPLORATION +eje I-EXPLORATION +espleno-portal. I-EXPLORATION +No I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +peritoneal. I-EXPLORATION +Colelitiasis. I-EXPLORATION +Múltiples I-EXPLORATION +quistes I-EXPLORATION +simples I-EXPLORATION +renales. I-EXPLORATION +Panendoscopia I-EXPLORATION +oral: I-EXPLORATION +normal. I-EXPLORATION +Colonoscopia: I-EXPLORATION +pólipo I-EXPLORATION +sesil I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +transverso. I-EXPLORATION +Rx I-EXPLORATION +tórax: I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +Biopsia I-EXPLORATION +duodenal: I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +patológicas. I-EXPLORATION +Rojo I-EXPLORATION +Congo I-EXPLORATION +biopsia I-EXPLORATION +duodenal: I-EXPLORATION +negativo.- I-EXPLORATION +D-Xilosa: I-EXPLORATION +patológico I-EXPLORATION +Elastasa I-EXPLORATION +en I-EXPLORATION +heces: I-EXPLORATION +positiva I-EXPLORATION +Coprocultivo: I-EXPLORATION +negativo. I-EXPLORATION +Hemocultivos I-EXPLORATION +y I-EXPLORATION +urinocultivo: I-EXPLORATION +negativo. I-EXPLORATION +Parásitos I-EXPLORATION +en I-EXPLORATION +heces I-EXPLORATION +negativo. I-EXPLORATION +Serología I-EXPLORATION +de I-EXPLORATION +enterobacterias: I-EXPLORATION +negativa. I-EXPLORATION +Tránsito I-EXPLORATION +gastrointestinal: I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea: I-EXPLORATION +pequeña I-EXPLORATION +población I-EXPLORATION +monoclonal, I-EXPLORATION +sin I-EXPLORATION +relevancia. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +diarreas I-EVOLUTION +incoercibles I-EVOLUTION +con I-EVOLUTION +12-15 I-EVOLUTION +deposiciones I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +a I-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +higiénicodietéticas, I-EVOLUTION +y I-EVOLUTION +deterioro I-EVOLUTION +nutricional I-EVOLUTION +progresivo, I-EVOLUTION +presentando I-EVOLUTION +una I-EVOLUTION +desnutrición I-EVOLUTION +moderada I-EVOLUTION +(ver I-EVOLUTION +tabla I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +noviembre), I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +(NP) I-TREATMENT +a I-TREATMENT +la I-TREATMENT +semana I-TREATMENT +del I-TREATMENT +ingreso, I-TREATMENT +utilizándose I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +central I-TREATMENT +de I-TREATMENT +inserción I-TREATMENT +periférica I-TREATMENT +(PICC), I-TREATMENT +al I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +iniciar I-TREATMENT +la I-TREATMENT +NP, I-TREATMENT +y B-EVOLUTION +dada I-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +clínico-analítica I-EVOLUTION +de I-EVOLUTION +nuestro I-EVOLUTION +paciente I-EVOLUTION +(ver I-EVOLUTION +tabla I-EVOLUTION +diciembre), I-EVOLUTION +se B-TREATMENT +decidió I-TREATMENT +introducir I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +conjunta I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +y I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +(NE) I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +suplementos I-TREATMENT +hiperproteicos I-TREATMENT +(600 I-TREATMENT +kcal/día), I-TREATMENT +aumentando I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +progresiva I-TREATMENT +el I-TREATMENT +aporte I-TREATMENT +calórico. I-TREATMENT +Dada B-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +tolerancia, I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +número I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +diarias, I-EVOLUTION +1 I-EVOLUTION +ó I-EVOLUTION +2, I-EVOLUTION +se B-TREATMENT +añadió I-TREATMENT +dieta I-TREATMENT +astringente I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +sus I-TREATMENT +necesidades I-TREATMENT +energéticas I-TREATMENT +1.600 I-TREATMENT +kcal. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +10 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +la I-TREATMENT +introducción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +la I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +por B-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +y I-EVOLUTION +estabilidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +nutricionales I-EVOLUTION +(ver I-EVOLUTION +tabla I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +febrero). I-EVOLUTION + I-EVOLUTION +Previamente B-EXPLORATION +al I-EXPLORATION +alta I-EXPLORATION +se I-EXPLORATION +repitieron I-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +heces, I-EXPLORATION +previamente I-EXPLORATION +negativos, I-EXPLORATION +aislándose I-EXPLORATION +quistes I-EXPLORATION +de I-EXPLORATION +Criptosporidium I-EXPLORATION +parvum I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +heces I-EXPLORATION +siendo I-EXPLORATION +la I-EXPLORATION +Tinción I-EXPLORATION +criptosporidium: I-EXPLORATION +positiva. I-EXPLORATION +Visualizándose I-EXPLORATION +abundantes I-EXPLORATION +quistes I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +heces. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +azitromicina I-TREATMENT +más I-TREATMENT +paramomicina, I-TREATMENT +mejorando B-EVOLUTION +las I-EVOLUTION +molestias I-EVOLUTION +gastrointestinales, I-EVOLUTION +estando I-EVOLUTION +asintomático I-EVOLUTION +actualmente, I-EVOLUTION +podemos I-EVOLUTION +ver I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +y I-EVOLUTION +mejoría I-EVOLUTION +a I-EVOLUTION +lo I-EVOLUTION +largo I-EVOLUTION +del I-EVOLUTION +tratamiento I-EVOLUTION +inicialmente I-EVOLUTION +nutricional I-EVOLUTION +(ver I-EVOLUTION +tabla I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +febrero) I-EVOLUTION +y B-TREATMENT +posteriormente I-TREATMENT +añadiéndose I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +específico I-TREATMENT +antibiótico, I-TREATMENT +estando B-EVOLUTION +actualmente I-EVOLUTION +asintomático I-EVOLUTION +sin I-EVOLUTION +diarrea I-EVOLUTION +y I-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +oral, I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +nutricionales I-EVOLUTION +tanto I-EVOLUTION +bioquímicas I-EVOLUTION +como I-EVOLUTION +antropométricos I-EVOLUTION +peso I-EVOLUTION +74 I-EVOLUTION +kg, I-EVOLUTION +IMC I-EVOLUTION +23 I-EVOLUTION +(ver I-EVOLUTION +tabla I-EVOLUTION +mes I-EVOLUTION +abril). I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Crohn I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +larga I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +fístulas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +resecciones I-PRESENT_ILLNESS +intestinales I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +mala I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +médico. I-PRESENT_ILLNESS +Tras B-TREATMENT +la I-TREATMENT +última I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +exclusión I-TREATMENT +intestinal I-TREATMENT +con I-TREATMENT +gastrostomía I-TREATMENT +de I-TREATMENT +descarga I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +nutrición I-TREATMENT +parenteral. I-TREATMENT +Estaba B-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +hepatopatía I-EXPLORATION +crónica I-EXPLORATION +no I-EXPLORATION +filiada I-EXPLORATION +con I-EXPLORATION +trombosis I-EXPLORATION +portal, I-EXPLORATION +varices I-EXPLORATION +esofágicas I-EXPLORATION +y I-EXPLORATION +pancitopenia I-EXPLORATION +leve. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +peso I-EXPLORATION +al I-EXPLORATION +alta I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +kg, I-EXPLORATION +talla I-EXPLORATION +de I-EXPLORATION +170 I-EXPLORATION +cm I-EXPLORATION +e I-EXPLORATION +IMC I-EXPLORATION +de I-EXPLORATION +17, I-EXPLORATION +3 I-EXPLORATION +kg/m2. I-EXPLORATION +Al B-TREATMENT +alta I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Nutrición I-TREATMENT +Parenteral I-TREATMENT +Domiciliaria I-TREATMENT +(NPD) I-TREATMENT +diaria I-TREATMENT +compuesta I-TREATMENT +por I-TREATMENT +35 I-TREATMENT +kcal/kg/día I-TREATMENT +(14g I-TREATMENT +de I-TREATMENT +nitrógeno, I-TREATMENT +225 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +glucosa, I-TREATMENT +50 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +lípidos I-TREATMENT +MCT/LCT). I-TREATMENT + I-TREATMENT +Durante B-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +meses I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +pancitopenia, I-EVOLUTION +parámetros I-EVOLUTION +nutricionales I-EVOLUTION +y I-EVOLUTION +función I-EVOLUTION +hepática. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +se I-EVOLUTION +produjo I-EVOLUTION +un I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +hepática I-EVOLUTION +con I-EVOLUTION +colestasis I-EVOLUTION +y I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +pancitopenia; I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +disminuyó I-TREATMENT +el I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +grasas, I-TREATMENT +oligoelementos I-TREATMENT +y I-TREATMENT +vitaminas I-TREATMENT +liposolubles. I-TREATMENT +Posteriormente B-EVOLUTION +empeoró I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +e I-EVOLUTION +ictericia I-EVOLUTION +intensa I-EVOLUTION +precisando I-EVOLUTION +ingreso I-EVOLUTION +hospitalario. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +presentaba I-EXPLORATION +importante I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +bilirrubina, I-EXPLORATION +coagulopatía, I-EXPLORATION +trombocitopenia I-EXPLORATION +severa I-EXPLORATION +y I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +albúmina I-EXPLORATION +con I-EXPLORATION +ferritina I-EXPLORATION +en I-EXPLORATION +valores I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +mostró I-EXPLORATION +hepatopatía I-EXPLORATION +crónica I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +obstrucción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar, I-EXPLORATION +trombosis I-EXPLORATION +portal I-EXPLORATION +y I-EXPLORATION +esplenomegalia. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +arquitectura I-EXPLORATION +mantenida, I-EXPLORATION +espacios I-EXPLORATION +porta I-EXPLORATION +con I-EXPLORATION +infiltrados I-EXPLORATION +inflamatorios I-EXPLORATION +y I-EXPLORATION +éstasis I-EXPLORATION +biliar I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +centrolobulillar I-EXPLORATION +con I-EXPLORATION +fenómenos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +hepatocitaria. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +punción I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +celularidad I-EXPLORATION +medular I-EXPLORATION +conservada I-EXPLORATION +con I-EXPLORATION +acúmulo I-EXPLORATION +de I-EXPLORATION +histiocitos I-EXPLORATION +con I-EXPLORATION +material I-EXPLORATION +lipofuccínico I-EXPLORATION +PAS+ I-EXPLORATION +(histiocitos I-EXPLORATION +azul I-EXPLORATION +marino) I-EXPLORATION +que I-EXPLORATION +constituían I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +el I-EXPLORATION +20% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +celularidad I-EXPLORATION +total, I-EXPLORATION +sin I-EXPLORATION +hemofagocitosis. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +administraron I-TREATMENT +3 I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +anti-TNFα I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +su I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +base I-TREATMENT +además I-TREATMENT +de I-TREATMENT +s-adenosilmetionina, I-TREATMENT +con I-TREATMENT +eliminación I-TREATMENT +total I-TREATMENT +de I-TREATMENT +las I-TREATMENT +grasas I-TREATMENT +en I-TREATMENT +la I-TREATMENT +nutrición I-TREATMENT +parenteral. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +desfavorable I-EVOLUTION +presentando I-EVOLUTION +insuficiencia I-EVOLUTION +hepatocelular, I-EVOLUTION +encefalopatía I-EVOLUTION +hepática, I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +y I-EVOLUTION +neumonía I-EVOLUTION +nosocomial, I-EVOLUTION +evolucionando I-EVOLUTION +a I-EVOLUTION +fallo I-EVOLUTION +multiorgánico I-EVOLUTION +y I-EVOLUTION +muerte. I-EVOLUTION + I-EVOLUTION + +Un B-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 +sin B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +médica I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos, I-PAST_MEDICAL_HISTORY +ingresó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +periumbilical, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +°C, I-PRESENT_ILLNESS +meterorismo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Un I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +notó I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +abdomen I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desaparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +tenía I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general. I-EXPLORATION +La I-EXPLORATION +temperatura, I-EXPLORATION +pulso, I-EXPLORATION +tensión I-EXPLORATION +arterial, I-EXPLORATION +cabeza, I-EXPLORATION +cuello, I-EXPLORATION +corazón I-EXPLORATION +y I-EXPLORATION +pulmones I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +abdominal I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +periumbilical I-EXPLORATION +izquierda, I-EXPLORATION +dura, I-EXPLORATION +dolorosa I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +diámetro I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm. I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +peritonismo I-EXPLORATION +ni I-EXPLORATION +hepatoesplenomegalia. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +presentaba I-EXPLORATION +14.000 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +a I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +VSG I-EXPLORATION +de I-EXPLORATION +94 I-EXPLORATION +mm/h. I-EXPLORATION +El I-EXPLORATION +hematocrito, I-EXPLORATION +recuento I-EXPLORATION +plaquetario, I-EXPLORATION +tiempos I-EXPLORATION +de I-EXPLORATION +coagulación, I-EXPLORATION +bioquímica I-EXPLORATION +general, I-EXPLORATION +orina I-EXPLORATION +elemental I-EXPLORATION +y I-EXPLORATION +sedimento I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +en I-EXPLORATION +hipogastrio I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +ecogenicidad I-EXPLORATION +heterogénea I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +músculo I-EXPLORATION +recto I-EXPLORATION +izquierdo. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +descubrió I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +bordes I-EXPLORATION +infiltrativos I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +músculo I-EXPLORATION +recto I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +llega I-EXPLORATION +al I-EXPLORATION +epiplon I-EXPLORATION +mayor, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +visceral. I-EXPLORATION +El I-EXPLORATION +tránsito I-EXPLORATION +gastrointestinal I-EXPLORATION +v I-EXPLORATION +el I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +demostraron I-EXPLORATION +divertículos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +3ª I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +distal I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +diverticulitis I-EXPLORATION +o I-EXPLORATION +perforación. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +guiada I-EXPLORATION +por I-EXPLORATION +TAC I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +histológico I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +reacción I-EXPLORATION +inflamatoria I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +colonias I-EXPLORATION +de I-EXPLORATION +Actinomyces. I-EXPLORATION +Se B-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +clindamicina I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +(600 I-TREATMENT +mg/6 I-TREATMENT +horas) I-TREATMENT +durante I-TREATMENT +45 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +desaparición I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +a I-TREATMENT +Penicilina I-TREATMENT +V I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +(800 I-TREATMENT +mg/6 I-TREATMENT +horas) I-TREATMENT +durante I-TREATMENT +1 I-TREATMENT +año. I-TREATMENT +Un B-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +realizado I-EXPLORATION +6 I-EXPLORATION +meses I-EXPLORATION +después I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Durante B-EVOLUTION +el I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +no I-EVOLUTION +hubo I-EVOLUTION +reaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +masa. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 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 +excepto I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +moderado, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +ingerido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +voluntaria, I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +antes, I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +100 I-PRESENT_ILLNESS +cc. I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Gramaxone® I-PRESENT_ILLNESS +extra I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +20%. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cavidad I-PRESENT_ILLNESS +bucal I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +intensos I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +inicial I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +consciente I-EXPLORATION +y I-EXPLORATION +orientado I-EXPLORATION +témporo-espacialmente, I-EXPLORATION +normotenso I-EXPLORATION +(140/80 I-EXPLORATION +mmHg), I-EXPLORATION +con I-EXPLORATION +una 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 +una I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +3 I-EXPLORATION +ºC. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +oral I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +eritematosas I-EXPLORATION +en I-EXPLORATION +orofaringe. I-EXPLORATION +El I-EXPLORATION +abdomen I-EXPLORATION +era I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +sin I-EXPLORATION +defensa I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaban: I-EXPLORATION +hemoglobina I-EXPLORATION +15 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +46%, I-EXPLORATION +leucocitos I-EXPLORATION +14.500/mm3 I-EXPLORATION +(84 I-EXPLORATION +% I-EXPLORATION +neutrófilos), I-EXPLORATION +plaquetas I-EXPLORATION +240000/mm3, I-EXPLORATION +glucosa I-EXPLORATION +200 I-EXPLORATION +mg/dl, I-EXPLORATION +GOT I-EXPLORATION +78 I-EXPLORATION +U/L, I-EXPLORATION +GPT I-EXPLORATION +91 I-EXPLORATION +U/L, I-EXPLORATION +creatinina I-EXPLORATION +2, I-EXPLORATION +1 I-EXPLORATION +mg/dl. I-EXPLORATION +El I-EXPLORATION +ionograma, I-EXPLORATION +los I-EXPLORATION +tiempos I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +cefalina I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +gases I-EXPLORATION +arteriales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +equilibrio I-EXPLORATION +ácido-base. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +refuerzo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +trama I-EXPLORATION +bronquial. I-EXPLORATION +La I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +ditionita I-EXPLORATION +sódica I-EXPLORATION +fue I-EXPLORATION +positiva. I-EXPLORATION +Inicialmente B-TREATMENT +además I-TREATMENT +de I-TREATMENT +sueroterapia I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +manitol I-TREATMENT +al I-TREATMENT +20%, I-TREATMENT +carbón I-TREATMENT +activado I-TREATMENT +y I-TREATMENT +tierra I-TREATMENT +de I-TREATMENT +Füller I-TREATMENT +por I-TREATMENT +SNG, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +vitamina I-TREATMENT +C I-TREATMENT +y I-TREATMENT +protectores I-TREATMENT +gástricos. I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +trasladado I-TREATMENT +a I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Intensivos I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +hemoperfusión I-TREATMENT +con I-TREATMENT +cartuchos I-TREATMENT +de I-TREATMENT +carbón I-TREATMENT +activado. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +sesión I-EVOLUTION +sufrió I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +hipotensión I-EVOLUTION +arterial I-EVOLUTION +severa I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +aminas I-TREATMENT +vasoactivas. I-TREATMENT +Posteriormente B-EVOLUTION +desarrolló I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +hematemesis I-EVOLUTION +y I-EVOLUTION +melenas. I-EVOLUTION +Durante B-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +sesión I-TREATMENT +de I-TREATMENT +hemoperfusión I-TREATMENT +se I-TREATMENT +produjo I-TREATMENT +parada I-TREATMENT +respiratoria I-TREATMENT +que I-TREATMENT +obligó I-TREATMENT +a I-TREATMENT +intubación I-TREATMENT +orotraqueal I-TREATMENT +y I-TREATMENT +ventilación I-TREATMENT +mecánica. I-TREATMENT +En B-EVOLUTION +las I-EVOLUTION +horas I-EVOLUTION +siguientes I-EVOLUTION +presentó I-EVOLUTION +gran I-EVOLUTION +inestabilidad I-EVOLUTION +hemodinámica I-EVOLUTION +y I-EVOLUTION +parada I-EVOLUTION +cardiaca I-EVOLUTION +por I-EVOLUTION +disociación I-EVOLUTION +electromecánica I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +refractaria I-EVOLUTION +a I-EVOLUTION +todas I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +terapéuticas, I-EVOLUTION +produciéndose I-EVOLUTION +el I-EVOLUTION +exitus I-EVOLUTION +tras I-EVOLUTION +12 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +ingreso. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +75 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +artralgias I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +artritis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +muñeca I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rodillas. I-PRESENT_ILLNESS +Estaba B-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +artropatía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +pirofosfato I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +artrosis. I-PAST_MEDICAL_HISTORY +Presentaba B-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +cuadros I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mareo I-PRESENT_ILLNESS +inespecífico I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inestabilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +tenía I-EXPLORATION +malnutrición I-EXPLORATION +importante, I-EXPLORATION +edemas I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +limitación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +mirada I-EXPLORATION +superior, I-EXPLORATION +discreta I-EXPLORATION +asimetría I-EXPLORATION +facial I-EXPLORATION +y I-EXPLORATION +marcha I-EXPLORATION +inestable I-EXPLORATION +con I-EXPLORATION +flexión I-EXPLORATION +ventral I-EXPLORATION +del I-EXPLORATION +tronco. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +tenía I-EXPLORATION +anemia I-EXPLORATION +microcítica I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +albúmina I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +0 I-EXPLORATION +g/dl I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones. I-EXPLORATION +Grasa I-EXPLORATION +en I-EXPLORATION +heces I-EXPLORATION +de I-EXPLORATION +11, I-EXPLORATION +2 I-EXPLORATION +g/día. I-EXPLORATION +El I-EXPLORATION +tránsito I-EXPLORATION +gastrointestinal I-EXPLORATION +mostraba I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +con I-EXPLORATION +imagen I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +malabsorción. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +unas I-EXPLORATION +placas I-EXPLORATION +amarillentas I-EXPLORATION +en I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +duodenal I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Whipple. I-EXPLORATION +Fue B-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +G I-TREATMENT +y I-TREATMENT +estreptomicina I-TREATMENT +dos I-TREATMENT +semanas I-TREATMENT +y I-TREATMENT +después I-TREATMENT +con I-TREATMENT +TM-SF I-TREATMENT +y B-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +había I-EVOLUTION +ganado I-EVOLUTION +8 I-EVOLUTION +kg, I-EVOLUTION +había I-EVOLUTION +desaparecido I-EVOLUTION +la I-EVOLUTION +diarrea I-EVOLUTION +y I-EVOLUTION +había I-EVOLUTION +mejorado I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +importante I-EVOLUTION +la I-EVOLUTION +inestabilidad. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +duodenal I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +las I-EXPLORATION +zonas I-EXPLORATION +PAS I-EXPLORATION +positivas I-EXPLORATION +eran I-EXPLORATION +ya I-EXPLORATION +amorfas I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +microscopio I-EXPLORATION +electrónico I-EXPLORATION +se I-EXPLORATION +veían I-EXPLORATION +membranas I-EXPLORATION +degeneradas I-EXPLORATION +sin I-EXPLORATION +bacilos I-EXPLORATION +viables. I-EXPLORATION +Se B-EVOLUTION +suspendió I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +usuario 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 +y I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH 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 B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería, I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +unas I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +semanas, I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +cansancio, I-PRESENT_ILLNESS +adelgazamiento I-PRESENT_ILLNESS +cuantificado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +3-4 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +(39 I-PRESENT_ILLNESS +ºC) I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +escalofríos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +intenso 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 +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +se I-EXPLORATION +objetivaba I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +destacando I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +venopunción I-EXPLORATION +periférica I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +y I-EXPLORATION +percusión I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +últimas I-EXPLORATION +vértebras I-EXPLORATION +dorsales. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +complementarios: I-EXPLORATION +los I-EXPLORATION +leucocitos, I-EXPLORATION +la I-EXPLORATION +fórmula I-EXPLORATION +leucocitaria, I-EXPLORATION +la I-EXPLORATION +hemoglobina, I-EXPLORATION +el I-EXPLORATION +hematócrito I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +plaquetas I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones. I-EXPLORATION +VSG I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +mm I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +hora. I-EXPLORATION +Fibrinógeno I-EXPLORATION +495 I-EXPLORATION +mg/dL I-EXPLORATION +(N: I-EXPLORATION +200-450) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +parámetros I-EXPLORATION +de I-EXPLORATION +coagulación, I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +elemental I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +fueron I-EXPLORATION +normales. 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 +627/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 +resultaron I-EXPLORATION +negativas. I-EXPLORATION +El I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +electromiografía I-EXPLORATION +no I-EXPLORATION +reflejaron I-EXPLORATION +hallazgos I-EXPLORATION +significativos; I-EXPLORATION +tampoco 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 +RMN I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +signos I-EXPLORATION +radiológicos I-EXPLORATION +de I-EXPLORATION +alteración I-EXPLORATION +morfológica I-EXPLORATION +de I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +D9-D10, I-EXPLORATION +con I-EXPLORATION +desaparición I-EXPLORATION +del I-EXPLORATION +disco I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +paravertebral. I-EXPLORATION + 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 +y I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +material I-EXPLORATION +purulento I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +sometido I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +microbiológico, I-EXPLORATION +siendo I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +BAAR 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 +administró 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 +200 I-TREATMENT +mg/día I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días, I-TREATMENT +seguido I-TREATMENT +de I-TREATMENT +fluconazol I-TREATMENT +200 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 +buena I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +radiológica I-EVOLUTION +con I-EVOLUTION +marcada I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +RMN. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +tratamientos I-PAST_MEDICAL_HISTORY +habituales, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +septiembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1999 I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +consistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +coluria, I-PRESENT_ILLNESS +hipocolia, I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +intermitente. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +como I-EXPLORATION +únicos I-EXPLORATION +datos I-EXPLORATION +reseñables I-EXPLORATION +ictericia I-EXPLORATION +mucocutánea I-EXPLORATION +y I-EXPLORATION +hepatomegalia. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen, I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computadorizada I-EXPLORATION +(TAC) I-EXPLORATION +abdominal, I-EXPLORATION +sólo I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +hepatomegalia I-EXPLORATION +homogénea. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +realizados I-EXPLORATION +destacaban I-EXPLORATION +transaminasa I-EXPLORATION +glutámico-oxalacética I-EXPLORATION +(GOT) I-EXPLORATION +775 I-EXPLORATION +UI/L, I-EXPLORATION +transaminasa I-EXPLORATION +glutámico-pirúvica I-EXPLORATION +(GPT) I-EXPLORATION +1116 I-EXPLORATION +UI/L, I-EXPLORATION +gammaglutamiltranspeptidasa I-EXPLORATION +(GGT) I-EXPLORATION +121 I-EXPLORATION +UI/L, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +(FA) I-EXPLORATION +362 I-EXPLORATION +UI/L, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +15, I-EXPLORATION +9 I-EXPLORATION +mg/dl I-EXPLORATION +(directa I-EXPLORATION +6, I-EXPLORATION +4 I-EXPLORATION +mg/dl), I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANA) I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +título I-EXPLORATION +de I-EXPLORATION +1/640, I-EXPLORATION +e I-EXPLORATION +hipergammaglobulinemia I-EXPLORATION +policlonal I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +IgG I-EXPLORATION +de I-EXPLORATION +2110 I-EXPLORATION +mg/dl. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +antimitocondriales I-EXPLORATION +(AMA), I-EXPLORATION +anticuerpos I-EXPLORATION +antimúsculo I-EXPLORATION +liso I-EXPLORATION +(ASMA), I-EXPLORATION +anticuerpos I-EXPLORATION +anticitoplasma I-EXPLORATION +de I-EXPLORATION +neutrófilo I-EXPLORATION +(ANCA) I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antimicrosomales I-EXPLORATION +de I-EXPLORATION +hígado I-EXPLORATION +y I-EXPLORATION +riñón I-EXPLORATION +(anti-LKM1) I-EXPLORATION +resultaron I-EXPLORATION +negativos, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +A I-EXPLORATION +(VHA), I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +(VHB) I-EXPLORATION +y I-EXPLORATION +hepatitis I-EXPLORATION +C I-EXPLORATION +(VHC). I-EXPLORATION +El B-EVOLUTION +cuadro I-EVOLUTION +cedió I-EVOLUTION +completamente I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +sin I-EVOLUTION +tratamiento, I-EVOLUTION +produciéndose I-EVOLUTION +la I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +previamente I-EVOLUTION +alterados. I-EVOLUTION +Cuatro I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +ictericia, I-EVOLUTION +coluria, I-EVOLUTION +acolia, I-EVOLUTION +astenia I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +derecho I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución. I-EVOLUTION +En B-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +únicamente I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +hepatomegalia I-EXPLORATION +homogénea. I-EXPLORATION +Los I-EXPLORATION +parámetros I-EXPLORATION +del I-EXPLORATION +autoanalizador I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +GOT I-EXPLORATION +de I-EXPLORATION +1665 I-EXPLORATION +UI/L, I-EXPLORATION +GPT I-EXPLORATION +de I-EXPLORATION +1366 I-EXPLORATION +UI/L, I-EXPLORATION +GGT I-EXPLORATION +de I-EXPLORATION +69 I-EXPLORATION +UI/L, I-EXPLORATION +FA I-EXPLORATION +de I-EXPLORATION +380 I-EXPLORATION +UI/L I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +de I-EXPLORATION +21.6 I-EXPLORATION +mg/dl. I-EXPLORATION +Los I-EXPLORATION +ANA I-EXPLORATION +fueron I-EXPLORATION +nuevamente I-EXPLORATION +positivos I-EXPLORATION +(a I-EXPLORATION +título I-EXPLORATION +de I-EXPLORATION +1/320) I-EXPLORATION +con I-EXPLORATION +negatividad I-EXPLORATION +del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +autoanticuerpos. I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +cierto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +distorsión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +hepática I-EXPLORATION +con I-EXPLORATION +espacios I-EXPLORATION +porta I-EXPLORATION +ensanchados I-EXPLORATION +por I-EXPLORATION +infiltrado I-EXPLORATION +linfocitario, I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +escasos I-EXPLORATION +eosinófilos, I-EXPLORATION +con I-EXPLORATION +proliferación I-EXPLORATION +ductular I-EXPLORATION +periférica I-EXPLORATION +y I-EXPLORATION +rotura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +limitante I-EXPLORATION +e I-EXPLORATION +inflamación I-EXPLORATION +de I-EXPLORATION +algunos I-EXPLORATION +ductos, I-EXPLORATION +apreciándose I-EXPLORATION +además I-EXPLORATION +lobulillos I-EXPLORATION +con I-EXPLORATION +hepatocitos I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +hiperplasia I-EXPLORATION +y I-EXPLORATION +colestasis, I-EXPLORATION +alguno I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +necrótico, I-EXPLORATION +con I-EXPLORATION +escasas I-EXPLORATION +necrosis I-EXPLORATION +focales I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima. I-EXPLORATION +Se B-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +azatioprina, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +año, I-TREATMENT +obteniéndose I-TREATMENT +la I-TREATMENT +remisión I-TREATMENT +completa, I-TREATMENT +tanto I-TREATMENT +clínica I-TREATMENT +como I-TREATMENT +analítica. I-TREATMENT +Tras B-EVOLUTION +tres I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +soldado I-PRESENT_ILLNESS +profesional, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +quirúrgicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +acudió I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +urgencias I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Hospital, I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +médico I-DERIVED_FROM/TO +militar, I-DERIVED_FROM/TO +relatando I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +molestias I-DERIVED_FROM/TO +abdominales I-DERIVED_FROM/TO +inespecíficas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +varios I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución. I-DERIVED_FROM/TO +El B-PRESENT_ILLNESS +enfermo I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontraba I-PRESENT_ILLNESS +realizando I-PRESENT_ILLNESS +unas I-PRESENT_ILLNESS +maniobras I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +supervivencia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +montaña. I-PRESENT_ILLNESS +Desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +difuso, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +focalizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +ilíaca I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +(FID) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumentado I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +intensidad. I-PRESENT_ILLNESS +Presentaba I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tránsito I-PRESENT_ILLNESS +gastrointestinal. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible, I-EXPLORATION +muy I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +FID I-EXPLORATION +con I-EXPLORATION +defensa I-EXPLORATION +y I-EXPLORATION +reacción I-EXPLORATION +peritoneal I-EXPLORATION +acusada. I-EXPLORATION +La I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +38, I-EXPLORATION +5º, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +reseñables. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +radiológicos I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +no I-EXPLORATION +reflejaban I-EXPLORATION +patología. I-EXPLORATION +Analítica: I-EXPLORATION +leucocitos, I-EXPLORATION +14.000 I-EXPLORATION +x I-EXPLORATION +109 I-EXPLORATION +/l I-EXPLORATION +(78% I-EXPLORATION +neutrófilos); I-EXPLORATION +hemoglobina, I-EXPLORATION +14, I-EXPLORATION +46 I-EXPLORATION +mg I-EXPLORATION +/dl; I-EXPLORATION +plaquetas, I-EXPLORATION +268.000 I-EXPLORATION +x I-EXPLORATION +109 I-EXPLORATION +/l. I-EXPLORATION +Resto, I-EXPLORATION +incluyendo I-EXPLORATION +química I-EXPLORATION +clínica, I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación: I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +intensa I-EXPLORATION +meteorización I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +que I-EXPLORATION +impedía I-EXPLORATION +la I-EXPLORATION +visualización I-EXPLORATION +del I-EXPLORATION +ciego I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +apéndice I-EXPLORATION +vermiforme. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +líquido I-EXPLORATION +libre, I-EXPLORATION +en I-EXPLORATION +cantidad I-EXPLORATION +significativa, I-EXPLORATION +entre I-EXPLORATION +las I-EXPLORATION +asas I-EXPLORATION +o I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +saco I-EXPLORATION +de I-EXPLORATION +Douglas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +indica I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +exploradora I-EXPLORATION +urgente I-EXPLORATION +bajo I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +apendicitis I-EXPLORATION +aguda. I-EXPLORATION +Se B-TREATMENT +premedica I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +con I-TREATMENT +amoxicilina I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +clavulánico I-TREATMENT +1.000/200 I-TREATMENT +mg I-TREATMENT +intravenosos, I-TREATMENT +respectivamente, I-TREATMENT +unidosis. I-TREATMENT +A B-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +incisión I-EXPLORATION +de I-EXPLORATION +McBurney, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +tumoración I-EXPLORATION +cecal I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +adenopatías. I-EXPLORATION +Tras I-EXPLORATION +el I-EXPLORATION +cierre I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +incisión, I-EXPLORATION +se I-EXPLORATION +aborda I-EXPLORATION +de I-EXPLORATION +nuevo I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +media I-EXPLORATION +supra-infraumbilical. I-EXPLORATION +La I-EXPLORATION +masa, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +perityphilitis, I-EXPLORATION +englobaba I-EXPLORATION +ciego, I-EXPLORATION +apéndice I-EXPLORATION +e I-EXPLORATION +íleon I-EXPLORATION +terminal. I-EXPLORATION +Se I-EXPLORATION +visualizaban I-EXPLORATION +y I-EXPLORATION +palpaban I-EXPLORATION +ganglios I-EXPLORATION +mesocólicos. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +retroperitoneo, I-EXPLORATION +en I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +gotiera I-EXPLORATION +parietocólica I-EXPLORATION +derecha, I-EXPLORATION +se I-EXPLORATION +drenó I-EXPLORATION +un I-EXPLORATION +absceso I-EXPLORATION +de I-EXPLORATION +pus I-EXPLORATION +cremoso, I-EXPLORATION +blanquecino I-EXPLORATION +e I-EXPLORATION +inodoro I-EXPLORATION +que I-EXPLORATION +contenía I-EXPLORATION +unos I-EXPLORATION +100 I-EXPLORATION +ó I-EXPLORATION +150 I-EXPLORATION +cc. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +cultivadas I-EXPLORATION +en I-EXPLORATION +tioglicolato, I-EXPLORATION +agar I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +agar I-EXPLORATION +chocolate I-EXPLORATION +y, I-EXPLORATION +posteriormente, I-EXPLORATION +analizadas I-EXPLORATION +mediante I-EXPLORATION +un I-EXPLORATION +sistema I-EXPLORATION +BACTEC I-EXPLORATION +9240®. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +las I-TREATMENT +dudas I-TREATMENT +sobre I-TREATMENT +el I-TREATMENT +origen I-TREATMENT +canceroso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración, I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +una I-TREATMENT +hemicolectomía I-TREATMENT +derecha I-TREATMENT +reglada, I-TREATMENT +con I-TREATMENT +intención I-TREATMENT +oncológica, I-TREATMENT +resecando I-TREATMENT +en I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +quirúrgica I-TREATMENT +el I-TREATMENT +peritoneo I-TREATMENT +parietal I-TREATMENT +afecto I-TREATMENT +y I-TREATMENT +todas I-TREATMENT +las I-TREATMENT +adenopatías I-TREATMENT +palpables. I-TREATMENT +La I-TREATMENT +reconstrucción I-TREATMENT +del I-TREATMENT +tránsito I-TREATMENT +digestivo I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +mediante I-TREATMENT +una I-TREATMENT +anastomosis I-TREATMENT +íleo-cólica I-TREATMENT +latero-lateral I-TREATMENT +manual. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +postoperatorio I-EVOLUTION +inmediato, I-EVOLUTION +el I-EVOLUTION +enfermo I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +pico I-EVOLUTION +febril I-EVOLUTION +vespertino, I-EVOLUTION +con I-EVOLUTION +temperatura I-EVOLUTION +superior I-EVOLUTION +a I-EVOLUTION +38, I-EVOLUTION +5º. I-EVOLUTION +Se B-EXPLORATION +extrajeron I-EXPLORATION +hemocultivos I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +ser I-EXPLORATION +microbiológicamente I-EXPLORATION +estériles. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +quinto I-EXPLORATION +día I-EXPLORATION +del I-EXPLORATION +postoperatorio I-EXPLORATION +se I-EXPLORATION +nos I-EXPLORATION +informa I-EXPLORATION +del I-EXPLORATION +crecimiento I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +biológico I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +bacilo I-EXPLORATION +gram I-EXPLORATION +positivo I-EXPLORATION +del I-EXPLORATION +género I-EXPLORATION +Listeria I-EXPLORATION +spp. I-EXPLORATION +A I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +técnicas I-EXPLORATION +habituales I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +serotipado, I-EXPLORATION +mediante I-EXPLORATION +el I-EXPLORATION +método I-EXPLORATION +de I-EXPLORATION +aglutinación, I-EXPLORATION +el I-EXPLORATION +patógeno I-EXPLORATION +fue I-EXPLORATION +identificado, I-EXPLORATION +definitivamente, I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +Listeria I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +especie I-EXPLORATION +monocytoges I-EXPLORATION +perteneciente I-EXPLORATION +al I-EXPLORATION +serotipo I-EXPLORATION +4b. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +antibiograma I-EXPLORATION +el I-EXPLORATION +germen I-EXPLORATION +era I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +ampicilina, I-EXPLORATION +cefotaxima, I-EXPLORATION +vancomicina, I-EXPLORATION +rifampicina, I-EXPLORATION +eritromicina, I-EXPLORATION +cotrimoxazol, I-EXPLORATION +ciprofloxacina I-EXPLORATION +y I-EXPLORATION +amoxicilina I-EXPLORATION +más I-EXPLORATION +ácido I-EXPLORATION +clavulánico. I-EXPLORATION +Dada B-EVOLUTION +la I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +del I-EVOLUTION +paciente, I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre, I-EVOLUTION +se B-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +pauta I-TREATMENT +antibiótica, I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +3.000/600 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +amoxicilina I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +clavulánico, I-TREATMENT +respectivamente, I-TREATMENT +repartidos I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +dosis I-TREATMENT +intravenosas I-TREATMENT +diarias. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +se I-EVOLUTION +inicia I-EVOLUTION +y I-EVOLUTION +progresa I-EVOLUTION +la I-EVOLUTION +tolerancia I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +alimentación I-EVOLUTION +por I-EVOLUTION +vía I-EVOLUTION +oral, I-EVOLUTION +con I-EVOLUTION +resultados I-EVOLUTION +positivos. I-EVOLUTION +En B-TREATMENT +el I-TREATMENT +día I-TREATMENT +catorce I-TREATMENT +del I-TREATMENT +postoperatorio, I-TREATMENT +como I-TREATMENT +medida I-TREATMENT +previa I-TREATMENT +al I-TREATMENT +alta, I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +la I-TREATMENT +antibioterapia I-TREATMENT +intravenosa I-TREATMENT +y I-TREATMENT +se I-TREATMENT +sustituye I-TREATMENT +por I-TREATMENT +una I-TREATMENT +pauta I-TREATMENT +oral I-TREATMENT +de I-TREATMENT +1.500/375 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +amoxicilina I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +clavulánico I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas, I-TREATMENT +fraccionada I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +dosis, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +durante I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +más. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +recibe I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +el I-EVOLUTION +enfermo I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +desarrollando I-EVOLUTION +una I-EVOLUTION +actividad I-EVOLUTION +normal. I-EVOLUTION +Se B-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +completa, I-EXPLORATION +colonoscopia I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +informaron I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +o I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +inflamatoria I-EXPLORATION +intestinal. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +exADVP I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +sustitutivo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Metadona, I-PAST_MEDICAL_HISTORY +consumidor I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cannabis, I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +HVC I-PAST_MEDICAL_HISTORY +(con I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +realizada), I-PAST_MEDICAL_HISTORY +herida I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +asta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vaca I-PAST_MEDICAL_HISTORY +brava I-PAST_MEDICAL_HISTORY +EII, I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +necrosis I-PAST_MEDICAL_HISTORY +avascular I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cadera I-PAST_MEDICAL_HISTORY +derecha, I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hombro I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +muñeca I-PAST_MEDICAL_HISTORY +derecha. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +llevaba I-PAST_MEDICAL_HISTORY +Tranxilium I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +1/2 I-PAST_MEDICAL_HISTORY +comprimido I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +horas. I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +ser I-PRESENT_ILLNESS +encontrado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +domicilio I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +familiares I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +situación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +restos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vómito I-PRESENT_ILLNESS +alimentario I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +extremidad I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +izquierda; I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +consumido I-PRESENT_ILLNESS +previamente I-PRESENT_ILLNESS +cocaína I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +intranasal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +consumo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alcohol I-PRESENT_ILLNESS +concomitante I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +previas. I-PRESENT_ILLNESS +Así B-EXPLORATION +mismo I-EXPLORATION +refería I-EXPLORATION +dolor I-EXPLORATION +e I-EXPLORATION +inflamación I-EXPLORATION +en I-EXPLORATION +ESI. I-EXPLORATION +Presentaba, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +febrícula I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +5 I-EXPLORATION +ºC, I-EXPLORATION +TA I-EXPLORATION +120/90, I-EXPLORATION +consciente I-EXPLORATION +orientado I-EXPLORATION +con I-EXPLORATION +bajo I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +conciencia I-EXPLORATION +sin I-EXPLORATION +focalidad I-EXPLORATION +neurológica, I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +en I-EXPLORATION +ESI. I-EXPLORATION +Al I-EXPLORATION +realizar I-EXPLORATION +primera I-EXPLORATION +valoración I-EXPLORATION +realiza I-EXPLORATION +escasa I-EXPLORATION +emisión I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +colúrica. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +ECG I-EXPLORATION +un I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +a I-EXPLORATION +105 I-EXPLORATION +lpm. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +ligera I-EXPLORATION +cardiomegalia. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +CPK I-EXPLORATION +33.255 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +10-80), I-EXPLORATION +ASAT I-EXPLORATION +1421 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +0-18), I-EXPLORATION +ALAT I-EXPLORATION +596 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +0-22), I-EXPLORATION +calcio I-EXPLORATION +9, I-EXPLORATION +4 I-EXPLORATION +mg/dL, I-EXPLORATION +amilasa I-EXPLORATION +396 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +36-128), I-EXPLORATION +urea I-EXPLORATION +135 I-EXPLORATION +mg/dL I-EXPLORATION +(normal I-EXPLORATION +10-50) I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +11, I-EXPLORATION +8 I-EXPLORATION +mg/dL I-EXPLORATION +(normal I-EXPLORATION +0, I-EXPLORATION +6-1, I-EXPLORATION +2). I-EXPLORATION +El I-EXPLORATION +sedimento I-EXPLORATION +urinario I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +tóxicos I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +cannabinoides, I-EXPLORATION +metadona, I-EXPLORATION +benzodiacepinas I-EXPLORATION +y I-EXPLORATION +cocaína. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +etanol I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +en I-EXPLORATION +cantidad I-EXPLORATION +no I-EXPLORATION +mensurable. I-EXPLORATION +Se B-TREATMENT +comenta I-TREATMENT +con I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Nefrología I-TREATMENT +que I-TREATMENT +realiza I-TREATMENT +varias I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +hemodiálisis I-TREATMENT +hasta I-TREATMENT +entrar I-TREATMENT +en I-TREATMENT +fase I-TREATMENT +de I-TREATMENT +poliuria I-TREATMENT +y I-TREATMENT +recuperación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal I-TREATMENT +(creatinina I-TREATMENT +de I-TREATMENT +1.6 I-TREATMENT +mg/dL), I-TREATMENT +mejorando I-TREATMENT +los I-TREATMENT +parámetros I-TREATMENT +enzimas I-TREATMENT +hepáticos I-TREATMENT +(ASAT I-TREATMENT +47 I-TREATMENT +U/L, I-TREATMENT +ALAT I-TREATMENT +95 I-TREATMENT +U/L) I-TREATMENT +y I-TREATMENT +con I-TREATMENT +CPK I-TREATMENT +de I-TREATMENT +80 I-TREATMENT +U/L. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +días I-EVOLUTION +es I-EVOLUTION +traído I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +por I-EVOLUTION +familiares I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +estado I-EVOLUTION +confusional I-EVOLUTION +y I-EVOLUTION +agitación I-EVOLUTION +psicomotriz I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +39, I-EVOLUTION +5 I-EVOLUTION +ºC. I-EVOLUTION +Refería I-EVOLUTION +haber I-EVOLUTION +fumado I-EVOLUTION +las I-EVOLUTION +horas I-EVOLUTION +previas I-EVOLUTION +50gr I-EVOLUTION +de I-EVOLUTION +cocaína I-EVOLUTION +mezclada I-EVOLUTION +con I-EVOLUTION +amoniaco. I-EVOLUTION +Presentaba B-EXPLORATION +fiebre I-EXPLORATION +de I-EXPLORATION +40 I-EXPLORATION +°C, I-EXPLORATION +taquipnea I-EXPLORATION +a I-EXPLORATION +47 I-EXPLORATION +rpm I-EXPLORATION +y I-EXPLORATION +agitación I-EXPLORATION +psicomotriz, I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +pulmonar I-EXPLORATION +crepitantes I-EXPLORATION +bilaterales; I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardiaca I-EXPLORATION +reflejaba I-EXPLORATION +taquicardia I-EXPLORATION +sin I-EXPLORATION +soplos I-EXPLORATION +añadidos; I-EXPLORATION +no I-EXPLORATION +ingurgitación I-EXPLORATION +yugular; I-EXPLORATION +además I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +hipoxemia I-EXPLORATION +parcial I-EXPLORATION +moderada I-EXPLORATION +(pO2 I-EXPLORATION +76 I-EXPLORATION +mmHg, I-EXPLORATION +pCO2 I-EXPLORATION +40 I-EXPLORATION +mmHg, I-EXPLORATION +SatO2 I-EXPLORATION +80%, I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +4, I-EXPLORATION +exceso I-EXPLORATION +base I-EXPLORATION +0 I-EXPLORATION +mmol/L. I-EXPLORATION +El I-EXPLORATION +ECG I-EXPLORATION +estaba I-EXPLORATION +en I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +a I-EXPLORATION +108 I-EXPLORATION +lpm. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +evidenciaba I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +intersticial I-EXPLORATION +bilateral I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +cardiomegalia. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +destacaba I-EXPLORATION +leucocitos I-EXPLORATION +13.100 I-EXPLORATION +(normal I-EXPLORATION +3, I-EXPLORATION +5-10, I-EXPLORATION +5), I-EXPLORATION +ALAT I-EXPLORATION +221 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +0-22), I-EXPLORATION +ASAT I-EXPLORATION +338 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +0-18), I-EXPLORATION +creatinina I-EXPLORATION +2, I-EXPLORATION +9 I-EXPLORATION +mg/dL I-EXPLORATION +(normal I-EXPLORATION +0, I-EXPLORATION +6-1, I-EXPLORATION +2), I-EXPLORATION +calcio I-EXPLORATION +8, I-EXPLORATION +4 I-EXPLORATION +mg/dL, I-EXPLORATION +urea I-EXPLORATION +88 I-EXPLORATION +mg/dL I-EXPLORATION +(normal I-EXPLORATION +10-50), I-EXPLORATION +CPK I-EXPLORATION +776 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +10-80). I-EXPLORATION +Así I-EXPLORATION +mismo I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +se I-EXPLORATION +determinó I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +cannabinoides, I-EXPLORATION +metadona I-EXPLORATION +y I-EXPLORATION +cocaína. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +etanol I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +fueron I-EXPLORATION +0, I-EXPLORATION +1 I-EXPLORATION +mg/L I-EXPLORATION +(normal I-EXPLORATION +0-0, I-EXPLORATION +5). I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +sueroterapia, I-TREATMENT +antibioticoterapia I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +expectro I-TREATMENT +empírica I-TREATMENT +y I-TREATMENT +oxigenoterapia I-TREATMENT +en I-TREATMENT +ventimask I-TREATMENT +a I-TREATMENT +10 I-TREATMENT +L I-TREATMENT +(no I-TREATMENT +precisó I-TREATMENT +ventilación I-TREATMENT +mecánica), I-TREATMENT +con I-TREATMENT +evolución I-TREATMENT +favorable, I-TREATMENT +precisando I-TREATMENT +sedación I-TREATMENT +mientras I-TREATMENT +persistió I-TREATMENT +inicialmente I-TREATMENT +la I-TREATMENT +agitación I-TREATMENT +psicomotriz. I-TREATMENT +Al B-EXPLORATION +alta I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +tórax I-EXPLORATION +mostraba I-EXPLORATION +practica I-EXPLORATION +resolución I-EXPLORATION +infiltrado I-EXPLORATION +bilateral, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +9 I-EXPLORATION +mg/dL, I-EXPLORATION +ASAT I-EXPLORATION +41 I-EXPLORATION +U/L, I-EXPLORATION +ALAT I-EXPLORATION +149 I-EXPLORATION +U/L, I-EXPLORATION +leucocitos I-EXPLORATION +7.000, I-EXPLORATION +urea I-EXPLORATION +32. I-EXPLORATION + I-EXPLORATION + +Varón B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +previos, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +días. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +fiebre I-EXPLORATION +(39 I-EXPLORATION +ºC), I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +supraclavicular I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +y I-EXPLORATION +otras I-EXPLORATION +tres I-EXPLORATION +algo I-EXPLORATION +más I-EXPLORATION +pequeñas I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +latero-cervical I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +menores I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +latero-cervical I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +los I-EXPLORATION +únicos I-EXPLORATION +datos I-EXPLORATION +reseñables I-EXPLORATION +eran I-EXPLORATION +una I-EXPLORATION +tasa I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +3.500 I-EXPLORATION +con I-EXPLORATION +40% I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +de I-EXPLORATION +626 I-EXPLORATION +U/L. 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 +y I-EXPLORATION +pruebas I-EXPLORATION +serológicas I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +Brucella, I-EXPLORATION +Leptospira, I-EXPLORATION +Francisella I-EXPLORATION +tularensis, I-EXPLORATION +Bartonella, I-EXPLORATION +VEB, I-EXPLORATION +y I-EXPLORATION +CMV I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +cérvico-torácico I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +cervicales I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +13 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +yugulo-digástrica I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +espacios I-EXPLORATION +cervicales I-EXPLORATION +posteriores I-EXPLORATION +de I-EXPLORATION +carácter I-EXPLORATION +inespecífico I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +axilares I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +axila I-EXPLORATION +derecha. I-EXPLORATION +Practicada I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +cervical I-EXPLORATION +se I-EXPLORATION +llegó I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +linfadenitis I-EXPLORATION +necrotizante I-EXPLORATION +paracortical, I-EXPLORATION +con I-EXPLORATION +abundante I-EXPLORATION +cariorrexis, I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +inflamatorias I-EXPLORATION +mononucleares. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +antiinflamatorios I-TREATMENT +no I-TREATMENT +esteroideos I-TREATMENT +desapareciendo I-TREATMENT +la I-TREATMENT +fiebre I-TREATMENT +y I-TREATMENT +encontrándose I-TREATMENT +asintomático. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +lleva I-EVOLUTION +diez I-EVOLUTION +meses I-EVOLUTION +sin I-EVOLUTION +recidivar. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +agrandamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +glandula I-PRESENT_ILLNESS +tiroides I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +compresivos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Exploración B-EXPLORATION +clínica: I-EXPLORATION +bocio I-EXPLORATION +multinodular I-EXPLORATION +intratorácico I-EXPLORATION +con I-EXPLORATION +nódulo I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +tiroideo I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +istmo. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +apeciaban I-EXPLORATION +adenopatías I-EXPLORATION +laterocervicales. I-EXPLORATION + I-EXPLORATION +Pruebas I-EXPLORATION +complementarias: I-EXPLORATION +analítica I-EXPLORATION +general, I-EXPLORATION +anticuerpos I-EXPLORATION +y I-EXPLORATION +hormonas I-EXPLORATION +tiroideas I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +múltiples I-EXPLORATION +nódulos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +tiroides I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +localizaban I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +tiroideo I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +istmo. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +presentaba I-EXPLORATION +áreas I-EXPLORATION +quísticas I-EXPLORATION +multiseptadas, I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +groseras I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +tiroideo I-EXPLORATION +izquierdo I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +algún I-EXPLORATION +nódulo I-EXPLORATION +aislado I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +anteriormente I-EXPLORATION +descritos. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +bocio I-EXPLORATION +multinodular. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +(PAAF) I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +atípicas. I-EXPLORATION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +compresivos, I-TREATMENT +fundamentalmente I-TREATMENT +disfagia, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +tiroidectomía I-TREATMENT +total I-TREATMENT +siendo I-TREATMENT +remitida I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +al I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +anatomía I-TREATMENT +patológica. I-TREATMENT + I-TREATMENT +Macroscópicamente B-EXPLORATION +se I-EXPLORATION +recibió I-EXPLORATION +una I-EXPLORATION +pieza I-EXPLORATION +de I-EXPLORATION +tiroidectomía I-EXPLORATION +total I-EXPLORATION +que I-EXPLORATION +medía I-EXPLORATION +8x6x4 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +pesaba I-EXPLORATION +38 I-EXPLORATION +g. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +cortes I-EXPLORATION +seriados I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +múltiples I-EXPLORATION +espacios I-EXPLORATION +quísticos I-EXPLORATION +multiloculados I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +localizaban I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +tiroideo I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +istmo. I-EXPLORATION +La I-EXPLORATION +pared I-EXPLORATION +era I-EXPLORATION +lisa I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +rosado I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +contenía I-EXPLORATION +zonas I-EXPLORATION +sólidas. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +tenía I-EXPLORATION +unas I-EXPLORATION +dimensiones I-EXPLORATION +máximas I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +contenido I-EXPLORATION +aparente. I-EXPLORATION +Histológicamente I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +grandes I-EXPLORATION +cavidades I-EXPLORATION +quísticas I-EXPLORATION +tapizadas I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +escamoso I-EXPLORATION +o I-EXPLORATION +respiratorio I-EXPLORATION +sin I-EXPLORATION +atipia I-EXPLORATION +y I-EXPLORATION +subyacentemente I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +intenso I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +linfocitario I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +folicular. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +tiroideo I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +alteraciones I-EXPLORATION +histológicas I-EXPLORATION +significativas, I-EXPLORATION +excepto I-EXPLORATION +un I-EXPLORATION +moderado I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +linfoide I-EXPLORATION +inespecífico. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +linfoepitelial I-EXPLORATION +intratiroideo. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +complicaciones I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +y I-EVOLUTION +está I-EVOLUTION +sano I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +actual. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disartria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +paralisis I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +craneal I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +RNM I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +ocupante I-EXPLORATION +de I-EXPLORATION +espacio I-EXPLORATION +parieto-temporal I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +gran I-EXPLORATION +edema I-EXPLORATION +perilesional I-EXPLORATION +que I-EXPLORATION +sugiere I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +neoplásico. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +iniciales I-EXPLORATION +son I-EXPLORATION +normales, I-EXPLORATION +incluyendo I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax. I-EXPLORATION +En B-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +neurocirugía I-TREATMENT +presenta I-TREATMENT +súbitamente I-TREATMENT +disnea I-TREATMENT +acompañada I-TREATMENT +de I-TREATMENT +desaturación, I-TREATMENT +motivos I-TREATMENT +por I-TREATMENT +los I-TREATMENT +que I-TREATMENT +es I-TREATMENT +ingresado I-TREATMENT +en I-TREATMENT +UCI I-TREATMENT +donde I-TREATMENT +precisa I-TREATMENT +ventilación I-TREATMENT +mecánica. I-TREATMENT +Bajo B-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +tromboembolismo I-EXPLORATION +pulmonar I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +torácica I-EXPLORATION +urgente I-EXPLORATION +existiendo I-EXPLORATION +una I-EXPLORATION +consolidación I-EXPLORATION +parenquimatosa I-EXPLORATION +pulmonar I-EXPLORATION +basal I-EXPLORATION +posterior I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +nódulos I-EXPLORATION +pulmonares, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +alveolar I-EXPLORATION +e I-EXPLORATION +intersticial I-EXPLORATION +bilateral, I-EXPLORATION +todos I-EXPLORATION +ellos I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +infeccioso. I-EXPLORATION +Se I-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +extracción I-EXPLORATION +de I-EXPLORATION +cultivo I-EXPLORATION +bronquial I-EXPLORATION +mediante I-EXPLORATION +lavado I-EXPLORATION +broncoalveolar. I-EXPLORATION +Debido B-EVOLUTION +a I-EVOLUTION +empeoramiento I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +a B-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +antibioterapia I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro, I-TREATMENT +se B-EXPLORATION +practica I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +esteroatáxica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +En I-EXPLORATION +ambos I-EXPLORATION +cultivos I-EXPLORATION +se I-EXPLORATION +aisla I-EXPLORATION +rhodococcus I-EXPLORATION +equi. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +del I-EXPLORATION +virus I-EXPLORATION +VIH I-EXPLORATION +es I-EXPLORATION +negativa. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunitario I-EXPLORATION +normal I-EXPLORATION +(CD3 I-EXPLORATION +65%, I-EXPLORATION +CD4 I-EXPLORATION +40%). I-EXPLORATION +A B-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +realizar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vancomicina, I-TREATMENT +sulfametoxazol I-TREATMENT +y I-TREATMENT +rifampicina, I-TREATMENT +el B-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +epilepsia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +polimialgia I-PAST_MEDICAL_HISTORY +reumática, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +prednisona. I-PAST_MEDICAL_HISTORY +Presenta B-PRESENT_ILLNESS +dolor, I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +impotencia I-PRESENT_ILLNESS +funcional I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +aquíleo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +iniciar I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +levofloxacino I-PRESENT_ILLNESS +(500 I-PRESENT_ILLNESS +mg/día) I-PRESENT_ILLNESS +indicado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +urinaria. I-PRESENT_ILLNESS +Mediante B-EXPLORATION +Ecografía I-EXPLORATION +se I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +rotura I-EXPLORATION +parcial I-EXPLORATION +del I-EXPLORATION +tendón. I-EXPLORATION +Tras B-TREATMENT +retirar I-TREATMENT +el I-TREATMENT +fármaco I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +conservador I-TREATMENT +con I-TREATMENT +reposo I-TREATMENT +y I-TREATMENT +ortesis I-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +se I-TREATMENT +resuelve I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +meses. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 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 +ulcus I-PAST_MEDICAL_HISTORY +gástrico, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +insulinizada, I-PAST_MEDICAL_HISTORY +angina I-PAST_MEDICAL_HISTORY +estable, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +dislipemia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +cerebrovascular I-PAST_MEDICAL_HISTORY +isquémico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +secuela I-PAST_MEDICAL_HISTORY +residual I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mano I-PAST_MEDICAL_HISTORY +derecha. I-PAST_MEDICAL_HISTORY +Tratamiento I-PAST_MEDICAL_HISTORY +habitual I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +clopidogrel, I-PAST_MEDICAL_HISTORY +carvedilol, I-PAST_MEDICAL_HISTORY +nitroglicerina I-PAST_MEDICAL_HISTORY +transdérmica, I-PAST_MEDICAL_HISTORY +atorvastatina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +omeprazol. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +febrero I-PRESENT_ILLNESS +2005 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +iliaca I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +exploración B-EXPLORATION +ginecológica, I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +que I-EXPLORATION +parece I-EXPLORATION +depender I-EXPLORATION +de I-EXPLORATION +útero. I-EXPLORATION +En B-TREATMENT +marzo I-TREATMENT +2005, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +practica I-TREATMENT +histerectomía I-TREATMENT +y I-TREATMENT +doble I-TREATMENT +anexectomía, I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +tercio I-TREATMENT +final I-TREATMENT +de I-TREATMENT +íleon, I-TREATMENT +al I-TREATMENT +identificarse I-TREATMENT +una I-TREATMENT +masa I-TREATMENT +fibrosada I-TREATMENT +adherida I-TREATMENT +a I-TREATMENT +éste. I-TREATMENT +Anatomía B-EXPLORATION +patológica: I-EXPLORATION +endometrio I-EXPLORATION +atrófico, I-EXPLORATION +cervicitis I-EXPLORATION +crónica I-EXPLORATION +folicular; I-EXPLORATION +tumor I-EXPLORATION +gastrointestinal I-EXPLORATION +del I-EXPLORATION +estroma I-EXPLORATION +(GIST) I-EXPLORATION +ileal I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +con I-EXPLORATION +2-3 I-EXPLORATION +metástasis I-EXPLORATION +por I-EXPLORATION +cada I-EXPLORATION +50 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +aumento, I-EXPLORATION +hipercelularidad, I-EXPLORATION +celularidad I-EXPLORATION +epitelioide, I-EXPLORATION +pleomorfismo I-EXPLORATION +celular, I-EXPLORATION +necrosis I-EXPLORATION +focal; I-EXPLORATION +c-kit I-EXPLORATION +positivo. I-EXPLORATION +Valorada I-EXPLORATION +en I-EXPLORATION +consultas I-EXPLORATION +externas I-EXPLORATION +de I-EXPLORATION +Oncología I-EXPLORATION +Médica, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +como I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión: I-EXPLORATION +analítica I-EXPLORATION +completa: I-EXPLORATION +hemoglobina I-EXPLORATION +11, I-EXPLORATION +7 I-EXPLORATION +mg/dl, I-EXPLORATION +con I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +normales; I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +toraco-abdomino-pélvica: I-EXPLORATION +colelitiasis, I-EXPLORATION +pequeño I-EXPLORATION +nódulo I-EXPLORATION +suprarrenal I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +benignas; I-EXPLORATION +gammagrafía I-EXPLORATION +ósea: I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +metástasis I-EXPLORATION +óseas. I-EXPLORATION +En I-EXPLORATION +octubre I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +por I-EXPLORATION +emisión I-EXPLORATION +de I-EXPLORATION +positrones I-EXPLORATION +(PET), I-EXPLORATION +que I-EXPLORATION +reflejó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +depósito I-EXPLORATION +patológico I-EXPLORATION +de I-EXPLORATION +fluorodeoxiglucosa I-EXPLORATION +(FDG) I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha, I-EXPLORATION +localizado I-EXPLORATION +sobre I-EXPLORATION +asas I-EXPLORATION +intestinales, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +SUV I-EXPLORATION +máximo I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +12. I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +hallazgos, I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +imatinib I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +400 I-TREATMENT +mg/día. I-TREATMENT +La B-EVOLUTION +tolerancia I-EVOLUTION +a I-EVOLUTION +dicho I-EVOLUTION +tratamiento I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +adecuada. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +nuevo I-EVOLUTION +estudio I-EVOLUTION +de I-EVOLUTION +reevaluación, I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +persiste I-EVOLUTION +el I-EVOLUTION +nódulo I-EVOLUTION +suprarrenal I-EVOLUTION +derecho, I-EVOLUTION +sin I-EVOLUTION +cambios I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +ni I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +aspecto, I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +PET I-EVOLUTION +no I-EVOLUTION +revela I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +ninguna I-EVOLUTION +lesión I-EVOLUTION +residual. 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 +45 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 +acude I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +brusca I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +frontotemporal, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acentuaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +cervicales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +bipedestación, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +aumentaba I-PRESENT_ILLNESS +progresivamente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +largo I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +nauseas, I-PRESENT_ILLNESS +mareos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fotofobia. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +mejoría I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +analgésico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +antiinflamatorio, I-PRESENT_ILLNESS +pautado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cabecera. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +flexión I-EXPLORATION +y I-EXPLORATION +movilización I-EXPLORATION +con I-EXPLORATION +contractura I-EXPLORATION +voluntaria I-EXPLORATION +cervical. I-EXPLORATION +No I-EXPLORATION +existían I-EXPLORATION +signos I-EXPLORATION +meníngeos I-EXPLORATION +claros I-EXPLORATION +ni I-EXPLORATION +focalidad I-EXPLORATION +neurológica I-EXPLORATION +evidente. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +Tomografía I-EXPLORATION +Axial I-EXPLORATION +Computerizada I-EXPLORATION +cerebral I-EXPLORATION +donde I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sangrado. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +subaracnoidea I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +lumbar, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +urgente I-EXPLORATION +de I-EXPLORATION +303 I-EXPLORATION +hematíes I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +tubo I-EXPLORATION +y I-EXPLORATION +301 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercero. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +centrifugado I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +xantocromía I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +sobrenadante. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +Resonancia I-EXPLORATION +Nuclear I-EXPLORATION +Magnética I-EXPLORATION +cerebral I-EXPLORATION +confirmó I-EXPLORATION +posteriormente I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +soltera, B-PAST_MEDICAL_HISTORY +mestiza, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Cirugía I-PRESENT_ILLNESS +Maxilofacial I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +HUSVF I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +“aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +pómulo I-PRESENT_ILLNESS +izquierdo” I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +ido I-PRESENT_ILLNESS +aumentando I-PRESENT_ILLNESS +rápidamente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +; I-PRESENT_ILLNESS +a B-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +tumefacción I-EXPLORATION +en I-EXPLORATION +maxilar I-EXPLORATION +izquierdo I-EXPLORATION +sin I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +ningún I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +sintomatología. I-EXPLORATION +Clínicamente I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +asimetría I-EXPLORATION +facial I-EXPLORATION +en I-EXPLORATION +maxilar I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +borramiento I-EXPLORATION +de I-EXPLORATION +surco I-EXPLORATION +nasogeniano I-EXPLORATION +izquierdo I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +sólida I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +definidos I-EXPLORATION +que I-EXPLORATION +altera I-EXPLORATION +la I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +apertura I-EXPLORATION +piriforme I-EXPLORATION +ipsilateral I-EXPLORATION +y I-EXPLORATION +produce I-EXPLORATION +abombamiento I-EXPLORATION +de I-EXPLORATION +piso I-EXPLORATION +nasal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +nasal I-EXPLORATION +izquierda, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +conserva I-EXPLORATION +la I-EXPLORATION +permeabilidad I-EXPLORATION +de I-EXPLORATION +dicha I-EXPLORATION +fosa. I-EXPLORATION +En I-EXPLORATION +radiografía I-EXPLORATION +panorámica I-EXPLORATION +(Fg. I-EXPLORATION +1b), I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +zona I-EXPLORATION +radiolúcida I-EXPLORATION +circunscrita I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +bien I-EXPLORATION +delimitados I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dientes I-EXPLORATION +22 I-EXPLORATION +al I-EXPLORATION +26 I-EXPLORATION +haciendo I-EXPLORATION +desplazamiento I-EXPLORATION +radicular I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +raíces I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +bicúspides, I-EXPLORATION +rechaza I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +e I-EXPLORATION +involucra I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +diente I-EXPLORATION +23 I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +internas. I-EXPLORATION + I-EXPLORATION +Al B-TREATMENT +momento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +una I-TREATMENT +masa I-TREATMENT +de I-TREATMENT +consistencia I-TREATMENT +sólida I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +5 I-TREATMENT +centímetros I-TREATMENT +de I-TREATMENT +diámetro, I-TREATMENT +recubierta I-TREATMENT +por I-TREATMENT +una I-TREATMENT +membrana I-TREATMENT +gruesa I-TREATMENT +y I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +fibroso. I-TREATMENT +Posterior I-TREATMENT +a I-TREATMENT +la I-TREATMENT +enucleación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +queda I-TREATMENT +un I-TREATMENT +defecto I-TREATMENT +óseo I-TREATMENT +en I-TREATMENT +el I-TREATMENT +maxilar I-TREATMENT +superior I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +5 I-TREATMENT +centímetros I-TREATMENT +de I-TREATMENT +diámetro I-TREATMENT +donde I-TREATMENT +estaba I-TREATMENT +respetado I-TREATMENT +el I-TREATMENT +seno I-TREATMENT +maxilar. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +periferia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +se I-TREATMENT +palpa I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +del I-TREATMENT +diente I-TREATMENT +involucrado. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +describe I-EXPLORATION +tejido I-EXPLORATION +que I-EXPLORATION +incluye I-EXPLORATION +diente I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +tumor. I-EXPLORATION +Muestra I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +porción I-EXPLORATION +quística I-EXPLORATION +delimitada I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +fibroconectivo I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +disposición I-EXPLORATION +paralela. I-EXPLORATION +Hay I-EXPLORATION +neoformación I-EXPLORATION +ósea I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +adyacente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +pared. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +central I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +hay I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +cilíndricas I-EXPLORATION +y I-EXPLORATION +algunas I-EXPLORATION +fusocelulares I-EXPLORATION +que I-EXPLORATION +forman I-EXPLORATION +varios I-EXPLORATION +nódulos I-EXPLORATION +intercalados I-EXPLORATION +con I-EXPLORATION +bandas I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +eosinófilo I-EXPLORATION +hialinizado I-EXPLORATION +a I-EXPLORATION +manera I-EXPLORATION +de I-EXPLORATION +membrana. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +proliferación I-EXPLORATION +celular I-EXPLORATION +hay I-EXPLORATION +múltiples I-EXPLORATION +calcificaciones I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +irregular. I-EXPLORATION +Además I-EXPLORATION +hay I-EXPLORATION +pequeñas I-EXPLORATION +estructuras I-EXPLORATION +tubulares I-EXPLORATION +revestidas I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +cilíndrico I-EXPLORATION +que I-EXPLORATION +contienen I-EXPLORATION +material I-EXPLORATION +eosinó- I-EXPLORATION +filo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lumen. I-EXPLORATION + I-EXPLORATION + +Neonato B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +indeterminado I-PRESENT_ILLNESS +llevado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pared I-PRESENT_ILLNESS +abdominopélvica. I-PRESENT_ILLNESS +Los B-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +administrados I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +sobre I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +embarazo, I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +prenatales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +son I-PAST_MEDICAL_HISTORY +contradictorios. I-PAST_MEDICAL_HISTORY +El B-EXPLORATION +abdomen I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +defecto I-EXPLORATION +infraumbilical I-EXPLORATION +con I-EXPLORATION +eventración I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +recto. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +lumbar I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +lipomeningocele. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +genitales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ano I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +imperforado. I-EXPLORATION +Las I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +son I-EXPLORATION +simétricas, I-EXPLORATION +con I-EXPLORATION +pliegue I-EXPLORATION +único I-EXPLORATION +palmar. I-EXPLORATION +Las I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +son I-EXPLORATION +asimétricas I-EXPLORATION +y I-EXPLORATION +dismórficas; I-EXPLORATION +el I-EXPLORATION +muslo I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +centímetros I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +cuyo I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +centímetros I-EXPLORATION +que I-EXPLORATION +termina I-EXPLORATION +en I-EXPLORATION +pie I-EXPLORATION +con I-EXPLORATION +ectrodactilia; I-EXPLORATION +el I-EXPLORATION +muslo I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +longitud I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +centímetros, I-EXPLORATION +en I-EXPLORATION +cuyo I-EXPLORATION +segmento I-EXPLORATION +distal I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +protuberancia I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +centímetros I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +pie I-EXPLORATION +con I-EXPLORATION +ectrodactilia. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +derecho I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +fémur I-EXPLORATION +y I-EXPLORATION +agenesia I-EXPLORATION +de I-EXPLORATION +tibia. I-EXPLORATION +El I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +izquierdo I-EXPLORATION +mostró I-EXPLORATION +bifurcación I-EXPLORATION +del I-EXPLORATION +fémur I-EXPLORATION +y I-EXPLORATION +agenesia I-EXPLORATION +tibial. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +cirugía I-EXPLORATION +reconstructiva. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +incluyeron I-EXPLORATION +alteraciones I-EXPLORATION +del I-EXPLORATION +aparato I-EXPLORATION +urogenital, I-EXPLORATION +como I-EXPLORATION +ectopia I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +ilíaca, I-EXPLORATION +extrofia I-EXPLORATION +vesical, I-EXPLORATION +agenesia I-EXPLORATION +de I-EXPLORATION +uretra, I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +uréter I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +proximal I-EXPLORATION +y I-EXPLORATION +uraco I-EXPLORATION +persistente. I-EXPLORATION +Se I-EXPLORATION +encontraron I-EXPLORATION +alteraciones I-EXPLORATION +del I-EXPLORATION +aparato I-EXPLORATION +reproductor, I-EXPLORATION +como I-EXPLORATION +clítoris I-EXPLORATION +bífido, I-EXPLORATION +agenesia I-EXPLORATION +de I-EXPLORATION +vagina I-EXPLORATION +y I-EXPLORATION +útero I-EXPLORATION +doble, I-EXPLORATION +cuyo I-EXPLORATION +segmento I-EXPLORATION +derecho I-EXPLORATION +se I-EXPLORATION +continuaba I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +cérvix I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +izquierdo I-EXPLORATION +desembocaba I-EXPLORATION +el I-EXPLORATION +uréter I-EXPLORATION +izquierdo, I-EXPLORATION +cada I-EXPLORATION +uno I-EXPLORATION +presentaba I-EXPLORATION +trompa I-EXPLORATION +y I-EXPLORATION +ovario. I-EXPLORATION +Se I-EXPLORATION +hallaron I-EXPLORATION +alteraciones I-EXPLORATION +del I-EXPLORATION +aparato I-EXPLORATION +gastrointestinal, I-EXPLORATION +como I-EXPLORATION +ano I-EXPLORATION +imperforado I-EXPLORATION +y I-EXPLORATION +fístula I-EXPLORATION +cecal. I-EXPLORATION +Durante B-EVOLUTION +su I-EVOLUTION +estadía I-EVOLUTION +hospitalaria I-EVOLUTION +desarrolla I-EVOLUTION +sepsis, I-EVOLUTION +insuficiencia I-EVOLUTION +hepática, I-EVOLUTION +acidosis I-EVOLUTION +metabólica I-EVOLUTION +e I-EVOLUTION +hiponatremia; I-EVOLUTION +fallece I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +siete I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +edad. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +referida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +externa I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +dermatología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Nacional I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Niños I-DERIVED_FROM/TO +Benjamín I-DERIVED_FROM/TO +Bloom I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +San I-DERIVED_FROM/TO +Salvador, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +engrosamiento I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +cambios I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +coloración I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +uña I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +pulgar I-DERIVED_FROM/TO +derecho. I-DERIVED_FROM/TO +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +en I-EXPLORATION +cuero I-EXPLORATION +cabelludo, I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +tres I-EXPLORATION +placas I-EXPLORATION +alopécicas, I-EXPLORATION +con I-EXPLORATION +cicatrización I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +periferia I-EXPLORATION +y I-EXPLORATION +escasas I-EXPLORATION +costras I-EXPLORATION +serosanguinolentas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +centro, I-EXPLORATION +dos I-EXPLORATION +de I-EXPLORATION +estas I-EXPLORATION +placas I-EXPLORATION +se I-EXPLORATION +localizan I-EXPLORATION +alrededor I-EXPLORATION +del I-EXPLORATION +ápice I-EXPLORATION +del I-EXPLORATION +cráneo I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tercera I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +parietal I-EXPLORATION +derecha. I-EXPLORATION +En I-EXPLORATION +cavidad I-EXPLORATION +oral I-EXPLORATION +y I-EXPLORATION +labios I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +placas I-EXPLORATION +blanquecinas I-EXPLORATION +que I-EXPLORATION +cubren I-EXPLORATION +el I-EXPLORATION +centro I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +ambas I-EXPLORATION +comisuras I-EXPLORATION +labiales; I-EXPLORATION +al I-EXPLORATION +remover I-EXPLORATION +estas I-EXPLORATION +placas I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +fisuras I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mucosa. I-EXPLORATION +La I-EXPLORATION +uña I-EXPLORATION +del I-EXPLORATION +pulgar I-EXPLORATION +derecho I-EXPLORATION +está I-EXPLORATION +engrosada, I-EXPLORATION +amarillenta, I-EXPLORATION +distrófica I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +eritema I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +pliegues I-EXPLORATION +periungueales; I-EXPLORATION +la I-EXPLORATION +uña I-EXPLORATION +del I-EXPLORATION +dedo I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +mano I-EXPLORATION +izquierda I-EXPLORATION +presenta I-EXPLORATION +coloración I-EXPLORATION +amarillenta I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +bordes I-EXPLORATION +laterales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +signos I-EXPLORATION +clínicos I-EXPLORATION +de I-EXPLORATION +hipoparatiroidismo I-EXPLORATION +o I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Addison. I-EXPLORATION + I-EXPLORATION +Desde B-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +ha I-PAST_MEDICAL_HISTORY +requerido I-PAST_MEDICAL_HISTORY +atención I-PAST_MEDICAL_HISTORY +hospitalaria I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +diarrea, I-PAST_MEDICAL_HISTORY +gastroenteritis I-PAST_MEDICAL_HISTORY +aguda, I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desnutrición I-PAST_MEDICAL_HISTORY +moderada, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +hospitalizaciones; I-PAST_MEDICAL_HISTORY +sufre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +candidiasis I-PAST_MEDICAL_HISTORY +oral I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +Los I-PAST_MEDICAL_HISTORY +análisis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +laboratorio I-PAST_MEDICAL_HISTORY +archivados I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +expediente I-PAST_MEDICAL_HISTORY +clínico I-PAST_MEDICAL_HISTORY +informan I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +parasitismo I-PAST_MEDICAL_HISTORY +intestinal; I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +exámenes I-PAST_MEDICAL_HISTORY +ELISA I-PAST_MEDICAL_HISTORY +para 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 +tomados I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +segundo I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida, I-PAST_MEDICAL_HISTORY +resultaron I-PAST_MEDICAL_HISTORY +negativos, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +descarta I-PAST_MEDICAL_HISTORY +esta I-PAST_MEDICAL_HISTORY +infección. I-PAST_MEDICAL_HISTORY +La B-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +es I-FAMILY_HISTORY +la I-FAMILY_HISTORY +segunda I-FAMILY_HISTORY +de I-FAMILY_HISTORY +tres I-FAMILY_HISTORY +hermanas I-FAMILY_HISTORY +y I-FAMILY_HISTORY +tiene I-FAMILY_HISTORY +dos I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +mayores I-FAMILY_HISTORY +con I-FAMILY_HISTORY +los I-FAMILY_HISTORY +que I-FAMILY_HISTORY +sólo I-FAMILY_HISTORY +comparte I-FAMILY_HISTORY +padre; I-FAMILY_HISTORY +padres I-FAMILY_HISTORY +y I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +son I-FAMILY_HISTORY +sanos. I-FAMILY_HISTORY +No I-FAMILY_HISTORY +se I-FAMILY_HISTORY +encontró I-FAMILY_HISTORY +evidencia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +infecciones I-FAMILY_HISTORY +cutáneas I-FAMILY_HISTORY +a I-FAMILY_HISTORY +repetición I-FAMILY_HISTORY +o I-FAMILY_HISTORY +endocrinopatías I-FAMILY_HISTORY +en I-FAMILY_HISTORY +abuelos I-FAMILY_HISTORY +y I-FAMILY_HISTORY +tíos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente. I-FAMILY_HISTORY +Ante B-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +inmunodeficiencia I-EXPLORATION +primaria, I-EXPLORATION +específicamente I-EXPLORATION +una I-EXPLORATION +CMC, I-EXPLORATION +se I-EXPLORATION +indican I-EXPLORATION +estudios I-EXPLORATION +inmunológicos. I-EXPLORATION +La I-EXPLORATION +citometría I-EXPLORATION +de I-EXPLORATION +flujo I-EXPLORATION +informa I-EXPLORATION +niveles I-EXPLORATION +séricos I-EXPLORATION +bajos I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +NK, I-EXPLORATION +que I-EXPLORATION +repercuten I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +número I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +linfocitos; I-EXPLORATION +las I-EXPLORATION +concentraciones I-EXPLORATION +séricas I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +B I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +déficit I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +inmunidad I-EXPLORATION +mediada I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +se I-EXPLORATION +constata I-EXPLORATION +también I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +candidina, I-EXPLORATION +que I-EXPLORATION +denota I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +induración I-EXPLORATION +tanto I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h, I-EXPLORATION +como I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +semana I-EXPLORATION +de I-EXPLORATION +haberse I-EXPLORATION +aplicado; I-EXPLORATION +iguales I-EXPLORATION +resultados I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +tuberculina I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +aplicación. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +séricos I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +A, I-EXPLORATION +E I-EXPLORATION +y I-EXPLORATION +M I-EXPLORATION +son I-EXPLORATION +normales, I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +de I-EXPLORATION +IgG I-EXPLORATION +altos. I-EXPLORATION +El I-EXPLORATION +cultivo I-EXPLORATION +micológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +uña I-EXPLORATION +del I-EXPLORATION +pulgar I-EXPLORATION +derecho I-EXPLORATION +arroja I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +Tricophyton I-EXPLORATION +mentagrophytes; I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +cuero I-EXPLORATION +cabelludo I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +crecimiento I-EXPLORATION +de I-EXPLORATION +Candida I-EXPLORATION +albicans. I-EXPLORATION +Las I-EXPLORATION +concentraciones I-EXPLORATION +séricas I-EXPLORATION +de I-EXPLORATION +electrólitos: I-EXPLORATION +sodio, I-EXPLORATION +potasio, I-EXPLORATION +cloro, I-EXPLORATION +calcio, I-EXPLORATION +fósforo, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +transaminasa I-EXPLORATION +glutámicopirúvica I-EXPLORATION +son I-EXPLORATION +normales; I-EXPLORATION +se I-EXPLORATION +halló I-EXPLORATION +una I-EXPLORATION +discreta I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +transaminasa I-EXPLORATION +glutámico-oxalacética. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +clínicos I-EXPLORATION +confirman I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +CMC, I-EXPLORATION +específicamente I-EXPLORATION +por I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +NK. I-EXPLORATION +Se B-TREATMENT +indica I-TREATMENT +itraconazol I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +por I-TREATMENT +dos I-TREATMENT +meses, I-TREATMENT +y I-TREATMENT +nistatina I-TREATMENT +1 I-TREATMENT +000 I-TREATMENT +000 I-TREATMENT +U/ml I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +4 I-TREATMENT +veces I-TREATMENT +día, I-TREATMENT +resolviéndose I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas I-TREATMENT +y I-TREATMENT +orales, I-TREATMENT +no I-TREATMENT +así I-TREATMENT +la I-TREATMENT +onicomicosis. I-TREATMENT +Aproximadamente B-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +terminado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +itraconazol I-EVOLUTION +reapareció I-EVOLUTION +la I-EVOLUTION +candidiasis I-EVOLUTION +oral. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +eutrófica, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia. I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +erupción I-PRESENT_ILLNESS +eritematosa, I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +descamativa, I-PRESENT_ILLNESS +generalizada, I-PRESENT_ILLNESS +pruriginosa, I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +compromete I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +90% I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +superficie I-PRESENT_ILLNESS +corporal I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +secundarias I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +despegamiento I-PRESENT_ILLNESS +ampollar, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +comprometen I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +axilas I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +ingles. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuello I-PRESENT_ILLNESS +exhibe I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +ampollares I-PRESENT_ILLNESS +pequeñas, I-PRESENT_ILLNESS +menores I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +bipalpebral I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +secreción I-PRESENT_ILLNESS +purulenta I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +impide I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +apertura I-PRESENT_ILLNESS +ocular. I-PRESENT_ILLNESS +Su I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +que, I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +previas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +ingiere, I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +mientras I-PRESENT_ILLNESS +jugaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hacer I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +comida, I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +planta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hojas I-PRESENT_ILLNESS +verdes I-PRESENT_ILLNESS +teñidas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rojo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +jugo I-PRESENT_ILLNESS +lechoso, I-PRESENT_ILLNESS +conocida I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +"lechero I-PRESENT_ILLNESS +africano". I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Inmediatamente, I-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ardor I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +boca. I-PRESENT_ILLNESS +La B-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +internada, I-EXPLORATION +se I-EXPLORATION +solicitan I-EXPLORATION + I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +evidenciando I-EXPLORATION +sólo I-EXPLORATION + I-EXPLORATION +leucocitosis I-EXPLORATION +(glóbulos I-EXPLORATION +blancos: I-EXPLORATION +14 I-EXPLORATION +300 I-EXPLORATION +mm). I-EXPLORATION +Por I-EXPLORATION + I-EXPLORATION +el I-EXPLORATION +antecedente I-EXPLORATION +del I-EXPLORATION +contacto I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ingesta, I-EXPLORATION +es I-EXPLORATION +evaluada I-EXPLORATION + I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Toxicología. I-EXPLORATION +La I-EXPLORATION +madre I-EXPLORATION +trae I-EXPLORATION + I-EXPLORATION +la I-EXPLORATION +hoja I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +planta, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +identifica I-EXPLORATION +como I-EXPLORATION +perteneciente I-EXPLORATION + I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +Euforbiáceas I-EXPLORATION +(especie I-EXPLORATION + I-EXPLORATION +Synadenium I-EXPLORATION +grantii). I-EXPLORATION +Recibe B-TREATMENT +hidratación I-TREATMENT +parenteral, I-TREATMENT + I-TREATMENT +antihistamínicos, I-TREATMENT +analgésicos I-TREATMENT +endovenosos, I-TREATMENT + I-TREATMENT +gotas I-TREATMENT +oftálmicas I-TREATMENT +con I-TREATMENT +eritromicina, I-TREATMENT +curaciones I-TREATMENT +de I-TREATMENT + I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas I-TREATMENT +con I-TREATMENT +crema I-TREATMENT +con I-TREATMENT +vitamina I-TREATMENT +A I-TREATMENT +y I-TREATMENT + I-TREATMENT +anestésicos I-TREATMENT +locales. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +paulatina I-EVOLUTION + I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas. I-EVOLUTION +Persiste I-EVOLUTION +con I-EVOLUTION +exantema I-EVOLUTION +descamativo I-EVOLUTION + I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +con I-EVOLUTION +controles I-EVOLUTION +ambulatorios. I-EVOLUTION +Remisión I-EVOLUTION + I-EVOLUTION +completa I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +accidente. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +o B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +importancia. I-FAMILY_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +pápulas I-EXPLORATION +poligonales I-EXPLORATION +rugosas I-EXPLORATION +cubiertas I-EXPLORATION +por I-EXPLORATION +escamocostras I-EXPLORATION +amarillento-parduscas, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +agrupaban I-EXPLORATION +formando I-EXPLORATION +placas I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +frente, I-EXPLORATION +cuero I-EXPLORATION +cabelludo, I-EXPLORATION +zona I-EXPLORATION +retroauricular, I-EXPLORATION +caras I-EXPLORATION +laterales I-EXPLORATION +de I-EXPLORATION +cuello, I-EXPLORATION +nuca I-EXPLORATION +y I-EXPLORATION +"V" I-EXPLORATION +del I-EXPLORATION +escote. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +oral, I-EXPLORATION +presentaba I-EXPLORATION +pápulas I-EXPLORATION +blanquecinas I-EXPLORATION +con I-EXPLORATION +umbilicación I-EXPLORATION +central I-EXPLORATION +en I-EXPLORATION +encías I-EXPLORATION +superiores. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +ungueal I-EXPLORATION +presentaba I-EXPLORATION +indentación I-EXPLORATION +en I-EXPLORATION +"V I-EXPLORATION +"en I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +libre I-EXPLORATION +del I-EXPLORATION +pulgar I-EXPLORATION +derecho, I-EXPLORATION +surcos I-EXPLORATION +longitudinales I-EXPLORATION +y I-EXPLORATION +líneas I-EXPLORATION +blancas I-EXPLORATION +y I-EXPLORATION +rojas, I-EXPLORATION +paralelas I-EXPLORATION +al I-EXPLORATION +eje I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +uña I-EXPLORATION +del I-EXPLORATION +dedo I-EXPLORATION +medio I-EXPLORATION +izquierdo. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +paraqueratosis I-EXPLORATION +focal, I-EXPLORATION +células I-EXPLORATION +disqueratósicas I-EXPLORATION +y I-EXPLORATION +sectores I-EXPLORATION +de I-EXPLORATION +acantólisis I-EXPLORATION +suprabasal. I-EXPLORATION +Cuerpos I-EXPLORATION +redondos, I-EXPLORATION +granos I-EXPLORATION +y I-EXPLORATION +leves I-EXPLORATION +infiltrados I-EXPLORATION +perivasculares I-EXPLORATION +en I-EXPLORATION +dermis I-EXPLORATION +superficial. I-EXPLORATION +Previamente, B-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +recibido I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +adapalene I-PAST_MEDICAL_HISTORY +tópico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +emolientes, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +escasa I-PAST_MEDICAL_HISTORY +respuesta. I-PAST_MEDICAL_HISTORY +Dada B-TREATMENT +la I-TREATMENT +magnitud I-TREATMENT +de I-TREATMENT +las I-TREATMENT +manifestaciones I-TREATMENT +cutáneas, I-TREATMENT +y I-TREATMENT +teniendo I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +el I-TREATMENT +deterioro I-TREATMENT +en I-TREATMENT +su I-TREATMENT +calidad I-TREATMENT +de I-TREATMENT +vida, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +tratamiento I-TREATMENT +sistémico I-TREATMENT +con I-TREATMENT +isotretinoína. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +oral I-TREATMENT +por I-TREATMENT +6 I-TREATMENT +meses. I-TREATMENT +Inicialmente I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +mg/d I-TREATMENT +(0, I-TREATMENT +4 I-TREATMENT +mg/kg/d), I-TREATMENT +que I-TREATMENT +rápidamente I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +hasta I-TREATMENT +40 I-TREATMENT +mg/d I-TREATMENT +(0, I-TREATMENT +7 I-TREATMENT +mg/ I-TREATMENT +kg/d). I-TREATMENT +Se B-EVOLUTION +realizaron I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +clínicos I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +laboratorio I-EVOLUTION +correspondientes, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +Evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +sintomatológica I-EVOLUTION +y I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +cutáneas. I-EVOLUTION + I-EVOLUTION + Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS